the perfect birth

letting go of expectations

In the middle of a February night earlier this year, a mother-to-be and her labor team drove through sheets of rain to Alta Bates hospital in Berkeley, California.

The mother, Michelle Johnson, sat upright in the back seat of the Honda CRV, her hands propping her up to relieve the pressure on her abdomen. From the passenger seat, her husband Sean kept one hand on her leg, helping her breath through contractions as he also tried to calm his father, who was passing stoplights and speeding through the empty streets. Two midwives and a doula followed closely behind.

Michelle had started to have contractions at 9am the previous morning. Her intention was to have a home birth. “At the hospital, there are so many restraints about what happens and what the timeline is,” she explains. “I wanted to be as comfortable and free as possible, and that meant being at home.”

When her midwife came to check on her later that day, things were moving according to plan. A Pilates and bodywork instructor, Michelle had been active during her pregnancy. She felt prepared and supported by professionals and her family. Her only concern was a chronic pain condition, the result of a major car accident 14 years before that had damaged her cervical and lumbar spine.

She had been nervous about the pain intensifying throughout her pregnancy and especially in childbirth. As the contractions became more intense and more frequent, Sean filled a tub with warm water and Michelle sank in to let gravity alleviate some of the pressure on her body. Her doula, another midwife and close family members arrived. But as the day progressed, the contractions became agonizing.

The baby’s skull was pressed against her spine and pain radiated from the injury site on her back. When she entered into the transition phase of labor””the point at which the baby drops further down into the pelvis””the contractions were virtually continuous. “In childbirth classes, the instructor talked about resting between contractions,” she remembers. “For me, there was no in between.” At this point, many women have an epidural””the spinal injection of lidocaine that numbs the lower half of the body””but Michelle felt strongly about having minimal intervention. Her transition state lasted for seven hours, and Michelle describes the experience as “labor land,” a state in which pain is perceived differently. “I’ve never been so present for such a long period of time. I just did whatever was needed in the moment, however painful or difficult.

There was never a time when I thought, ”˜That last contraction was intolerable,’ or ”˜It’s been 20 hours of intense labor, when is this going to end?’” After finally dilating to 10 centimeters, Michelle began to push along with her contractions. But after four more hours, she was dehydrated, exhausted and in excruciating pain. The very top of the head could barely be seen with a flashlight. The baby was stuck. Michelle’s midwife, beginning to worry that mother and child’s health were in danger, decided to transport everyone to the hospital. For all the preparation and thought that goes into childbirth, the process takes on a life of its own once it begins.

It is an emotional and physical experience, highlighted by a woman’s expectations of herself and her child, and colored by all the birth stories she has doubtlessly heard from other women before her. When it comes down to it though, the process unfolds in a way no one can predict. For a woman who chooses a natural home birth, it can be a heartbreaking moment when her plans go out the window and medical intervention is needed. Dr. Raymond Castellino, a pre- and perinatal birth therapist and chiropractor, knows this situation well.

For 25 years he has coached parents, facilitated bonding and attachment and conducted trainings in pre- and perinatal birth therapy. His work centers around discovering what a mother and her baby need to do together for the baby to arrive. “I always start by understanding a mother’s expectations,” Castellino says. “I make sure that I clarify what the mom wants and then I encourage her to consider what she wants for the baby.

I support mom not to be attached to her expectations, but to hold them as an intention for birth. This makes space for honoring the baby’s impulse and intention for how the baby wants to birth.” Considering birth from the baby’s perspective is a relatively unexplored territory in Western medicine, but one that is being given increasing attention. The recent National Geographic Channel documentary series “Inside the Womb,” which aired in November of last year, is evidence of a shifting tide toward trying to understand a baby’s experience and consciousness. As far as Castellino is concerned, this is an important part of the birthing process, and one that keeps the focus on what is happening for the child as well as the mother in each moment of labor and delivery. Mary Jackson, an R.N. midwife for the past 30 years, has mid-wived 50 consecutive home births without transfer to the hospital””a record that keeps her services in high demand.

She and Castellino run the private practice About Connections in Santa Barbara, where they support and train parents and their babies from the prenatal period to around six to nine months outside the womb. Jackson reflected on births that start at home and end up at the hospital. “Transferring to the hospital is a continuation of the birth process, not a failure,” she points out. “When I work with a family, we go through all the possible steps to stay in conversation and connection with mother and baby. I name for the baby what’s happening in each moment, holding presence with the experience from a place of health inside my own body. Hospital interventions happen so quickly that it is much harder to make clear decisions. I work with the mother to verbally prompt and prepare her for what is about to happen.

That connection is very strong. We can still be connected and stay slow inside.” This approach to birth calls on Buddhist philosophy and vipassana meditation, which involve releasing attachments, naming what is present and noticing the sensations as they continue to pass in each moment. No matter what style of birth a woman wants, these practices can help her learn to deepen into acceptance of what happens. When Michelle and her labor team finally arrived at the hospital, the expecting mother shuffled into the emergency room and lowered herself into a cushioned seat with a loud grunt. “I was wearing a long fleece nightgown with a pink angora hat,” she says. “You couldn’t really tell I was pregnant.

I remember the receptionist looking at me as if I should be in the psych ward.” With a C-section crew on hand, the doctors gave Michelle an epidural. After more intense pushing and a vacuum extractor, the baby finally appeared. Two loops of umbilical cord had wrapped around the neck, requiring quick work by the obstetrician. After being suctioned and administered oxygen, a healthy, swaddled baby boy, Finn Storm Johnson (named in part for the blustery weather on the night of his birth) lie on his mother’s belly. As she reflects on that day, Michelle cautions pregnant women about being too “heady or left-brain” about birth.

“Trust the process and the inherent wisdom of your body,” she says. “My intention of a home birth was not met, but I never had the sense of failure, only a sense of loss, which I worked through. Even though we birthed at the hospital, I did feel empowered, which I think came from knowing that I had given my very best in each moment.”

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