Birth Classes in Chicago by El in the Winter

A reminder of how cold it was last winter in Chicago, and a taste of what taking the el/walking to our classes was like.

At a midwife appointment, one of the midwives suggested that we sign up to take birth classes, and proposed a couple of options: something called “hypnobirthing” (I’m still suspicious – but many people we care about and trust found it very helpful, so perhaps I shouldn’t be) and also the Bradley Method.  At the time neither of those phrases meant anything to me, but, as with so many other things, thankfully, Brooke had done some reading and suggested we go with the Bradley Method.  Brooke also looked up, found a class for us and enrolled us in it.

The trust I place in my wife’s judgment, some sense of the problems with the medical-industrial complex (see below), and the simple fact that I generally go along with things Brooke plans brought me to the first of our 12 2-hour Bradley Method classes.  When I tell people I spent 24 hours in classes, they look at me like I’m crazy.  Many of them quite literally spent many more hours planning their weddings (even with all of its attendant outsourcing) than they did learning about what was going to happen to their body or their wife’s or girlfriend’s body when they gave birth to a child.  THAT is crazy, not going to a bunch of classes and surrendering 12 Monday evenings in December, January and February.

That said, last winter was cold.  It was FUCKING COLD.  The winter of 2013-2014 was Chicago’s nastiest since I was a teenager.  And I’m convinced that if you consulted the weather records, you would find that those Mondays were all the coldest ones.  And we had this whole other idealistic thing about getting rid of our cars, using the El to get everywhere.

The class was in Logan Square, just a few short blocks from the California Blue Line stop.  The Lasalle blue line is about 100 feet from our front door. Which is fine in the abstract, but when your wife is pregnant, and therefore of compromised balance (and still not quite giving up on the idea of heels), and the sidewalk is snow or iced-over every single time, and there’s biting wind harassing you as you walk along, nevermind the hipsters somehow wearing only hoodies and texting with their earbuds in while they walk straight at you without seeing, and then well, then you have a dicier proposition than I might have led you to believe I’d approach this enterprise with.

I’ve got a pretty good flaky-liberal detector.  Years of attendance at war protests, a BA from an east-coast liberal arts college and sporadic attendance at liberal protestant churches have ensured that if nothing else, I can spot a milk-skeptic or an anti-vaccinator, for example, from a mile away.  I can tell who’s the Dennis Kucinich nut, or just reads Paul Krugman and votes Democrat, whatever.  I can make these fine-grained distinctions.

When I walked in, the space (it was called a “space” – that was the first giveaway) reeked of flaky-liberal.  It looked like a storefront, or more properly, one of those buildings that used to be a storefront but now is just a first-floor residence, that dot streets in Chicago’s outlying neighborhoods.  There were two women welcoming us into a space that looked a little like a dance studio – big flat open hardwood floor area, backed by a low-lying galley kitchen, and an array of blankets strewn around the floor, seemingly intentionally.  A coat-rack just a few feet in front of the door suggested some defined entryway, but only just.  A row of chairs flanked the used-to-be storefront windows.

Walking through this front room, off to the right and past the kitchen was something that looked like a performance area.  There were a few rows of clearly reclaimed auditorium chairs, perhaps from a decommissioned elementary school, and a stage area made up of about eight-inch-high risers covered with the kind of carpet-ish padding you might find in a church choir practice room.

One of the women – our teacher Becky – was 40-something, with ruddy-to-flush Irish complexion and a mop of reddish hair.  She was repeatedly checking her phone, intermittently texting and answering calls, and then also loudly and nervously remarking about why some people are going to be late, our numbers might be a little diminished, etc. etc.  The other woman, who was much calmer, was chatting with Becky. She had bobbed gray/salt-and-pepper-type hair and wore a somewhat asymmetrical sweater.  As we sat in the auditorium seats (in slanted rows of 3 or 4), the rest of the class trickled in.  They mostly seemed like late 20’s-early-30-somethings, a couple of years younger than us, and also on the flaky-liberal fringe.  There were a couple more corporate looking types too, fleeces and logoed shoulder packs in tow, and some other guys with the longer, scragglier facial hair that’s popular among people just a few years younger than me (plus ratty but deliberately chosen vintage-looking t-shirts), wives in various stages of pregnancy.  Some small talk, but I was so tired I didn’t do much myself.

The second woman, whose name I don’t remember, turned out to be the owner of the “space.”  She spoke for just a few minutes, letting us know how “important” our work together would be, how long she had known Becky, and that we should feel free to complain if we heard her daughter practicing violin upstairs.  This was a house, it turned out, with the “space” in the back.  Total privileged-liberal-Portlandia-type stuff for sure.

As much fun as I’m making of the setting, what happened next was extremely moving: I felt a feeling I’d feel with increasing frequency as the months rolled by as our child grew to term in my wife’s body.  It was a state of almost-tears, lump-in-the-throat, emotionally charged and unexpected, that would just come out of nowhere.

Once Becky put her phone away (though, more about that a few months later), she started into an engrossing narrative of the birth of her two children.  It wasn’t overly physical or disgusting, but it was intimate and revealing.  I don’t remember too much of it, just the feel, the longer and longer she talked, the more I thought “I’m so glad I’m doing this.”  Just like the first visit to the hospital,  When people talk about feminism, and the inclusion of and attention to women’s voices, well, this is what they meant.  Not in an academic setting, not as a provocation, but as a mother reclaiming the words, setting aside the modesty often expected around women and childbirth, telling us a simple and compelling story.  She had spent hours laboring with her first child, including receiving Pitocin for most of that time, and things had generally not gone well.  But she got through it.

The classes themselves were hit or miss.  Becky was much better at the psychological aspects of coach-training than the physical ones.  The flaky-liberal alarm would go off at least once a class, when Becky got dangerously close to making ridiculously false medical and scientific statements about the magical qualities of certain herbal supplements or directing people to clearly untrustworthy websites that would confirm a pseudo-conspiratorial whim she thought we all should pursue too.

The basic idea behind the Bradley method is that people who understand what the various medical realities of different stages of labor are will generally have much more luck with a low-intervention, “natural” pregnancy and birth.  Of course, “natural” is always a relative term, and I think perhaps a misleading one.  “Traditional” or “minimally invasive” might be better.  The establishment of a knowledge base is supposed to lessen the grip that fear tends to have over patients, and that doctors tend to exploit (unwittingly in some case, wittingly in others) to control the direction of birth.

The basic problem with the medical approach to birth is that it tends to get treated like an illness.  If all you have is a hammer, everything looks like a nail.  If all you have is a hospital room with fancy devices and a million specialists on call, it’s really easy to use them.  Hospitals demand interventions.  If something isn’t happening right away, there’s a ready-to-hand solution.  Of course, labor doesn’t happen right away.  Its a gradual process.  But given how much pain is involved for the woman, it’s pretty easy for a doctor to say “well, we could do a C section right now and this could all be over” and for the woman to accept this without thinking.  It’s way easier if the woman is feeling pain and she has no idea why.  If she doesn’t know where the baby is, how much longer it’s likely to take, why the pain might be growing or lessening at a given time…

It’s not the pain per se that causes most of the interventions, it’s the total lack of context that the woman experiencing the pain often has about it.  Twelve classes gave us the context to get our heads around some of what would happen.  It gave us a vocabulary, allowed us to generate a plan, or at least, a story about what might happen.  Our heads were full of facts and figures, yes, but they were also full of a general kind of awareness, and a set of skills for advocating for ourselves and maintaining that awareness all through the process.  You can’t get that by looking around the hospital and talking with a doctor who wants delivery to work the way getting your tonsils out might work.  Even if it’s a well-meaning doctor, they’re in the grips of an institution and its interests (largely monetary and legalistic) that they’re pretty much powerless to stop.  And after a time, most of those doctors capitulate to those interests, whether consciously or not.

To make this a bit more concrete: did you know more C-sections happen right around late afternoon than at other times?  Do you know why?  It’s because the doctors want to go home.  They want to press a button, write an order, and “deliver the baby.”  But – and this is revealing – doctors don’t deliver babies, mothers do.  At least they would if they weren’t doped up almost beyond consciousness and made delirious through hours of non-supportive hospital staff that keep pushing you towards the supposedly easy way out.

We also spent lots of times practicing.  I see in retrospect that that practice was very, very far from game conditions.  Please note – this is not Lamaze-style “breathing,” more like establishing mental and physical relaxation routines, and then also practice with various laboring positions, and what both the father- and the mother-to-be can do to work through those phases of labor successfully.

As a contrast to our Bradley Method classes, let me tell you about the birth class options you will find at Northwestern – Chicago’s consensus pick for “the best birth money can buy.”  They offer a course with a ridiculous and corporate-sounding pseudo-literary reference-containing name – “Great Expectations.”  Setting aside the obvious problem (that without a doubt no one involved in the naming of this class – and very few of its attendees – has read Dickens’ novel and is still nevertheless impressed by the allusion in that weird way the corporate crowd often is), this class, so far as I can tell from talking with people who have attended it, is really just a PR-friendly tour of the hospital.  It lasts a couple of hours, and during it, you get to see all the nice leather chairs, granite countertops, open-floor-plan foyers and clean looking culinary options you’ll have when you’re there.  Perhaps a doctor stops by during the tour and looks the part for a few minutes while you ogle over how much money it looks like has been spent on the place (for money, see above).  This is not a “class” any more than a college tour is a B.A.

Here’s someone’s quasi-Yelp review:

Personally, I found it to be a waste of money. I took the class over the summer to prepare for my baby that was born two weeks ago. They didn’t teach me anything that I didn’t already know thanks to books I’d read and internet sites I spend far too much time on. The tour was definitely nice (though irrelevant for me as I was admitted to the hospital three times before delivery so I knew the drill quite well by then). You can get the tour for free though. I don’t remember the details but the website for Prentice explains it. If I remember correctly, it’s twice a month they offer their free tours of labor and delivery.

This treats the birth experience pretty much the same way we treat, say, a wedding.  “Look at this venue!”  “Let’s try the food!”  What you buy when you pay for a wedding venue is basically the confidence that comes with division of labor: you get a caterer, a bartender, a DJ, a pastor, etc.  The idea being, leave it to the experts.  We all could cater our own weddings, and I think even if our parents’ generation this was much more common, and probably still is among people with less disposible income than I usually am around.  But since we have the money, and we don’t want the hassle, we think – well, I’ll just let them take care of it.

And that’s fine – for weddings.  What kind of a way is it to handle the birth of a child though?  Imagine if, when preparing to take the ACT in high school, you wanted a better score, so you had resolved to spend some money on it.  What would you spend that money on?  Choice 1 – a prep book, and a tutor with whom you’ll meet 5-10 times.  Choice 2 – a tour of the really really nice building in which you’ll be taking the ACT.  A quick stop by the snack-bar.  And then a pop-in from the proctor, who is prepared to assure you all you’ll have do to is sit down, struggle for a little while, and then get put out of your misery while a really high-tech computer handles the rest of your test for you – “we’ll wake up up when you get into Harvard!”  Smiles all around.

The vast majority of American women are encouraged to handle childbirth more like booking a wedding venue than prepping for the ACT.  This makes zero sense.  It says a lot about our culture and all the other decisions we make about ourselves, and how most of those make zero sense as well, but the bottom line is – there’s no good reason why we do this.

For one, “leave it to the experts” turns out to be terrible advice in this context.  American women have at least twice as many C-section deliveries as the rest of the developed world, far more induced births, many, many epidurals, and oh yeah – like I said before, it costs way more per baby and is economically unsustainable and results in shamefully unjust treatment of poor (largely non-white) women and families.

Which again, would be fine, maybe, if what you were buying was some sort of safety and security.  You are not.  You are buying the impression of that.  Thoreau’s “some complicated machinery or another to satisfy our idea of” birth.  C-sections, epidurals, inductions, and all the rest result in far, far more complications than natural birth.  There is decisive aggregate data to support this claim, and yet, the Bradley Method and its ilk are generally in the United States seen as refuges for naive hippies or flaky science skeptics.

I think this skepticism about “doing it yourself” has three principal causes.

Cause 1 – Americans are hopelessly and uncreatively consumeristic.  When making ANY decision with which they’re unfamiliar, they turn to market thinking.  Many of the problems across our political world can be seen as having a similar cause.  College education, health care, mega-churches, political campaigning itself in addition to childbirth specifically: we try our best to treat these situations just the same way we would when deciding what new TV to buy.  Unfortunately, not everything works like TV’s.  I’m not anti-markets in general, just pointing out that they don’t work for everything, even if they do work for many things.  But when we’re faced with a new decision, we go for the TV example for some reason.  Perhaps because it overwhelms our life, that sort of thinking.  This does real harm, but it is what we do.

Cause 2 – Fear of extreme circumstances.  When you’re building a house, you might do some things yourself, like paint small rooms or install faucets.  Maybe.  But for the most part, you would never do the foundation work yourself, or even the major structural elements.  You could read about how to do them in a book, but you’d sort of, in the back of your mind, wonder whether maybe you’d get it wrong, and if you did, you think, there’d be huge consequences, and so, well, you’ll just hire an expert.  And if things don’t work out, you could still sue.  But they’ll probably work out, and they’ll do so more often than if you did it yourself.

The trouble with this analogy is that the numbers are off.  The way we think about health care is something like this: 90% of the time, things go fine.  10% of the time they don’t.  When they don’t, 99% of the time, the doctors will know what’s wrong, and so using a doctor give you 99.99% chance of things working out.  Not using a doctor gives you only a 90% chance.  And that 9.99% difference means a whole lot, and so, well, you go with the doctor.

It’s more like this: 95% of the time things work out.  5% of the time they don’t.  about 50% of that 5%, the doctors can tell you exactly what’s wrong and then prescribe and implement a  clear solution that avoids all complications.  The other 50% of that 5%, the doctors CAN’T tell you exactly what’s wrong, and then spend gobs and gobs of your money (whether you’re insured or not, it still costs you) failing to find out what’s wrong.  And during some of that 5%, they end up carrying out interventions that themselves lead to complications.

We focus on the “oh my god what if there’s no doctor there and then everything goes wrong” but we FORGET about the “oh my god the doctor cut my body open and I bled for hours and had to be brought to the emergency room where they barely saved me!”

Whether my percentages are right, my argument doesn’t really depend on them.  In the case of childbirth, what I think I AM right about is that we overestimate the amount of time something will go wrong in a doctor’s absence, and we underestimate the amount of time something will go wrong BECAUSE a doctor is involved.  Or we think, like with the house, that we can just sue the doctors if it does go wrong.  But it’s not that easy.  Cascading interventions – where one procedure leads to the assessment of other risks, and then another procedure, more risk-assessment, and on and on – is a very real risk women face.

But the Great Expectations tour lulls you into consumerist complacency.

Cause 3 – anecdotal evidence.  Everyone knows someone that has some complications during birth.  Since medicated birth is so much more common in the US, most anecdotes most of us have heard tend to re-affirm the sorts of self-fulfilling prophecy that seems to both justify and then later necessitate medical intervention.

Mix Causes 1-3 together and you get a disaster.  You get a bunch of intentionally clueless people embarking on a serious undertaking with minimal preparation, spending mind-numbing sums of money, and achieving middling (or worse) results.  And insisting that this is the best things could have been.

In short, large swathes of the American population are making totally irrational, severely under- or mis-informed decisions about the prenatal and birth process.  We tried our best not to fall into this pattern.  As it turns out, of course, no matter what we did we were completely unprepared for the reality.  But the old sports-coaching cliche – that you have to run a play 9 times in practice before it will work 1 time during a game – was pretty relevant here too.  We had 12 weeks of classes, and that meant that for one intense 27-hour period, we almost knew what we were doing.

 

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