Nonfiction | March 01, 1990

For most American women, the question of where to have their first child is easily answered. Either they would never dream of having it in a hospital or they would never dream of not. For these women, there is no decision to make, no research, no late-night reversals. Intuitively they have determined the relationship between birth and technology. Most accept pregnancy as a medical “event,” belonging to the realm of doctors, pharmacology, and electronic equipment. A few reject that model as undesirable and unsafe. Right or wrong, pro-homebirth or pro-hospital, these women feel secure. They have made their judgment.

I envied this security–this intuition–when I became pregnant with my own first child. Traditionally, cultures surround the uncertainty of birth with protective ritual. From the funny sayings on maternity clothes to deciding who to allow in the delivery room, we erect a bulwark of standardized, morally required routine. Yet for various reasons, at the age of thirty, in the year 1984, 1 did not possess that sense of what was “routine” or morally required. Like other questions related to society and self, the concept of birth seemed to require painful and ludicrous analysis–ludicrous because, for this particular mystery, analysis is like using a hammer to peel a banana.

In this case, the hammer was statistics. A game of roulette was wheeling in my stomach and I wanted to know the odds, the specific odds of what could go wrong in the day-to-day growth of an embryo into a human being. I wanted to know what could go wrong in utero. I wanted to know what could go wrong in labor. I wanted to know what the doctor could do wrong. I wanted to know what the midwife could do wrong. I wanted to know what I could do wrong.

This was a new dimension in negativity. Did I dare to eat a peach? Nosedrops could contract the blood vessels in the placenta; too much Vitamin A might cause cleft palate. Three out of one hundred babies will have a major congenital defect. Five in a thousand will have abnormalities of the heart. Another two in a thousand will be missing an arm or leg. The fist goes on. In twenty-five percent of births the cord is wrapped casually about the baby’s neck. In a much smaller percentage, it tightens like a hangman’s noose.
Confronted with the range of potential disaster, it seems any mother would demand having her child near, if not in, an intensive care unit. Surprisingly, statistics do not necessarily confirm that the hospital is safer. Ninety-nine percent of babies in the United States are delivered in a hospital. Yet countries like the Netherlands, where forty percent of women give birth at home and midwives actually outnumber physicians, consistently have a lower infant mortality rate. Other studies within the United States–in Marin County and urban Chicago–show homebirth to be as safe, if not safer, than a hospital birth.

The obvious question is why, and I spent a fair amount of time during my first pregnancy examining that question in unrelenting detail. One answer has to do with the screening out of high-risk patients. In most areas only the very healthy are permitted the luxury, or the risk, depending on one’s viewpoint, of a non-hospital birth. Another, more complicated reason, involves modern obstetrics and the indiscriminate breaking of the mother’s membranes, the use of synthetic hormones to stimulate contractions, the use of pain-relieving drugs and fetal monitors, and the sometimes overly hasty resorting to forceps or to Caesarean.

When it comes to tracing the history of my decision to have a homebirth, however, most of this information–the length of time that Demerol is stored in an infant’s brain, or the high blood pressure caused by a spinal block–is supplemental. It is important, but it is not the heart of the matter. In truth, I would not have had a homebirth if most of my friends had not. More bluntly, I did it because they did. Peer pressure may not seem a good reason for this or for any decision of importance. In reality, it is exactly why we do so many important things. Normalcy is defined by what people are normally doing around you, and my friends who birthed at home include a computer consultant, a museum director, an architect, and a number of university and public school teachers. In the rural area where I live, there is also a cultural tradition of homebirth among the Hispanics who make up more than half the county’s population. Here, the question, “Who is your midwife?” is considered fairly normal. In this we are eccentric, a pocket of the Netherlands in southwestern New Mexico.

My decision was also influenced by my husband. Together, we had sweated and strained to build our one-room adobe house, twenty-eight miles from town. We had made each brick, hammered each nail, and rolled up the vigas onto the roof by the brute strength of our arms. Although the choice was mine to make, it was clear that a birth in this, our home, followed truly and cleanly from the vision that had brought my husband here. It appealed to his imagination, and in our lives imagination was a potent force.
Finally, not least, there was my midwife. A beautiful woman, at the age of twenty-eight she projected the authority of someone much older. Those who do not find beauty powerful are possibly around it too much, or have never seen it at all. I don’t know what this gift did to or for my midwife, who, out of all the possibilities in her life, chose to deliver babies as a profession. I know only that she appeared tremendously competent, forthright, and self-assured. In her presence I sensed it would be too gauche, too life-denying, to feel anything but trust in whatever she believed in.

My midwife’s assumption that I was also forthright, competent, and self-assured more or less corresponded with my own self-image. At the same time, I had doubts that I never revealed to her in our biweekly, and then weekly sessions. There were moments when I hoped for some physical problem that would rule out homebirth at the last minute. In New Mexico, under a licensed midwife, the list of these is long: a baby in breech position, bleeding before labor, a baby too large for the pelvic area, diabetes, a history of more than six pregnancies, too much amniotic fluid, high blood pressure, malnutrition, twins, a premature baby, a late baby, and maternal anemia. I had had little experience with hospitals, and throughout my pregnancy, my picture of them grew increasingly benign. Suddenly, hospital beds sounded so cool and inviting. Hospital white was such a clean color. Secretly I yearned to lay down the burden of having a child and to lay it precisely in the hands of someone who was paternal and overbearing. Let an obstetrician take credit for the birth if he wanted, as long as he also took the blame. Let him lead me blindfolded through this valley of uncertainty. Let the drugs contract my uterus and the forceps extract the child. If the unspeakable happened, if horror struck and the baby died or was damaged, I believed–I rationalized in some corner of my mind–that I would be safer in the hospital. I did not mean that I or the baby would be physically safer. I meant safer emotionally. I would not have to feel as much. A passive figure, wheeled on a metal table, strapped in, drugged, catheterized, fed through an IV, hooked up to a machine: I would not be myself. I would not be responsible.
Of course I mistrusted these feelings, and with inverse psychology they also led me home. The more I yearned for outside authority, the more I suspected how wrong it would be to relinquish my own. My sudden fondness for a tidy white bed seemed clearly juvenile. Something messy, bloody, strenuous, and intensely personal lay ahead. It must be important if I was so afraid of it. It must be, I reasoned, too important to give away.

Desired, even “orchestrated,” my first pregnancy was nonetheless linked with inauspicious omens. As I drove home with the good news, a truck turning suddenly left my fender accordioned into the passenger’s seat. Three days later, while having stitches removed from my lower lip, I complained of cramps and the doctor gave me a shot of progesterone to “prevent miscarriage.” In my vulnerable state, I roused myself to protest. I had never heard of progesterone, but I didn’t think I needed a shot of it. “Don’t take it,” the doctor said classically, “if you don’t care about your baby.” I took it. Immediately afterwards, I called a friend whose midwifery textbook, more up to date than the doctor’s, stated that progesterone was a cause of birth defects. I rushed to confirm this with a local obstetrician who spoke of “heart holes” and “limb reductions” and who noted, in a kindly way, that his office did abortions. My third consultation was with a genetics counselor in Albuquerque. He dismissed the whole affair. In his opinion, the increased chances of a birth defect were negligible: if my husband and I were not willing to risk this pregnancy, we were not willing to risk pregnancy at all.

At this point, some four weeks after conception, I settled into being an expectant mother. My initiation was fairly typical. Most women I know have either had a true scare in their pregnancy or have concocted one. The experience of growing a baby is bordered by joy, fraught with a sense of danger, and beset by internal politics. Nine months is barely enough time for us to drain emotions to the last bittersweet dregs. By the end, discomfort compels us. Like adventurers cast on some Pacific isle, we are ready to sail back to civilization.

Thirty-year-old women often have a long first labor, and I was no exception. The amniotic sac ruptured at four o’clock Tuesday morning and, as I jumped from the bed to let the water gush from my body, I felt very young, like a child on Christmas Day. For two full weeks, I had kept prepared the list of things my midwife required of me. These included disposable surgical gloves, a bottle of Betadine, a suction for the baby’s nose, a thermometer, a large pan, sanitary napkins, three towels, three sheets, and a dozen clean rags. The last three items had to be sterilized, a feat accomplished by placing them in a brown paper bag in a 350 degree oven for two hours. The “sterilization” lasted only two weeks and I had conscientiously re-sterilized everything only a few days ago. Smugly I returned to bed and a fitful sleep.

In the morning I called my midwife and by afternoon she had arrived with her assistant, also a licensed midwife, in a big red van. My contractions did not begin seriously until the summer evening began to darken our south-facing wall of windows that looked out to the Mimbres Valley and the jag of Cooke’s Peak. By nine o’clock I was having pains that lasted not quite a minute and were two to three minutes apart. My husband set out dinner–not for me, since I threw up even the water he offered–and a good friend came over to help with the birth. More snacks were put out, music was played, happy talk eddied about the fifteen-by-twenty foot room. I began to pace up and down from the bed to the table to the rocking chair that symbolized our future. My route followed no particular pattern but traced the cement grouting of a floor recently covered with yellow and orange Mexican tile. As each contraction heightened, my steps slowed, and I counted the tiles, and my steps.

By midnight people began to speak of taking shifts. My midwife was herself seven months pregnant and had already fallen asleep in the big red van. Her assistant lay on a cot outside, under the dramatic sweep of the Milky Way. For three hours, my friend stayed up with me and then woke my husband who, for the rest of the night, read aloud The Yearling by Marjorie Kinnan Rawlings. I listened to his voice, not the words, and continued to pace the floor, slowly, slavishly, like some ancient Chinese woman with bound feet.

Tedium is a word I would later use to describe the labor. The contractions went on, and on, over 400 of them, a kneading and cramping that was meant to stretch and pull open the circular muscles around the cervix. This dilation, measured in centimeters, is complete at the magical number of ten: at that point, the baby is ready to be squeezed and pushed down the birth canal. Periodically throughout the night, the midwife and her assistant would wake to check the baby’s heartbeat with a stethoscope on my belly. They also checked inside me for an update on the cervix and, for most of that interminable Wednesday, the update proved disappointing. At 1 a.m., I was three centimeters. At 6:45 a.m., I was four.
At that time, our small adobe had no hot water, and as a way of “making it happen” we all trooped over to a neighbor’s house in the morning so that I could take a shower and enema. Now, in the few minutes between contractions, I dozed in the hallucinatory way that causes the head to snap upright just as the soul touches the coastline of sleep. There in the shower, I saw the porcelain tile come alarmingly close. I snapped awake and did not fall. A few hours later, back home again, I had dilated to five.

It was a bold bright afternoon and the southern glass wall of which we were so proud framed the lengthening shadows of yuccas on grama grass. My waters had broken almost a day and a half before; I had been in moderate to hard labor for over fifteen hours. I asked my midwife why it was taking so long. She may have replied that a mother can lengthen labor out of fear or rejection of the child. More probably she did not say this at all. More probably it was only an idea rattling about in my head and, I suspected, in the heads of those around me. It was an idea that made me angry. I wasn’t afraid! I wanted the baby! I asked my midwife if there was something I could do.

“Get mad,” she suggested. “Tell your body that you’re ready.”

That fit my mood well and so I began to mutter, “I’m mad! I’m ready!” as I wandered in my slow and crazy way about the room.

Next I asked the midwife if crying ever helped.

“Oh yes,” she assured me, brightening a little. We were both lovers of strategy. Who knew what chemicals a good cry might stimulate?

Strategically then, my husband and I went off for a car ride on the bumpy road that leads from our house to the black-topped highway. When we reached its flat expanse, we went on driving and in the car, between contractions, as the scenery unrolled, I cried.

In hindsight, the comic moment occurred when my husband stopped at a trailhead into the Gila National Forest. The path follows the sparkling Sapillo Creek, and my husband thought that a short hike along this creek, in the beauty of the woods, would be a good idea. By now my contractions had sharpened considerably, and suddenly it was these, not the tedium, that made me feel like crying. Protesting, I stumbled from the car and leaned heavily on his arm. As we hobbled a few steps down the path, a backpacker emerged from what must have been a first trip, or a long one. Spying us, he lengthened his stride and broke into a grin. We were the first human beings he had seen for days. Eagerly he began the “hail-well-met” exchange of lonely hikers. He received no answering greeting. Instead, a huge woman moaned in his face, turned her husband around, and labored back to the car before ever reaching the scenic Sapillo. The backpacker’s face remains with me today: young, acne-marked, shocked at my rebuff.
At the house, the midwife’s assistant lay tanning on her cot as she finished the last pages of a murder mystery. The midwife sat inside, doing nothing, in a straight-backed chair. She had circles under her eyes, and her own pregnant stomach bloomed uncomfortably beneath her folded hands.

“You know,” she said, as I began once more to whine and pace the floor, “the pains are only going to get worse.”

I stared at her, devastated. They were? At that moment they felt pretty bad. Was this a hint? A move to the hospital? The latter had not occurred to me, for all my doubts about homebirth had vanished at the onset of a labor that was long but never fearful. Now I felt admonished and betrayed.

“I’m really mad now,” I muttered to my body, to my uterus, to the baby itself. “I’m really ready!”

Two hours later we checked my dilation. “Oh, you’re going to love this,” the midwife said. The room’s ceiling of pine vigas glowed with the golden light of freshly-cut wood. In fact, the ceiling always glowed like this but I rarely noticed it. “You’re at nine centimeters. You’re almost there!” She laughed, I laughed, and suddenly everyone but me began to move with a bustle and wonderful sense of purpose. Water started boiling. I heard the joyful clink of instruments. I got up from the bed, but now, for the first time, I wanted only to lie down. From the windows I could see the blue of Cooke’s Peak turning to lavender. Another evening, another night, was at hand.

It took an hour more of waiting and three of pushing before the baby was born. In that time, I learned a lot. As a child I had never been an athlete, had never understood about concentration or team effort. Once in the sixth grade I did make the “B” team, where my idea of playing baseball was to daydream in the outfield until the ball came to me, by which time it was almost always too late to catch it. Later, for exercise, I became a runner and let my mind and body go their separate ways. Now, here, lying naked in a quilted bed, was what I imagine the best kind of athleticism to be about–about pushing yourself to the limit, about believing in yourself, about trying again, moving through the pain, listening to your coach, and trying again.
You can do it! The baby was posterior, lying against my back, and that made it harder. You can do it! I had no urge to push, I didn’t know how, and that made it harder.

You can do it!

My squad of cheerleaders–midwife, assistant, husband, friend–rallied me again and again with that cry. You can do it, they said, and when they forgot to cheer me on, I reminded them, for I depended on their enthusiasm. I followed their instructions. I used their energy. This was a group effort, and for the first time in my life I was at the center of that effort. I was the focal point, concentrating, intent, working, scared sometimes. Can I do it? I asked them. You can, they said. And I did. It felt great. (My husband has his own story to tell. The pine vigas glowed. Darkness lapped at the window. He had never felt so connected to his life.)

As seven pounds of newborn spilled into the world, I heard the assistant say, “It’s a blondie!” and then, in a moment, “Oh, what a temper.” Gently, they put the amazingly solid baby on my stomach. My husband and I drew close together and stared: our daughter looked floppy, distracted, radiantly pink. It was one minute past midnight, slightly chilly, and someone bundled her up in a blanket. My husband cut the cord and we squabbled briefly over who would hold her. I won.

“Maria!” I breathed into her ear.

She turned to me, dazed and uncomprehending. Then she held still and took my breast.

As the placenta slithered out, the midwife kneaded my stomach. When I continued to bleed, she gave me a shot of pitocin, used to control hemorrhage. By then the baby had already been given its one- and five-minute rating on the Apgar scale. The ratings take into account heartbeat, respiratory effort, muscle tone, reflex, irritability, and color. Maria scored high. As in a hospital, silver nitrate would later be applied to her eyes to prevent infection and she would be given a shot of Vitamin K. Meanwhile the midwife was sewing up a small tear in my perineurn and my good friend, as she is wont to do, went quietly about the business of washing dishes and cleaning house. My husband sat and rocked his child. Outside the darkness had the eerie expectant sheen of early morning. The birds were still asleep. The birth was over. I felt tremendously energized.

The word midwife literally means “with woman” and this quality of “withness” is perhaps the midwife’s greatest virtue. Withness implies empathy, equality, and, in practical terms, a willingness to stay with a laboring mother for as long as it takes. In the age of Hippocrates, midwives were an honored class. Later, during the Dark Ages, this uniquely feminine profession became increasingly devalued, even suspect, in Western society. The idea that witches, acting as midwives, killed unbaptized babies and used them in Satanic rites seemed logical to the Church; as potential sources of birth control and abortion techniques, midwives were doubly damned–and occasionally burned.

In the sixteenth century, physicians began to look more scientifically at labor and delivery. By now, tradesmen called “barber-surgeons” were being brought in for cases of obstructed childbirth. These men came with a bag of instruments, perforators, and metal hooks used to muscularly drag a child from the womb whole or piecemeal. Although the later refinement of forceps was a major breakthrough, like other tools of science they were seen as distinctly masculine. At this point, the use of instruments in delivery can be seen as a rough dividing line, with women on one side and men on the other.

The rest of Western midwifery is marked by a struggle between the sexes to gain control of the birth process. A few attempts were made to train midwives in normal deliveries, but the pattern of excluding women from the “obstetrical revolution” remained. By 1850, a part of life historically dominated by women was being successfully usurped. At first, midwives fought back, accusing doctors of using instruments unnecessarily to avoid “the onerous chore of staying up throughout the night.” Playing hardball, they also brought in the specter of lust: what other motive could explain such “frequent examinations with the finger and the hand?” In response, physicians encouraged the idea that even a normal delivery was so dangerous as to override any embarrassment or suspicion on the part of the patient. Eventually the labeling of pregnancy as a life-threatening disease evolved into the philosophy of twentieth-century obstetrics.

Starting in the 1920s with the beatific-sounding Twilight Sleep morphine followed by the hallucinogenic scopolamine coupled with ether or chloroform–mothers could be completely removed from the birth of their children. In 1950, my own mother fondly remembers being given a shot, blankness, and then waiting in bed while the nurses took care of my sister. As a hospital birth became more of an assembly line production, however, it turned into an experience that was anything but beatific. After the bleak isolation of labor, some patients found themselves fully or semi-conscious on a flat white table with their arms restrained by leather straps and their legs held high in metal stirrups–a position which, short of being hanged upside down, is perhaps the worst one for delivery. In this setting the woman was seen from a technician’s point of view, as a birthing machine that required service. Usually the machine also required tinkering: oxytocin to start up a “slow” uterus, pain relievers to ease the artificial and unnaturally strong contractions, synthetic hormones again as the drugs impaired the mother’s ability to push. Too often, babies were born “blue” from drug-induced lack of oxygen. And in part due to these practices, the ultimate intervention, the Caesarean, has risen to account for over twenty percent of today’s births–as opposed to the Netherlands’ three percent rate. (Bang goes the hammer of statistics. In 1979, over eighty percent of American women were medicated during childbirth. At the same time, we had more infant deaths due to birth injuries and respiratory diseases than most industrialized nations. Today, some form of brain dysfunction affects one out of every eight American children.)

There was opposition. As we learned more about the dangers of drugs, both mothers and doctors came to see them as less desirable. Gradually, husbands and family members were allowed into the delivery room, while certain medical routines–induced labor, intravenous feeding, the shaving of pubic hair, enemas, and the episiotomy–became less routine. In remote areas, progress, as always, moved in fits and starts. In 1984, my medical choices in Silver City, New Mexico, were strictly conventional. When I went to the “best” obstetrician in town, he smirked at me and let loose the Freudian quip, “I’d love to have your baby for you, Sharman.” Well, he didn’t mean it as a quip. But he couldn’t have meant it literally. It seemed a statement, said without conscious thought, that revealed how he really perceived his role–that he had the baby.

By 1987, when I was pregnant with my second child, a progressive family-care doctor had just opened her office, my midwife’s assistant was delivering hospital babies as a certified RN midwife, and the hospital itself touted a “birthing room” with homey atmosphere and wooden cradle for the baby. Even the “best” obstetrician in town had adopted a different, if still paternal, stance. One friend reported with dismay that he would not let her have the painkiller she requested. “Wait it out,” he cajoled her cheerfully. “Just a few more minutes. You can do it. ”
In part because my options were greater, my decision to have a second homebirth was not automatic. In some ways I felt more conservative than before and, to my surprise, so did my midwife. After three more years of catching babies, she had a greater respect for her relationship to statistics. If only one percent of mothers hemorrhage dangerously after labor, the midwife who sees a hundred mothers will see the one who does. If only a fraction of cords are looped too tightly about the baby’s neck, still, in one year my midwife had three such cases. That she could handle these emergencies was not in question. But her natural optimism had tempered, and she no longer did births more than twenty minutes from the hospital. For my husband and me, she was willing to make an exception. But she also suggested we consider arranging to have the birth in town, at a friend’s house, say, or–as one couple did–at a nearby hotel.

This time my husband and I even visited the hospital’s new birthing room. There was nothing wrong with it, exactly. The pink pillows matched the pink coverlet, the baby’s cradle had been varnished to a shine, and a poster with trees covered one entire wall. Best of all, as the nurse showed us, was the mechanical bed that rose up and down and actually let the woman sit up during delivery.

In the tour we went on to examine the traditional labor room next door. Here was the flat white table with its heavy stirrups, surrounded by the decor of machinery and plastic. Of course, our guide said, there was no guarantee I would get the birthing room. I would get on a list, and it was first-come, first-served. There was no guarantee I would not wind up flat on my back on the white table, or that my child would not wind up in the rather questionable nursery with its reputation for minor infections and diaper rashes. There was no guarantee I would get the pink coverlet.

In the end, as I went home and thought about it, the coverlet didn’t even look that good. At long last, my intuition had started to kick in. Naturally I would come to the hospital if I needed to. In fact, I would even have the birth in town in order to be closer to its services. But as for the mechanical bed that rose up and down–as though I couldn’t rise up and down by myself–as for first-come, first-served and stirrups … no, I thought, not for me.
I was grateful for the hospital. My friend in Silver City, in whose bedroom I would have my second child, had once started a homebirth that ended in the hospital as soon as her blood pressure went up and stayed up. Without the subsequent Caesarean, my friend might have died. Without the hospital, her child might have died and she would not have gone on to have a second son. I was grateful for the existence of drugs, forceps, fetal monitors, surgeons, and anesthesiologists whenever they are needed. Such things did not represent a “failed birth” to me; they represented a miracle, the best of medical technology. They were aids to birth. But they were not replacements.

In retrospect, it seems my ambivalence concerning homebirth disappeared for the rest of that pregnancy. In truth, I don’t think it did until the beginning of labor. Then, as before, all my anxieties vanished. As before, there was no room for doubt. I was right where I needed to be, focusing on the task at hand.

In this birth, events moved so rapidly that my focus blurred a little. Labor started with strong contractions at 12:30 a.m. and ended with a ten-pound baby boy six hours later. In this birth, I didn’t even try to be stoic. This one hurt more. This time, too, my husband’s and midwife’s reassurances rang a bit perfunctory. We were all surprised at the speed of dilation. We were all a bit more businesslike. No golden vigas glowed over our heads, for we were in a modern child’s room made of sheetrock. This time, when the baby’s rather large head began to crown, I screamed in outrage. I hollered out my midwife’s name, not caring who heard me or what they might think. In fact, my friend, her husband, their two young sons, and my three-year-old daughter were an sitting in the middle of the room, watching me with considerable interest. Something in their position made me feel briefly like a television set. In a small, well-lit clearing of my mind, I realized that I had a choice. I could grit my teeth or scream unbecomingly. What does it matter? I remember thinking. Perhaps in this instance, screaming was the better strategy.

After all the fuss, our son emerged with a headful of brown hair and a mouth screwed only slightly in irritation. His Apgar scores were nearly perfect, his wrists and ankles rolled with fat. Flopped on my stomach, he stared up at me peacefully in the morning light. For a few minutes, the assistant took the baby and busied herself verifying his patently healthy condition. Peacefully I delivered the placenta and continued to bleed. My midwife gave me a dose of pitocin and then another. Because large babies are associated with diabetes, she also telephoned our pediatrician. In any case, the follow-up on my son’s health would include a visit from the midwife the next day, a visit to the pediatrician within two days, and a third visit to the midwife in a week. It would not include circumcision, for one thing I gained from choosing a homebirth is a trust in nature that does not come easily to me. The natural way is not always right, but it is often right. This time, without wading through agonies of statistics or research, it simply seemed logical that the sheath of the penis glans had evolved for a purpose and that there was no medical reason to cut it away. That the American Board of Pediatrics agrees with this viewpoint is nice, but not as necessary as it once might have been.
Outside the window, the sky trailed banners of celebratory pink. Relieved and euphoric, I submitted to the other medical procedures: my blood pressure taken, some light stitching up. I am Rh negative and a sample of the baby’s cord blood had to be sent to the hospital. This was done in the first birth as well. Later, because I had hemorrhaged, the midwife measured the iron in my blood with a small hand-held device, and my husband was impressed with this bit of gadgetry. Later still, a friend came by and took pictures. In all of these, my daughter holds her new brother. While the rest of us look obediently at the camera, she and he gaze intently, with complete concentration, into each other’s eyes.

My daughter is five now. Recently, in a seminar for teachers, the moderator asked us to remember a time when we had felt powerful. Instantly I saw Maria’s birth. I did not, of course, see a baby’s head crowning. Instead I saw my own thighs and knees spread unnaturally apart. I saw, at the periphery of vision, the blurred hands and faces of my husband and friends. I saw the colors of my grandmother’s quilt glowing intensely. It seemed that one of my naked legs was streaked with blood. It might seem that I had never been so vulnerable, so dependent in all my life. Yet I remember this as a moment of power. In my second homebirth, remember as well the unabashed decision to shriek. I remember still, feeling at the center. These are physical memories, lodged deep in my body now. Perhaps, as I pushed my children out this was the exchange. Perhaps this is the gift, unpredictable and arbitrary as grace, that I sought to claim.