by Anissa Sartini LM, CPM
All names have been changed for privacy.
I first heard about Steph through my insurance biller. I knew she was from another state and had attempted an herbal abortion. When that did not succeed, she decided to give the child to her brother and his husband, who had longed to begin the next stage of their family. She would be staying with them for her third trimester through postpartum recovery.
I told my biller sure, pass my info along. I never did hear from them, so I didn’t give too much thought to it. But, months later, Steph called me. Soon after, we had our first prenatal visit scheduled at 29 weeks.
When I first met Steph, she had just gotten back from her travels, preferring life on the road to a standard one-place residence. Steph was loud, beautiful, with short thick black hair and covered in tattoos. Her strong and assertive energy greeted me; we bonded quickly and easily. She shared that she had been consistently very stressed, emotional, but excited to meet me and start care. Her blood pressure measured a little high, but we agreed to try some remedies and watch it closely. When that proved insufficient, we tried medication, which held us over for a while.
When my assistant and I greeted her at her 35 week visit, her swollen face, high blood pressure, +1 proteinuria, neurologic changes, and 26 pound weight gain hailed us with the very obvious information that her pregnancy had progressed to pre-eclampsia. We did a 24-hour urine test and referred her to a trusted OB. They confirmed what we knew and tried to keep her stable enough to birth at 38 weeks. However, at 37 weeks and 3 days, her symptoms let us know that baby needed to meet her new parents now.
I had met with Steph and kept in touch closely during this time. When the day of birth arrived, something told her she did not want to induce labor. Following her intuition and research, as surely as she knew she did not want this child for herself, she knew she did not want to subject herself or the baby to induction of labor. We discussed the risks and benefits of induction vs. cesarean. “It just seems wrong,” she maintained. “I’d rather have a cesarean. I just don’t feel right about an induction; I don’t think it will go well. I won’t do it.”
“So, I know you don’t ever want kids,” I told her at the end of this discussion. “One other benefit of getting a cesarean is that you can get your tubes tied at the same time.” “I CAN?!” She exclaimed. This was the happiest I had seen her her entire pregnancy. “Then I’m DEFINITELY getting a cesarean.”
We both felt comfortable with her thoroughly educated choice. Getting the hospital to cooperate, however, was another story. And this is where I learned the most.
When Steph was admitted for birth, her will shone as adamantly as ever. She declined induction without hesitation. And moreover, she refused to get a cesarean until a doctor agreed to ligate her tubes alongside the procedure for birth. The OB on shift refused. What if she changed her mind? This was only her first child! She waited undaunted and insisted somebody else be called. After some back and forth, the hospital contacted the next two on call obstetricians. One agreed, wisely acknowledging that a 35-year-old pre-eclamptic woman giving her only child up for adoption was probably quite certain that she never wanted to be pregnant again.
And so, she got it. I waited with her mother while her brother, the father-to-be, attended the birth with her. The child was healthy at exactly six pounds, despite the very sickly appearance of the placenta. This reinforced Steph’s decision after the fact, feeling that perhaps the baby and placenta would not have fared well through the force of induction. The baby is now enjoying life with her two doting fathers, who plan to give her siblings in a few years.
Today, Steph is gleefully child-free, and is thoroughly grateful to have transitioned to Aunt.
As a midwife and a human being, I have always held choice in the highest regard. Force or coercion is never a real choice, and whatever comes from it will not feel empowering. Many of my clients have been forced or coerced into a cesarean. I have seen many times the joy and power that comes with choosing a home birth. Seeing the empowerment of birth in another context struck me, as well. Although it was not her first choice, Steph stood up for the back up plan that she knew was right for her.
It was an honor to stand by Steph as she stood resolute until she received the care she needed. Steph thanked me many times for helping her through what she looks back on as one of the hardest times of her life. I am grateful likewise to Steph. She showed us all a perfect balance of the self and the other: she got the care she needed and desired, all to deliver this baby as a gift to another set of parents. I think on Steph’s determination and giving spirit often, and use her story as an example of empowerment to my other home birth clients.
Anissa Sartini is a CPM LM with a home birth practice in Dallas-Fort Worth. She and they are her favorite pronouns. She is queer, hard of hearing, and of Mediterranean ancestry. Her favorite thing about being a midwife is serving families across class, race, gender, sexuality, and relationship structures.