“Are you a labor puker?” Cassandra* asked Kimberly Krick. Cassandra, Kim, and Kim’s fiance, Steven McCarty, were sitting in Cassandra’s living room talking while quiet new age music seeped from the stereo. It was an unseasonably warm day in April 2002, and Cassandra was wearing a black sundress that revealed the tattoos on her arm and calf. At 11 weeks pregnant, this was Kim’s first prenatal appointment, and Cassandra needed to take her history.
Pitocin is a synthetic hormone frequently used in hospitals to induce or speed up labor. The contractions it causes are sudden and intense, lacking the slow buildup of normal contractions, and women tend to feel more pain when it is administered so they’re often given anesthesia along with it. Hungry and tired from laboring, Kim thought a sandwich would boost her energy but was told that she could only suck on ice chips. When she tried to get up and move around–a natural way of speeding labor and a more comfortable way to deal with contractions–the nurses scolded her. To get them to let her stand, she repeatedly told them she had to go to the bathroom.
Cassandra moved to Chicago in 1999, fresh out of a five-year apprenticeship and with a lot fewer births under her belt than most Illinois midwives. Nevertheless she has established a busy home-birth practice with a fairly visible presence.
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Some medical professionals think that midwives of Cassandra’s ilk are dangerous. Dr. John Schneider, president of the Illinois State Medical Society, the largest and most powerful opponent of those advocating legal status for home-birth midwives, argues that direct-entry midwives are dangerous because they are not properly trained to deal with the life-threatening complications that may arise at birth. “I have no objection to a physician working with an advanced-practice nurse midwife,” he says, but he vows that the organization will never recognize the legitimacy of direct-entry midwives: “This is not a third-world country.” The American Public Health Association and the World Health Organization, on the other hand, have both endorsed births attended by midwives in out-of-hospital settings as a safe–and in the case of the WHO, the preferred–alternative.
The World Health Organization believes that it’s dangerous for ob-gyns to treat every birth as if it’s a disaster waiting to happen. In “Care in Normal Birth,” a 1997 working paper, it warns that such an attitude toward birth “interferes with the freedom of women to experience the birth of their children in their own way, in the place of their own choice,” and “leads to unnecessary interventions.” C-sections, for example, may deprive babies of the contraction-induced stimulation to their nervous system that helps to prepare them for life outside the womb. In hospital births there is a greater incidence of low birth weights, premature births, and respiratory distress. Some midwives use Pitocin to deliver the placenta, but when the hormone is used to induce labor, patients are usually required to undergo continuous fetal monitoring because of the increased likelihood of fetal distress. Being hooked up to the monitor and unable to move decreases a woman’s ability to handle the pain, which makes her more likely to ask for anesthesia, inviting even more potential complications.
Cassandra was born on a Friday the 13th in 1969, while her mother was in “twilight sleep,” probably from an anesthetic cocktail of morphine and scopolamine that blocks women in childbirth from remembering it afterward. She was raised in Louisville, Kentucky, by her mother and stepfather, whom she describes as “the kind of Christians that believe God loves you and wants you to have a lot of money so you can put the fish on the back of your Lexus or Mercedes.” She grew up as a southern princess, showing dogs and participating in cotillions and debutante balls. Her rebellious nature didn’t really hit its stride until she was at the University of Kentucky, where she became known by her dormmates for her willingness to accompany them to the abortion clinic. She wrote poetry and partied like she thought all great poets did, and when she was 22, the unmarried, green-haired princess came home pregnant.
