Laboring in the Dark

It occurred to me that Matt’s beard looked unallowably scruffy, sticking out underneath his hospital hairnet into the antiseptic room. It was early on what I gather was a beautiful May morning. The doctors and nurses were fresh and relaxed, pleasantly chatting amongst themselves. I took some comfort in this. For the past twenty-three hours, I had been laboring fruitlessly in a dark, quiet room down the hall without rest or food. Now, wheeled out into the light, I was shaking uncontrollably from some combination of anesthesia, terror, and exhaustion. The nearest nurse caught my eye and reassured me that everything was fine. The shaking happens sometimes, but it’s not a problem. I would meet my babies soon.

At 6:20 a.m., a tiny human covered in white waxy goo appeared over the blue curtain, and after a brief, heart-stopping pause, cried out. Everyone exhaled and smiled. Matt gripped my hand. I watched a team of nurses take the baby over to the warming lamps. But I was quickly distracted by the quest for Baby B, who was still nestled in my body, way up high by my ribs. Somehow, under the magic of epidural anesthesia, I could feel pressure and movement, like an earthquake in my belly, without pain, as the doctors deftly guided a hard wiggly mass down and out. At 6:22, another tiny human came up and over the blue curtain, this one longer and purpler under the waxy goo. She cried out right away. Her voice was different! This struck both Matt and me as miraculous.

I lost all connection to what was happening behind the blue curtain after that. Someone had come to my bedside with an expertly wrapped little package. I laid eyes on a small squashed pink face, wearing a serene expression and a tiny pink and blue striped hat. I gazed at her for a timeless minute before a second package, with a strategically embellished second hat, was placed beside her. I don’t know where my arms are, in the memory. I wasn’t holding the babies, but I could feel their weight on my chest, and it was good enough.

And Laban had two daughters. The name of the elder was Leah and the name of the younger Rachel.

—Genesis 29:16

Birth is always a beginning, twin birth doubly so. But for Matt and me, this was also the end of a grueling path we had been on long enough to forget what life was like before we started.

Six years earlier, in my mid-twenties, I’d gotten really into birth. This came as a surprise to Matt, who had just started a Ph.D. program and thought he had more time before contemplating fatherhood on top of school. I was spending my days babysitting, researching grad school programs for myself, and trying not to envy his sense of purpose in life while I wandered around lost. We weren’t married yet and neither of us were making money beyond the minimum required to feed ourselves and pay the rent.

One of those days, I watched a documentary called The Business of Being Born. The film, now fifteen years old but still buzzing in certain circles, presented the idea that something has gone wrong with the practice of childbirth in the United States. For a developed country, we had, as we continue to have, surprisingly high infant and maternal mortality rates, yet we spend more money on childbirth than anyone else. Why? Because we have gone unnecessarily far in medicalizing even normal, low-risk birth.

But the movie’s emotional appeal, for better and for worse, does not lie in this argument, which is fairly well supported in the literature. It shocked and transfixed audiences with its portrayal of an alternative to hospital birth, birth at home with a midwife. The film includes footage of women laboring at home and delivering babies, some of it filmed for the documentary and some of it reclaimed from home movies. Producer Ricki Lake shares raw footage from her own home birth, as does the most prominent midwife in the film, Cara Muhlhahn. They struggle and curse, writhe and persevere, and eventually push babies out on camera.

When I stumbled across the movie in 2010, I had never seen anything remotely like this before. I’m not sure I knew midwives still existed or attended births at home. All I knew was that most people went to the hospital, and that not nearly as many women died in childbirth as they did in old novels and history books, so this was probably a good thing.

But watching these women, seeing their babies be born, caught, and placed on their chests as though this were the most natural thing in the world, flipped some kind of switch in my brain. I felt like I’d stumbled upon a hidden stream of raw human experience I’d been longing for without knowing it existed. Who knew that twenty-first-century women, who shop in supermarkets and watch documentaries on Netflix, could go deep into themselves, suffer something beautiful, and come out radiant and powerful, babes in arms? What was any other accomplishment compared to this? I stopped looking at schools and reading philosophy books. All I wanted were birth stories, histories of childbirth, novels with midwife protagonists, birth, birth, birth.

And Jacob loved Rachel. And he said “I will serve seven years for Rachel, your younger daughter.” … And they seemed in his eyes but a few days in his love for her.

As it turned out, there was a thriving home-birth community in my city. I got the scoop from one of the moms I babysat for. I learned that there was a small birth center just down the street from the house where I was living, and a real, live midwife holding prenatal appointments and attending births. She had a senior apprentice who was getting close to certification, ready to start her own practice, and she was looking for a junior apprentice to help out and learn the ropes. All I had under my belt was a couple of months’ interest and reading, but I got up the nerve to call her and ask for an interview. We settled on a temporary, unpaid arrangement. I would hang around, observe, fetch towels and instruments as needed, borrow books, ask questions, and run errands. After a few months, if I wanted to proceed, we’d figure out a more formal training program. I jumped right in.

Over the next three months, I had the privilege of attending seven births and countless pre- and post-natal appointments. I learned to listen for a baby’s heartbeat with a special stethoscope, and to measure a woman’s belly to estimate weeks of gestation. The senior apprentice showed me how to set up the birth tub at the birth center, and how to position chucks (absorbent disposable pads) on a bed before a birth. But most importantly, I learned to wait, quietly, while a woman labored. I saw mothers who yelled and cursed during labor, and mothers who quietly swayed through contractions and moaned. I saw dads who could hardly bear the anxiety and dads who cracked jokes. The births were all beautiful. I saw for myself that that moment when the baby is finally out in the world and the midwife says, “Reach down and grab your baby,” is even more powerful in person than it looks on film.

But I also learned that the hours of labor can stretch on so long, it feels like they will never end. Sometimes the baby’s heart rate dips or rises alarmingly, the baby’s head is at the wrong angle, or a shoulder gets stuck on the way out. A skilled midwife knows what to do when these things happen, stays calm, and moves what can be moved. But fear and anxiety are formidable enemies in the birth room, and once they enter, it’s difficult to expel them.

One of the labors I attended went on for more than forty-eight hours and stopped progressing. The mother was scared and exhausted. When we suggested transfer to the hospital, she wept with relief. The midwife and senior apprentice drove her in with her husband. Being inessential, I stayed behind. But I could feel the malaise that hung over the practice for days afterwards. Labor had gone on for several more hours in the hospital, and pushing for hours after that. The baby was born, eventually, with a vacuum-assisted delivery. Everyone was alive and recovering. But the doctors and nurses at the hospital had treated both the mother and her midwives with suspicion and contempt. Why had we allowed this to go on so long? Why this obsession with natural birth? Everyone was bitter and no one had gotten enough sleep.

And Jacob said to Laban, “Give me my wife, for my time is done, and let me come to bed with her.”

Midwifery is a hard calling. The stakes are high, the pay is bad, the hours are long, and failure is not an option. Birth can happen at any time. And when the call does come, the midwife’s duty is to stay with the laboring woman through everything. She doesn’t know how long she will be needed, what challenges are awaiting her, when she’ll get to sleep, or see her family again. Any mistake, any negative outcome for mother or baby, breeds distrust in the community, and can result in legal action against her, or in public disgrace.

The fact is, birth is both a normal process and a vulnerable one. It is not a disease, but it does carry risks, and this makes it genuinely hard to find the right place for it in the modern medical system. Hospital administrators, medical malpractice lawyers, and insurance companies value constant vigilance against all possible danger. Midwives preach that patience and faith in the power of the woman’s body, in most cases, given time and support, will get the baby out alive. But no one can deny that there are dangers lurking around birth, and in moments of danger, hospitals save lives.

The difficulties of the midwife’s position are compounded, therefore, in an environment where midwifery is, or is seen to be, a willful rebellion against the larger medical system. To work well and practice safely, midwives need to be able to transfer patients who need lifesaving interventions to the hospital without friction or delay. They also need rigorous training and recognized credentials in their own right. But these needs are not met everywhere. There is a long history of animosity between midwives and hospital-birth professionals in the United States, and midwifery laws vary significantly from state to state, meaning that some midwives practice in a legal gray area or without sanction at all.

When the time came for me to decide whether I wanted to continue training, I knew I wasn’t up for it, at least not yet, however much I admired the midwife I had been working for and the calling she pursued. When I was honest with myself, it wasn’t the midwife whose role I envied at the births I attended. It was the mothers. I wanted to go through this rite of passage for myself. I wanted a baby of my own.

And when evening came, [Laban] took Leah his daughter and brought her to Jacob, and he came to bed with her.

So, I set about putting ducks into rows. Matt and I bought a house and got married. I found a grad school program, got in, and did my course work. As Matt was finishing his program and settling on a post doc, we finally started trying for a baby.

For the first few months, I was happy just to have Matt on board. When a cycle ended and I wasn’t pregnant, I would celebrate with a glass of wine or some sushi. One more month to be carefree. Next time, maybe, we won’t be so lucky. I spent that summer studying for my comprehensive exam, the last hurdle before I’d start work on my dissertation. But it was very clear to me throughout that I wanted a baby more than I wanted the degree. I often found myself looking up baby names or mapping out my cycle instead of studying.

Three, four, five months passed. The yearning got more intense with time. I would read article after article, watching my chances of conception go down with every cycle tried and failed. I started taking my temperature every morning to pinpoint ovulation. Once the fertile window was past, I became hyper aware of every flutter in my belly, any tiny indication of a hormonal shift. I gave up alcohol, cut back on sugar, started taking the most expensive vitamins. I threw out all the plastics in my house I couldn’t be sure were BPA-free. I started worrying about all the time I’d spent in saunas and all the years I’d been lazy about washing fruit. Matt stopped riding a bike. I switched to a gentler workout routine. None of it made any difference. I mourned the loss of an invisible baby every month. I could not understand why this was happening.

And when morning came, look, she was Leah. And [Jacob] said to Laban, “What is this you have done to me? Was it not for Rachel that I served you, and why have you deceived me?” And Laban said … “Finish out the bridal week of this one and we shall give you the other as well for the service you render me for still another seven years.” And so Jacob did.

That fall, waiting for the results of my comprehensive exam, I was also waiting for my period yet again. I sat at my desk and bargained with God. I’ll trade you grad school for a baby. Let me fail the exam, but please, let me be pregnant.

I wasn’t. School plodded on, and now it was time to propose a dissertation. I spent long days in coffee shops wrestling with philosophers, dutifully taking notes and arguing myself in circles. But I was distracted and uncertain. I couldn’t decide what I wanted to say, and I couldn’t picture my own future.

When spring came again, I was jealous of flowering trees and birds in their nests. Everything around me was full of life, but I was barren, a desert, the discarded chaff of natural selection. I stopped tracking my ovulation. I tried to give up hope and move on with my life. But hope wouldn’t die.

I thought of Sarah and her decades of infertility in a strange land, despite God’s continued promise to make a great nation of her husband, Abraham. I imagined myself the martyr, telling Matt to leave me and try for a family with some other woman, relishing the deliciousness of abject self-pity. But only for a moment. I could see he loved me and was suffering too. We were kind to each other.

And, indeed, [Jacob] loved Rachel more than Leah, and he served [Laban] still another seven years. And the Lord saw that Leah was despised and He opened her womb, but Rachel was barren.

I had cherished a certain image of myself since I was a little girl. I was gentle, good with animals, I loved babies. As a child, I spent my Sundays in the church nursery. Mothers and grandmothers had been telling me I had a gift and giving me and Matt meaningful looks for years.

For all the time I’d spent agonizing over my possible career, whether I even wanted it, what it would look like if I had one, I’d never questioned motherhood, not for myself. I didn’t know to fear infertility until it happened to me. What just and merciful God could deny me (me!) a baby?

I had done everything right. I’d found a man I knew would be a good dad and married him. I’d started early, before any of my friends. I’d taken care of myself. I’d learned everything I could learn about birth and babies. I had shaped and moved everything in my control my whole adult life to make room for a family. I didn’t want to ask for help. I didn’t want to need it. I wanted to get pregnant the good old-fashioned way and give birth at home. But it didn’t happen.

And Rachel saw that she had borne no children to Jacob, and Rachel was jealous of her sister, and she said to Jacob, “Give me sons, for if you don’t, I’m a dead woman!” And Jacob was incensed with Rachel, and he said, “Am I instead of God, Who has denied you fruit of the womb?”

Acquaintances, women on TV, teenage girls were getting pregnant every day. Women with successful careers were struggling to balance all the blessings in their lives. And I sat empty-handed. Why? I daydreamed one of them would leave a baby on my doorstep, like in a Victorian novel. I searched adoption websites, but I couldn’t face the paperwork, the waiting lists, the years of continued uncertainty I found there. And I couldn’t quite give up longing for my own baby, my own pregnancy, my own birth.

All this time, I was keeping my infertility a secret. I didn’t even tell my mom what I was going through for months. I had always heard that you don’t tell the world about any expectations for a baby until it’s a pretty sure thing, at least twelve weeks into pregnancy. And I was far from that, so I kept quiet. Also, job security is not a thing for graduate students, and much depends on projecting confidence and enthusiasm. The handful of friends I did tell about my trials were just as puzzled and powerless as I was.

For all the books I’d collected about birth, the only book on my shelf to treat infertility as a major theme was the Bible. I was surprised, and a little bit relieved, when I turned back to it to see that the barren matriarchs of the Old Testament didn’t suffer their affliction in silence. But it was hard to take comfort from their stories.

And Reuben went out during the wheat harvest and found mandrakes in the field and brought them to Leah his mother. And Rachel said to Leah, “Give me, pray, some of the mandrakes of your son.”

Sarah, Rachel, and even Leah offer up slave girls to bear children in their places. But in no case does it end their longing to have babies themselves. Rachel’s slave, Bilhah, bears Jacob two sons. But Rachel still suffers. She asks Leah to give her mandrakes, a plant believed to stimulate fertility, in exchange for access to Jacob. It doesn’t work. With renewed access to Jacob, Leah has two more sons and a daughter, while Rachel remains childless.

On our three-year wedding anniversary, Matt and I went to the fertility doctor’s office. We took a battery of tests: blood tests, ultrasounds, sperm analysis, ovarian reserve testing. But nothing appeared to be wrong. There was no clear problem to fix.

So we moved on to intrauterine insemination. A first cycle failed, then a second. I celebrated my thirtieth birthday and the end of another school year. We did a third cycle. I got my period again.

When I went into the doctor’s office to prep for a fourth cycle, I broke down. I didn’t know what I was doing with my life. I felt like I was treading water and running out of breath. I couldn’t go on much longer, but if I stopped, I would drown. My doctor heard me out without interrupting. Then she said, “Do you want to move on to IVF this cycle? We can start today.” And I said “Yes.”

This might sound like an act of taking control, but it felt like an act of surrender, like giving over the keys to my body and letting someone else drive.

And God remembered Rachel and God heard her and He opened her womb.

The next couple of weeks were a blur of visits to the doctor’s office and the specialty pharmacy. I gave myself daily injections of follicle-stimulating hormone and watched in the ultrasound as my ovaries got bigger and bigger, laden with maturing eggs. When my doctor gave the word, I gave myself a final injection to trigger ovulation, and thirty-six hours later went in for the retrieval.

We got thirty-four eggs. Of those, twenty-four fertilized. Three days later, most of the embryos were still growing. We had an embarrassment of riches. But the real test was to come on day five, when embryos either stop developing or form blastocysts, that is, lumpy, thin-walled, spheres that are the first step toward a fetal human form.

Day five came and went and the lab didn’t call me. The phone finally rang on day six, but when I asked what was happening, the lab tech took a long pause. In my mind, all twenty-four of my babies were dead and I was barren again. But it wasn’t quite that bad. One passable blastocyst had formed on the fifth day, and another, somewhat wonkier, had followed on the sixth. The lab had frozen both embryos. These would become my babies.

And she conceived and bore a son, and she said, “God has taken away my shame.”

The moral of this story is no easier for me to discern than the stories of Sarah or Rachel. Fertility is and always has been a science of imponderables shrouded in shame. A wise woman once told me that you really don’t know what you will do to have a baby, save a baby, or preserve a life, until you find yourself at the moment of decision. And most couples face these decisions in utmost privacy. They suffer in silence and consult doctors in shame.

By taking eggs out of my body and fertilizing them in the lab, we were able to shine a light on what was happening all those other months in darkness. The fact that so many of our embryos stopped developing between day three and day five suggested to my doctor that there was something wrong with the cytoplasm in my eggs. She gently sought to manage our expectations for the embryo transfer, and, if neither of these embryos implanted, urged us to consider egg donation. My sister was ready to give her eggs if I needed them. But as it was, we didn’t; we’d found two needles in the haystack. Even the wonky one made it, and I had twins.

We were lucky. Many women go through rounds and rounds of IVF, spending tens of thousands of dollars, and putting their bodies through hell for months on end. Many get pregnant only to lose babies and try again. This is, in some sense, a choice. But it is more like the choice a cancer patient faces between another round of chemo or the spread of cancer in her body than the choice a homeowner makes to spend all his money on a kitchen remodel. What is money, risk, and suffering as a price for life?

This doesn’t mean we have to take the logic of medical intervention in fertility to any and all extremes. It doesn’t mean we shouldn’t think about the cost, emotional, physical, and financial, of fertility treatments, the fate of embryos in freezers, or the ethics of egg donation, sperm donation, genetic diagnosis, embryo selection, and surrogacy. But as we think about those things, we should recognize the basic, irreducible, human longing that is at play here and treat it with respect.

Infertility is more common than you might think. An estimated one in eight couples trying to have a baby fail to conceive in the first year. This number goes up to one in five when the woman turns thirty. And the longer a couple tries without success, the lower their chances fall. Infertility is linked to high rates of anxiety and depression. It wreaks havoc on marriages and drives wedges between friends. It is profoundly isolating. It feels like failure. It is a heavy cross to bear.

Having twins, I didn’t get the low-risk home birth with a midwife I’d dreamed of in my youth. My pregnancy was medically managed from beginning to end. But I did go deep into myself, suffer something beautiful, and come out humbler and wiser, babes in arms. I now have two beautiful, naughty, brilliant girls. They are no less real, no less human, independent, and surprising for having been conceived in the lab. And I have no lingering doubts about whether I’ve earned full entry into motherhood, even if I’ve never gotten pregnant or given birth from the comfort of home.

The presence of a doctor in the birth room, or even in the bedroom, so to speak, is not the absence of God. No human being, surgeon or midwife, no mother, father, or fertility specialist, can bring a child into the world at will. The origin of each little life remains mysterious, a gift given rather than earned.