Where Midwives Are Worth Gold
/Having assisted a number of deliveries during my medical schooling in the Philippines, I had grown accustomed to the idea that natural births were a thing of the past, only for women who could not afford to deliver in a private hospital. Hospitals gave the luxury of attending doctors and private rooms, guided deliveries and anesthetized labor to liberate the modern woman from the pain and shame of screaming through her delivery.
Even elective Caesarian deliveries had become part of the norm; it made giving birth easily manageable for both the mother-to-be and her physician. Being that student then, it had never crossed my mind to one day choose to birth both of my children naturally, with only the assistance of my husband and a midwife, refusing pain killers of any kind and determined to endure the natural pains of labor without medications. But that’s exactly how this story ends, and the road to that decision was anything but smooth, filled with a lot of anxiety, doubts and fears, but one that I’m proud I did not run from.
No matter if you're seasoned and experienced or new and nervous, every parent receives a short primer on the "how-to's" of newborn handling, from bathing, to changing diapers, to holding them properly. (Photo courtesy of Cherry Malonzo)
Fixed Plans
When I became pregnant, natural birth was one of the last things on my mind. In fact, pregnancy had happened rather unexpectedly. At the time, my husband and I were not prepared, financially, emotionally or otherwise. Knowing that natural birth is encouraged in the all the local public and private hospitals in Switzerland, I feared the inevitable pain of labor all the more. And in order to eliminate it, I initially planned for a painless delivery, imagining myself opting for anesthetics in order to withstand the apparent horrors of birthing a child.
I was so afraid of the possibilities I even briefly considered going home to my parents, leaving my husband behind while I deliver our child at a familiar hospital back in the Philippines. Nevermind that I would have had to deliver on my own because bringing a relative into the labor room is not part of standard procedure. Nevermind that I would have been handled by a number of strangers, doctors and interns throughout my ordeal. This option would have ultimately isolated me during my most vulnerable state, in order for experts to properly handle my “case” and deliver yet another baby into the world. But I was not concerned about any of that. My biggest concern was to be able to recover with the help of my parents. I was so unprepared for pregnancy and motherhood that I instinctively turned to the thought of my own mother, to save me from my fears.
Knowing is Half the Battle
To ease my apprehension, I read up. Everything I could get a hold of about pregnancy, in English and German, devoured it like a mystery book and studied like I was reviewing for an exam. I compared notes in both languages, testimonials from other mothers, reports from research journals and books from experts. Although I didn’t write down notes, I definitely took mental ones, filling my thoughts with all the details about each month: baby’s growth; baby’s size; baby’s movements; baby’s feet; Mama’s appetite; Mama’s hormones; Mama’s biological and physiological changes! Disappointed to realize I had forgotten or had failed to learn all that when I had been in medical school, it was apparent that none of this had interested me in the least back then. But now that I was the case at hand, I became obsessed, arming myself with the theoretical knowledge, in order to prepare for treatment. Knowing is half the battle, I told myself.
This calmed my disposition, and I felt protected with the knowledge I surrounded myself with. With the months, as my pregnancy unfolded, my own experiences slowly verified theory. My senses woke up to the gradual changes in my body. I watched my belly growing, and I learned to instinctively cup the underside of my abdomen every time I would sit down or stand up. When I walked, I felt my hips loosening, finding myself adapting the signature waddle of expectant mothers. Every time I rode the train, I felt my stomach turning (more than usual), so I learned to always have a pack of ginger-candy handy, to avert it. And the faint fluttering in my stomach in the early months slowly evolved into an uncomfortable jolting in my gut by the end of the second trimester. Those sensations always made me laugh, but I often had to shudder too, realizing the culprit was not just a grumbling belly that would pass, but an undeniable entity on its own. One that was growing inside of me!
“I initially planned for a painless delivery, imagining myself opting for anesthetics in order to withstand the apparent horrors of birthing a child.”
Losing Control
Soon, thoughts of the baby started haunting me. His personality, his feelings, his sensations. How will he be like? Who will he be like? I hope he’s healthy, and stays healthy! How do we do this; can we even do this?! I started to question everything I thought I had known about standard procedure, all the medical intervention I was initially convinced of. I thought to myself, but what did baby have to say about all this? Given a choice, would baby also wish for the pacified road to the real world? As my excitement continued to mount, the knowledge I thought I was building on began to crumble. And what about natural delivery? Is it really a thing of the past? Has the modern woman become unnaturally fragile that she needs a team of medical experts to assist in what is an otherwise natural condition? My certainty in the standards was soon replaced with an equal sense of losing control.
But in time, my understanding of pregnancy flourished and my appreciation of the female body blossomed. However, I could not, for the life of me, eliminate my distrust of that vague idea of delivery. No book could explain it the way I needed. “Every woman’s experience is different”, was a common statement. But how different? It was disarming. And the child inside of me was relentlessly growing despite my discomfort. Knowing is half the battle, I kept saying to myself, but I need to arm myself with the other half to get through! I just didn’t know what that meant.
At Public Hospitals
By seven months, I enrolled for prenatal courses to be taught by a midwife at the public hospital I would deliver in. At first I was curious at what I would actually learn. Back home, midwives were not known to work in hospitals, they usually worked in the smaller health clinics, assisting home births in the provinces. Often the image of a midwife was stereotypically a middle-aged woman dressed in a style that was as old as her practices, all of which were rumored to be inferior to hospital standards. The average middle class woman in the Philippines did not consult a midwife. Instead she sought the sole service of her obstetrician, who was responsible for all her prenatal check-ups and her delivery as well.
So I was surprised to I find out that locally (and in the rest of Europe), only midwives manned the delivery rooms and guided and assisted all calls, in public and private hospitals alike. Doctors were summoned in time for the delivery, but only those who were on duty. A patient’s private doctor would only be informed by means of a case report, posted only after hospital discharge. The number of days a woman was permitted to stay in the hospital would be determined by the type of delivery she had, regardless of how she felt. Three days for normal delivery, five for C-section. “Sorry, madame,” I imagined a surly midwife declaring in Swiss German, “but you have to take your business elsewhere now.” I felt quite uneasy contemplating all these technicalities. Giving birth, wrapped in what seemed like red tape, was fast becoming more and more a potentially frightful and impersonal experience.
The Midwife
But on the first day of the prenatal course, I was intrigued when instead of an aging woman wearing conservative clothes and talking with a raspy voice as I had imagined her, the course midwife turned out to be young and fit, in her 30s and with no trace of old-fashioned practices. She styled her hair short and silver and wore one earring longer than the other. Her clothes were comfortable and stylish, reflective of the current trends. She had this air of confidence that was befitting an athlete; it was hard not to admire her. She did not fit at all my idea of the typical midwife.
One of the many visits of my midwife after the birth of our first son. She was the prenatal course midwife. Although she was not on duty when I gave birth, I nonetheless requested for her services after discharge. (Photo courtesy of Cherry Malonzo)
The first session began with the eight of us, cupping our bellies, sitting in a circle, each of us cross-legged on a yoga mat, introducing ourselves. Although a roomful of pregnant women sets the stage for an awkward situation, the midwife had an authority that turned the attention to herself, to everyone’s relief, so we could continue the sessions with our concerns at the heart of the talks, and not ourselves.
The meetings that followed were a mix of group discussions, not unlike support group sessions, and yoga class. She taught us techniques to alleviate the chronic discomforts of pregnancy, letting us utilize an exercise ball, introducing us to cherry-stone-filled bags and the many uses of nursing pillows. She coached us like a yoga teacher, directing our positions and guiding our breathing, approaching each of us to correct our posture and ensuring our comfort. She spelled out the obvious, reiterating the need for loosening joints, despite the nuisance it brought. After all, how else will the baby make its way out if the hips are too stiff? We joked about myths and cultural beliefs, talking about dark spots, stretch marks, carrying low or losing your beauty—all because the child was a boy. Or a girl. We talked about superstitions and labor tales and horror stories, imagining ourselves in them, feeling sorry for the real women who endured them, but nevertheless comforting each other with collective worry and dread.
Nature’s Way
In the last few sessions, with words of encouragement, she urged us to trust our bodies. The pain of labor does not appear so suddenly, she stressed, the pain adjusts to the body and the body adjusts to the pain. We are built for this, she reminded us, we’ve been engineered by years of evolution to withstand labor, how else would we have survived all these centuries?
Then she countered, the pain is, however, necessary, it is a rite of passage, and your hormones won’t be making you numb to it either. Well, primarily so you know you’re in labor, of course. “But how do you know when labor is starting? How does it feel like?” one of the troubled women asked. Don’t worry, when it happens you’ll know, she replied, there’s no doubt you would know. The pain is necessary, she continued, because bringing a child into this world is not meant to be painless, rearing a child is not meant to be easy; it is Schmerzhaft (painful) emotionally, often times along the way. But with the pain comes great joy, and once the baby has arrived, as mysterious as it may sound, the pain will miraculously dissipate and be replaced with an indescribable feeling of exhilaration.
Such is nature’s way, she said. Trust your body.
The Birthing Rooms
Later, during an evening together with the anxious husbands, she used relief posters, a doll and a hip model to illustrate and explain the steps of delivery like a science teacher to her most eager students. Many had basic questions and found no shame in voicing their ignorance, and she in turn addressed them calmly and clearly, knowing that everyone else was probably wondering about the same thing.
That evening, we were shown the different birthing rooms: “Fire,” “Wind” and “Water.” Painted with harmonizing colors and decorated with wooden furniture, each room in its own color and style. They were very inviting, not in anyway reminiscent of sterile hospital rooms. Each room offered alternative birthing positions, from standing to sitting on birthing stools, to lying in ergonomic birthing pools.
The "Water" room: painted and decorated in shades of blue, and equipped with a private shower (the door behind the white curtain) and music dock (not shown). The birthing pool is not unlike a whirlpool bathtub, but ergonomically designed with foot-rests and handles for a woman in labor. (Photo courtesy of Cherry Malonzo)
The rooms were equipped with music docks and private showers; even the husbands were impressed and preoccupied themselves with the technology on offer, while the women discussed among themselves which would be their room of choice come D-Day.
“The Fire room,” one declared. “Oh, me too!” the other piped in. Everyone nodded in agreement. It was like deciding on real estate. The inevitable was shortly forgotten, and we could all divert our thoughts to a fantastic hospital stay, as if we were escaping for a wellness weekend in a five-star hotel by the lake.
And though it was impossible to say what experience these rooms would truly bring each one of us, there and then, I felt my apprehension suddenly subside. Like a castaway that just sighted shore, I felt rescued. Never had I seen or heard of such possibilities in hospitals I had known before. At least at the moment, it was easy to imagine giving birth in those rooms, filled with my own personal music, wearing my own comfortable clothes, being with my own husband.
Finally I realized why these sessions were necessary. If I had entered that course full of skepticism just a few weeks before, I was leaving it enlightened. Among these women sharing a similar predicament, with a midwife who fed us with mantras that spoke to our deepest unease, I felt my armor complete.
The Decision
Towards the end, with an otherwise uncomplicated pregnancy, I had grown at peace with myself, overflowing with courage and confidence to birth my baby naturally. Learning more about the risks in pain-free births and C-sections, I no longer deemed my child’s first glimpse of the world irrelevant. Instead I felt determined to give the best to him, one that was untainted with medications that were bound to leave me drowsy, and my baby too. I wanted to experience my delivery awake and alive, with my husband by my side. And with his assurance and optimism, I felt ready. No longer did I imagine a pacified delivery at a hospital far from my new home. No longer did I feel like a child in dire need of her mother to overcome a great fear. I had grown up, and I felt ready, and I wanted what was best for my own child, a birth as natural as possible.
Birth
Our first son was born on land. When the baby came, he came quite suddenly that we did not make it in time into the birthing pool. But when he came, it was like a dream, my husband and I locked in each others embrace. We held one another in disbelief as we watched our life permanently change in the blink of an eye: There he was, our son. It’s true, in that moment, the hours of enduring the pain were magically forgotten; suddenly the agony was all over, and suddenly we were a family. That was all that mattered.
When our second son was born, my hopes for a waterbirth were fulfilled. But he too came quite suddenly that when the doctor finally arrived, the baby had already been placed on my breast to latch on, and my husband was already cutting the cord.
In the final moments of my labor, the only two people who mattered most were my husband and the midwife on duty. The doctors came in time to assist the actual delivery and declare the birth and to congratulate us. But the support and encouragement I had needed most during those difficult hours of labor came from only the two people who were assisting me throughout my entire ordeal. Afterall, pregnancy is not a disease; doctors have more important things to do than to attend a natural condition that in most cases, will, in due time, resolve itself.
As a rule, the doctors and midwives are not allowed to take the baby from the parents' sight, if there are any additional assessments to be accomplished outside of the delivery room, the husband must come along, otherwise the baby is placed on the breast immediately after birth to latch-on while the cord is being cut or the placenta being delivered. (Photo courtesy of Cherry Malonzo)
The Other Half
Although I stayed in the hospital for only three nights for each of my deliveries, they felt longer than just 72 hours. I enjoyed those days as if they really were wellness weekends, spending the first hours with my newborn having nothing else to worry about but us. My meals were cooked for me, my bed sheets changed daily, I even received acupuncture therapy to help with residual pain. And like all new mothers and their babies, we also received a full-program from the pediatric nurses and midwives. They came at pre-determined hours of the day to teach us all the basics about handling a newborn, from breastfeeding, to changing nappies, to bathing them correctly and carrying them ergonomically, to being coached on postnatal exercises for proper recovery. Becoming a new mother for our first and later our second son felt like an all-inclusive weekend getaway with the new baby.
But at one point, we all must face reality and go home. Fortunately, new mothers are required to hire a midwife who would make regular house calls during the first few weeks. My midwife came the first day after discharge, and every other day for the two weeks thereafter. She weighed and checked my baby regularly, explaining why all of it was necessary. She palpated my abdomen during every visit, to ensure my recovery was also in order. And she asked if I was feeling okay, if I needed anything, wanted anything or had any questions, no matter how silly or embarrassing. Even my husband profited from the midwife’s visits, asking his questions concerning the baby too. And we felt saved, not alone or clueless like all new parents must feel when they realize that the survival of an entire being is now all in their hands.
I often wondered then, and still do now, if all women around the world could receive this much support and respect from the onset of their pregnancy to the first critical weeks after delivery, would there be fewer fatalities for both the mothers and their newborn? There surely would be less apprehensive couples trying desperately to cope with the change in their lives. Instead there would be more dignified and confident couples being guided into the right direction, able to take on their new roles as parents.
“Die Hebammen sind wirklich Gold Wert,” my mother-in-law once said, and I couldn’t agree more; the midwives really are worth gold. I did not know it before, but I would not dispute it now.
Cherry Malonzo
After living as a child in Saudi Arabia, later as a teen in the Philippines, Cherry Malonzo now resides in Switzerland after unexpectedly meeting her husband in Rome in 2006. A mother of two boys, she’s currently taking time off from being a lab rat working with stem cells and spending most of her days outside with her children. (She blogs at www.whileinswitzerland.com.)