Saturday, July 21, 2012

Guest Post: Entertaining Little Ones in the Las Vegas Heat

While pregnant with my first baby, I spent so much time learning the best way to give birth and successfully breast feed, that I rather forgot an important fact: my baby would only be a baby for a very short time.  Then, I would have a toddler. Someday, that toddler would want me to provide one of life's most pressing needs: Entertainment.

Today, my dear friend Lindsay shares on her blog some creative ideas for keeping little ones busy when it's too hot to set foot outside.
Moms who are having their second or third babies while their first are still toddlers often feel overwhelmed.  La Leche League gets calls from these desperate moms all the time. They ask, "How can I possibly nurse this baby all day long when my toddler is into everything!?" These are the kinds of ideas they need to hear. (Lindsay is in charge of Mommy and Me Arts and Crafts at Pinkpeas, and her ideas are always a big hit! Thanks, Lindsay!)

Wednesday, July 11, 2012

Breastfeeding is Not Awesome

Lately, I've been trying to call things what they are. This is partly because a few of my children take things very literally and that can lead to some embarrassing or frustrating moments. (I've learned never to ask a little boy to "hold it" because we are "just around the corner" from the bathroom, for instance.)
But I've also been learning that sometimes too much use can cause a word to lose its power, like too much kneading can cause bread dough to fall flat just when you need it to rise to the occasion.

(Don't let that sentence mislead you into believing that I bake. I don't, at least not on days like today, when the Las Vegas weather report claimed it would be a mere 112 degrees, but my friends with dashboard thermometers report that it was actually 126.) ANYway...
Words just don't mean what they used to.  "Extreme" doesn't mean intense, severe, or radical anymore; it just means that the snack food in the shiny bag has slightly more cheese flavor than it used to. For a fun exercise (AFTER you have read this to the end, of course), try looking up the original meanings of the words dork, dude, or gentleman. I am ashamed to admit that these words occur with regularity in my vocabulary, despite the unsettling knowledge I have gained from brief Google searches.

When it comes to motherhood, specifically the seasons of pregnancy, birth, and breastfeeding, it is easy latch on to words that don't describe things as accurately as they should. In our enthusiasm to promote breastfeeding, we overuse the wrong words and underuse the wrong ones. We lactivists do this without realizing it.

("Lactivist" is not a real word.  It's okay. Just keep reading.)
Like most mothers who have discovered the joys of natural mothering, I feel a strong urge to share the good news with the world! All too frequently, this means succumbing to exaggeration.
"Breastfeeding is awesome!" I have been known to say. "It has so many advantages.  I know bottle feeding is normal these days, but did you know that breastfed babies score an average of ten points higher on IQ tests and are sick less often than normal?"
My La Leche League Leader pointed out the fallacy of this logic to me. She taught me the difference between "normal" and "common."  She encouraged me to think about words like "advantage" and "alternative."

Imagine a society that has forgotten how to breathe. Let's say a well-meaning group of physicians and researchers came up with a wonderful new device for people with lung problems. It is cleverly named the Aspiration Invention Regenerator. At first, it seems crazy. You've only seen one or two people use the AIR; just the sick or elderly.
Then, it is advertised to the general public, and soon it is so popular that you cannot walk down the street without seeing them strapped to the backs of half a dozen people.  Not sick people, not people with lung problems, but otherwise healthy people who used it once or twice when they had a cold, or were out of breath from too much exertion, and decided that the convenience of machine-breathing suited them. It allows for faster conversation without the annoying need to pause to inhale, and eliminates yawning altogether. (Who wants to be seen yawning in public?! How embarrassing!) Everyone knows the risks of dependency, but there aren't really any terribly bothersome side-effects.

"Natural breathing is best," coos the TV advertisement, "but when it's not possible, AIR is THERE!"
Of course, most of the people who use the AIR are quick to tell you that they think natural breathing is great for those who can do it, but that they truly need the AIR.
"My doctor says I have to use it," repines a reluctant user. "I had bronchitis last fall, and when I went in to get my oxygen levels tested, they were really low. So he put me on the AIR. My oxygen levels are just low, that's just the way I am.  He told me to stay on the AIR, or I could get really sick."
A few decades pass, some studies are done, and a few fringe radical doctors begin to question the safety of the widespread use of the AIR.  Nay-sayers become louder and more organized,  and before long, a movement begins to emerge; the Natural Breathers. Oprah invites some hippy Natural Breathers on her show. They gush about the advantages of Natural Breathing; how it lowers a person's chances of needing a back brace, how studies have shown that Natural Breathers get sick less often, can run further and faster, and even sleep for longer periods of time!

This sounds ridiculous to us.  Most of us have been breathing happily all our lives without much effort or thought.  We wouldn't think of dependency on a device to breathe as "normal."
If everyone breathed artificially, it still wouldn't be normal.  It would just be common.

This subtle misuse of words has changed the conversation about how we feed our babies, too.  Is it really awesome that my breastfed baby is sick less often than an artificially fed baby, and that when he is, he recovers more quickly? Or is the artificially-fed baby getting sick more often than is normal and taking longer to recover than should be expected?

Is it really an advantage that my breastfed baby will probably score higher on an IQ test than an artificially-fed baby? Or is my sweet angel not a genius, but normal, and that other poor child is actually scoring ten points below what he could if he had enjoyed a normal diet of breast milk?
Is it a benefit to me that I don't have to cart around a bag full of bottles and formula everywhere I go or wash an extra sink full of dishes? Or is it just a major pain to the mother who feeds her baby artificially?
Does breastfeeding really promote my own health, reducing my chances of developing any type of female cancer, osteoporosis, or postpartum depression?  Or is the mother who chooses not to breast feed, in reality, placing herself at a much higher risk for all of these diseases?



Many people feel that taking too honest of an approach may alienate those who find it absolutely necessary to artificially feed their babies. Of course, I hope I will always be sensitive to the needs of those who experience this great misfortune, just as I hope I would respect the needs of someone who had lung problems necessitating the use of a breathing device.  But does it really do any good to refer to this misfortune as anything but unfortunate? Am I really doing this mother a service by assuring her that feeding her baby artificial food is normal?
We live in a society that prides itself on having achieved a high level of tolerance.  Afraid to hurt a pregnant mother's feelings, we don't dare tell her that the formula she is considering giving to her baby as a replacement for real food is risky and has been proven to be harmful.  Instead, we aim to spotlight the "benefits" of breastfeeding to make it look too good to pass up.
If I really want to help this woman in her mothering difficulties, maybe I could offer to wash her dishes for her.  If I want to "normalize" breastfeeding for this society that claims tolerance but demands that women cover up or hide in bathrooms to nurse, perhaps we should stop singing its praises and just nurse. Everywhere.  All the time. It's just normal.





Isn't normal awesome?

Wednesday, June 13, 2012

What Las Vegas Can Teach Mothers

June 10th marked the 12-year anniversary of my arrival in Las Vegas.  While I am now quite happy to call myself a resident of this bustling, hot, flashy city, I was not always so.  I am a country girl at heart, and I came from Icy Cold Nowhere, Colorado.  When I left my hometown, they had not yet installed their first stoplight.  So, you can imagine my terror the first time I was forced to drive a busy Las Vegas freeway.  I was sure I would die from the heat. But, over time, I came to love Las Vegas and my family thrives here.  I often look back on those first few years of life in this desert paradise.  They were also my earliest years of parenting babies and toddlers, and it's interesting to reflect on the lessons this city has taught me about pregnancy, birth, and parenting.


A woman who has learned she is going to have her first baby often doubts her ability to handle giving birth. She's heard the stories and she's watched the movies, and if there's one medical term she is familiar with, it's "Epidural."  She probably has friends who've told her that they intended to give birth naturally, but when the contractions became unbearable, they were happy to have the drugs.  Maybe she doesn't think of herself as a very strong person.
I liken labor to a Las Vegas summer. Yes, it is scorching hot.  No one around here is saying it's "on the warm side."  And I'm not going to lie to a first-time mother and tell her that labor is "very uncomfortable." Her contractions will be very, very hard, and they will be closer together and longer than she would like.  But each one will have an end. If her labor began normally (meaning she avoided induction), her brain will be kicking out endorphins stronger than morphine, and as the intensity of her contractions increases, so will her ability to handle them.  My first summer here, I counted the hours till the sun went down each day.  It only took a few weeks for me to realize that the sun was guaranteed to set every single evening, and I could look forward to sitting by the pool and refresh my sweltering, shriveled self in preparation for the next day.  A laboring mother gets times of refreshment and rest, too.  Even when labor is at its strongest, most urgent stage, she will have breaks.  Some mothers joke, eat, or even sleep during these breaks.  Labor is a lot of hot, sweaty work, but you can take the heat. You really can.



Perhaps more than any other US city, Las Vegas is obsessed with billboards.
Most of them can be divided into two categories: Young, Underdressed Women and Ecstatically Happy Gamblers.  Both are misleading. Having known personally many of the women who dance at the "gentlemen's clubs" here, having massaged them and caught their babies, I can assure you that they are quite ordinary-looking women, with all the same aesthetic flaws you and I have.  And having observed the real, zombie-like, lethargic people who gamble at the local casinos, I can assure you that most of them seem to be bored to tears.
Those billboards don't bother me so much anymore, however.  It's easy for me to point to them and tell my children, "That's a lie."  What bother me more are the billboards, and even the less obvious forms of advertising, for the local hospitals' labor and delivery wards--oh, excuse me, "Birth Centers."
It's really just a floor in the hospital, but the advertising gurus have discovered that women like the idea of giving birth in a more "home-like" environment, so they use the term quite loosely.  One local hospital boasts of their "all-private Labor, Delivery, and Recovery rooms."

                                           Here is the truth: there is no such thing as privacy in a hospital birth.
The gown they insist you wear does not button in the back, there is no doorbell on your door, and there is very little discussion before any number of people put their fingers inside you. If privacy is important to you, stay home, lock your door, and turn away uninvited guests.


The above-mentioned ad also uses a  rather unfamiliar term, "couplet care," which refers to the idea that the mother and baby will share the same nurse. This system, evidently, "optimizes family bonding time and enhances continuity of care." It goes on to say that if a prospective customer would like to tour the home-like L&D, she is encouraged to bring her partner, but children are not allowed to join in the fun.
Here is the truth: the hospital staff is not as interested in your family bonding as they are maintaining protocol.  And why should they be? They work with each other every day. They have never met you. During your labor, you will have one set of nurses (usually two or three), and if there is a shift change during your labor, you get a whole new batch.  Most OBs are present only for the bare minimum time requirement--the instant he has sewn the last stitch of your episiotomy, your care is transferred to a team of postpartum nurses.  Your baby will probably be transferred to a team of pediatric nurses. If your hospital was one which was built using the generous donations of an infant formula company, it is likely that your baby will be kept on an entirely separate floor from you.  Your husband will have to choose who needs his attention more. When you and your baby are released, you will probably never see any of those people again. If continuity of care is important to you, hire a midwife.  See her for the entirety of your pregnancy, and at each of your prenatal visits, plan to stay for at least two hours. Bring the kids; they love to help hold the doppler when it's time to listen to the baby's heartbeat.  Enjoy the company of this midwife for your birth, all of your postpartum visits, well-baby visits, future births, and playgroups for many years to come.


A friend of mine came to visit recently from out of town. She called, distressed, as she was trying to find our house."There were these cones and flashing warning signs everywhere!" She wailed into the phone. "I tried to follow the detour signs, but they didn't seem to lead to anywhere.  And I couldn't see any construction happening. My GPS was telling me one thing, but the signs were telling me another..."
Fortunately, my husband and I were very familiar with the area, and we were able to give her clear, simple directions.  We laughed when she arrived and explained that the road construction was fake.  The warning signs had been up forever, and the cones were beginning to melt into the asphalt with age.  But no work had commenced.  We were convinced it was all a ruse to test our intelligence.
The road to having a baby is often fraught with dire warnings, signs flashing at you to proceed with utmost caution.  There are important-looking machines on display to remind you that soon, the road as you know it is going to undergo some drastic changes and you'd better have your seat belt on.
"Don't eat tuna--the mercury will poison your baby." "Don't raise your arms above your head--the umbilical cord will choke the baby." "Don't take a bath--the dirty water will infect your baby." "Don't breastfeed--it will ruin your breasts."  "Get regular ultrasounds every two weeks just to make sure everything is OK." "Find the best doctor and the best hospital and get there as soon as you think you are in labor, or you and your baby could die." "You must stay on your back.  If you try to roll on your side to deliver, it will kill your baby!" I have heard all of these uttered in all seriousness...that last phrase, in particular, was yelled a mother I was assisting in the hospital.  Fortunately, she was too busy pushing her healthy baby out to listen, and delivered on her side, as millions of women have done.
Very often, it is easy to dispel these fears with a little common sense. (If a pregnant woman could choke her baby on its own umbilical cord by lifting her arms over her head, how have women been shaving their armpits for the past century?) It is when the dire warnings are so cleverly presented as medical "fact" that it becomes more difficult to trust that pregnancy and birth are a normal, everyday state of nature. (Did you miss that link? It's a good one.)
If you want the quickest, safest route to your destination in spite of the crazy, fake road construction, call a friend who lives in the area.  And if you want a normal birth, call a person who specializes in normal birth.


Las Vegas can be a challenging place to make friends. Lonesome for family, daunted by the freeways, and unwilling to step foot outside without your own personal fan, it can be tempting to become a recluse. I recall vividly my first official social gathering here. It was about four miles from my house, but it may as well have been four hundred.  I was lost. I was pouring sweat. I almost turned back for home. My baby was crying in the back seat, so of course I arrived with two wet patches of breast milk on my shirt.
I spent the evening in the company of people with whom I had very little in common. There was not a child in sight and I was afraid of getting fingerprints on the glass coffee table.  Truth be told, I didn't have a very good time. But, as I was headed home (in the blessed coolness of a 90 degree evening), I was elated.  I was very proud  of myself for getting there, sticking it out, and getting to know some people.
As it turned out, one of the women who had been there introduced me to another young mother...who, Providentially, happened to live in my apartment complex!  It took a little courage and creativity, but I found excuses to knock on her door.  (The first one was lame.  I asked if she needed any of the boxes I'd unpacked before I threw them away.) We became fast friends, and so did our children.  I hadn't realized how desperately I needed a friend! A few weeks later, I was stunned to hear her say, "I hadn't realized how desperately I needed a friend! What would I do without you?"
A few years later, I found a true friend in my midwife, Corrine.  I thought she went a little overboard trying to connect me with more friends, though.  She was constantly giving me meeting times for  La Leche League. If I mentioned I needed car repair, she was quick to give me the name of her mechanic friend "whose wife is so-and-so and whose baby is so-and-so." She pointed me in the direction of other mothers to answer questions I knew she was capable of answering herself. She invited me to sign up for a Yahoo group of like-minded "radical" moms. I didn't feel I had much to offer anyone, being a young, newly single, broke person whose children often misbehaved. Though I felt woefully unworthy, she sent countless people to me for advice and massage. After a few months, I found, to my complete surprise, that I had a sizable group of people I considered good friends. I needed them. And they needed me. That silly word, "community" took on a whole new meaning for me. I became addicted to introducing people to other people.  (I think this had more to do with my becoming a midwife than my interest in natural birth.) It's catching, too. My friends have caught the bug, and they regularly snag unsuspecting women at parks, grocery stores, and libraries.
"I love your skirt. Did you know my friend makes those?" "We're dairy-free, too. I abhor coconut, too. But I learned how to make coconut milk in my blender, and it's yummy. Want to come over, and I'll show you?" "Your baby's coming in a few days?  What does your family eat? I'm bringing you dinner." "I heard your husband restores cars. Deborah's husband, does too. Have you met them?" At Pinkpeas, my home away from home, I am warmed to the toes to hear these sorts of conversations nearly every time the doors are open.

And that is the most important lesson that Las Vegas has taught me: Mothers need other mothers much more desperately than they need a midwife. Good friends will keep you cool in the heat, help you sort through the false advertising to get to the truths you need to make your life better, send you on detours that actually lead somewhere you want to go, stick with you longer than it takes to build a casino, and, best of all, they will need you.

Tuesday, May 22, 2012

Fearful, Wonderful Cone Head

My five-year-old son recently fell asleep with gum in his hair.
Anyone who has been a parent to a toddler is familiar with portions of the story: peanut butter, ice, tears...finally, I asked my husband if he would please set aside some time in the evening to shave his son's head.  Head-shaving is a regular occurrence in our house, as my husband prefers to go hairless, and he likes our three and five year old boys to be low-maintenance, also.  My husband was happy to comply, and the shearing happened while I was gone for the evening.  My boys were sleeping when I came home, and I peeked in on them.  I could just make out the dark shapes of my slumbering sons. Their heads were two huge, beaming orbs reflecting the nightlight. Evidently, the gum had required a closer shave than usual, and since shearing is assembly-line style, there was no time to bother with changing the setting on the clippers to spare the hair of the youngest victim.
The following week, the anatomy of the human head became a frequent topic of conversation at our house.
"Why is his head a different shape from mine?"
"Are there holes in the skull for eyes?"
"Are boogers my brains leaking out?" (Sometimes, yes, but that is another story for another day, and I would be hard-pressed to link it with midwifery, other than to say when I first heard the story, I was in a group of seasoned midwives, and the entire roomful recoiled in horror. Yes, gross).
Of particular interest has been the head of our one-year-old son, which is currently unshaven but essentially bald, anyway.  It has a bit of a soft spot left; a slight diamond of rubbery scalp in the center of his head.  It will be there till he's about two, to allow for his rapidly expanding brain. My children remember well when the soft spot was larger.  They enjoyed watching his hair move in time with his pulse (no matter how bald the baby, there are always one or two long hairs centered directly over the soft spot, like a beacon for alien communication.)  We had many interesting conversations about the sutures on his head; which are very prominent in a newborn.
The medical term for the soft spot is fontanel, and along with the other sutures of the skull, it is God's gift to babies and birthing mothers. 
Years ago, I read a fascinating piece in National Geographic which argued quite convincingly that human childbirth is flawed and risky. Unfortunately, the "expert" who helped to scare the bejeezies out of the author is not an expert in human childbirth at all.  Rather, she is an anthropologist, well-versed in evolutionary theory.  The expert has a roomful of impressive-looking bone casts, which she uses to demonstrate, quite smugly, the terrible difficulty of trying to "ram" an unyielding skull through an unforgiving pelvis.
The problem with her demonstration is that it is missing two important elements: a uterus, and well-placed rubber bands.
Parents who have been fortunate enough to attend a good childbirth class have a better understanding of the anatomy of childbirth than this very misguided anthropologist.  Practically before they have the chance to get comfy on their pillows and introduce themselves, they've seen models like this:(photo credit)


As you can see from the caption, this picture illustrates "Fetal Head Molding," which sounds kind of like what my husband described finding on the scalps of my sons when he shaved their heads.  It actually refers to the process by which a baby's skull will mold itself to a perfect fit for the birth canal.  Sometimes, especially in a first-time mother, this process takes hours.  It is greatly enhanced by the movement of the mother, if she has not had immobilizing drugs.  A mother laboring under normal circumstances and unhindered by an unwelcome audience will usually find herself in excellent positions to aid in this process, with no guidance at all.  She will swing her hips like a pole dancer on the Las Vegas strip, rock on hands and knees, and hang from her husband's shoulders.  While her baby is twisting and nudging himself into a good position, her pelvis is   stretching, widening, and shifting to allow for more room.  It is able to do this because God made the pelvis not as a uniform chunk of bone, as the plastic castings would suggest, but as intricate puzzle pieces held together with stretchy rubber bands at three points; the sacroiliac joints and the symphisis pubis.  These stretchy points are particularly pliable by the time the mother is in labor, thanks to weeks and weeks of her body producing softening hormones.  As a mother who has tripped over air molecules and waddled into walls more times than I can count, I can attest that these hormones serve their purpose very well.  I have, on occasion, wished that my brain would also produce a "coordination" hormone in the late weeks of pregnancy.

Another advantage the laboring mother has over her lifeless, plastic counterpart is a uterus; an incredibly powerful bag of muscles which take turns contracting here, there, everywhere around the baby.  The force of these contractions is astounding.  
Now, add in to this mix the famous "urge to push," and you have a  pretty darn good system.  If that system is left to function with little to no intervention, you've got yourself a cute little baby who probably has a whopper of a cone head, which you will not notice, but your children will.  Then, you will spend the next few weeks lightly stroking those sutures with your finger and pressing your nose to the delightfully-scented soft spot on your baby's head and happily sigh to your children that your cone-headed baby and your achy pelvis were "Fearfully and wonderfully made."

Thursday, May 17, 2012

Giving Birth in Las Vegas

Who wants to read about giving birth in Las Vegas? Is it any different from giving birth in, say, New York City, or Mexico, or Nepal? Yes...and no. Mothers all over the world share this one thing in common: they have children. The question is, how did they have those children? Did it hurt? Did it take long? How big was the baby?  Was the baby's father there, and if so, was he a doting coach or an incurable jerk? Did the baby go straight to mom's arms or disappear for hours? Was there blood? Screaming? Fainting? Stitches? Ice chips? Was the room full of giddy aunts and bustling nurses, or perhaps dozing friends and a massaging doula? Were there beeping machines and needles, or flickering candles and a steamy hot tub?
These are the details that become so very interesting to new mothers, and to "birth junkies" everywhere. They tell us things; important things. They give us a launching pad to the more important question: Was it a good birth? No, really...was it a good birth? This century's women have discovered that having a good birth is no simple matter, and having a good birth in Las Vegas, Nevada is...a gamble.
Sure, that chubby child you hold in your arms is healthy, and you are up and around and more or less in control of your bodily functions once again...but when you think about your birth, do you think, "That was a good birth."? Some mothers hold their birth stories closely, proudly, as if the whole experience could be wrapped with the baby itself and presented to those adoring relatives: "Yes, he is super cute, isn't he...and I gave birth to him!" Others tuck their stories away only to be discussed with understanding and sympathetic listeners: "I really wanted it to be natural, but it just didn't work out...I just wanted it to be over." And of course, some hardly give it a second thought: "The baby's healthy. We survived."
Las Vegas is an interesting habitat for growing families.  The international nature of the city draws women from all walks of life; the savvy executive from an even bigger city, the down-home girl from one of the simpler states next door, the crunchy mama looking for some connection with nature in the midst of the billboards.  Some are pregnant for the very first time. Some have kids on all sides. Their personalities and backgrounds will necessarily take them down different paths to different births.  But I am amazed, over and over, at how often those paths collide.  They sit next to each other in childbirth classes, still green from nausea and wide-eyed with the unknown, and they all wonder; "Will this be a good birth?"
That's when they hit a brick wall.  No. This will probably not be a good birth.  Because chances are, they will fall into the overwhelming category of women who will deliver in a Las Vegas hospital. Chances are about 50/50 that their babies will be delivered surgically.  Of those who deliver vaginally, a small handful will get what those parenting magazines call a "natural birth," meaning a minimum of drugs and drama.  They'll likely spend 20 grand. With not too much elbow room at the end of the four-foot-high display table, her husband will be nudged off to the corner (a fortunate thing, considering the trauma associated with watching your wife's center of all marital bliss cut with very sharp scissors). They will probably not hold their babies in the throes of birth and gaze in wonder and share kisses with their husbands.  Breastfeeding will probably not go very well at first, and will likely get derailed altogether.  They will likely be told when to show up, and where, and their babies will arrive in a prescribed amount of hours, with a prescribed amount of drugs, and they will not know the deep and abiding joy they heard about.  I hate to think it, to say it, but their baby might be one of those who presents with a hue of yellow that displeases the hospital pediatrician, and he will see green and insist that the baby live in a plastic box, isolated, for the first week of life. Stripped of all responsibility, with no parenting milestones to reach on their own, these mothers will admit defeat and acquiesce all authority to the experts. Each passing week will likely find them in the pediatrician's office, apologizing for the baby's slow weight gain. Sadly, these haggard mothers will show up in the chairs across from me and whisper, ashamed, that they just don't feel all that connected to their babies and they can't stop crying. Maybe they will have a good experience...but probably not.

That's the likelihood. Thanks be to God, there is also the unlikely possibility that they will choose differently and walk determinedly down an entirely different path. They might choose a home birth.

It might be a convoluted path to home birth for some.  Finances are always one of the first and most pressing concerns the couple must face. Some will have insurance to cover the $20,000 day out of the house. Some will not, and will begin wondering if there is a way to harvest an organ to sell during the C-Section. Having considered the dismal statistics of the area's hospitals, despite claims of being "supportive of natural birth," many will hunt around for a good OBGYN.  They'll pose questions they never thought they'd be asking, such as; "How long will you let me be pregnant before you refuse to be my doctor anymore?" or, "Can I drink water or go to the bathroom during labor?" They might, in a moment of excitement, Google "birth center," with visions of a gentle Nurse-Midwife delivering their baby next to homey-looking curtains and a cleverly hidden oxygen tank. But they will find none in the entire state of Nevada.  If they are wise, they will set out to educate themselves and make the best of it with childbirth classes and La Leche League. It's a slippery slope from there.  Some enthusiastic mother of five will regale them with tales of her "awesome" home births, and they will stare, unbelieving, at her whole, healthy baby, and they will discover that they...must have a home birth. It's only a matter of a few evenings pouring over safety statistics on the the internet, perhaps a book or two by Ina May, and the decision is made.
Knowing a couple has chosen to give birth at home, I can wink at them and squeeze her hand and make off-color jokes about welcoming them to the cult.  Because I know that chances are, it will be a good birth.  Odds are in her favor for a peaceful, strong delivery, in which she victoriously overcomes her fear and pain to bring her baby through a space she didn't know she had.  She'll call me a hundred times, and I will probably come to her house a few times before the "real thing." She'll be surrounded with her favorite foods.  She'll haul her favorite pillow from room to room.  She'll finally find her strength in the birth tub. Everyone in the room will watch, completely dumbfounded, as this previously genteel lady transforms into a bellowing powerhouse of energy. Her husband will most likely be inches from her face to eagerly welcome his new little delight, and he will be bursting with pride for his wife's incredible accomplishment. Her baby will be nursed a half dozen times in his first hours. But the truly wonderful joy will be in the following weeks.  Every day will bring a new sense of rightness, of new instincts, confidence.  Chances are, she will be that crazy lady beaming as she regales the room with her awesome birth story. Maybe not...good plans go bad sometimes. But the happy truth is that she will probably have a good birth.
I'm so thrilled when this happens.  I know there are variations of this all over the world, every day.  I know midwives in other places share incredible stories about their clients overcoming intense political and cultural problems to have good births.  But there's just nothing like being a midwife in Las Vegas.