I have been working as a consultant with FPCN for almost two years, assisting with fundraising and project management for the new birth center. My husband, Jorge – who is Mexican – and I met in Philadelphia (my home city) in 2012 and have lived in Mexico City since 2015. I gave birth to my first child on April 24, 2020 in a home birth in Mexico City. Here is some of my story…
A Note On Privilege
I am a white woman who was born into an upper-middle-class family and afforded access to many privileges, including a college education, a master’s degree, and the ability to train as a doula while I held another job. I think it is important to acknowledge this privilege within the context of our maternal mortality crisis. While my childbirth experience was positive; it can be contrasted with the reality for so many birthing people – especially Black birthing people – in the U.S., where the rates of birth trauma, unnecessary medical intervention, and dissatisfaction with childbirth experience are very high. In this context, my story may serve as an example of the positive experience we are working to provide at the birth center – an experience which centers and empowers the birthing person.
Photography by Abril Zapote with Juntitos Los Dos Birth Photography in Mexico City
A Personal Story of Home Birth
Written by Molly Porth Cabrera
“With so many birth plans changing worldwide due to COVID-19, more people are desiring out-of-hospital, or community-based, settings for labor and childbirth. As a doula, I always knew I wanted a home birth, so when the coronavirus hit in Mexico in February 2020 during my third trimester of pregnancy, my birth plan wasn’t affected. I was excited and prepared for a home birth; however, out-of-hospital birth – which most commonly refers to a birth center or home birth – isn’t for everyone. Here is a look at what the experience was like for me and how it can be a safe option for many who desire low-intervention, “natural” birth experiences.”
Early Labor: “I don’t think it will happen tonight”
On the evening of April 23, 2020, at 39 weeks pregnant, as I was baking cupcakes in the cramped kitchen of my fourth-floor Mexico City apartment, I started to feel tightening sensations around my abdomen accompanied by pelvic pressure. The sensations came repeatedly, and I thought, these must be contractions. They were unlike the practice contractions I had been having for the past several days – these were more intense and coming in a pattern – every 5 minutes, about 1 minute-long. I began to track the contractions on a labor-tracking mobile app, and after an hour, a notification popped up reading “It’s time to pack your bags and head to the hospital!” I laughed, first because I didn’t believe the app – after all the contractions didn’t even hurt yet – and second, because the app assumed I’d be birthing in the hospital setting.
You see, I am a birth doula (see our previous post on doulas for more information) and ever since I learned about the myriad benefits of physiologic birth – which is defined as birth that is powered by the innate human capacity of the birthing person and fetus (in other words, spontaneous, natural, and without medical intervention) – for both the birther and the baby, I knew I would be having a home birth. Additionally, I had come to understand that besides personal preparation, the two most important factors or predictors for having a physiologic birth were 1) your care provider and 2) your chosen place of birth. For example, if you choose a care provider who has an 80% induction rate, your chances of giving birth naturally are low, as this provider clearly incorporates the practice of routine induction. Similarly, if the place/institution you choose to deliver in has a policy to continuously monitor fetal heartrate, your chances of giving birth naturally are also low, as you will be hooked up to a monitor and likely confined to bed for the duration of your labor, which increases pain perception and lengthens labor duration, leading to more interventions.
So, I had shown my husband video after video of home birth on Instagram, made him watch the documentary The Business of Being Born, which explores the industrial-complex/conveyer-belt approach the United States healthcare system takes towards childbirth, and reminded him that his own father was born at home with the assistance of his great grandmother, who was a traditional Mayan partera (“midwife,” loosely). The final ingredient was finding a care provider who inspired confidence, trust, and professionalism. With this, we had the complete recipe for a home birth.
Back in my kitchen, I laughed at the app’s automatically generated message to head to the hospital and texted my care provider – a combo OB/GYN and partera who specializes in attending home births – and my doula, letting them know that contractions had started but adding that “no creo que arranque hoy” (I don’t think [active labor] will start tonight). Famous last words.
An hour later, my husband and I were trying to rest when I felt a little burst of liquid – my water broke. Immediately, my contractions intensified. This is it!, I thought. We let our team know that they should come over – as opposed to hospital births, in a home birth, they come to you.
From 1 to 10: Active Labor
It was around 1am; the city was dark and quiet. Many a labor begins in the middle of the night because it is when the body revs up production of oxytocin – the “love hormone” – also the hormone that drives labor. It is also the hormone that rules relaxation, which explains why labor often slows down once a laboring person arrives to the cold, brightly-lit and intimidating hospital setting. This is another benefit of home or birth center birth – continuous intimacy, feelings of security, being in a cozy space – all factors that lead to more oxytocin production and oftentimes quicker labors.
I paced the hallway of my darkened home – feeling the strong mammalian instinct to move, letting gravity do its work – stopping only to sway during the contractions. Speaking of mammals, Alan, our dog, followed me cautiously around the apartment, never letting me out of his sight. Just before 3am, my team arrived. The timing was perfect, as I had worked through early labor with the intimacy of my partner, Jorge, and I was beginning to feel the need for more support. As the contractions quickened, they also shortened in duration and intensified in sensation. I began to feel nauseous and my team speculated that I was in transition – usually the most intense part of labor, towards the end of dilation (dilation refers to when the cervix dilates from 0 to 10 centimeters) and before pushing.
My partera and Jorge quickly got to work filling the birthing pool, while my doula took me to the shower for some hydrotherapy. The use of water during labor has been shown to decrease pain and quicken labor, and sure enough, I found relief during the intensity of transition as she directed a stream of warm water to my low back.
As the intensity skyrocketed, I retreated farther and farther from my rational mind, entering what we call in Spanish partolandia, or labor-land – a place of instinct over rationality. I was following the lead of my contractions, with my team offering support through each surge.
They helped me with warm water and massage on my low back.
They spoon-fed me honey and chocolate chips to help me with nausea and keep my energy up.
They waved lavender oil in front of my face to help me relax with aromatherapy.
They prepared the birthing pool, filling it with warm water which allowed me to melt into the peaceful tide of the soothing, velvety water– a return to the womb.
They helped me to relax as transition gave way to a brief break in the tide before the waves of pushing came roaring in.
The Last Mile: Pushing
Every body and every birth is unique, but one universal truth is that labor and birth is hard. There comes a time in every labor that the birthing person begins to doubt themselves. For me, that was pushing. It brought me to the deepest, darkest corners of my soul: self-doubt, weakness, helplessness and desperation. It was in these moments that I truly leaned on those around me and later was reminded of the importance of a supportive team.
Midwives (or parteras as they are known in Mexico) are known for being more hands-on and nurturing than your typical OB/GYN. It makes sense, as midwives have traditionally been recognized as community providers and experts in physiologic birth, while OB/GYNS typically specialize in high-risk or complicated pregnancies/deliveries.
So, while I cried and wailed, my team – the doula, the partera, and my partner – stood watch over me, like traditional healers, supporting me and holding space as I confronted my demons of self-doubt. In short, they believed in me.
I would have given up if I could have. But the only way out was through, and my team wouldn’t give up on me, offering words of encouragement, helping me change position, trying every trick in the birth book.
After a short time in the birthing pool my partera suggested trying a different set up. I agreed, feeling the need for more solid ground, so I transitioned out of the tub, switching between squatting and the banquito maya, or a birthing stool as we call it in English, a U-shaped stool that allows you to be in a supported squatting position. I felt the help of gravity in these positions.
This is another benefit of laboring at home or in a birth center: freedom of movement.
While hospitals are beginning to support more free movement, they have traditionally held policies that confine laboring people to bed. Being in bed greatly restricts the progress of physiologic childbirth. I like to compare it to burning your finger on a hot pan: you immediately shake your hand to alleviate the pain. Labor is the same; when left to instinct, the body literally moves throughout the contractions in order to cope with the pain, and the movement in turn helps the baby descend lower in the pelvis, which leads to dilation. When you are confined to bed, this process is much slower and more painful.
At this point, I had been in the pushing phase of labor for an hour or so. It was clear that this baby was taking his time being born. And while I worried about it taking so long, my team reminded me to be patient. The baby was fine (they were monitoring his heartrate intermittently), and with each contraction and pushing effort he was descending a little more in the birth canal, so there was no reason to worry.
Labor and delivery in a community setting tends to unfold at its own rhythm, while hospital births are frequently sped up with medical interventions like synthetic oxytocin (the synthetic hormone used to induce or “speed up” labor). Although I dilated relatively quickly, pushing lasted for about 3 hours, which is considered on the longer side of the “normal” spectrum. In a hospital or highly-medicalized setting, pushing phases that last for this long may end up being “assisted” with forceps or vacuum delivery, which come with their own risks and complications for both baby and birther. But in my case, as is the case in most home/birth center births and midwife-assisted births, there was no need for external interventions. As long as the baby and the birthing person are safe, patience is always the preferred route.
I was starting to get exhausted, so just as a marathoner pushes through the final miles, I had to draw on the last of my internal reserves to push through the final contractions. Just when I thought I had nothing left to give, I mustered every ounce of strength, and with one final push, our baby was born. On April 24, 2020 at 7:08am, I became a mother to Nicolás Cabrera Porth in the most difficult and empowering experience of my life. My partera “caught” Nico and immediately passed him to me to begin our “golden hour,” the first undisturbed hour of skin-to-skin bonding between mother and baby, which has numerous documented physical and psychological benefits.
We had done it. The perfect team. We had completed that arduous few-centimeter journey from womb to earth.
When I reflect back on my experience of labor and childbirth, I am left with enormous gratitude to my team, each of whom played an essential role in empowering me through the experience, and pride in myself and in my body. My wish for every birthing person in the world – and my motivation for working on FPCN’s new birth center project – is for birth to be treated with respect, as the rite of passage and the spiritual journey it is, not as a pathological event to be managed. Imagine how the world would change if each birthing person and baby were treated like that.
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