Metro Pulse/Cover/The Family Issue

Comment
on this story

My Life as Mom
Parenthood ain't for sissies

Not Death or Taxes

Butting In
The importance of being an uncle

Families Suck
God wasn't kidding around when he slapped Eve with familial duty for biting the bad apple

The options for giving birth in Knoxville are numerous

by Adrienne Martini

A note: the opinions contained within are my own. I am not a birth expert, just a big ol' pregnant lady who was been wading through the local birth scene for the past couple of months. Birth is a touchy subject, one in which every woman should feel empowered enough to make her own decisions when the time comes—and my best advice is that you should read every last thing you can get your hands on, long before the big day arrives.

If you lined up all of the dixie cups into which I have peed in the last nine months, you could make a lovely (if damp) white, waxed-paper path that leads from St. Mary's Professional Building to the Sunsphere. You would, of course, have to be inclined to do such a thing in the first place—but I reckon it could be done.

Of all the many, many, many things that have been a surprise about the whole having-a-baby

experience, the concern about my bladder and its contents has been one of the more startling ones. While all this urine has a bonafide medical purpose, the sheer number of specimens required is a bit unnerving. On the plus side, I've gotten really good at peeing in dixie cups.

Most of the other unexpected stuff has been less, well, icky (and the parts that have been moreso I shall spare you). One of the larger surprises has been that morning sickness is almost exactly like being green to the gills seasick, yet actually throwing up isn't the slightest relief. Smaller surprises: people you pass on the street can't help but stare as you waddle past them, and you really are always 10 degrees warmer than anyone else in the room. And somewhere in the middle, surprise-wise, is the shock of just how difficult it is to sleep once your belly is the size of a beach ball, one that has a tendency to start up a kick-line once you finally settle in to the only quasi-comfy position you have left.

But perhaps the biggest, psyche-rattling surprise of them all is when you first find out that the hypothetical rabbit has died. While this baby was very much one that was planned—spurred a bit by 9-11 and the realization that life is very short, plus the hubby and I noticing that we were about as stable financially, emotionally, and physically as we were probably ever going to be—those first few seconds were stunning. First thought: Wow. Which was closely followed by: Shit. Now I have to go through with this.

No matter how OK (thrilled, even) you may feel about the prospect of having a baby, the actuality of it is a much different animal. But one thing that you can't help but get stuck on is that you are about to spend the next nine (closer to 10, really) months growing another human being who is then going to want out. And that, no matter how brave a face you wear, it will hurt more than anything you can imagine.

For this, if you're lucky, you may get a card on Mother's Day.

While you can't get around that basic fact of biology, there are options for dealing with it, most of which are determined by the physical place where the birth occurs. Moms who labor at home have fewer pain-relief choices than those who do so in state-of-the-art hospitals. But there is a wide range of options to choose from—which can be overwhelming when you're still trying to adapt to the thought of being someone's mom—even right here in East Tennessee, a region not known for quickly jumping on to every health care trend that blows in from the coasts.

One of the fringe trends is unassisted births, which are pretty much what they sound like. No doctor, no midwife—just a woman catching her own baby, literally, as the event occurs. Given the stigma and danger-factor (a reputation that is well-earned, again in my opinion, and one that can be evidenced by the infant/mother mortality rates of previous eras) attached to this sort of birth, most women aren't inclined to shout about it from the rooftops; therefore, it's hard to say whether this sort of birth has caught on in Knoxville. But I would be surprised if it didn't happen here.

What happens more frequently here are home births, which are attended by a midwife and, most times, a doula. Even though it sounds like some exotic dessert or medieval medical procedure, a doula is actually a woman who attends to "mother the mother." This mothering can range from helping with breathing exercises to back massage to simple moral support to coaching through the pushing stage. Support begins prenatally, with information about the birth process as well as pregnancy itself, and continues through labor and post-partum. Some doulas are also lactation consultants who can help with those tricky first weeks of breastfeeding. Originally solely an Eastern European tradition, doulas have crossed the pond and made it to Knoxville. Your best source for more information about doulas is www.dona.org, the national certification body for doulas.

While birthing at home has decided advantages—not having to hazard hospital food, for one—it can be unnerving to ponder not having a tiny bit more medical support available, which is a concern that birthing centers, like the Lisa Ross Birth and Women's Center (www.lisarosscenter.org), can help to assuage.

Founded in the early '90s, this center bridges the gap between home and hospital births. They have all of all of the necessary medical equipment and medications on hand in case something unexpected should occur. (And should the really unexpected occur, the center works in concert with Ft. Sanders Hospital and has an ambulance bay at the back of the building.) However, the rooms are homey, containing standard beds, spacious bathrooms, and private porches. The center also smells vaguely of patchouli. A small pool is also available for water births and the mother can be attended by whomever she chooses. Babies are delivered by a midwife (three are on staff), and two doctors act as advisors to the center as a whole.

"The philosophy is the thing that is very different [here] than the hospital and the power dynamic in the hospital—the physician really is the decision-maker," says Linda Cole, executive director as well as director of midwifery. "I think that most physicians are pretty good at including their patients in decision-making these days. But I think we're even more sensitive to that here.

"We spend a lot of time educating our patients during the prenatal period about all of their options so that they have the expectation that during their labor they're also going to be very much kept informed and presented with choices and know that they have the ultimate responsibility of making those choices. Now, of course, if something's happening and we feel strongly that we need to go to the hospital, we're going to go to the hospital. But they do have a lot more [input on] decision-making."

Along with this priority on educating mothers-to-be, the center also tries to keep medical procedures at a minimum, and that philosophy has paid off. For example, nationally, the rates for episiotomies runs about 50 percent, and 25 percent of deliveries are by cesarean section, in standard hospital births. But at the center, Cole says, "Last year, out of 109 deliveries there were only three episiotomies that were cut, and those were all cut in the hospital. In the past four years, we've had a 3 percent cesarean section rate for women who were admitted in labor here. We're really proud of that. We're also proud of our 95 percent breastfeeding rate; we really support breastfeeding and our nurses are wonderful about helping with breastfeeding early on."

Despite the pluses to using a birth center like Lisa Ross, there is no getting around the fact that hospitals are still the most popular choice for imminent moms. Compared to Lisa Ross' 100-plus births last year, the Clayton Birthing Center at Baptist Hospital delivers, on average, 40 babies per month and closer to 55 per month during the summer. And hospital-based birth centers like the one at Baptist (www.baptistoneword.org), St. Mary's (www.stmaryshealth.com) or Fort Sanders Park West (www.fsparkwest.com/fspw-womens.cfm) have become more user friendly in recent years, moving from M.A.S.H.-like triage units and wards to an almost hotel-like atmosphere.

Sometime in the last couple of decades, hospital administrators realized that babies can be big business and that more services geared toward pregnant women can only increase the bottom line. Rather than move moms from location to location depending on their stage of birth, most hospitals are switching to private L/D/R/P (Labor/Delivery/Recovery/Post-Partum) rooms, keeping the family in one place for their whole stay.

These spacious—for a hospital—rooms contain almost anything a person could desire: a fold-out bed for the birthing partner, warmer for the baby so that he/she can stay with the parents, TV, VCR, rocking chairs, commodious bathrooms—heck, some even offer Internet access, although I suspect surfing for porn would be verboten. The beds themselves are wonders of modern engineering, able to transform into almost any position one could desire. While you'd never really mistake one of these rooms for your own home, they are quite lovely and a huge step up from the maternity wards of years past.

One of the biggest advantages to hospital births is that, well, they're in a hospital. Should something go wrong, getting advanced medical help doesn't require calling an ambulance. Also, hospitals have a greater range of pain-killers, including the blessed epidural, just in case rhythmic breathing and/or relaxation techniques aren't quite doing the job. Larger hospitals usually have a fleet of anesthesiologists on call.

Terri Chaires, nurse manager at the Clayton Birthing Center at Baptist Hospital, sees other advantages as well.

"The same nurse that's taking care of you is taking care of your baby, which makes for good continuity of care. Visiting hours are open and we try to make it as home-like as possible. Plus, the mother gets to choose who she wants to have share the experience with her."

Ultimately, it's all about the labor process ending with a healthy baby and healthy mom. But pregnant women do have a wide range of choices for how they reach that goal, and a little bit of education can help you sort out where you'd like to have this experience.

"I think it's an individual preference more than anything," says Chaires. "I think we should consider ourselves lucky that we live in a country where we can provide different kinds of care."