A Case for Freebirth

Indigo’s Birth May 2021

I first heard about unassisted birth around six years ago. My cousin’s childhood friend was expecting her son and preparing to give birth at home alone with her partner. She had been receiving prenatal care from an obstetrician up until her 20th week, at which point she decided to drop their services and do things differently. She and her partner would be responsible for her prenatal checks and everything else including the birth, immediate postpartum, and newborn care.  

At the time, I was surprised and shocked to hear her plans. It seemed like an extreme and irresponsible choice to give birth without a medical professional. I had so many questions like whether or not it was legal or how she’d register the baby, but I was primarily concerned with its safety. Why would anyone choose to give birth without a midwife and aren’t they necessary? 

I didn’t find the answers to these questions or even sit with them long enough to do so until much later, right before becoming pregnant with my second child. My cousin’s friend had had her son and everything went beautifully, but instead of changing my mind or digging deeper I felt relieved for them. To me, they had just been lucky. 

It was my daughter’s easy and relatively quick birth that sparked a change within me. We had been preparing for a home birth, but she was born in a hospital out of town. Although the setting was not what I’d envisioned, I felt empowered and energized afterwards. 

I had dilated naturally without monitors, strangers, or cervical checks. I retreated within myself and rode the waves with the strength of all the women who came before me. I felt held by my partner even though I preferred to be left untouched and alone most of the time. My baby and I worked together.. My body knew how to birth the same way it knew how to grow a healthy baby, and I only had to let it. 

We started trying for Indigo in August 2020, and I got pregnant right away. His pregnancy was different physically and emotionally, and I dreamed of an entirely different birth for him. Naia’s had been wild and eventful with last minute ambulance rides and Argentinean paramedics, but this baby wanted peace and calm. We both did. 

After birthing my daughter, my mind recognized what my body had always known: birth belongs to women. And when I pictured my son’s arrival, I realized that he and I were the only essential components of birth, not the doctor or the midwife. It is not extreme to choose to do things on your own, it’s extreme to not even consider that a real option. 

Pregnant in a Pandemic

This pandemic has changed everything:  the way we relate to one another, the way we work and (try to) make a living, and even the definition of what is considered essential. It’s been eight months since the first containment measures were taken where I live, and like most, I thought after two weeks or a month of staying at home we’d go back to our regular lives. It’s now November and the world’s only sense of hope seems to be entirely dependent on a miracle cure. What if our global response to this new “threat” is all wrong? What if isolation, sterilization, and separation (of mothers and babies, for example) only exacerbates the problem? What if our new ideas about what’s essential or not, actually puts the most vulnerable people at risk?

I am pregnant during this pandemic, and my prenatal care so far has been less than ideal in part, due to new and ever-changing coronavirus protocols. In Spain, most new moms-to-be see a midwife around week ten of pregnancy for a full blood analysis and a genetic screening test, if they so choose. During week 12, there is a first ultrasound during which specific measurements are taken and compiled with the information from the blood sample to determine the probability of chromosomal abnormalities. The results of the “regular” blood tests are picked up in person at your main doctor’s office, and the results of the genetic screening are sent in the mail. It took me two hours to schedule an appointment with my main doctor in order to get the results, and it ended up being a brief phone call ( he was over an hour late), and all he said was, “Excellent results, no anemia.” 

18 weeks +1 day

Spain’s healthcare system works like a machine, and for better or worse, patients receive the same standardized care. While I can understand the importance of standardized medicine, this service model does a disservice to expectant mothers and women, given the normal variations of pregnancy and birth. Coronavirus prevention measures have made things worse, and women all over the country are having their rights stripped away left and right all for the “greater good”. For example, pregnant women are not allowed to be accompanied at midwife visits or scans, masks must be worn at all times including labor and birth, prenatal dental visits are no longer an option, expectant moms with asthma no longer have direct access to a specialist (even during crisis), only one additional person is allowed during /after labor and birth which means no children or doulas allowed, etc.

Although I am planning and hoping for a homebirth, I’m using the public system for most of my early prenatal care. The home birth midwives in my area don’t offer ultrasounds, blood analysis, or any other testing; they literally only handle the birth and postpartum visits. Basically,  once the “state” determines the mom to be low risk, then they’ll take on the pregnancy. Honestly, it all feels a bit sterile and overwhelming, but I’ll do anything to give my baby the very best start. 

*I’m now 19 weeks along and a lot has changed. For example, my clinic now allows pregnant women to be accompanied during visits. I’m also just one appointment away from switching my prenatal care entirely to an awesome woman centered midwife. I’m feeling grateful that the tide has shifted, and I feel more empowered than ever to bring this baby into the world my way. No more poking and prodding. Pregnancy is not a disease. I trust my body and my baby.

Embracing the Power of Pregnancy

As a first time mom, pregnancy and birth can seem intimidating. All of a sudden, there are many new sensations in the body, questions, and appointments to be made. The freedom and familiarity that you might have had before pregnancy can sometimes feel out of reach during this time. Some of that has to do with the obvious physical changes that take place but also the loss of body autonomy and authority in dealing with healthcare professionals.

Pregnancy and birth are normal physiological processes, but most of us think and talk about them as if they were medical emergencies that require strict protocols and control. When I became pregnant with my first child, I had a clear idea of how I wanted to bring her into the world, but I didn’t give much thought to what my prenatal care would look like.

My hospital midwife turned home birth worker and advocate was very hands off. For her, the birthing mother had to be the protagonist and the authority at all times. One day in my birth group, a woman asked, “What do you do after the baby is born?” and the midwife responded, “Nothing.” She was joking, of course, but her answer wasn’t far from the truth. For some, this response was too radical and not comforting at all, but most of the negative reactions were rooted in fear. Why are we afraid and is it possible to birth without fear?

There is an alternative to ultrasounds, constant monitoring, antenatal vaccines, cervical checks, and strangers. Hospitals and clinics offer standardized care not individualized care that can compromise anyone who dares to ask questions and exist outside of what is considered normal. I was in the hospital for 20 minutes before my daughter was born, and I had to fight for every second of that time. No one should have to do that. No child should be born into that.

Women have been kept in the dark about their bodies for too long. What if tracking and charting cycles by way of temperatures, cervical mucus, and cervical position was common knowledge? What if sexual energy and potential was considered an integral part of our being? What if we treated our bodies like the temples they are? What would birth look like then? Maybe if we knew and understood our power, we wouldn’t be so willing to give it away.

Easy Vegan Pregnancy

I’ve been vegan for going on nine years, and so much has changed since those early days. For starters, there weren’t half as many products available at my local grocery store. Now almost every supermarket has at least five different milk alternatives and plant based cheeses to choose from. People and companies alike are waking up to the reality of climate change and animal cruelty and it’s clearly creating big waves. Even though the number of people who identify as vegan is steadily increasing worldwide, we’re still only a small percentage, which is why I think it’s crucial to share our lived experiences.

Seeing other people eat abundantly and thrive on this lifestyle really helped me stick to it and feel confident in my decision. Having been vegan for such a long time before becoming pregnant, I never imagined another way, but I can see why it can be daunting at first. According to the American Academy of Nutrition and Dietetics, a well planned plant based diet is appropriate for all stages of life including pregnancy, lactation, and infancy. It can even be beneficial. Like all parents, I want to do what’s best for my baby, and feeding her plenty of whole plant foods right from the beginning seemed like a great segue into motherhood.

As a “seasoned” vegan, my eating habits didn’t change drastically during pregnancy, but I did my best to eliminate most processed foods, refined sugar and flour, and caffeine. I began taking a prenatal vitamin three months before trying to conceive and continued throughout my first year of nursing. Before TTC and pregnancy, I only supplemented with vitamin B12. Even though I felt wonderful throughout, I had a very small appetite during my first trimester and roughly two weeks of nausea and vomiting. When I did eat, I focused on folate rich foods like leafy greens, beans, and legumes. Folate is crucial in preventing neural tube defects like spina bifida, and many plant foods contain this vital nutrient.

The second and third trimesters meant an increase in energy, appetite, and calories. Pregnant women need an additional 300-450 calories after the first months, and I wanted to make them count by eating nutrient rich foods. For breakfast, I might’ve had oat or amaranth porridge with fortified soy milk, nut butter, hemp seeds, and berries. Later a green smoothie with kale, orange juice, and seasonal fruit and vegetables. Lunch could be quinoa with bok choy, red pepper, and tofu stir fry with sesame miso dressing and an afternoon snack of hummus and veggie sticks. And lastly dinner is broccoli and pea soup with whole grain bread and coconut chia pudding for dessert.

I obviously didn’t have the same meals every day, but eating a variety of whole grains, fruits, vegetables, and proteins (beans, legumes, tofu, tempeh, and seitan) ensured that I was always getting “enough” of everything. I had a blood analysis at 13 weeks and another at 30 weeks, and I never had issues with deficiencies. My midwives were especially pleased with my iron levels, which made sense considering the amount of leafy greens and beans I consumed regularly.

Healthy food doesn’t have to be all or nothing. I’m not a nutritionist, but I am certain that whole plant foods can benefit us all. Big changes aren’t ideal during pregnancy, especially not without consulting a health professional, but a little effort can go a long way. Swap out dairy milk and yogurt for an unsweetened plant option or eat fresh fruit to satisfy a sweet tooth. Eat one vegan meal every day for a week, and then after a couple weeks attempt an entire day of plant based meals. I had a beautiful pregnancy and birth, and a big part of that had to do with what I put on my plate. Obviously, food is only one part of the puzzle when it comes to optimal health, but it can be a great place to start.

 

Birthing Abroad and Challenging a System

Spain had been my home away from home for many years before becoming pregnant, so it was almost expected that I would have and raise a family abroad. Like most European countries, it has its own universal healthcare system, meaning that Spanish citizens and legal residents have access to “free” medical care and government subsidized pharmaceuticals. In addition to this coverage, parents are allowed fully paid parental leave; Pregnant parents are given 16 weeks and their partners eight, though the latter is set to increase. Upon returning to work, nursing parents  have one hour to pump for five months. However, many forgo this option and consolidate the time into a fifth month of leave. Having had these options, far more than I would have had in the United States, my decision to birth my baby here was relatively easy.

I knew right away that I wanted to give birth at home, but it was clear that finding a midwife prepared and willing to assist me in that way could be difficult. Given the reality of healthcare here, home births are even less common than in the U.S., though I was lucky enough to find a home birth midwife with a birth center where I live. Midwives or “matronas”  are all trained to work and assist women in a hospital setting; they are in charge of all prenatal appointments not including blood work or ultrasounds. And nearly all of them do work in clinics and hospitals. For that reason, the word midwife itself doesn’t evoke the same imagery as it would back home. They are trained birth professionals.

Although home birth and other holistic approaches to medicine are practiced openly, they aren’t widely regulated or accepted due to the healthcare system’s accessibility and their additional charge. Because of this lack of funding and support from the community, they don’t always provide services that would be almost guaranteed stateside. For example, my midwife’s fee did not include the glucose tolerance test, blood analysis, multiple marker test, vaccines (whooping cough), or ultrasounds, even though her care did depend on some of those things. For that reason, I maintained two midwives throughout my pregnancy, one primarily tasked with my medical care and the other with my emotional wellbeing and overall enjoyment of the process. It was not easy having to straddle the two and pass information back and forth, but I felt it was necessary for balance. Regulation would make home birth more affordable, safe, comprehensive, and dependable.

My partner and I conceived on the fourth cycle of ttc, and I found out at three weeks and five days gestation. However, my first prenatal appointment wasn’t until week twelve. I opted for simple non-invasive prenatal care rather than a medicalized approach, which undoubtedly made for tense doctor’s visits at times. My private “hands-off” midwife and the one I was assigned via social security didn’t perceive pregnancy and birth the same, and I felt caught in the middle. I wish there had been a clear way to bridge the gap between the two. My experience with the public healthcare system was positive, but anytime I deviated from normal protocol there was conflict. There seemed to be a “right” choice.

Even though my specific case was somewhat out of the ordinary, the feeling that those prenatal appointments often left me with were not. After sharing my experience, I learned that many women often feel pressured to undergo certain medical procedures and are even made to feel incompetent. For some, pregnancy means a loss of bodily autonomy in terms of the type of care they receive. Families hoping to avoid unnecessary tests and interventions often choose out-of-hospital settings or freebirth their children, but statistically most women have their babies at hospitals. How can we make hospitals better, more hospitable and humane? Women who feel comfortable, supported, and safe have better birth outcomes. How can we ensure that environment during pregnancy, labor, and birth? How can we better equip medical professionals to deal with emotional and physiological needs without compromising themselves? It’s not about jumping ship, but making sure we’re headed in a direction that serves us all.

 

My (Positive) Natural Birth Story

“Again and again, motherhood demands that we break through our limitations, that we split our hearts open to make room for something more than we thought we could bear. In that sense, the labor with which we give birth is simply a rehearsal for something we mothers must do over and over: turn ourselves inside out, and then let go…” Susan Piver

It has been nearly two years since my daughter’s birth, and the memory of that day still feels as fresh and vivid as the moment I held her that first time. My birth, while erotic, exciting, and absolutely empowering, was nothing like I had planned. The days leading up to it are all hazy now. We spent them cleaning, organizing, and love making, and I realize now that my version of nesting is most likely the culprit behind our premature labor. I remember feeling utterly and absolutely in love with my partner and constantly aroused. While I couldn’t help but daydream about what our future would look like together, I did my best to stay present and enjoy having my partner to myself. Pregnancy is a subtle dance between two realms; it’s savoring the moment while at the same time wishing it away. I wanted more than anything to have my daughter in my arms, but I thoroughly enjoyed being pregnant as well.

My daughter was born at 36+2, five days before my midwife would go on call for a month. It was Holy Week, and we were eager to escape the hustle and bustle of the festivities and relax at the beach. The morning we left for our trip was hectic. I can still see myself holding my belly as we hurried to catch our train (08:00). I experienced my first waves there bumping along to our destination, but they weren’t painful at all. I was certain they were Braxton-Hicks, but after experiencing nine in an hour I had my doubts.

When we organized our trip, it made sense for us to take our time getting there since I’d be well into my third trimester. Because there isn’t a direct train from where we live, we decided to linger a while after our first stop. After train one, things slowed down some; my waves were still irregular and walking felt good (10:30). We explored the market, ate breakfast at the quaintest café, and wandered around my old neighborhood. It was nearing midday and the rushes picked up in intensity, so we rested in the park and called our midwife, who happened to be on vacation as well. She wasn’t convinced I was in labor, but she urged us to get our destination as quickly as possible for me to rest. She also recommended Arnica and a few herbs to help slow things down.

The second train was only thirty minutes, but it seemed to go on forever (15:30). I was the most uncomfortable I had been and was eager to get to the house. When we got there, my partner went to the kitchen to prepare lunch and my infusion, and I headed straight for the bedroom in the back (16:30). It felt impolite not to socialize with his family and thank them for leaving us their apartment, but I needed to lie down. I fell asleep briefly before an intense rush forced me to my feet (19:00). I went into the living room, where my partner was sitting, to tell him what was happening and we chatted for a while, still doubtful that I was truly in labor. I drank more tea and for the next hour or so I felt like myself again (19:30).

The sun was beginning to set and the stores would be closing soon, so my partner left to stock up on groceries for the holiday (20:00). He assured me that he’d be back as soon as possible and rushed off, leaving me alone on the couch. Twenty minutes went by and the waves started back where they left off. By the time he returned, I was moaning and swaying on all fours between ever so frequent trips to the bathroom (21:00). I had to poop five or six times! The last time I went, I noticed a tiny spot of blood on the toilet tissue moments before losing part of my mucus plug. I think that’s when we accepted that baby was coming and really started to dive deep into the laboring process.