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.