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by Eleanor J. Bader

The Midwife’s Narrative

According to midwife-turned-memoirist Ellen Cohen, when people hear the word midwife they typically assume that it refers to someone who assists women giving birth at home. But while this is certainly true for some in the profession, Cohen’s engaging account of the three decades she spent delivering babies, providing general gynecological care, and educating patients about abortion, contraception and sexuality aims to set the record straight.

“More than 95 percent of midwife deliveries in this country take place in hospitals,” she writes. It’s a setting Cohen knows well. During her tenure, she worked in both public and private facilities and estimates that she delivered at least 1400 babies, the offspring of the homeless, the HIV-positive, the indigent, the mentally ill and, of course, the perfectly healthy.

One of the most riveting stories she tells in Laboring: Stories of a New York City Hospital Midwife (self published; available at Amazon, $15.95) involves Mia, a woman diagnosed with schizophrenia who refused to believe that the intense pain she was feeling had anything to do with parturition. “I’m not pregnant,” she screamed. “Get your hands away from my pussy…No, I don’t use drugs…Just my Thorazine and my crack.”

Mia had been taken to the hospital by Emergency Medical Services after she was discovered in a mid-Manhattan subway station. She was terrified. “Mothers feel intense pressure from the baby’s head and a burning sensation in the perineum during the moments just before birth,” Cohen explains. “Mia must have been feeling that; she jumped over the raised side rails and out of bed, as if that would help her escape the pain, and ran out of the room into the large open area near the nurse’s station. After a split second of shocked disbelief, I ran right behind her. Mia leaned against the wall with the next contraction as the baby’s head emerged.” Cohen encouraged her to crouch down, and an incredulous Mia delivered a healthy baby, subsequently placed with the same relative who was caring for Mia’s first-born daughter.

Cohen admits that patients like Mia, while relatively rare, take their toll on staff. Likewise, the unanticipated stillbirths, birth defects, and other complications have a jarring impact on midwives and other medical personnel, underscoring the dangers inherent in pregnancy, no matter how sophisticated the technology or how good the prenatal care.

The story of Tonia is a case in point. Thrilled to be having a girl, Tonia was a young, healthy non-smoker who did not drink or use drugs. Everything was going perfectly, the baby kicking and growing normally. Then, out of nowhere, Tonia developed pre-eclampsia, a serious pregnancy complication that caused the baby to be born 12 weeks early. The infant later died, and Cohen’s description is heart-rending.

That said, all is not grim, and Laboring includes dozens of joyful anecdotes. At the same time, Cohen reports encounters with arrogant, sexist physicians and pig-headed bureaucrats. She also chronicles several just-in-the-nick-of-time actions by helpful maintenance people — the usually unheralded workers who keep health centers running smoothly. What’s more, while the book does not directly tackle deficits in the healthcare system, it addresses — and condemns — the high rate of Caesarian deliveries in the United States.

Cohen notes that midwives are trained to let nature take its course, and the profession favors a “high touch, low tech” approach over a “high-tech, no touch” medical model for women about to give birth. “Pregnancy,” Cohen concludes, “is not a disease. Midwives trust birth rather than trying to control it. Science supports this approach.”

And if it takes longer than one might like? Cohen acknowledges that labor follows neither formula nor game plan. “We do not view the normal mainly as preparation for the interesting complication,” she writes. “The ordinary miracle of life is interesting enough.”


 

Eleanor J. Bader is a writer and teacher whose work appears on Truthout.org, RHRealityCheck.org, Theasy.com and in The Brooklyn Rail and other progressive feminist magazines and blogs.