Perfectly natural: childbirth on the cheap

I have not cried much since I got pregnant. I assumed it came with the territory, like throwing up and craving pickles (neither of which I’ve done).

But I wept watching a YouTube video of New York City paramedics marveling over baby Mila, the “Occupy Baby” born in the back seat of a Brooklyn taxi cab just a few minutes from her parents’ apartment. As the video goes on, you see Beka (the mom) holding the baby, talking on the phone, being wheeled into the hospital and relating her so-NYC story with calm dramatic flair. Meanwhile, the baby—with a head full of dark hair—latches right on and starts nursing and Jason (the dad) keeps the camera steady and focused.

It is all sort of incredible, a miracle, a wonder and perfectly natural.

The hospital, stretcher and blue paper outfits seem like an afterthought. They did it, alone, together, in one of the least appealing places imaginable—the backseat of a yellow cab.

Watching this video, which I have done multiple times now, helped me start to reflect on what kind of birth experience I want to have—not that I am in control of all the variables, of course. Strangely enough, I have been thinking about nonviolence too; about how that philosophy (or set of tactics, mindset or lifestyle) is about being responsible, about being educated, about applying belief to daily activity. Nonviolence at a demonstration can look really different than nonviolence in our personal relationships or in how we treat ourselves, but it is all part of the same package—or it should be, in my mind. So, part of what I envision for myself, my husband and our families is a nonviolent birth experience. And for us, that means a homebirth.

Empowering, in our own time and place, natural, unmedicalized… and cheap!

In fact, it is hard to figure out the cost of the average birth in the United States. There are so many variables—insured, not insured, with what insurance company and at what deductible, caesarean or vaginal birth, length of labor, complications and medications, recovery time.

With all the unknowns to come, I do know one thing: we will pay $650 to have our baby. That is a lot of money in our one-income household, but I know enough to know that many women don’t even get a shot of Pitocin for that much. I have state health insurance, and our midwives (hallelujah) accept it.

The Wall Street Journal’s Healthy Consumer gave (“uncomplicated, traditional”) birth at a Los Angeles hospital and was shocked to discover that the total costs were upwards of $36,000.

One of the big costs is the medicalization of birth. Check out this stream of facts:  In 1900, 95 percent of births were accomplished at home in the United States. In 1938, half of births happened at home. By 1955, less than 1 percent of births happened at home. That is still the case today. Well, you may say: but fewer babies and mothers die from complications associated with childbirth now that most births happen in the hospital.

Not so. Even with all the hospital intervention and medical high-tech windings, CNN reports that in 2007

the U.S. rate of almost seven deaths per 1,000 live births ranked the U.S. behind the majority of other developed countries. Thirty developed countries have lower infant mortality rates, according to the Organization for Economic Cooperation and Development, all of them spending much less than we do on healthcare.

Poverty within the United States and economic disparities that determine the degree to which women receive prenatal care and their ability to maintain a healthy diet and lifestyle throughout pregnancy and after the birth of the child accounts for much of our infant mortality crisis. It is worth noting that at a point when the political discourse in the United States is once again fixated on abortion with its attendant rhetoric about the sanctity of life, that (once again) we hear very little hue and cry from those right to lifers about women’s access to affordable healthcare, consistent prenatal care and safe, appropriate and dignified birth options.

Speaking of which, the World Health Organization says that a national caesarean rate of 5 to 10 percent provides the best outcomes for women and babies. In 2007, 32 percent of women in the United States had a caesarean, according to the Centers for Disease Control.

While it is easy to put the blame on the women—and tempting too when the blame-game comes with its own alliterative moniker, “Too Posh to Push”—a women and child’s health organization called Childbirth Connection puts the onus on the medical industry. In a concise and compelling essay, they offer seven reasons for the medical industry’s pushing of caesareans on women, including:

  • Refusal to offer the informed choice of vaginal birth
  • Casual attitudes about surgery and caesarean sections in particular
  • Limited awareness of harms that are more likely with caesarean section
  • Providers’ fears of malpractice claims and lawsuits
  • Incentives to practice in a manner that is efficient for providers

One thing that the essay does not mention is the cost of this often unnecessary medical procedure. A caesarean costs nearly twice what a vaginal birth does—$24,700 compared to $14,500. In a recent white paper, the California Maternal Quality Care Collaborative asserts that while in some cases, like breech birth, caesareans are clinically necessary, in many cases they have “greater risks and complications than vaginal birth.” The report, published in December 2011, goes on to note that:

Higher caesarean delivery rates have brought higher economic costs and greater health complications for mother and baby, with little demonstrable benefit for the large majority of cases. With the marked decline in vaginal births after caesarean, caesarean deliveries have become self-perpetuating; and every subsequent caesarean brings even higher risks.

The costs are significant, as the white paper’s co-author, the Pacific Business Group on Health, estimates that

additional caesareans cost public and private payers in California at least $240 million in 2011 alone. An effort to reduce caesareans could save California between $80 million and $441.5 million a year, depending on the number of caesareans prevented.

And that is just one state.

These issues and so much more are explored in Ricki Lake’s The Business of Being Born, the groundbreaking 2008 documentary from the star of Hairspray and daytime television. The documentary generated so much interest when it came out, that Lake and her filmmaker Abby Epstein have made another movie More Business of Being Born, which includes celebrity birth stories from Gisele, Alanis Morissette and Laila Ali.

The most striking thing about the film for me was its explanation of the cascade of intervention that leads to a caesarean in a hospital birth. Time is money. Hospitals want women to give birth and get out. So, lengthy labor with all the breathing and walking and moaning and snacking and napping is not allowed. After a few hours the pressure for Pitocin—which induces labor—begins, but the drug makes the contractions much harder, longer and more painful, and women are not prepared for the pain. The epidural (or other local anesthetic) arrests the pain, but also slows the labor, which often leads to more Pitocin and another epidural. And now, the baby is being squeezed and pushed by the harder contractions and is having a harder time in the birth canal. The baby goes into distress, and then a caesarean is necessary. Self-fulfilling prophesy.

Now, of course at the end, it is time for the disclaimer. I have no idea what I am talking about. I am doing some reading—in particular Ina May Gaskin, the mother of American midwifery—and a lot of listening to women who have had children, including my mother who had three at home (one when she was in her 40s) and my mother-in-law who had both her kids at home. I am watching YouTube movies, but not too many because they are sort of strange and make me feel voyeuristic. I am learning as I am growing.

If I hit hour ten of labor and start begging for pain medication, feel free to read aloud from this essay in a sing song-ey tone. I am sure it will work wonders for me. To paraphrase Beka, my vision for child birth remains this: “it felt like I had to go to the bathroom, I pushed and out came the baby, healthy and whole.” Taxicab optional.

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