Cuts You Up

As the number of cesarean section deliveries in South Florida soars, some women use midwives to learn to trust their bodies and give birth naturally

A ceramic ape bares his teeth from his perch on a bookshelf in the Kendall townhouse where Cher Durham is preparing to deliver her first child. A quizzical little monkey in a framed print stares at midwife Corina Fitch from the dining room wall as she settles herself under a blanket at one end of a couch in the Durhams' living room. Having delivered more than 150 babies and witnessed 300 more births, the midwife knows from the serene expression on her client's face that delivery is a far way off. Still Fitch, a registered nurse as well as a licensed midwife, measures the expecting mother's progress: The usually thick tissue of the cervix is now paper-thin and is beginning to part ever so slightly for the baby -- a process that could take a first-time mother ten hours or more. The Durhams are in for a long wait.

Johnnie Durham has been up half the night already. The head primate keeper at Monkey Jungle met his wife at the attraction while she was studying primate biology at Florida International University. Soon the pair were dating and Cher was working at the park too, preparing the animals' diet. They married at Monkey Jungle in May 2003. Nine months later, at 5:30 in the morning of February 18, the father-to-be distracts himself by bouncing on an enormous plastic ball that the couple learned in childbirth class could help relieve back pain during labor. Johnnie flashes his wife a chimp's grin when she walks past, his extra-long sideburns almost touching the strained outer corners of his lips. Cher is too uncomfortable to be amused.

The enormous stomach and breasts protruding from her petite frame make 32-year-old Durham almost as round as her exercise ball. Her tawny hair is pulled back into a severe bun, revealing a freckled Irish face and light-blue eyes set in a determined squint. She pads into the kitchen, peels a pair of athletic socks filled with rice off her shoulders, and places the fuzzy tubes in the microwave. When Durham lies down again in the couple's bedroom -- the air thick with incense, candlelight, and birdsong twittering from a battered boom box -- her husband gently presses the warm rice socks against the lower curve of her aching belly. All night long Durham watched the couple's pet sugar gliders chase each other around the wooden cages stacked outside the patio door while her mind replayed the objections to home birth raised by her friends and family: What if something goes wrong? Now as the tiny marsupials nestle down to sleep for the day, she tells herself: If I can do this, I can do anything.

Jonathan Postal
Cher Durham gives birth to daughter Haile at her 
home in Kendall this past February
Jonathan Postal
Cher Durham gives birth to daughter Haile at her home in Kendall this past February


Durham had not expected to wait until so late in her pregnancy before going into labor. She had been sure the baby would come on her due date, February 7, the night of the full moon. Had she followed the example of her sister-in-law and gone to Baptist Hospital to give birth, as she originally planned, she almost certainly would have delivered by Valentine's Day; her doctor, following the guidelines of the American College of Obstetricians and Gynecologists (ACOG), most likely would have induced labor by her 41st week of pregnancy. Instead at 1:00 p.m. on February 14, a still-pregnant Durham hauls her bulging belly to a rally outside South Miami Hospital, where her midwife has organized one of the twenty anti-ACOG demonstrations taking place that day across the nation. Representing more than 40,000 doctors in the United States, ACOG sets guidelines for obstetric practice. Because ACOG is the primary professional organization of ob/gyns in the country, those guidelines help establish the standard of care by which doctors are judged in malpractice suits. The protesters believe that ACOG promotes a level of medical intervention in birth that is at best unnecessary and at worst deadly.

Durham joins a group of 30 or so natural childbirth advocates handing out flyers that decry the nation's rising cesarean section rate. In 1990 the U.S. Department of Health and Human Services set a target c-section rate for the country by the year 2000 at fifteen percent, the same number recommended by the World Health Organization. But the National Bureau of Health Statistics reveals that in 2002, the most recent official count, the national cesarean rate hit an all-time high of 26.1 percent. The statewide rate in Florida is currently 32.4 percent, and in South Florida the rate at most hospitals is higher still. At 50 percent in 2002, South Miami Hospital had the highest rate in the area, but the latest figures from the Florida State Center for Health Statistics show that at Baptist Hospital, Durham's initial choice, the c-section rate is 41 percent.

Activists link the rising rate to a series of ACOG positions that they believe promote cesarean section over vaginal birth. Critics are especially concerned about 1999 ACOG guidelines that warn that the scars left from the surgical incision during a c-section place mothers at a slightly higher risk of rupturing the uterus when delivering subsequent babies vaginally. Although the risk is statistically low, the organization recommends that hospitals have an emergency surgical staff on hand throughout labor whenever a woman is attempting a VBAC (vaginal birth after cesarean), a requirement too costly for most hospitals to meet. Eager to follow ACOG recommendations, a growing number of doctors and hospitals refuse to do VBACs at all. Critics fear that the rate of cesareans will soar even higher since ACOG released a document in October 2003 that they believe promotes "elective cesareans" -- surgery not prompted by any medical necessity, but by a woman's "choice." Concerned that expectant mothers tend to "choose" whatever their obstetricians recommend, the women stalking the sidewalk outside South Miami Hospital on this windy Valentine's Day hold purple balloons emblazoned with the words: Cesarean is dangerous, risky, and major surgery. Durham dons a sign that says: Women of Earth/Take Back Birth.

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