Baby's Day Out

Elizabeth Vick knew that the contractions she'd been having for the last month were normal. The official name for them is "Braxton Hicks," after the nineteenth-century doctor who first recorded the intermittent uterine spasms that often accompany the final trimester of pregnancy. But Elizabeth liked to think of the involuntary cramps as "baby hugs," a more maternal-sounding term that she'd picked up from an online forum, one evoking an image of two little infant arms giving reassuring squeezes to her womb. Photos pasted in a journal charted the growth of her belly month by month as it ballooned from the center of her 95-pound frame like a prize pumpkin.

A lithe twenty-year-old, Elizabeth felt little anxiety about the impending labor, a rarity for a woman carrying her first child. She had researched and detailed every aspect of the birth until it played like a home video through her mind. But her mental footage didn't include shots of a maternity ward: Her plan was to give birth in the bedroom of an apartment she shared with her husband in rural Douglas County. The birthing tub had already been inflated and inspected for leaks. Towels and a plastic bucket were laid out to sop up water and other fluids. A blanket was at the ready for swaddling. They even had string and clean scissors on hand to cut the umbilical cord.

Still, this birth would be remarkable not for what the parents had, but for what they lacked: experts. Elizabeth and her husband fully intended to deliver the baby themselves, without a doctor or midwife within twenty miles. Even the landlords who lived upstairs had no idea what their tenants were planning below.



A Clear Road to Birth by Judy Seaman
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(Warning: contains graphic content)

While scouring dozens of alternative birthing books and as many websites, Elizabeth had come upon the concept of unassisted childbirth -- or "freebirthing," as it's known to the thousands of female devotees who've adopted this simple but radical approach. She found special inspiration in the writings of Laura Shanley, a Boulder woman who'd been Elizabeth's age when she'd had her first unassisted birth almost thirty years ago, with the support of her husband but against the wishes of the rest of her family.

One morning in January, Elizabeth woke up with a happy feeling. She asked her husband to stay home from work that day.

"Why?" Jason asked.

"The hugs," she replied. "They're getting pretty intense."

So I decided that with my next birth, I was going to give birth standing up over this little plastic baby bathtub," Laura Shanley says. "And I was going to catch him myself."

Sounds of awe and disbelief rise from the twelve women gathered in the upstairs room of a west Denver church. This is a meeting of the local chapter of the International Cesarean Awareness Network, a nonprofit that aims to reduce the national rate of C-sections, which has surged in recent years to a whopping 30 percent. Unlike Laura, most of the mothers gathered here sport five-inch-long scars on their abdomens. Some have avoided surgery in subsequent births by having a VBAC (Vaginal Birth After Cesarean) at home with a midwife or in one of the few hospitals that allow the procedure. Only a couple of the women have heard of unassisted childbirth, and Shanley's presentation is opening everyone's eyes. Very wide.

"And that's when my water bag broke," she says, now describing the birth of her second child. "I really was not in pain. And then his foot came out and he was wiggling his toes around." The baby, she realized, was traveling the birth canal upside down. "And I said to my husband, 'What do I do, do I call an ambulance?'"

If they had called 911, Laura would undoubtedly have undergone a C-section for her breech baby. Instead, she employed her self-taught birthing techniques, remaining calm and trying to erase all the fear in her mind through positive "life affirmations."

"And little by little, his foot came out and his other foot popped out, and meanwhile I just wasn't doing anything. I did nothing," she says. Finally, she pulled the leg gently, gave a small push, and out slid the baby into the world. (Twenty-six-year-old Will Shanley now works at the Denver Post as a reporter for the business section.)

The stories of all five of Laura Shanley's unassisted births have a similar serenity. In contrast to most women, who describe labor as the most painful, lengthy episode of their lives, Shanley says that her deliveries involved little to no pain and only a few hours. Her 1994 book, Unassisted Childbirth, is based on her own observations; she has no formal training in gynecology or obstetrics. But since the death two years ago of spiritual midwifery proponent Jeanine Parvati Baker, who coined the term "freebirthing" in the mid-'80s, to replace the amateurish "DIY childbirth" -- Laura is considered the foremost authority on unassisted childbirth.

Every month, over 40,000 viewers visit Shanley's website, www.unassistedchildbirth.com, which appears on the front page of a Google search for "childbirth." Her site and a dozen others cater to a small but growing number of women who are bypassing the catalogue of obstetricians, nurses, osteopaths, doulas, midwives -- the birthing industry from its most formal to what's known as "natural" -- by conducting their labors without any help from professionals. Births become independent affairs, coached only by a husband or significant other, or endeavored completely alone.

Shanley's voice is powerful with intent as she delivers an hour-long, stream-of-consciousness lecture about her life's work. Bouncing babies on knees and assisting toddlers with crayons, the ICAN mothers listen politely as Shanley talks about how childbirth is inherently safe and painless, but society has turned the natural process into a sinister medical event.

"So I do believe that you are given a baby and you are also given the knowledge of how to birth that baby. And I don't think it has to be this deep, dark, mysterious process," she says, explaining that birth, like sex, is a natural bodily function and even involves the same sensitive organs. "How do you know when to push? To me it isn't any more mysterious than how to know when to thrust when having sex. You just do what feels right for you."

The prospect of eschewing even the most basic prenatal care -- as Shanley did with each of her pregnancies -- makes a few of the mothers uncomfortable. Shanley's husband, David, sits in a chair next to her, his gray ponytail bobbing as he nods approvingly at several points in his wife's speech. It was David who first introduced Laura to the concept of giving birth without an attendant, back when she was a freshman at the University of Colorado at Boulder.

David Shanley had always been interested in how the mind affects the body, and had read the book Childbirth Without Fear, written by English obstetrician Grantly Dick-Read in 1942. Dick-Read, who's credited with founding the natural childbirth movement, had noticed how women who felt inhibited during labor often had difficult births. He associated this with the fight-or-flight response in humans, a reaction that causes them to pant and sweat when confronted with a threat or fear.

"When you're afraid and you turn white, it's because you're telling your body 'danger,' and your body is taking your blood and oxygen and diverting it into your arms and legs to fight or run," Laura says, adding that the same thing can occur to a woman during birth. "So what happens to a frightened woman in labor is that her uterus is literally white, and it doesn't have the fuel it needs." This fear can be triggered by an unfamiliar maternity ward, or doctors or nurses performing uncomfortable procedures.

It's like you're having sex and someone knocks on the door, she explains, "or comes in and says, 'What's your Social Security number?'" It's a moment-killer, as they say, and blood flows away from the organs.

The theory of birth pain as a psychosomatic construction had a huge influence on Laura. "It made so much sense to me," she says. "Here is this thing that is insuring the continuation of the race, and it's going to be fraught with peril. What kind of sense does that make?"

When Laura became pregnant with her first child, the couple initially considered getting a midwife. Laura came from a medical family; her father was a doctor and past president of the American College of Rheumatology, her mother did medical research, and her sister is a labor and delivery nurse. Still, she says, she "was always terrified of doctors growing up. I never looked at doctors as someone who was going to save me." And even though she insists she's not anti-doctor or even anti-midwife, she decided she didn't need medical help with her birth. "It was like, 'You know what? Let's just do it ourselves,'" Laura remembers.

While in labor with her first child, Laura meditated and got so "within herself" that she almost forgot they'd invited a bunch of friends over to witness the birth, including a filmmaker from CU. Her body was telling her not to let anyone touch her. She felt like a wild animal. When she sensed the baby's head was emerging, she walked over to the bed and gave birth on her hands and knees rather than on her back. The filmmaker didn't even have time to turn on the camera.

After that, Laura decided that she should give birth completely alone. "I just realized that to bring anyone else into the room would alter the process," she says.

Fifteen years later, she published Unassisted Childbirth. Though the book continues to sell modestly, Laura says she's not interested in pushing freebirthing to greater mainstream acceptance. And even among practitioners of natural childbirth, who strive to avoid the epidurals and labor-inducing drugs so common in modern maternity wards, the undertaking is regarded as controversial.

But for Laura Shanley and like-minded women, unassisted birth is the logical next step in natural childbirth, making it even more natural. Although exact figures are hard to come by, some proponents estimate the number of intentional unassisted births in North America at around 5,000 a year -- still a minuscule amount given the United States' annual birth rate of 4 million.

As a community, freebirthers are generally distrustful of formality and standardization, attributes they associate with the cold, assembly-line drive of corporate hospitals. These women prefer to communicate through informal networks on the Internet, where their conversation is punctuated by the radical rhetoric of motherhood empowerment.

"I don't really like anybody telling me what to do," Laura Shanley admits. "So I really shy away from rules."

Elizabeth Vick was raised in Colorado Springs, where she and her five siblings were home-schooled by their mother, Jackie Leingang, a nurse.

Her third child displayed an ethical certitude by the time she was fifteen, Jackie recalls, when Elizabeth stridently refused to see a movie with her cousins because of sexually suggestive scenes. "She's quiet and analytical, but her personality is very black-and-white," says Jackie, who recently returned to work after twelve years of home-schooling. "When she had a conviction in her heart, she never was really afraid to say it when pressed for an answer."

Elizabeth's family regularly hosted small church gatherings in their modest home. Jason Vick, an Alabama transplant, met Elizabeth at one of them. As devout Messianic Jews, believers in a theology that conjoins New Testament teachings with Jewish doctrine, Jason and Elizabeth shared common spiritual and moral expectations.

Their courtship lasted two years. Elizabeth enrolled at the University of Northern Colorado, then dropped out to get married. After many months of trying, she became pregnant last May. The couple moved out of their apartment in Colorado Springs and found a nice one-bedroom place on some ranchland nestled amid the plateaus and brush near Larkspur. Here they could enjoy the outdoors, and Jason could still commute to his IT job in Denver.

Elizabeth knew she wanted a natural birth without anesthesia or labor-inducing drugs, an ideal she thought would be difficult to maintain if she had her baby in a formalized medical environment. She was surfing online when she came on a Yahoo group devoted to unassisted childbirth. "Women have been giving birth for thousands of years in an intimate way and a private way. It's totally a natural experience," she says. "In this Yahoo group right now, there's like 700 ladies in it. Like it's not just something like a dumb idea -- it could happen."

The more she read about unassisted childbirth, the more it appealed to her. "I've heard way too many stories of women saying, 'I hated my experience of having my birth in the hospital. Don't ever do it if you can help it. You'll hate it,'" she says.

At her mother's behest, Elizabeth contacted a midwife in Colorado Springs. The midwife seemed nice, but Elizabeth was not impressed. "I was like, 'What are you going to do? Take my temperature?' Midwives don't have ultrasounds or anything, so what are you going to see that I can't tell from my own body?" she remembers. "Women should know if something's not right. The [midwives] didn't show me what they could do that I couldn't do for myself.

"Because midwives...I don't know. They all come with an attitude like, 'You'll do it my way, and if I don't feel it's safe for liability reasons, then we'll go to the hospital.' And I just didn't want to deal with that."

Her decision to have the baby at home was influenced less by her dislike of the hospital environment -- which she considers unpersonable and autocratic -- than her concern that labor could slide into a sequence of events that would end with the use of forceps or surgery to extract the baby. She'd read about the record rate of C-sections, and also about the shots and vaccines mandatory for newborns at hospitals. "I just felt in the hospital setting, you'd really have less control over things that I know are best for me and my baby," she says. "I just did not want to have to deal with any of that if I didn't have to."

The fact that 99 percent of all babies in Colorado are birthed in hospitals only fueled her determination. "I've never been that kind of person to go with the flow of society just because the medical or political establishment says it's the right thing," Elizabeth explains. "My husband, too. We like to find things out and research them for ourselves and see why."

Over the next few weeks, Elizabeth and Jason read up on everything they'd need to know to deliver at home, "to see if this is something that's smart or a dumb idea," Elizabeth remembers. Though Jason wasn't as into the natural stuff as his wife was, he supported her decision and studied female anatomy so that he could help in case of an emergency. By the end of July, they'd decided to go with a freebirth.

The next step: telling Elizabeth's mother.

With out-of-hospital births, it's the unintended scenarios that get the publicity. During the December blizzard, paramedics in Fort Collins had to use snowmobiles and a front-end loader to help three women who'd gone into labor.

A couple of years earlier, a 911 dispatcher in Denver had to coach a teenager through the birth process when the baby's father and firefighters failed to arrive in time. "You were there when I couldn't be," the father told the dispatcher afterward. "Even if I was there, I couldn't have done anything."

Some of the situations are more tragic. In February, eighteen-year-old Addie Kubisiak was arrested after a newborn's body was found in the ceiling panel of her Western State College dorm room. But the first-degree murder charges were dropped after it was determined that the baby, who'd been born in Kubisiak's car as she drove from her home in Parker, had been stillborn. Sensational stories of abandoned newborns regularly reveal women giving birth in all types of bizarre locations: seedy motels, prison cells, nightclub restrooms, movie theaters, alleys.

But though such episodes run high with peril and drama, they do not represent the average home birth. They do not represent official home births at all.

Since 1989, when Colorado's health department began collecting data on birth attendants and delivery locations, the number of home births has steadily risen from under 400 annually to over 700 in 2005. The vast majority of those babies were delivered by the fifty midwives who are certified in Colorado. Statistics show that there are no greater rates of complications or death associated with assisted home birth.

Midwives aren't the only ones catching babies at home, though. That same year, 88 births were listed as being attended by the husband, 47 babies were delivered by the women themselves, and 90 labor assists were credited to "Other," a category that could include anyone from a relative to a taxi driver. While some of these out-of-hospital, non-midwife births can be attributed to accidents or were necessitated by poverty or geographic isolation, many were by choice.

Rixa Freeze, a doctoral student at the University of Iowa, is writing her thesis on the very unstructured freebirth movement. "By its very nature, there is no professionalism involved, because nobody's making money off of it," Freeze explains. "Nobody's advocating a necessity to become trained through an organization, because the whole idea is that this is not something that you need specialized training for -- because it's an inevitable, involuntary bodily function."

It may be an inevitable function, but childbirth is such a definitive moment in the lives of women that it can shape how they view the world and how they wish to present themselves as mothers and people. "A lot of women talk about unassisted birth as kind of being part of a larger paradigm shift in which they realize, 'Wait, we don't need to be slaves to authority figures,'" says Freeze, who delivered her daughter unassisted last fall. "We can take responsibility for our own life, become autonomous. Mothers know what's best for their children in all ways."

But the medical and legal communities do not necessarily agree with that philosophy, and many freebirthers operate in secrecy. Tips on how to avoid trouble with authorities fill the forum boards. Sometimes, freebirthers will obtain "shadow care" from doctors or midwives by visiting them for prenatal checkups without revealing that they have no intention of going to the hospital or calling the midwife once labor begins. Others avoid prenatal visits altogether, referring to them as "scare care" because they feel they'll be lectured or coerced into having a hospital birth.

And some keep it quiet for fear of bigger problems. In Nebraska, it is a misdemeanor for a husband to deliver his child in a non-emergency situation. And in 2005 in Florida, Mara McGlade had just delivered her second baby unassisted when she started hemorrhaging. She was taken to the hospital, where she died two days later. McGlade's mother-in-law and sister-in-law were convicted of practicing midwifery without a license and sentenced to two and a half years in prison last November.

"A lot of women don't even tell their family members that they did it unassisted," says Freeze. "Some will say they have a midwife, because they are their own midwife, and so it alleviates the fear of family members, and they feel like they're being semi-truthful. Some women actually never apply for birth certificates, or do it much, much later in the game. So even if you are actually looking at birth-certificate data, it's not very reliable."

Jenny Hatch, who runs a website devoted to unassisted childbirth, blames the medical community for pushing mothers to the fringe. As a Mormon, she hoped to have a big family with as many as twelve children -- but had a C-section for her second child. "It left me feeling very demoralized and afraid and concerned about having any more vaginal babies," Jenny says. Since most hospitals have policies against allowing VBACs -- sticking to the adage "once a Cesarean, always a Cesarean" -- she was looking at ten more surgeries.

"For those women who were not very educated with their first births, they kind of got railroaded into surgery with their first, and with their next baby, they are hitting this wall of opposition," she explains. "Unless you're highly educated and willing to take on the risk of an unassisted birth, you have no choice."

After fighting with doctors and nurses to allow her third child to be born vaginally, Jenny vowed that she would never deliver in the hospital again. Her husband, Paul, wasn't against the idea of a home birth, but his wife's insistence that they do it without even a doula or a midwife made him very uncomfortable.

"And that debate almost killed my marriage," Jenny says. "The birth issue has really taken us to the depths of our relationship. What Paul eventually came to was that it was my body and I was the one who had to give birth, and he supports my rights of self-determination to give birth how, where and when I feel comfortable."

So in 1996, they chose the upstairs bedroom of their townhome in Louisville as the site for the birth of their fourth child. The three-hour labor was so quick, and the eleven-pound boy arrived with such force, that the umbilical cord snapped and the baby wasn't breathing. Jenny was also hemorrhaging deep in her uterus. Emergency personnel were called, and baby and mother were taken away in separate ambulances. Both survived, but the family was shaken.

Still, that experience didn't stop the stay-at-home mom from continuing her freebirth activism. In 2001, she organized the second International Husband/Wife Homebirth Conference, with Shanley as the keynote speaker. The event drew about thirty families from as far away as Utah and California to Louisville, where they attended workshops and exchanged tips on unassisted birth. Having another freebirth themselves was still a tender subject for Jenny and Paul, but by the time Jenny got pregnant in 2002, her heart was settled.

"I decided I would rather die than go back to the hospital," she says. "If I end up dying during home birth, great, then it's my time to go. But I will not cave."

Their fifth child, Ben, was born at home successfully. Instead of lying on her back, Hatch chose to give birth standing in the yoga Goddess position, a kind of warrior squat with her arms raised at right angles.

By August, Elizabeth could envision her birth perfectly. "I want to surrender and let my body do what it needs to do. I want to open up with every rush that flows through me," mused the mother-in-waiting in her online journal. Her body would push, but her mind would not. "During transition I hope more than anything I will be calm and confident. I don't want to be afraid and go backwards or stay there, but I want to surrender completely."

When it came time, her body would push with unbelievable force. And then when the head began to crown, she would slow down with quick breaths while supporting the ring around the baby's head, to prevent tearing. She'd take it slow, wait for the next few contractions to get the shoulders out. "If the shoulders are stuck I'll get on my hands and knees and release them," she wrote. "The body should then pop out quite quickly into Jason's arms. He will slowly and gracefully bring the lil one up to the surface and onto my chest. Then after making sure the lil one is warm and content and I'm cleaned off, I want to lie in bed with my lil one and husband rejoicing in our Father over our special blessing together."

She posed lots of questions to her Yahoo group: about signs of a pre-term labor, post-partum hemorrhage, what herbs not to take - and, especially, what to tell her parents.

At first Jackie thought that her daughter might be open to at least having a midwife at the birth. "Especially for her first time," Jackie says. "And she read some really radical books -- and Elizabeth is a very radical personality. And I even said to my husband once, 'For the safety of our grandchild, we really should have a nurse/midwife on call.'" But every time she tried to bring it up, Elizabeth would change the subject.

Elizabeth felt that her mother was pushing her toward a choice she didn't want. "And I was like, 'Gosh, why do I have to go see a midwife? I don't have an illness. I'm pregnant,'" she recalls. "It's something most women go through. I'm not going to die if I don't go see a midwife right away."

Finally, in November, Jackie drove out to the ranch and the two sat down for a long mother-and-about-to-be-mother talk. Jackie grilled Elizabeth about every complication she could think of. If something went wrong, where would the couple be legally? Could they be charged with child abuse? And she quizzed Elizabeth about everything that might occur during a birth: hemorrhaging, a placenta that doesn't detach, the cord wrapped around the baby's neck. Elizabeth, armed with knowledge from midwifery books, had an answer for every query.

"My mom was totally blown away that I had all of this information," Elizabeth says. "I think that she respected that more, and she said, 'You know even more about it than I do. I believe that you can do this.' So she was definitely supportive of it toward the end."

Jackie remembers it differently.

"Finally, I had to remind myself that Elizabeth and Jason are together now, and though we may have all this experience and be willing to help, that it has to be something the husband and wife really want," Jackie says. "We have to respect that."

But Jackie had one last warning for her daughter. "I said to Elizabeth, 'I do want you to be careful about who you tell this to, because right now you have to have positive people around you if this is truly what you want to do. I'm probably not going to be able to talk to any of your aunts, who are all nurses, about this. Or your godfather, who is an emergency-room doctor, who would think we are negligent.'"

Jason and Elizabeth made the decision not to call either set of parents until after the birth was complete -- partly because they didn't want them to worry, partly because they didn't necessarily want Jackie showing up at their door to help.

Last year, Tracy Ryan opened Mountain Midwifery Center, the state's only licensed freestanding birth center. Over the past eight months, the Englewood facility has overseen 63 births. Seventeen more babies are due this month.

In 80 percent of all births, everything goes fine and the kids come out healthy. It's the other 20 percent that Ryan worries about. "You know, if I had an 80 percent chance of winning the lottery, I'd buy a ticket," she says. "But this is not the lottery we're talking about; we're talking about your kiddo's life. And when things go bad, they tend to go bad really quick. And usually not just one thing: The baby doesn't breathe and the mother is bleeding badly. It gets hairy and scary."

Mountain Midwifery is located across the street from Swedish Medical Center; Ryan says they take mothers to the hospital about 15 percent of the time. Insurance covers such trips, because the $1,800 birth-center fee is a lot cheaper than the $6,000 the hospital charges as its facility fee.

Ryan has counseled women who are planning on unassisted childbirths, particularly on the risks involved in such births, and she always states right away that she will not be able to help if things go wrong. "Do not call me during unassisted birth," she'll say. "I cannot help you. Call 911."

Although Ryan has tried to smooth the birth process at Mountain Midwifery, she's still uncomfortable with the idea of unassisted birth. "It's absolutely true that women have been giving birth throughout time unassisted. And babies have been dying, too," she says. "If you want to get totally natural about it, death is natural, too. So a very small number of babies and mothers will die, and that's totally natural. But in our especially litigious society, I'm always afraid of the extremes of both sides of the pendulum."

Dr. Michael Hall, who has a private practice in Englewood, has been a obstetrician for thirty years. He has testified as an expert witness in many cases of alleged medical malpractice -- for both plaintiffs and defendants. Though he says he's never heard of the unassisted childbirth movement, he's dealt with cases in the emergency room when homebirths haven't gone well.

"We're there to pick up the problems," he says. "Anyone can deliver a baby. You could deliver the baby, paramedics could deliver the baby -- anyone can deliver a baby, and most of them do fine. But we're not looking at the ones that have no problems at all; we're there to assist the problems that occur." Complications occur in at least 10 to 20 percent of all deliveries, he notes.

"Look to the 1900s or before, and go back to the East Coast and look at the graveyards," Hall says. "You find hundreds of women and babies dying because of hemorrhage, primarily, and then because of postpartum depression. Now we have antibiotics. We have a lot of simple things that we take for granted nowadays, such as medications that assist with the contractions of the uterus after birth so that they don't hemorrhage to death. That's probably more important than the delivery of the baby -- the management of the placenta. And if it's not managed well, they die."

Though Hall is supportive of natural births -- his wife is a midwife -- many obstetricians are not. According to the guidelines of the American College of Obstetricians and Gynecologists, the organization "strongly opposes" any birth not performed inside a hospital. A spokesman for the ACOG has a one-word assessment of freebirth: "dangerous."

On January 25, the baby hugs were no longer playful. By four in the afternoon, they were so intense that Elizabeth had to cut short her planned walk down the road. By six, Jason was pressing on her lower back to alleviate the pressure of the baby's head pushing against her spine. Though she had no way to check, Elizabeth figured her dilation at that point was about three inches.

It felt good to keep moving around the house. She took a few showers, and the warm water did wonders to alleviate her pain. At eight that night, they filled the birthing tub and Elizabeth climbed in, wearing only a loose tank top. Immediately she felt more relaxed as the water eased the pressure. As each contraction came, she'd squat while Jason held her hands, and they'd look into each other's eyes. Hours passed. By midnight or 1 p.m., she wasn't sure of the time anymore, she could reach down between her legs and feel the baby's head poking out, with little wisps of hair on top.

Elizabeth tried to concentrate on her birth affirmations, but it was difficult. She was tired and she wanted the baby out. She didn't care if she woke the neighbors with her screams.

Even then, she knew she was "looking at life pessimistically, and it's so much in your mind," she says. "If you have a good mindset going into it, you're saying, 'With every contraction I have, it's getting me closer to the good thing' instead of 'Oh, I hate these contractions, not another one.' And that's what I regret doing in my mind. The more you embrace it, I guess, the more it will come."

Finally the head was fully out, but the shoulders were stuck. Elizabeth pushed hard and out the baby came, like a seal pup into the water. Jason grabbed the baby, a girl, and lifted it to Elizabeth's chest. They had already chosen a name. Now Ani breathed.

Elizabeth knew that it wouldn't be bad if they left the umbilical cord attached for a little while, at least until it stopped pulsating. A few minutes later, out came the placenta at the end of the cord like a deflated volleyball. Elizabeth couldn't believe how big it was. She put it in the bucket. The tub water was murky with blood and other fluids, and they noticed it getting darker red. Elizabeth was still bleeding.

She stood and climbed into the shower with Ani to rinse off so that she wouldn't drip blood on the carpet. Then she passed out. When she came to, she was lying flat on the living-room floor, wrapped in a sheet. Jason was running around the apartment frantically. Elizabeth saw that Ani was on the couch, wrapped in a towel -- Jason must have grabbed the baby when she blacked out. The placenta was in a bowl on a cushion next to the baby.

"Why are you freaking out?" Elizabeth asked Jason.

"We're going to the hospital," he answered.

She told him he was overreacting. She couldn't see that the sheet was becoming increasingly stained with blood. Jason thought she might be hemorrhaging. He was terrified. So he carried Elizabeth to the car, then went back for Ani and the placenta bowl. He sped along the dirt road to the interstate, then turned north, flying through the left lane, toward Sky Ridge Medical Center in Lone Tree. Drifting in and out of consciousness, Elizabeth looked over at Jason and saw that he was sobbing. It was the first time she had seen her husband cry.

Jason pulled up to the emergency lane, and the attendants came out with a wheelchair. Elizabeth was still swathed in her bloody sheet.

Nurses examined her first; they were calm and said there was nothing to worry about. Elizabeth had just torn a bit, and the blood loss wasn't dangerous yet. They put her on an IV. The relief that Elizabeth felt at being told she wasn't going to die was replaced with a deep disappointment that after all her planning, she'd still ended up in the hospital with her baby.

The nurses took Ani away to clean her up.

"Don't give her any shots!" Elizabeth screamed.

Once the nurses found out that the out-of-hospital birth wasn't a surprise but a planned, unassisted delivery, Elizabeth says, she could feel their scorn. As the doctor stitched her up, she told him that she knew she'd done it wrong. She'd pushed too hard when she should have waited. "I know what it was," she said. "It was my fault that I did this."

The doctor didn't seem judgmental. In fact, he seemed a little impressed that she'd given birth on her own.

And everything looked better when Ani was back in her arms.

Elizabeth and the baby stayed in the hospital for two days. "It was a really great time to be in the hospital, because you could just relax afterward," she admits. "Like recuperate."

Laura Shanley knows firsthand that not all unassisted births are successful. In 1984, her fourth baby was born two months premature while she was taking a bath. The child's skin was gray and it wasn't breathing. She breathed into the newborn boy's nose and it began to cry. Two hours later, he stopped breathing. David called the paramedics, but it was too late.

"If I were at the hospital, could they have saved him?" Laura asks rhetorically, while the women at the ICAN gathering listen, spellbound. Laura says that when she spoke to the coroner, he told her that the baby had congenital heart defects as well as other malformations and would likely have died regardless of medical attention.

"So I feel that some babies just don't make it," she says. "I did grieve that baby, but life went on. And I didn't look at it as a horrible tragedy. My other kids were one, three and five, and it was very stressful. And I think my body responded to the stress."

Three months after the birth, Elizabeth stands in her living room, bouncing Ani on her hip. She glows with pleasure in her child. She makes Ani's food from scratch.

Elizabeth still surfs the mothering and childbirth forum boards. Even with the complications, her unassisted birth was "definitely an awesome experience," she says. She feels like she has entered an exclusive club.

Still, she'd probably use a midwife next time. "Things didn't go the way that we had planned," she says. "We should've just known, because you can never expect what a birth is going to be like. You can read up on the subject as much as you want and feel that you know it..."

Ani's pacifier pops out of her mouth and lands on the carpet. Elizabeth stoops to pick it up and heads to the kitchen, where she washes it off in the sink.

"But until you've experienced it several times, just like a midwife experienced it several times, you just don't ever know. She would know you're bleeding because you're tearing, not that you're bleeding because you're hemorrhaging, and fix the tear rather than rushing to the hospital because you're bleeding."

Next month, she, Jason and Ani are moving to Idaho. They plan to eventually buy some land where they can raise sheep and a few more little Vicks, if God so blesses them. Elizabeth considers this for a moment.

Even if she has a midwife at the house, she wouldn't want the midwife to be in the room the whole time she's in labor. "Maybe," she says, "she would enter as soon as the baby is born to check on it."

Elizabeth's mother is relieved to hear the news.

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