Like Di Giacomo, Spence believes the rising cesarean rate is driven by perceived liability rather than real health benefits and risks. "A lot of info we're using now is more protective to the physician," he points out. "Everybody is so worried about being sued, we're not paying attention to the experience." For Spence, what the expectant mother and her family want carries as much weight as any controversy over obstetric practice. "Forget what ACOG says; forget what the midwives say. Anybody can manipulate the data to say whatever they want," he suggests. "At the end of the day, I'm going home and you're the one with the baby. Even if you take two million dollars out of me. How you want it is how it should be. What can we do to make you comfortable? Comfortable and safe."
Wasserman says she felt comfortable and safe in Fitch's hands. "It was so peaceful and calm at home," she remembers. Yet after eleven hours of labor her lingering fears prompted her to go to the hospital as planned: "I still had in the back of my head: You have a scar. Something could go wrong. You have to go to the hospital."
Jonathan Postal
Jonathan Postal
Cher Durham gives birth to daughter Haile at her
home in Kendall this past February
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Although his practice delivers 25 to 30 babies a month, Spence remembers Wasserman well. "Since her [previous] doctor said, I'm going to cut you, that took away a lot of her confidence," Spence surmises. He remembers the fear he read in her face: Was my doctor right? Is this person going to treat me the same way? Is he going to see a blip on the monitor and cut me?
Wasserman was so panicked about potential intervention that she locked herself in the hospital room's tiny bathroom rather than allow herself to be hooked to the fetal monitor. The exasperated nurses noted Wasserman's lack of cooperation on a chart, then left to attend to other patients. Fitch waited patiently outside. She did not call the nurses or the doctor back into the room until the baby's head had crowned.
By that point, Wasserman had placed herself on her hands and knees on the floor, a stance Fitch recognized as the Gaskin position helpful in dislodging babies whose shoulders get stuck in the birth canal. Not schooled in midwifery, Spence told Wasserman that as a VBAC, according to hospital protocol, she would have to get on the bed where she could be better monitored. "They're the deep pockets," the doctor deferred to hospital administrators. Shortly afterward Wasserman pushed out the head and -- despite a short delay because, sure enough, the shoulders were stuck -- she pushed out her daughter's body. At eight pounds, four ounces, Talia was her biggest baby yet.
Cher Durham reclines naked on her bed. Her enormous breasts rise and fall as her stomach heaves with every push. Her husband Johnnie sits beside her, holding her hand and caressing her leg. He murmurs encouragement in her ear: "Good! Oh, beautiful!"
"As the head comes closer, you're going to feel burning," Fitch warns. "It's your tissue stretching."
"Oh, God," Durham moans.
With a slender gloved hand, Fitch massages olive oil into Durham's straining vagina. A few drops fall onto the midnight blue shower curtain covered with constellations that protects the mattress. The crown of the head appears, framed by Durham's legs.
Durham whimpers. A tiny head covered with slick black hair bursts out. Durham's vagina is like a red flower ringing the baby's neck.
"Oh, God, I can't believe it," she moans.
"When you get the next contraction," Fitch promises, "you're going to push out the baby."
"Whooooooooaaaaaa," Durham wails in a rising tone.
The body does not come out with the next push. For a moment the baby is stuck, snagging her mother's insides with her left hand. Durham feels the strange sensation of the little body wiggling inside her.
"Push, sweetie, push," the midwife coaxes.
Durham responds with a guttural moan.
"Push. One more. Push."
All at once the body slides out. The baby stuffs her left hand in her mouth. It is 3:07 p.m. Fitch puts the infant on her mother's chest, and swaddles the girl in a purple towel. A white translucent cord connects mother and child.
"Hi, baby," Durham murmurs through tears. She stares into her daughter's dark eyes, strokes her hair. The baby girl reaches for her mother's face with her left hand.
Suddenly Durham looks up and announces: "I'm so proud of myself."
She is not moaning anymore; the pain and discomfort washed away in a flood of adrenaline and endorphins. "I can't believe I did it naturally," Durham says, resuming a conversational tone. The new mother is already imagining how she will pass on this story to her daughter. "I can't wait to tell her when she grows up that she was born at home. I feel like I can do anything now."
