My son was born the other day. It wasn't an easy birth. He came into this world pushed from the back and pulled from the front, and I want him to know the first chapter of his story and how it changed our lives.

It all started back in Johannesburg. Beatrice and I met in Winter of 2006, and by summer I had asked her to meet me in Nairobi on July 12th to explore East Africa for six weeks together. By the time we arrived in Johannesburg at the end of August, we went to a good bookstore, where I sat her down, gave her a pile of baby-name books, and said she could choose two. Looking at all the names was just the start of a 16-month process that included getting engaged, getting pregnant, getting married, and trying to learn everything we could about obstetrics as her belly grew and grew.

He was late. According to the six-week ultrasound and all the usual computations, he was more than two weeks late, and that puts him in about the last 3% of births to first-time mothers. The last two weeks weren't so bad - it was the second last two weeks that were stressful, as we watched his due date sail by with no contractions in sight. We kept asking, "Where are the contractions? Where could they be? Brazil? Why don't they come?" Of course, everyone suggested her special trick that brings the baby, and no matter how hard we tried and what tea my wife drank, he continued to be as happy in her uterus as a cat in a pile of hot laundry. I believe the scientific results on these tricks are finally in - they all work MUCH better if you do them the night before you go into labor. And that includes castor oil, which may or may not bring on contractions, but it will almost certainly eject vile liquids out both ends of your GI tract.

I'm not too thrilled with the field of obstetrics in the United States. Our country ranks number 29 in infant mortality worldwide. Countries like Spain, Czech Republic, and Australia have better outcomes for live births. Of course, in the medicalized US birthing industry, we try – and sometimes succeed - to save the youngest babies on earth. Just trying skews our statistics and makes the comparison a bit unfair. But that doesn't make up most of the difference. Obstetrics in the U.S. remains governed by an old-boy's club of business-savvy doctors who set the rules according to long-standing principles that have been adjusted and improved to bring in the most profit for doctors, hospitals, and labs. For example, in the third trimester, our doctors wanted us to come in for an office visit (urine sample, weight, and physical exam) every single week for 12 weeks! I believe no other country does this - it's GREAT for the industry, but there's no evidence that these check-ups do anything for mothers and babies. Unfortunately, all the office visits make our doctors tired and stressed. In contrast, in Switzerland, a pregnant woman sees her doctor only a few times during the last trimester, for a good hour each time, in a relaxed setting where they can go over everything and discuss all options.

In the U.S., Most testing done on pregnant women is misleading and results in unnecessary worry and further tests when the results are falsely "positive." It seems that many Manhattan mothers unquestioningly go to their doctor visits, and most of them expect some kind of “pain-management” (obstetrics code for an epidural) without even considering a natural birth. Some women even schedule their c-sections months in advance. Somehow, during all our registering at the hospital, the nice people at Similac got our name and address and started bombarding us with samples and flyers in the mail - I wonder who sold them our address?

Plan A: A Natural Birth in the Birthing Center
Everyone said you should have a birth plan, so we bought about a shelf full of books, a stack of DVDs, and went to classes. Even today, when I log into Amazon.com, the site offers me many birthing-book suggestions. We already knew we wanted a natural birth, with as few medical interventions as possible. We found the ONLY birthing center in all of Manhattan, and it has exactly three beds. Fortunately, it was a short walk from our home, and so were the doctors we chose. We were not the average patients. In my opinion, the best of all the books and classes was The Thinking Woman's Guide to a Better Birth, which I think should accompany every woman to every doctor visit during pregnancy and yes, bring it to the hospital for your delivery. It's about the hard evidence for and against - and in most cases missing entirely - all the different practices you encounter along your journey through the strange land of obstetrics. It gives good, evidence-based information so you can question your doctor's reasoning and skip unnecessary procedures. I would like to see the book available right at the doctor's office and a doctor who recommends you buy it on the first visit - that's a doctor I would trust.

We knew we didn't want a home birth. We wanted a doctor who could support us in a natural birth plan and back us up in case anything went wrong. In our case, we got the right doctor, but the practice of obstetrics in this country makes the whole process much more stressful than it should be. And the outcomes aren't any better in the US than in Cuba. Someone once said that if we took half the doctors in the US and shipped them to Africa, people in both places would be healthier. I'm pretty sure in Africa they don't want any of our obstetricians. We had bought and watched The Business of Being Born, and I recommend this film to all prospective parents. We also got a wonderful doula, Sasha Slocombe, who is a fantastic support before, during, and after labor. We thought that with all this information and all this support, surely we would have a healthy baby naturally.

Problem number one: he was OP - Occiput Posterior - which meant his head was down in the pelvis, but his nose was facing her belly, not her back. Babies born this way are called stargazers. The human birth canal isn't designed to be nice to these babies - it makes a tight squeeze even tighter. Unless a woman has a very wide pelvis, she will have much more painful contractions with a baby in this position, contractions that start in the back as opposed to the front. As we will see, this caused us to change our plans several times to get him out into the light.

Plan B: Make the Labor-and-Delivery floor like the Birthing Center
Our hopes for a birthing-center birth sailed by as we missed the forty-weeks-and-six-days deadline. We didn't like going in for "fetal viability tests," because as Beatrice said, "Any time they do a test there's going to be a point score, and they're going to find reasons to take away points and start us down the slippery slope to a highly medicalized birth." But it made sense to go have an ultrasound just in case, and they said he was in fine shape, just late.

Late. Where are those contractions? In Madagascar? What's taking them so long to get here? Plan B was to work with our doula to "make the labor-and-delivery room as much like the birthing center as possible."

When we reached 42 weeks with no contractions in sight, we had another test and once again passed with flying colors. The baby was fine, but we were determined to get him out before his first semester at university. Should we wait another week and see what happens? All the books left us short here - they didn't have a section on what to do at 42 weeks. Our doctor said we should go for an induction on Thursday, because the hospital won't do them on Fridays or Saturdays and the next opportunity would be Sunday night. What should we do? We were tired already - we didn't want to be extra tired on Sunday and have to give up and go get induced anyway. Everyone seemed to think 42 weeks was the end of the line and 43 weeks was just dangerous, like eating a low-protein diet or crossing a pug with an Afghan hound. We're in New York, remember, not Summertown, Tennessee - one of the Meccas of natural childbirthing.

We decided to use the energy we had and go in that evening, because we were too fed up waiting. We would have been too much at our wits' ends on Sunday. But we didn't know he was sunny-side up. Had we known, it might have changed our plan.

Checked in and ready for action.
Plan C: Just Cervidil
So we got everything together, took showers, kissed the cats goodbye, and showed up at the regular labor-and-delivery floor at 5pm on Thursday, Dec 4th. Our nice doctor gave her the first inducing drug, Cervadil, which is meant to ripen (soften) the cervix, so it can open. Then we had some time to get settled. We tried to make the room as much "ours" as possible. One great thing we did was to bring pillows from our bed at home, so when we both got into the hospital bed for a moment of quiet, it felt like home. We were told to expect a fairly peaceful night and that we would get the contraction-inducing drug in the morning.

It was nice to bring our own pillows from home.

At around 8pm, her water broke. Whoops. This could have happened by itself within a few days, but now the long-awaited contractions started, and they were gentle. Four hours later, at 1am, they were so strong, she couldn't talk through one. That's the beginning of real labor! Let's not get a good night's sleep; let's get this baby out of there and ask what took him so long.

The labor-and-delivery floor has 12 rooms for giving birth, and each room has a machine that monitors the mother's contractions and the baby's heart rate. These two hockey pucks just slip into an elastic band that goes around the belly, then their wires run to the screen and the paper print-out showing the "seismic" record of contractions. On computer monitors everywhere, all 12 screens show these two graphs for each room, so they can see how each baby is responding to each mother's contractions. The line that counts is the baby's heart rate. If it goes down too much during a contraction, it means the cord is being squeezed somewhere and he's not getting the oxygen he needs. People who work on the floor constantly have one eye on these screens, so even if your doctor is in with another patient she can see how your baby is doing. If the number is above 140, you're in good shape. If it's below 110, you're looking for it to go back up right away. If it's below 90, you'll find your room filled with people trying to push or pull the belly to give the baby more room to breathe. The hockey-puck sensors often need to be repositioned, so the two graphs have to be reset often.

Plan D: Just an Epidural with Pitocin if Needed
By 2am, the contractions got serious. She breathed and did her pain-management stuff, but the nurse recommended an epidural. That wasn't in Plan C. By 3am, Beatrice gave in, saying please bring the epidural as soon as possible. It took about eight more contractions for the anesthesiologist to come set up and get the line in, and those were probably the eight most piercing moments of pain in her life. Then, immediately, they faded and she kept saying "It's like being at the dentist, but instead of the cheeks, my belly is numb," and laughing. We had to look at the monitor to see whether she was having a contraction. By 4am, she was asleep with an epidural in her back - we were now on Plan D.

The room was a refrigerator. If you are ever in the same room with a woman in labor, bring your ski clothes. I had packed several long-sleeved shirts and a turtleneck, and I also brought a camping pad and a lightweight down sleeping bag, which I set up on the ratty old chair from the 1970s that pulled out to let the partners sleep. Thank god for the sleeping bag, because I was able to get about 90 minutes of decent sleep in a very cold room. Beatrice's contractions raged, keeping her hot, as she slept with just a sheet in a 50-degree room.

She woke up around 6am, and the doctor said we might go into full active labor without the need for Pitocin, the drug that starts contractions. Pitocin. I hated that word. To me, it stood for everything that was wrong with the medical establishment's conversion of a cottage industry to a mega-profit machine. If you're in the hospital, you're likely to get Pitocin "to speed things up." If you get Pitocin, you're already on an epidural and your chances of getting a c-section just went up. Knowing that Plan D included Pitocin, we thought that if we could get fully dilated and make the transition to pushing without Pitocin, it would be a small victory for the natural-birth team after waving the white flag of surrender to the intense pain of the contractions brought on by the Cervadil. Unfortunately, we were now on Pitocin, because we needed it. This was not the birth we had hoped for, but it was the reality, and we were heading for home. All we needed to do was go from 8cm to the full 10cm dilation.

By 9am, our doula, Sasha Slocombe, arrived, and I asked her to wait in the waiting room because I was doing fine on my own and the room didn't need extra people. The contractions were dragging out and becoming less forceful, so the doctor added more Pitocin to the IV drip and put an oxygen mask on my wife's face. That helped the baby get more oxygen. By 11am, the Pitocin still hadn't brought the contractions to the height and frequency we were looking for – they need to become “angry,” as my wife later put it. My wife was tired and achy - the baby's feet were somehow pushing on her ribs, and each contraction was quite painful in a place that the epidural didn't cover. I was already very tired but had plenty of energy. I didn't want to give up and go to the OR for a c-section, but for the first time it seemed like a real possibility. I asked Sasha to come see what she could do, and we all worked to make my wife comfortable and keep the baby's heartbeat up. By noon, the contractions got stronger and the dilation increased to 9 - it looked like we were turning the corner and heading into the final stretch.

Plan E: Push him out Without Stressing the Baby
The nurse and I kept an eye on the baby's heart rate. We kept working with my wife to find the best position for both her and the baby as it was starting to get more and more uncomfortable. A resident came in and stuck a fetal scalp monitor on his head. This is done using a long plastic wand, on the end of which is a tiny spiral blade attached to a wire. You poke it through the dilated cervix and hit the baby's head, then you turn the handle and the spiral blade cuts into his scalp like a corkscrew, attaching the tiny sensor. Then you remove the plastic wand and there is now a thin wire running from his head to the control panel, so you can see his heart rate better without having to keep moving the external hockey puck around to try to pick up the baby's heartbeat.

I had read that the U.S. uses scalp monitors much more than other countries, mostly because the insurance companies require them to keep a log of the baby's heart rate to use in case the hospital is sued later. I had read that the man who invented this device testified before congress that it is of no actual benefit to the patient (that's sometimes how they refer to mothers), that the site of the cut can lead to infection, and the procedure just adds to the cost of births. But I have to say that in this case, knowing the baby's heart rate at all times was important to let my wife keep pushing, and the scalp monitor was MUCH better at getting an accurate number than the stupid hockey puck that kept sliding around on her belly. Once again, I had to adjust my concept of what constitutes an unnecessary medical intervention. In fact, during the course of the next four hours, our doctor later removed that monitor (I'm not sure why). An hour later, she attempted to attach another one (it didn't stick) and then another one (it didn't stick either) before giving up and going back to the hockey-puck monitor for the rest of the ordeal. I was wishing that initial clip had stayed in - it really seemed like a better tool for the job. Later, I saw the three small cuts on the baby's scalp from the three monitor attempts.

We were now on Plan E - a much more medicalized birth than we had wanted, but it was also an incredible education. Given our decision to induce, we were certainly marching toward a c-section with step, but I could see that everything they did actually helped, and none of us was willing to give up yet.

At 1pm, it was time to push. Sasha was great. She and the nurse helped my wife find a pain-free position that was good for both her and the baby. With the rib pain gone, my wife pushed hard for two hours. She had made good progress. My main role was to make jokes and tell people to do what they were already doing. I also kept the oxygen mask on (the oxygen smelled like cedar to me, for some reason). The doctor worked really hard to adjust everything she could to make the pushes more effective. In those two hours, he moved down about a centimeter total. You could now see his scalp if you looked into the cave where he had been living for the last ten months.

Amazingly, Beatrice was now really finding her groove and pushing like crazy. It seemed she got better with every push (a "push" was actually a set of three hard ten-second pushes during a single 90-second contraction). She pushed like a champ for another hour - about sixty hard pushes. Between contractions, I would bite an ice cube in half and feed her a small piece of ice to suck. After three hours, we took stock of the situation. My wife wanted to find a way to push the baby out, she seemed to have the energy, but her bones were in conflict with his skull. Our doctor has a 7% c-section rate (which is as good as it gets), and she didn't want to give up yet, but three hours is normally the limit. She said another hour and a half of hard pushing (!) and she thought he had a good chance of coming out. To increase our chances or reduce the time, something would have to change. Our doctor doesn't believe in using forceps (thank god), but she did think it would help to use a suction device, so she could pull on his head and guide it through the bones as my wife pushed. We learned about the pros and cons of the suction device, and we decided to try pushing a bit more first. After two hard pushes/contractions, green gunk came out and slid onto the floor. Meconium. The baby had pooped in utero. A sign of stress. Oh no. Time for Plan F. I was starting to wonder how many more letters of the alphabet we could use before we had to switch to numbers.

Plan F: Vaginal Delivery with Vacuum Assist
The doctor said this was our last chance, and Sasha, who was as against medical interventions as anyone, nodded soberly in agreement. It was time for him to come out, one way or the other. We would use the vacuum extractor, and if it pops off three times - or if it looks like the baby or my wife can't take the stress - we're going to the OR. We were tired, but we were a team and we all had the same goal: Plan F - get that baby out in this room as soon as possible. My wife didn't want to go this far and not try everything she could to get him out before resorting to major abdominal surgery. Sasha said she was going to have to push 110% of what she had until now. Think of going to the gym, getting into a piece of equipment, and doing sixty HARD reps in one hour. Now imagine doing that for three hours and being STRONGER and more eager to push than you had before - that's how impressive it was that my wife was up for another try. We knew it was going to take even more than what she had done for the last three hours, and this was our last chance. It was now 4:30pm. It felt like that moment in Apollo 13 when Rusty Swigert says, "If this doesn't work, we're not gonna have enough power left to get home."

The night before, when it was quiet in this room, we laid down on the bed together and cuddled. On the other side of the thick wall, we could hear the loud sighs of a woman in labor. Then the sighs became cries, and the cries became wails. It was difficult for my wife to hear these sounds and not project them into our room about 12 hours later. It was like being in the green room before going on stage. However, had you been in that other room during our labor, what you would have heard would have sounded like a rugby match. My wife said very little the entire time, just conserving her energy, focusing, sucking on ice chips, and listening to the doctor's directions. The four of us, on the other hand, were shouting like crazy, telling her to Push! Go harder! Even more! Come on! Really hard! Push him out! You can do it! The doctor put the suction cup on the baby's head, we all cheered, my wife pushed like crazy, and after three attempts the suction cup pulled right off. That was one. We all caught our breath, sat down, and tried to save our energy.

We tried three more times, which is nine HARD pushes, and each time, Beatrice pushed like a water buffalo. It was a contest of strength and endurance, but fortunately not a lot of pain. A few times, she actually slept between contractions. We were exhausted but he was moving, painfully slowly, down the birth canal. We let the baby's heart rate recover from the stress, and we all knew we had one more contraction to go, or we would have to go to Plan G: a c-section.

I looked on the wall that contained all the power outlets and plumbing outlets (yes, this building is plumbed - plumbed! - for oxygen, an extremely explosive gas under high pressure, and it was bubbling out through a water bath in our room, so a fire, if there was one, couldn’t flow back into the line). I saw a button that was labeled "CODE BLUE." I was glad we hadn't needed that button, but we weren’t out of the woods yet. We were all stressed and exhausted, including the baby. Beatrice was the one who was most composed and focused. I told her she had pushed like an Olympic champion, but this time she needed all that and one centimeter more. She nodded. We all got set. It was really like fourth down and 22 yards to go, with 2 seconds left in the game. We waited for a good contraction, and then we got on it. The first time she pushed, the nurse actually came around behind her and pushed my wife's head forward onto her stomach, to help give her more to push off against. I yelled "He's coming! He's coming! Push more - he's coming!” I was lying. The steel cable was taught and the doctor was pulling with all her 90 pounds of weight, but the cable wasn't moving. I told her he was almost here. She took a deep breath and we went into the next push, and this time she pushed so hard I actually did see the steel cable move about a centimeter. That was it. The dam was about to burst. I yelled HE'S COMING! PUUUUUUSHHHHHH! And the third time, my wife could have pushed a 747 uphill with her abdominal muscles. The cable started coming out, the doctor slid back on her wheeled chair, and what I saw next I will never forget.

I saw the head of my son pulled out by a cable in an image that could have been painted by Hieronymus Bosch. His eyes were WIDE open and his head was so stretched, gray-green and bloody, that he looked like a space alien. He looked like E.T. was when born (how I know how E.T. looked when he was born, I have no idea). His head was elongated to an extent I didn't think possible. The rest of him followed - a gray turkey body with long, alien-like fingers and long fingernails that had been growing for the last two weeks so they looked chicken feet. His hands were gray. As soon as his feet were out, they clamped and cut the cord, whisked him to the warming station, and started suctioning him before he could breathe. It all happened in just a few seconds. I shouted HE'S HERE! HE'S OUT! HE LOOKS LIKE A SPACE ALIEN! I hugged my wife and everyone was elated - it was like being in the control room when the Apollo 13 crew landed safely. We cried, we kissed, I asked Beatrice to marry me again, the little gray body started to cry and turn bright pink like a cherry, and the doctor started sewing up the very small tear to the perineum. Wow. What an experience. Four hours of pushing! And my son - my son! - was on that table getting his shit wiped off him. As soon as we could, we put him on her breast and she held her little schnumpf - the baby with the bright red body, big blue eyes, and the still-gray hands and feet. I said "No c-section! No c-section! We had a B-section: a birth-canal delivery,” the one thing we most wanted, and probably the most empowering experience my wife has ever had.

He's out! He's here! Hooraayyyy!

Plan F was fine for us. She'll be able to do more in her life knowing she didn't give up and she got her son out the way she wanted. She won't be in the hospital recovering for a full week from surgery. That whole alternative reality that we came so close to was now on the other side of the mirror, and here was our son, the cone-head from another galaxy, sitting on her breast, wondering what all the fuss was about.

Shai River Siegel, December 5th 2008, 5:06pm, 7 pounds, 6 ounces.

Recovery
We moved over to the recovery room (shared), and they took him to the nursery to do a bunch of unnecessary tests, one of which is a glucose test. This test is not even suggested for babies after 38 weeks, but doing tests makes good money for hospitals and labs. They told me they wanted to start him on formula right away, because his glucose was only at 45 and if it goes below 40 that's dangerous and he would probably fall into a coma that lasts 37 years. I told them no formula. I said we would like our baby to sleep next to my wife all night, away from the nursery. As we got her set up in the room, I overheard the nurse explaining to the woman on the other side of the curtain, who had just had a baby girl, "Now, we need to get your baby used to feeding outside your body, so you just hold the bottle like this, and ..." We agreed that we were going to get out of the hospital the next day, no matter what it took.

The next morning, he was unceremoniously circumcised, and the doctor on the floor said Beatrice was in fantastic shape for having given birth twelve hours earlier. She could go home whenever the baby was ready. Then the pediatrician dropped by. She was a nice old Jewish lady from the Upper West Side, the kind you’d find in a Woody Allen movie. She said he was a beautiful baby. We said we really wanted to go home that night and sleep in our own bed. She wasn’t too sure about that. She asked, “What kind of support system do you have at home?” I said my brother, he’s a cardiologist. She said “That’s no good. That’s a negative. What else do you have? A grandmother? A neighbor? A cleaning lady? Someone who knows a bit about caring for newborns?” “Yes,” I lied. “We have a post-partum doula coming tonight to stay with us for a few nights, to get us off on the right foot.” Then she said okay, because we have such a good support system at home, she’ll let us out at 8pm. As soon as she left, I fired up my iPhone, went to CraigsList, and found Valerie, the perfect post-partum doula. She agreed to come the same night and in fact stayed with us for three nights. Valerie was wonderful. If we have another child, I’ll plan to have a post-partum doula lined up ahead of time.

New mom calls her parents while dad shows off the son.
We did it. She did it. Plan F. Healthy baby. Tired. Happy. Amazing wife. Great team. Huge effort. As Mick Jagger says, “You can’t always get what you want. But if you try some time, you just might find, you get what you need.”

His name is Shai River Siegel. He's vibrant, sparkling, inquisitive, and happy. He's the best gift, ever.

Hope for the Best, Prepare for the Worst
About four million babies are born each year in the United States, a tiny fraction at home, and most in places like this. We could have waited longer and might have had a completely natural birth, but there were too many unknowns. We both feel we made the decision that was right for us. And we had a great team supporting us. From the anesthesiologist to the doctors to the nurses - the entire team, except for me, was female, and extremely competent. We experienced the full cycle of the wave, from the first positive pregnancy test last March to the crest of the wave when the space alien came out on the last push, to the joy of our son, with his cone head shrinking, spending his first night in a crib next to my wife's hospital bed, and back down the other side, with breast feeding and several weeks of recovery. And the people who work here, they ride the crest of that wave every day, with easy births, technical births, pain, joy, suffering, elation, and loss. The monitors are always on. Someone always needs a sensor repositioned, a higher dose of medication, a cup of ice cubes, a special tool for doing something necessary. They are happy to see the Plan A couples walk out with their uncomplicated babies, but they are prepared for Plan Q, when all else has failed and the tiny baby is in the incubator, fighting for her life. Home birth is great, and I hope more women do it. But in our case, we needed help, and we were lucky to have the team and the tools and the support we needed to get the job done. Everything, from the drips, to the drugs, to the doula, to the incredibly committed doctor with the low-caesarean rate, to the nurse pushing my wife's back forward so she could push that much harder, was necessary for our son to come into the world the empowering way he did.

Our wonderful doctor.

In the end, you can ask why the contractions didn't come, why he was facing up, and you can wonder what might have happened if you had waited another day. You can ask why you were dragged through almost every medical procedure you never wanted. You can blame the industry and insurance companies for not acting in the best interests of patients. But when your baby comes into the world and he looks at you with those big blue eyes and squeezes your finger with his tiny gray fingers, it doesn't matter what you had to do to get him there. You hope for the best, prepare for the worst, go on to the next medicalized intervention if necessary, and kiss the doctor on the cheek for the extraordinary gift she has helped deliver. And you hold your wife tenderly, giving her all the praise she deserves for doing what no man can ever do and what only women know they have the inner power and strength to accomplish when the time comes.

The next morning, I came back to the hospital and saw Beatrice nursing our son. I asked if she was ready to do it all again.

She said yes. Family. Yes.