I was in the bathroom just after midnight, wishing I'd skipped that extra piece of my husband's birthday cake. At nine months and a day, my pregnant body didn't have room for extra anything.
A bit too slowly it dawned on me. This wasn't about cake. My heart began to beat as if it too, like the tiny person inside me, were ready to break free. Then I shivered. What had I gotten myself into?
I'd decided to go natural, relying on the fast-growing practice of hypnobirthing. Despite the name, there's no swinging pendulum, no "your eyes are getting heavy'' mantras -- just deep breathing, imagery, meditation and massage.
Unlike some natural methods, hypnobirthing isn't about powering through pain, warrior-style. It's about having a gentle birth, reducing and avoiding pain as much as possible. That sounded great on paper. Yet as my stomachache morphed into the sensation of a paring knife twisting through my back, my decision began to seem a bout of hormone-induced insanity. Could I do it, or was all this natural stuff like the no money down mortgage -- too good to be true?
MIAMI'S HIGH C-SECTION RATES
For years, I imagined the birth of my first child as a happy, epidural-assisted event. The doctor would say "push,'' and out would pop Baby X.
Things changed when I encountered obstetrics in Miami, where cesarean rates averaged 45 percent in 2006, way above the already high national average of 31 percent, according to the federal Centers for Disease Control and Prevention. My doctors' resistance to my casual interest in natural birth only made me want to know more. At 35, with two miscarriages, I wanted as natural an experience as possible but also the security of a hospital.
Surely, it wouldn't be hard to achieve both.
INDUCING WITH DRUGS
My first Miami OB/GYN, Dr. Steven Silvers, touted his low cesarean rate and told me a good way to help a woman avoid a C-section was to induce her early with the drug Pitocin. That, he said, keeps the baby from getting too big. His patients also liked this option because their spouses and out-of-town relatives could time their visits for the birth.
Pitocin helps the cervix dilate and brings on contractions. It's useful, for example, after a woman's water breaks if her labor doesn't progress. But it also heightens the pain, makes an epidural more likely and usually requires a woman be hooked up to constant monitoring. That's not ideal if mom wants to move around and find a comfortable, gravity-friendly position for the birth.
I told Silvers I'd like to pass on the Pitocin and the cesarean.
CALL THE DOULA
In our bathroom, I began to reconsider. It didn't seem possible this thing could get out on its own.
"Honey.'' I shook my husband.
"What? Am I snoring?''
"Hogging the sheets?''
"Oh my God'' he said, hopping out of bed. My contractions were coming every three minutes. Maybe we'd better call the doula.
In a different time and place, it would be easy to find a female relative or close friend to help a mother during labor. But many of us live a long way from best friends and family. My own mother was more likely to join a harem than guide me through natural childbirth. The word doula comes from the Greek word for female servant. The idea of having a wing-woman, someone who knew the mysteries of childbirth but wasn't part of the medical team, was beginning to sound pretty good.
Silvers was less enthusiastic. He warned that doulas can make mothers feel guilty about using drugs. It was time to break up with my doctor.
NEW MEDICAL TEAM
My second group of doctors was old school -- kind and authoritative. They also smiled indulgently at the idea of a doula and scoffed at no drugs. But I was so grateful the pregnancy had finally taken hold. I nodded dumbly at most everything they said. I kept silent even when they left me sitting for an hour on the flat examination table, about as comfortable for my ballooning body as a sidewalk.
Outside their office, I was becoming more interested in natural birth. I was beginning to want candles, mantras and music.
Still, I was skeptical at my first hypnobirthing class. Our teacher and. doula, Vivian Keeler, told us the first thing we needed to do was banish our fear. Fear inhibits the love hormone oxytocin, the natural form of Pitocin that relaxes the mother and helps start uterine contractions.
We watched videos of women smiling between contractions. We said no to scary birth stories. We listened to CDs that helped us relax and visualize our bodies giving birth. We learned massage techniques and what to request at the hospital (dim the lights, please).
Yet, I was seven months pregnant when I finally got up the nerve to ask my doctors the tough questions. What were their cesarean and episiotomy rates? Did I have to be hooked up to an IV?
This time, they initiated the break up.
"Look, we've been delivering the same way for a long time,'' Dr. Pedro Brasac told me. "If you want all these natural things, then maybe you should find a new doctor.''
AND ANOTHER ...
So I did. Dr. Mauricio Bitran was supportive of the 20-year-old practice of hypnobirthing and known for working with doulas.
"About 70 percent of the time, everything goes fine, and all we need to do is sit back and watch most of the action,'' he said. "What we are needed for is that 30 percent of the time. Then I need you to trust me.''
I decided I would.
During labor at home, my husband's massaging helped, as did the meditation CD. Then Vivian arrived. She took a look and said in her calm doula voice that perhaps we ought to head to the hospital.
Translation: Go now or baby will arrive on bathroom floor.
At the hospital, I kept focused on my breathing, so much so that the nurse shrieked when she realized I was 9 centimeters dilated.
"Get a doctor,'' she yelled.
Unfortunately, my doctor wasn't at Mt. Sinai Medical Center waiting for me at 3:30 a.m., nor were any nurses accustomed to hypnobirthing. Instead, while I was on all fours during a particularly hard contraction, a visiting nurse demanded I sign a slew of papers I'd already filled out. Then she threatened that if I didn't get on my back so she could wrap the external heart monitor around me, she'd have to break the water and measure internally.
So much for no fear.
Vivian intervened, explaining what I was trying to do in a Jedi Obi-Wan Kenobi sounding voice. The nurse agreed to try again and succeeded.
For the next two hours, Vivian and my husband fed me ice chips, encouraged me and took turns maintaining counter-pressure on my hips.
THE BIG MOMENT
Soon, my doctor's partner, Franz Rivera, arrived. My water broke, and then came the moment when he was supposed to utter that magic word "push.'' But he didn't. There was no vessel-popping breath holding. Instead, Rivera waited for me as I breathed deeper, grunted and worked with gravity to ease the baby down, all in my own sweet time.
"There's his head,'' my husband exclaimed.
Then I did push -- once, twice, three times -- and out roared Joaquin, all 7 pounds, 8 ounces of him.
At 5:30 a.m., I brought my screaming child to my breast. Minutes later, the experience was as blurry as a drunken prom night, but I was wide awake.
SO MANY LOCAL C-SECTIONS
The number of low-risk cesareans done in the morning or around lunchtime in Florida have steadily risen in recent years, as have the number of 38- and 39-week births, said state epidemiologist Bill Sappenfield.That meshes with a longstanding trend nationwide toward earlier births, a change also linked to C-sections and inductions.
Doctors don't get paid more for C-sections, but my insurance company, Aetna, said its total reimbursement rate for hospitals averages about $4,000 more for cesareans than vaginal births.
Some experts say Florida's high malpractice rate makes doctors proactive.
Dr. Mauricio Bitran had a different take. Sometimes the interventions are medically necessary, he said, but doctors often order an epidural and Pitocin so they can control the patient's pain and reduce the time it takes to deliver a baby.
"Otherwise, you can go hours and hours of needless waiting. Who likes that?'' Bitran said. "The patient is putzing around and putzing around, and you want to go home to your family.''
-- LAURA WIDES-MUNOZ