Happy 21st Birthday, Margaret!

Twenty-one years ago today, my husband and I drove 50 miles from our midtown Atlanta home so that I could give birth to our first child in a rural hospital's birthing center. The decision to drive past 5 or 6 well-regarded hospitals, all with maternity units larger and more sophisticated than the one we selected, wasn't difficult. (But it was a little dicey when the first stage of my labor progressed so rapidly that I had to put my feet on the dashboard and use "B-98.5 FM" as a focal point while en route.)

In 1988, the Cesarean Section rate in metro Atlanta hovered around 35%. I was an intrapartum nurse, who had dutifully pushed more than my fair share of laboring patients to the OR due to presumed fetal jeopardy, only to watch--delighted and perplexed--when the vast majority of infants came out screaming: pink, flexed, and oxygenated. I was certain there were better ways to have a baby.

When I gave birth, I was a healthy, young woman at 41 weeks gestation, the far end of a planned and uneventful pregnancy. Back then, nurse-midwives offered a better approach to caring for women like me, and I believe they still do.

I wasn't morally opposed to surgical birth: I just didn't want to give birth that way unless it was necessary. So I shopped for care, using indicators I understood, like C-Section rates, episiotomy rates, and the number of infants still breastfeeding at 3 months. (If you have a C-Section in a facility where only 15% of the infants are welcomed that way, you probably need one.)

Although my daughter seemingly could not wait to arrive, labor slowed as we reached the hospital, a lull that's pretty typical when laboring mammals are disrupted. And it took a long time, quite a long time to finish transition and birth my 8lb 3oz baby, who had chosen to position her hand alongside of her face for the journey.

In the late '80's laboring women were allotted about 2 hours to get their first baby pushed into the world. And I can remember feeling worried as I approached that mark. It was around that time, however, that my nurse-midwife--who had delivered 3 other babies early that morning--settled herself in, assessed the situation, and began providing very specific directions: "Pull back this way, now push." "Try this." "Push again: harder!"

Eventually, I was but a push away from having a baby. Or so it seemed to everyone in attendance. (While I was in labor, I was nicer than I usually am and, after 3 hours of pushing, I had become something of a sympathetic patient to the nurses on the unit. So, in addition to my nurse-midwife, primary nurse, and husband, I had a gaggle of interested L&D staff members offering support.) But still, I could not push that baby out. "Push harder, one more push, and the baby will be here!"

The voices became louder with each contraction, and I remember thinking, "How in the world did I wind up with precisely the kind of mad, directive, cheering crowd we had driven past all of those other hospitals to avoid?" But, as my grandmother had opined, giving birth was a lot like shitting a ham. There was, literally, no room to worry about anything else.

That's when my midwife, Margaret, did the most amazing thing: She told everyone in the room to be quiet. Then she tapped my leg, kind of brusquely and said, "Look at me." So I stopped doing whatever I had been doing that hadn't resulted in birth. The contractions abated. I looked at her.

"Why won't you push your baby out?"

There was a very long pause. "Oh, Margaret," I said, "I'm really afraid to be a mother." And I cried.

The quiet in the room turned to silence. I could sense the staff shifting and felt their gazes move toward the ceiling. By the time I delivered my firstborn, I had probably witnessed upwards of 500 births myself. And I knew that this was not an everyday announcement. A stuck baby and "being stuck" were infrequently differentiated in the world of traditional obstetrics I had come from. And I had never witnessed an intervention like the one I had just received.

But Margaret knew what she was doing.

She took her time responding. And when she did, I remember her saying something like this: "You are young and healthy. You've worked hard to get this baby here, and it's ready to come out. And your life is going to change when it does. There are no guarantees in this world, but I think you'll be able to handle whatever changes come along. And I think it's time to let this baby go."

With the next contraction, there was no holding back. Moments later, my husband and I were welcoming our own baby: pink, flexed, and screaming. We named her Margaret Claire.

I've thought of Margaret's words many times over the years. And they're with me again tonight as I once again prepare to leave my daughter in a college town 800 miles from my home. You'll be able to handle whatever changes come along. It's time to let the baby go.

See you at Thanksgiving, Mags!