Giving birth in America is probably a lot like giving birth in Britain from a physiological point of view. But since I haven’t done either yet, M and I conscientiously signed up for a 4-week birth preparation class at Evanston Hospital.
At the first class I was apprehensive. The week before (putting the cart before the horse somewhat) we had been to a session on caring for a newborn that got me into the kind of state I remembered from school Geography lessons with a teacher I held in complete contempt. As the idiotic nurse-teacher jokily and repeatedly told the parents-to-be of twins that they’d have their hands full I muttered ‘Sure they’ve never heard that before’. As we spent fifteen minutes learning to make a circumcision dressing I squirted half a tube of Vaseline onto the plastic baby’s penis, just to see if I could get told off. And as she advised us against having our babies sleep in the room with us in the hospital I wrote in my notebook ‘flies in the face of all current medical advice’.
Luckily the birth class instructor was much less annoying. For satirical blog-writing purposes I had sort of hoped the classes would be either a festival of hippiness – my friend A, who took classes with his wife in California, had to produce an artwork that expressed his feelings about birth – or that they would represent Evil Lies of the Medical Establishment that I could get as angry about as Naomi Wolf does in Misconceptions. Instead, I reliably got the giggles each week when we did relaxation and breathing techniques and I was encouraged to stare into M’s eyes while being told ‘the warmth is entering your boo-TOX’. Breathing techniques seem to be a staple of childbirth classes everywhere, but we certainly did make a big palaver of them.
Anyway, there are differences, and the biggest of all seems to be the epidural rate. 85% of women giving birth at Evanston Hospital have epidurals, which appears to contrast with 16% in NHS hospitals. The odd thing was that all substantive discussion of epidurals was delayed until the final class, so we spent three classes effectively pretending that everyone was going to give birth without pain relief. Our instructor was Lamaze-trained, and Lamaze’s principles are all about avoiding unnecessary interventions, moving around in labour, and not giving birth on your back. None of which is entirely compatible with an epidural. But she was employed by the hospital to tell you about hospital approved policies. And what this came down to was that she spent a lot of time saying: ‘Try not to get the epidural until you’re 4cm dilated.’ 4 – that’s the magic number – was my main take-home message.
As far as I can make out, there are three main reasons that British women don’t get epidurals in the same numbers as their American cousins. One: gas and air. While it’s the norm in Britain, it’s unheard of in America, so pain relief is all or nothing. Two: in NHS hospitals, anecdotally, it seems the anaesthetist often isn’t around at the moment someone wants an epidural, and the moment passes, and it’s too late, and before you know it you’re pushing. Three: there’s more of a concern in Britain that an epidural leads to further interventions, episiotomies and the like (when I asked at my class if epidurals were associated with a higher ate episiotomies, I was told no – but subsequent googling suggested otherwise). But the epidural norm here has a few spin-offs: they expect you to wear a hospital gown (or how will they get at your back), and be attached to a drip and foetal monitor constantly (because that’s what you’ll need when you have an epidural). I was a little freaked out to see how far these assumptions were built into the room design when we did the hospital tour.
You can definitely do things differently, but the resources are all on the epidural side. There are thirteen labour rooms at the hospital, one birthing tub (which I haven’t seen, so can’t say whether it’s different from what we would call a ‘birthing pool’ in Britain), and only two birthing balls, so we were advised to bring our own if we wanted to use one. I am hoping not to have to spend my entire labour arguing with medical professionals about my preference for wearing my own clothes and not having a drip put in until I need one.
Of course, I can rely on my birth coach to be my advocate. The American practice of calling your partner as a ‘coach’, when he is generally even more clueless than you are about the whole birth thing, is deeply irritating to me and more than a mere linguistic quirk. We kept being told at the class about things that coaches should do for their labouring coachee: sort out inept breathing, give her a reward after every contraction (the main reward envisaged appeared to be ‘an ice chip’, which has to be about the shittest carrot in the world, barring actual carrots, which I hate), and, according to our handbook, strategically ignore her demands for pain relief if they believe them not to represent her true beliefs. I found all of this massively patronising and spent a lot of time in the class muttering ‘don’t say that’ and ‘don’t do that’ to poor M.
Coaches were also meant to have a role in various labour positions, including one where you knelt on the floor and leant your arms on their knees as they sat in a chair. What benefit this position offered over leaning on the actual chair was unclear to me, and after we joked that the only thing it was good for was giving a mid-labour blow job there was more giggling. At least, unlike at school, no one sent me out to stand in the corridor until I could get my giggles under control.
But the whole coach thing strikes me as pretty patronising to men, too, like the baby books that assume they’ll never have cooked a meal or put on a load of washing before their baby’s born. As if they won’t want to be present at a birth just to hold their partner’s hand and listen to her complaints: they have to have an active practical role invented to soothe their male egos.
Evanston Hospital is a weirdly luxurious place: there’s a wall with cascading water in the lobby, and a grand piano that plays itself, and a concierge. After you give birth you order room service and get a celebration dinner with steak or seafood. There is valet parking. And yet the birth education classes happened in an obscure basement room, with no refreshments provided in a 2 1/2 hour class, and for name badges we wore slips of paper that we had to reattach with pins each week, like Remembrance Day poppies. I’m not sure whether this reflects the hospital’s attitude to natural birth, and I’m not sure, when the time comes, if I’ll want a natural birth anyway. But in this capitalist idyll I certainly would like a choice.