[This was originally begun January 10th, but it took ten days of editing and tinkering for me to finally cut the whole essay in half and post this first half. The other will follow shortly. [it is here]]
I’m disregarding, as I write this, the good advice all new parents disregard. Like most wise counsel it is wonderfully rational, but just doesn’t seem to take into account the fact that we human beings have emotions. It’s late in the evening; snow is falling on the fields outside, and I’m sitting in front of the fire. My newborns are asleep upstairs, and I should be sleeping too. That’s the advice every new parent hears: “Sleep when they sleep.” But I just can’t do it. I’m exhausted, of course, but also charged with energy. I can feel the tension in my shoulder and neck muscles, which no amount of hot showers or muscle rubs seems to ease. When I lay down, I end up tossing and turning, or looking at my children sleep. And I think of how much things are changing already, after just a week – the kind of thing that makes a writer want to stay awake and write it all down.
Catherine and I came to Ohio for the birth of our first child, just under a month ago. Eight days ago she gave birth – not to just one, but twins, with all healthy, here in this Ohio farmhouse. I am aware that I have now seen something that not many people today have seen: the natural birth of twins in a home. Home births are rare enough as it is: I know several women who have done natural births in birthing centers, but I don’t think I know any woman of my generation who has had a birth at home; it was not common forty years ago, when my mother had me, and it’s still not common now. One friend mixed her worries in with her congratulations when we announced the safe delivery, confessing that she had three friends who had tried home births, but all three “had to be whisked to the hospital at the last minute, with the baby’s heartbeat slowing to a whisper,” and now that we had made it past the crisis she could confess her fears.
This was what we had come to Ohio for, and in fact there’s probably very little chance we could have had a home birth of twins anywhere else: very few other midwives would have been likely to attempt to deliver a first-time mother’s twins at home. Here is the short version of how this all came about.
We had wanted to do a home birth from the beginning; a hospital being almost precisely the opposite of the kind of human landscape we want to spend time in. It might be necessary at times, but to us it was worth avoiding if we could avoid it. I had been born at home and four of Catherine’s siblings had as well. We both agreed that a winter birth at the cabin was too much: even beyond the questions of risk it simply not did offer sufficient comforts for something so physically difficult. There were then two obvious options: in New York City with my family, or in Ohio with Catherine’s. Since I was born in the same house my mother lives in now, and I desired to pass on to my children the privilege of being born New Yorkers, I voted for New York; Catherine thought this was great. She went down to the city to meet with potential midwives: which ended up being not very easy. The cost was very high – sometimes as high as ten thousand dollars, and insurance was complicated. None seemed to take our insurance; some said we could switch our insurance to one they accepted; one normally didn’t take medicaid but maybe was willing to wade through paperwork because she didn’t want to just serve the wealthy; but nothing was really easy. “Talk to my biller,” said one. The midwives talked about payment a lot and wanted to be paid at each visit, because they warned her that as a first-time mother their services were probably redundant – she would almost certainly have to deliver at a hospital anyway. So they wanted their money up front: if it was in their pocket already there would be no billing disputes afterwards when she felt that she had just thrown away several grand on a home delivery that took place in a hospital anyway. She despaired of ever having anything better than a bureaucratic relationship with people who gave her 80 pages of paperwork to fill out and said, “That’s to get you started, we’ll do the rest next time.” And the general impression from them all was: this is the new New York City. A home birth is a luxury product. Not everyone gets one, and you too may not be worthy of it. So don’t count on it. Success in this town is for the few.
I could tell by her complaints about the process that she was not happy. “Why don’t you go to Ohio, and meet the midwives there,” I told her. “If they’re no better, then fine, we’ll stay here and see how it goes.”
So Catherine made an appointment with the midwife group that her mother had used, and in September she drove out to Ohio and spent a few days there. From the very first meeting there was no question. I could tell on the phone that Catherine had the right midwife for her: someone comforting, simple, and confident but not because of an ideology: confident merely because she had never thought not to be confident. The midwife seemed to have no doubt that Catherine could deliver the babies at home: she was Mennonite, and part of a community where most babies are born at home. The paperwork was minimal, and the cost was less than one-tenth of the cost in New York.
When Catherine got back, I got a chance to review the packet the midwife, named Jena, had supplied. I hadn’t met her, but the packet was very promising. “I can’t believe,” I told Catherine, “how much of this I agree with!” Agreeing with things other people say is not a luxury I get to indulge in very often, so I noticed it. Catherine was happy about this, because birth is one of those things which could potentially divide a couple. You don’t really know beforehand if you really agree when you get down to details. But we apparently did. The packet contained all kinds of information about diet and taking care of your own body, stretches, massages, etc. Its knowledge of herbal remedies was beyond anything I had seen (“white oak capsules”?) and yet it did not strike me as fruity or far-out in its thinking – there was no “wheat juice will cure your cancer” stuff. Witch hazel to help with hemorrhoids – well, yes, that made sense, now that I thought of it: I’d seen witch hazel presses almost magically reduce the swelling in my fingers. And hemorrhoids were basically just swelling. Never heard of it before, but it made sense. And the principle of the whole packet – all the information on diet, exercise, and remedies – was quite explicitly spelled out in the beginning:
Homebirth is for responsible people who take care of their bodies. Pregnancy is not a sickness, but it is extra work for your body, therefore you need more food, water, and rest.
Homebirth is for mothers who believe God created all things well. From the beginning, women have been giving birth. It is a natural event, and trying to make it a medical one is doing more harm than good.
I like to see the women I will be helping through birth periodically to ensure that all is going well. Your urine, blood pressure, pulse, weight, and general well-being are checked each month, as well as position, size, and heartbeat of the baby. Your hemoglobin levels are checked at least once. Visits are closer together as you enter the last two months.
Homebirth is for couples who wish to be free to experience totally natural childbirth. Birthing a baby is hard work, but it is also a time of great excitement and joy. Having the mother (and baby) drugged decreases from the experience.
When you are admitted into a hospital, you are pretty much turning over to them the responsibility for your health and the baby’s. At home, YOU remain responsible and free to make the choices you feel are right.
She was offering just enough medical expertise to allow us to be free and do this in our homes, and no more. Ultimately, we were taking responsibility for the event, instead of paying someone else to be responsible. And that was something we believed in.
The food recommendations – mostly meat and vegetables – not only seemed correct, but they made me glad. For almost the whole of Catherine’s pregnancy she had been eating out of our garden, and from our neighbors’ bounty – several servings every day of our own fresh-grown arugula, lettuce, ramps, peas, radishes, spinach, parsley, basil, cilantro, rosemary, garlic, potatoes, carrots, currants, kale, raspberries, blueberries, ground cherries, pears, apples, pumpkins, and tomatoes. And from neighbors we had gotten rhubarb, corn, squash, persimmons, eggs, cabbage, plums, grapes, pawpaws, and all kinds of other treats. And the Hudson Valley provided fresh, local meat and dairy. This was precisely the kind of eating the midwife was recommending – and indeed, Catherine seemed healthy and glowing all this time.
We arrived in Ohio after my work at the nursery was done, in December. Catherine immediately began her regular visits to the midwife. It was my first time meeting her. The midwife was what a New Yorker would call an Amish woman – she wore one of those caps – but technically she was a Mennonite, which could basically be described as the least strict of German non-conformist/pacifist (=Amish) communities in America. She was an interesting mix of old and new – which I liked, perhaps, because I was a mix like that too. She wore the cap but had a car and cellphone; she was young and pretty and sent texts like a teenager (“c u in 10”), but was demure in a way that I have really only read about: she typically would not look me in the eye unless I really insisted on it by staring at her. She was gentle and patient, and her speech (and indeed her whole style) was accurate but very simple. She would not come in bubbling with news or questions. She certainly never asked us a personal question. There are plenty of words for her, but they’re not the stuff of modern Hollywood heroines: patience, simplicity, tranquillity, modesty. She could have been a farmgirl in any 19th century novel: and yet she was younger than the two of us.
So it was surprising to us that after examining Catherine in our first visit she suggested that we probably wanted to get an ultrasound. She had not recommended one before, but in this instance she thought it would be useful. She suspected Catherine was carrying twins. “In fact,” she said, “I’d be surprised if it wasn’t twins.” She had not been able to locate a second heartbeat (neither had the obstetrician back in New York, despite looking), but just looking at Catherine she thought there were two in there. And she measured her “fundal height” (the term of art for those who deal with pregnancy) at 43 cm. at 37 weeks. Typically this measurement indicates the number of weeks of pregnancy: a woman will get to 40 cm. at 40 weeks. To be a good 6 cm off in such a linear measurement was quite unusual.
We had been through eight months of pregnancy, from the Catskills to Johannesburg to Dakar and New York City, but this measurement caused the first real substantiated worry of the pregnancy. Of course when your wife is pregnant you are worried generally; but earlier we worried without particular cause. Now we knew that Catherine’s condition was the most feared of all conditions: an abnormal one. She was too big. Now we were going to make the rounds of the experts to get an explanation for the abnormality.
This led to the next worry. Getting an ultrasound of course meant a dip into the medical system, and there was no way that was going to be easy. Obamacare works via “state exchanges”; it apparently does not cover out-of-state medical visits; we would have to pay out of pocket (or pay even more to go back to New York). Figuring that out took a little time. Then we had to deal with the fact that the medical establishment was not terribly helpful; it was not obvious anyone wanted anything to do with a woman eight months pregnant already (presumably this means some exposure to liability); only one hospital anywhere near us had an obstetrics unit at all (most have abandoned obstetrics due to liability concerns), and they claimed that it would not be possible to get an ultrasound for several weeks, which would be after the baby’s due date; we got a prescription for an ultrasound from a doctor, but he said he did not know where we could take it to get the procedure done. We could wait for the hospital, but he was quite sure Catherine would deliver before we got the ultrasound. It was impressively frustrating: no one wanted to help and we were on our own. In the end we had to drive more than two hours away, to Ohio’s capital, Columbus, and go to a vanity ultrasound place (“Ultrasona”) which did high-quality images and videos of babies in utero. No prescription was required and appointments were available.
The day we headed for the appointment Catherine had an egg on toast, and did a double-take as she dropped the egg into the frying-pan: it had a double-yoke. “A lot of jumbo eggs have double yolks,” she pointed out, but it was noticeable nevertheless. And when we got off at the exit in North Columbus for the ultrasound place and found that the exit was called “Gemini Parkway,” Catherine was quite convinced that these coincidences were a sign. Whatever the acausal connecting principle in the universe is – and wouldn’t we all like to know – in the end the coincidences were indeed prophetic. “Oh yeah,” said the ultrasound technician, “that’s another head there.” We were having twins.
We were overjoyed, for several reasons. First of all, in fact it came as a relief. We didn’t have an explanation, before, for why Catherine was so big; now we did. And in fact people had been telling us this for months already. In Africa, when Catherine was four months pregnant, she met a woman who was eight months pregnant with about the same size belly; the woman did not believe Catherine when she said she was only four months. People in the supermarket would come up to Catherine and say, “Twins!” My niece said, “I think it’s twins!” My employer’s wife commented, “Are you sure it’s not twins?” When we asked my nephew whether he thought it was a boy or a girl, he said, “Both!” Now we had an explanation for all this.
But more than anything it was good news because it was news of life: first of all, the abundance and fertility of it, that two whole new human beings were going to come into the world at a single stroke. And it was not only quantity but vitality: twins are different and cool and interesting and odd. We all know the stories about how they can be a thousand miles away and both order the same thing at a restaurant or know what the other is thinking, and in general have some unfathomable special connection. My mother liked the idea of children being spaced and being given their own experience; and I approved of that, but of course it also made me curious about the other side of things, where children are close together and share experiences and build a bond. Twins are the utmost example of that.
Both of us like surprises, and both are willing to have to adjust plans. And that was the next process: figuring out how we were going to have to adjust. The most immediate question was how it would affect our plans for a home birth.
We had gotten information about the babies’ positioning while getting the ultrasound: they were both head-down, in perfect position. We found out they were in two separate amniotic sacks in the womb – a crucial point. If the babies are in the same sack, their cords frequently get tangled, causing problems during birth. As long as they were in separate sacks, and both in the proper position, a twin birth should not be much more difficult than a single birth. The reasons for the home birth had not changed, our commitment to the midwife had not changed, and we still believed Catherine was capable of delivering them safely at home. I re-read all the emergency procedures I needed to know, and kept the card in my pocket at all times; I paid especial attention to the “plan B” for where we were going in case of difficulty; but all in all, we felt good. Catherine’s pregnancy had offered all the normal discomforts but no special complications, even into the ninth month. The ultrasound technician had estimated their weights at around seven pounds each: two healthy, full-sized babies.
In fact, Catherine said she was glad that she didn’t know it was twins until near the end. She might never have believed she could carry them to term, were it not for the fact that she already had. We could have marched into a hospital right there, and delivered two healthy babies. All they lacked now were some of the womb’s finishing touches. And not only had Catherine carried them to term, but she had brought them to Africa, climbed mountains in the Catskills, tended a garden, done the cooking and cleaning and washing and managed our little homestead, while bringing them to term. In fact, all that physical activity had probably helped them, but if she had been anxious the whole time about her double pregnancy, she might never have done it. Cicero writes in his De Divinatione about how useful to human beings is our ignorance of the future; and that might have been the case here. We felt that we found out only when we really needed to know. Similarly we did not ask the sexes of the babies, not finding that information necessary at present.
So we went back home, told our news to our friends and family, did some basic additional preparation (we needed a second birthing kit, more clothes, more diapers, etc.), and got back to the active waiting that is the end of pregnancy. It was Christmastime and we were around her family; there were all kinds of events to attend and people to see. We tended to be home early, but I went to work (helping a carpenter) and she kept the house and saw people just like normal.
It is unusual for twins to go to full term, but ours did. Catherine went into labor in the fortieth week, just five days before her due date. We went for an unusually long walk the day before she went into labor. I awoke at three in the morning to find her on the phone with the midwife, talking about contractions. She had been discussing her “Braxton-Hicks contractions,” which are preparatory uterine contractions and not part of labor proper, with the midwife for weeks now. I disliked the use of the term “contractions” for these muscle spasms, because it made it seem like labor had begun, and I presumed she was still discussing them with the midwife. I thought this was a bit much, waking the midwife up at three in the morning to talk about what was a routine physical preparation for labor. I looked at her dimly in the darkness and said, “You’re not in labor,” and rolled over to return to my sleeping. I don’t remember what convinced me otherwise – I think it was just her telling me so. All I can remember is that all of a sudden I was out of bed, got dressed, and things were serious. Labor had begun.
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