Behind Closed Doors: You May Get Groceries and Other Adventures in Childbirth

Ask any doctor you meet to describe the most amazing thing that they
 have ever experienced in their career, and I would lay strong odds that 
most would say childbirth. Of course everyone in all of history has been present for at
 least one birth, and mothers for at least two. But I have always felt
 it has been a great privilege to be present for so many. I have witnessed thousands, and have even had to help deliver a few babies myself when things moved faster than the obstetrician or midwife expected, and I along with the nurse were the only ones present. It may be trite to call it a miracle, but for lack of a better word, it really is. The first breath and cry of a baby as the lungs expand with life-sustaining 
air, is like a brilliant white sail snapping full on a crisp ocean 
breeze. Even after the thousands I have seen, I still have a catch in
 my breath, and a skip of my heart with every new birth.

As the Chief of Obstetric Anesthesia at my hospital, I feel doubly professionally privileged. Not only do I get to participate in the clinical care of obstetric patients, but also help administratively, working with a wide array of health professionals, from obstetricians, to OB nurse, to pediatricians, to midwives, and even doulas. We are all focused on the health, and comfort of our patients with the common goal of ensuring a safe delivery and a healthy baby. We also strive to provide an individual experience for every one of our patients that respects their wishes and expectations for the birth and beyond.

Sometimes these goals are in conflict. There are few
 areas in medicine that garner so much public attention and generate
 such heated discussion as birthing options. Should one try for a home
 birth? A water birth? Should we be like Tom Cruise and remain totally
silent during delivery so the baby remains free of negative engrams? Hospital versus birthing center? 
Natural versus epidural? Vaginal versus C-section? There is a lot to
consider. One thing is for certain, childbirth is now safer than it ever 
was in all of recorded history. Take a walk in any 18th or 19th century cemetery and read the gravestones. They are a cold and stoney reminder of the high price of pregnancy and childbirth in the past. It was not unusual for a man to out live three or four wives, or for a mother to bury several of her babies. Fortunately, in our lifetime, this is no longer the case.

With choice however, comes controversy. Despite the theoretical
 ability to perform well-controlled birthing studies, in practice it’s not so easy; thus many issues we would like definitively resolved just
 aren’t. Even 90% probability leaves 10% uncertainty. Why do we have so many C-sections, approaching nearly 30% nationally? Does choice of pain relief matter? Does increased fetal monitoring lead to more frequent and unnecessary interventions? Do 
fertility treatments that allow older mothers to bear children, with
 an increased chance of twins, triplets, and beyond increase risk? Should anybody be allowed to have fertility treatments? Octomom anyone? I, for one, have mellowed with both age and experience in thinking there is one right answer. I believe in choice and intuition, but I also believe in science, and data-driven answers. My personal journey in the birth of our first child outlined below is illustrative of some of these dilemmas. Let’s just say, I was young, I was a new anesthesiologist, and I was faced
 with a challenging situation…of course hilarity ensued.

When Dana and I found out we were expecting our first child in the 
final months of my anesthesia residency, we simultaneously became inundated with good wishes and overwhelmed with advice on how to prepare for the big day. As a new anesthesiologist, I truly believed that we were the good guys and helped make the process of birth a lot more comfortable and safe. But not everyone is always on board with our efforts, even today. Miranda Kerr, the Victoria’s Secret supermodel and wife of erst while “Lord of the Rings” elf Orlando Bloom, has opined in the current issue of Harper’s Bazaar, U.K.

The Aussie who is on the cover of the August issue, told the magazine
 that she decided to have a natural birth without any pain medicine 
after watching baby-bonding videos. Kerr saw that babies without an
 epidural come out and go straight for the breast.

“Then they showed the ones (babies) right after the epidural, and that 
didn’t happen,” Kerr said. “The baby was a little drugged up, and I
 was like, ‘Well I don’t want that.’ I wanted to give him the best 
start in life I could.”

There is little doubt, if I were fortunate enough to be in that genetically
 privileged baby’s booties, I would leap like Legolas, straight for 
Miranda Kerr’s perfect breasts, drugged up or not. And for the record, here is Victoria’s real secret. The fertile Queen became a huge fan of pain medicine for labor. One of the world’s first
 anesthesiologists, John Snow was celebrated for his ability to safely 
gas Her Highness senseless with chloroform during the births of her 
last two children. For this skill, and perhaps his success in
identifying and halting the source of a horrific cholera epidemic in
1854, he was named by a 2003 poll of British doctors as “the greatest
 physician of all time.” Is it a coincidence that we have the word 
“snowed” to describe the state of blissful lack of awareness?

Faced with our impending delivery, one of our first tasks
 was to register for a childbirth education class. I must admit, as an
anesthesia chief-resident with a fair amount of experience on the 
obstetric floor, perhaps a little arrogantly harbored doubts about 
the value of this undertaking. I had seen numerous complicated birth-plans crafted in these classes burst into flame at the
 unyielding onslaught of the dragon’s breath of labor pain. I looked at 
the glossy brochure brought back from Dana’s first OB appointment. The misty cover picture was a mother gazing down at her 
preternaturally chubby baby nestled against her breasts; its inner 
copy was filled with words like “holistic” and “toxin-free.” I began to 
cynically snicker… and was immediately shot
down with “the look.”

Here is some hard earned marital advice. Do not laugh at your pregnant
 wife. Even if in the past she has been a willing co-conspirator with
 you against the excesses of modern baby marketing, just 
don’t do it. To this day, one of the biggest arguments in the history 
of our twenty-two year marriage was about the exorbitant cost, and
“real need” of designer crib linens and bumpers. Give up. Just buy

On the very threshold of the first day of birthing class, empathy 
pillow in hand, Dana paused and made me solemnly swear that I would 
not let the teacher or anyone else in the class know that I was a 
doctor, and even worse, an anesthesia resident. She made me promise 
that I would listen attentively, wouldn’t snort derisively, roll my eyes, or sigh heavily… no… matter… what. In order to cement this 
deal, she gave me “the look” once again, and I knew I had no choice. I 
even agreed to carry the empathy pillow and go “hee-hee-hee, 
hoo-hoo-hoo” when prompted. I introduced myself to the doula-educator who seemed a touch too sweet, and 
had an edge I immediately recognized as pure passive-aggressiveness. Kind of like Dolores Umbridge for all the Harry Potter fans out there. I
surveyed the room and the ten or so other couples scattered about. Some were bewildered and dazed newbies, and a few were clearly repeat
 parents, bored and all been-there-done-that.

The first few classes were actually fine, nothing too controversial. Most of the topics were blandly informational, about such 
things as the early changes of pregnancy, lactation, mood swings, and and 
must-have baby equipment. The routine was to present paired related 
topics, like nutrition and exercise, stretch marks and skin-care: so 
far, so good. I was dutiful. I was attentive. I was respectful. I
 took pains never to wear my scrubs to class, or discuss my day in the 
operating room. When asked, I said I was a student, which was sort of 
true. It would be an exaggeration to say that I enjoyed the class, but 
all in all it wasn’t horrible. So we continued to attend. And then one
 week, late in the curriculum, things took a decided turn for the

On that fateful evening, we arrived a little tardy to find the teacher at the whiteboard busily scribbling away. Everyone seemed 
unusually hushed and serious. Her ample rear-end wiggled, and the
 dry-erase marker squeaked as she wrote. The two topics of the night
were already delineated on either side of the board – doubly 
underlined in her flowery script:

“Unexpected Fetal Demise” and… “Risks of Epidural Anesthesia”

Dana shot me a warning glance as she could tell I was starting to get
 riled up. She painfully squeezed my hand after we sat down on the
 floor - no chairs allowed here - the empathy pillow accusingly thrust
 between us.

Under “Risks of Epidural Anesthesia” she had drawn an elaborate
 diagram. In the middle was a big circle with the word “Epidural” in 
it. Several spokes extended from the center like a wagon wheel. At the
 end of each spoke were other circles, some big, some small. And then
 she started to write in each of them… In the first big circle she 
wrote, “Nerve damage, Possible Paralysis!” in the next, “Chronic Back
Pain!” and the next, “ Use of Caine Drugs and Narcotics = Toxic, May 
Cause Future Addiction in Baby!” and the next, “Interferes with 
Breast-Feeding and Attachment!” then, “C-Section nearly Guaranteed!”
And then starkly, “Death!!” Undoubtedly she felt the ultimate
 catastrophe gleefully deserved two exclamation points. Finally, in the 
tiniest, loneliest, most distant circle attached to the growing wheel 
of anxiety she glumly wrote in small letters, “…you may get pain 
relief.” And that was it 
for me. I lost it.

I imagined myself a superhero, like Clark Kent ripping off my striped oxford
 button-down to reveal my scrubs with the crimson “S” beneath. Only in
 my case it was an “A” for Anesthesiology! I leapt to the board, grabbed the marker from the startled woman, and drew my own 
wagon wheel. In the big central circle I wrote, “Trip to Grocery 
Store” and then the spokes: “Horrific Flaming Car Crash!” and, 
“Kidnapped by Aliens and Anally probed!” and, “Poisoned by Botulism!”
 and so on. Finally in a small circle I wrote, “… you may get

Needless to say, we were invited not to come back to class after that.

I could tell Dana felt sort of relieved, even co-conspiratorial. She smiled at me, and I was reminded once again that I had married the right person. Later, in the 
hall, several of the dads clapped me on the back, and made me feel
 a little better. A few of the experienced moms mouthed, “Thank you!” Of course
I knew that some of them had epidurals with their first pregnancy, and as far 
as I could tell, they were alive, they all walked just fine, and not
one of them had cocaine-addled junkie toddlers in tow.

Jeff Swisher, M.D.

San Francisco, CA

Dr. Jeff Swisher is an anesthesiologist who practices in San Francisco. He graduated from Stanford University with degrees in International Relations and Medicine, and lives in Marin County with his wife Dana, three teenagers, two large dogs, and a merciless take-no-prisoners black Bombay cat named Gin. He also plays in a middle-aged-guy rock band named “Blatant Malpractice”.

4 thoughts on “Behind Closed Doors: You May Get Groceries and Other Adventures in Childbirth

  1. Well, my wife Genell and I didn’t make it as far as you did in the class. It just wasn’t our cup of tea. At that time we were both staff nurses and decided to go it on our own. We were never offered an epidural. What a good read and your discipline is to be commended.

    Chris Hilton

  2. Bravo, Jeff! You had me rolling.

    I don’t know if this will help convince my husband to happily attend all of the birth classes that I’ve signed us up for, but you can be my superhero anesthesiologist any time. :)

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