Chapter 30: A Commune Couple

How would I describe them? Not shiftless, just idealists. Anarchist? Perhaps. Communists? No. But maybe Socialists. Hippies . . . that could fit, too. They were living in a community of sorts: four houses on one street, with vegetable gardens and chicken coops in between the houses—in the city. Faded jeans and unbleached diapers always hung on the lines above the chicken coops. There were usually kids playing a game of tag, running past us at the speed of lightning.

My husband and I had gone to a few of their neighborhood cookouts and once to a potluck wedding. The dozens of bicycle parts that had formerly littered the drive were miraculously all put away before the wedding. I can’t crack on that wedding. It sure was better than taking out a loan to get married in a dress she’d only wear once and paying for a caterer when the food they cooked was much tastier.

There is something to be said for living simply: no debt, no car or car repairs, no phone bills. They could and did go dumpster diving behind all the co-ops and bakeries and grocery chains and harvested all the food they needed for a week. Sure, the luxuries of life were absent, but they found hidden treasures in nature and other people. They made some good points in our conversations.

But when it came to babies, I drew sharp lines through some of their judgmental beliefs. To boycott all hospitals under all circumstances because they are part of a “materialistic, consumer-based conglomerate and perpetuate our capitalistic policies that only enable the rich and don’t serve the poor equally” was something I couldn’t agree with. But it was exactly what Juliette and Pierre had decided: they would do without “the system” entirely and live on the fringes at the edge of the rest of the population.

My first baby was born in a hospital but the other four were not. However, if something had gone wrong we would not have hesitated to transfer to a hospital. That’s what they are there for. There are countries all over the world where babies and mothers die every day because they don’t have the facilities we have. We had several conversations about our different views but they were not swayed by my arguments.

So when Juliette got pregnant, they looked for and found an unlicensed home-birth midwife who shared their worldview.

Then they asked me to be their doula. I hesitated. Did they have a plan B should they need to employ one? No. Did the midwife have any backup? No. If she needed it, what would she do? “Nothing” was the answer; they’d be on their own. They could show up at a hospital, according to her, but she would not come along. Oh, boy. I wasn’t sure I wanted to be part of this scenario.

We continued to talk and they grew on me slowly. They rented a birthing tub for their tiny room. They ate well enough and Juliette was gaining steadily. But then she told me that she had high blood pressure and a congenital kidney problem. Holy bleep!

I told them that I couldn’t be their doula unless they had a doctor backing them up. And she would have to find one before her eighth month. For me to be their doula and be her primary care provider at her home until we called her midwife, I would need to know that she had been screened and approved for a home birth. My scope of practice as a doula does not allow me to do blood pressure checks. I also required a plan B, a doctor who already knew her and who had hospital privileges should we need to transfer.

I didn’t hear from them for over a week. It was clear that they were battling between themselves over priorities versus idealism. Their relationship was not a committed until-death-do-us-part arrangement. She understood my concerns. He did not. He dug in his heels and did not want to budge.

I was worried. I was afraid they would “drop out,” even disappear, perhaps with Juliette having a possible fatal complication. It was not entirely farfetched on my part, knowing some of the medical issues and the personalities involved.

I had received a call a week earlier from a birthing clinic asking if I could consult on a breastfeeding problem they were seeing. The couple was from the same communal group as Pierre and Juliette. The issue was that he thought she should be able to skip drinking altogether until they could find a 100% pure reverse-osmosis water source and that they could get along just fine with just raw foods they “harvested” from around the city. It quickly became obvious that he was dictating or controlling everything she put into her mouth. It turned out she had not eaten that day and possibly not the day before. She was very thin and very pale, had not taken vitamins and as soon as I started prying a little further, she simply looked to him to answer. He then tried to assure me that he had studied nutrition and that we should respect their choices.

Their midwife, who had called me, felt that the baby was getting dehydrated and losing precious ounces that he should have been gaining by now. The father would not let us visit with her unless he was in the room. Both the midwife and I spoke to them rather firmly, hoping to wake him up a bit. Mom had already given up any autonomy she may have once possessed, though I doubt she ever had any, at least not since meeting him.

When I called the next day to see how they were, the phone had been disconnected. The midwife went out to their house and was told by their landlady that they had moved out that morning. They were gone. Vanished. We never heard from them again.

Juliette finally called me. She had been to a regular “establishment” doctor who, she said, cleared her for a home birth. Great! Her blood pressure and sugars were within normal range. The couple was delighted and wanted to proceed with their original plan, but as another week unfolded, things changed drastically. Juliette was sick, feeling horrible, and vomiting. She went back to the doctor and, as she edged near her eighth month, was put on several medications and a restricted diet in the hope of stabilizing both her kidney function and blood pressure. In spite of the ominous recent chain of events, her midwife told them it was still the better choice to have their baby at home.

They had scraped together the midwife’s fee by begging and borrowing from family and friends and selling an old car Pierre had fixed up. The midwife was officially hired. I knew they didn’t have any savings and offered to barter. Pierre, an accomplished carpenter, could suggest something he could build for my family in exchange for my doula services. Everyone was happy.

About six weeks before her guess date, Juliette called saying she was having horrible headaches and feeling really crummy. I insisted she return to the doctor and get checked out before it got any worse. She had been under a lot of stress, she admitted. Pierre was nowhere near ready for a baby. He wouldn’t pack up his tools or the mountains of junk that covered the floor of their tiny room. And though she had expressed the wish that they move their mattress onto the floor from its location on a platform built on stilts, which was too difficult to climb up and down in her eighth month, not to mention how she couldn’t do it after the baby was born, he was not doing any of it.

Juliette blamed herself for being so picky and cranky, but they weren’t really as “together” as she had hoped they would be, especially with their baby about to be born. I could only encourage her to keep the lines of communication open with him. In the end, I told her, she had to do what was right for her and her little one, even if Pierre didn’t agree.

The report from the doctor was not good. Her overall numbers were alarming. Her kidneys were being taxed and her blood pressure was too high. He strongly recommended that she check into the hospital that same day and be induced. He felt that her health could still recover after the delivery, though she was getting into a danger zone, and if she waited she might not come out of it without some permanent damage. He also emphasized that the baby’s health would be compromised, even at risk if she didn’t deliver soon, given the new developments.

Negotiations with their midwife went back and forth all that day. She was willing to help them should they choose to stay at home, but I made it very clear that I could no longer be part of the team then. She countered that her job description didn’t include being with them throughout the whole labor, which was why she had recommended they find a doula, even though they had paid her several thousand dollars. I told them again that hospitals are there precisely for their kind of situation and that I felt the doctor was on their side, committed to having a healthy baby and a healthy mother in the end. The battle had begun.

The cards were blatantly stacked against them. Her health might not recover if she didn’t deliver the baby soon, putting her at grave risk. I pointed out that her baby needed a mom and that although we would like to have control over our health and our births, it was not always possible. Welcome to parenthood.

I could not tell her what to do, but I could encourage her to think on her own, without Pierre going on and on about corporate greed and disregard for the poor and multi-billion-dollar facilities. He simply did not understand that her life was creeping closer and closer to a point of no return; her numbers were now that bad. I had never had a mother so ill in my thirty years of midwifery practice.

I told them to call me if I could do anything for them and tried to let go. I had not been so frustrated in a very long time. I said a prayer and made supper. Later that evening Juliette called to tell me that she had decided to go to the hospital and asked if I would be able to meet them there. I said I would be glad to.

I explained what induction meant and how that might be attempted five weeks before a due date. She had written a birth plan and we had talked about the numerous options she had for a home birth; now we tailored it for a hospital birth, including induction.

She wanted to have her baby as naturally as she could with as few interventions as possible. I outlined the various options the doctor had for induction, explained that some interventions were more invasive than others, and that she would have time to ask questions and could ask for privacy to decide what she wanted to do. Once she was settled in her room, the doctor suggested using a ripening agent placed at the cervix that would help get things started. Then they could start a small amount of Pitocin by morning and get her into active labor. The couple asked for some time to discuss it privately. While they talked, I went down to the coffee shop.

They called me on my cell phone a short time later to tell me that they had called their midwife for advice and she had warned them about what not to let the hospital do to Juliette under any circumstance and suggested some alternatives to try. I did not realize she was still influencing them and found it rather bold of her to be making decisions from some undisclosed location.

Pierre and Juliette decided to try a non-medicated approach instead of the ripening agent and opted for a balloon catheter to be placed so it would stretch the cervix open and hopefully trigger labor. By morning it had succeeded in getting the cervix to dilate slightly but not appreciably. The next suggestion was to try Pitocin and then perhaps break her water if the baby’s head came down further. Again the couple asked us to leave and talked it over, and as I suspected, again called the midwife who told them not to let them break the water under any circumstance. I had never seen anything like it. I did not understand their trust or devotion toward this woman. Even though I was a friend, somehow by being a licensed midwife and certified doula, they seemed to consider me as having gone over to the “other side” and I was deemed too medical or too swayed by “the system” to be consulted on how to stay on the natural side of things.

The nurses soon got the hang of how to approach this couple. Each step would require consultation, then consideration in private, then double-checking what I thought (but only after the midwife was called). Only then could the nurses and/or doctor come back in and negotiations would resume. I was beginning to feel like an international conflict-mediation envoy deliberating the politics of civil unrest. Many of the suggestions met with rejection as being too invasive or they simply felt that things were being unjustly and routinely rushed and asked for a few more hours of walking or sitting on the birth ball to let things work. I took to listing options for them from least to most invasive, knowing they would veto any and all suggestions unless their invisible midwife approved. I felt their midwife was calling the shots in a realm that was now outside her sphere of skill or experience.

The nurses started asking me to ask them thus and such, hoping I had more “say” because they realized they did not have any at all.

I do not go to any birth, at home or in a hospital, ready to do battle. I sincerely feel honored to be welcomed onto a birth team and readily defer first to Mom and her wishes and then follow her midwife’s lead. But this tug-of-war went on all night and all the next day. By evening I was called out to the nurses’ station and given an overview of the bigger picture. Baby was still doing remarkably well. Mom was okay—blood pressure and other numbers not off the charts yet. But it was time for the baby to be born. I asked what options they would propose next. Breaking her water was the least “medical” in their eyes and might speed labor up appreciably. I went back in and while slowly rubbing Juliette’s feet I told them what I had learned. I told them that they were doing great, that Baby was sounding really good and that she was actually making progress, which is not the same during an induction as it is in a term birth. They were not agreed between themselves what to do next.

Juliette was able to eat and drink and was doing okay. She had refused all IVs and meds up until that point. I knew they would continue to call their midwife whether I was there or not, and I was frankly at my wits’ end after forty-eight hours. I proposed I go home and sleep and that they try to rest, even if it was only dozing between the rushes. I hugged them each goodbye, assuring them I would be back within fifteen minutes if they wanted me.

I walked the short six blocks home from the hospital. I was so tired and drained that I just showered and cried until I got into bed.

I slept in and called the hospital once I was awake. The nurse told me that Juliette had just given birth to a healthy eight-pound girl. Their midwife had come in once she heard I had left, though they were instructed to say she was just a supportive friend. She helped them try different positions that helped the baby along and they were grateful.

Later that evening I called the couple and asked if I could visit. I congratulated them and told them how happy I was that they had been able to have the natural birth they wanted. She was nursing, which her baby took to right away. She was still five weeks early but was doing really well and did not have to go to the NICU. I was so glad all the drama was over.

Two days later I got a call from another woman who was living in their communal house. She reported that a public health nurse had come by to make sure the baby was doing well. She looked at the baby and voiced some concern about her color, that she seemed to look jaundiced and also appeared dehydrated.

Juliette and Pierre had read books on natural birth and said they had chosen to nurse on demand, meaning only when the baby awoke or fussed and asked for it. They had thrown out the doctor’s instructions for preemies in which he insisted they needed to wake the baby to eat every two to three hours until she reached her original due date. He had explained that their baby might act very sleepy and needed to be fed to catch up, whether she appeared interested or not. But they thought the doctor was just spewing routine medical jargon and that “nursing on demand” sounded more natural.

The baby came five weeks early. She was sleeping up to six hours at a time. She did not cry. The baby was in trouble.

The public health nurse took a blood sample and told them she would call back later that same day after she got the results of the tests. They dismissed the nurse as just another member of the “establishment,” turned off their cell phones, and went back to sleep.

Their baby did have seriously high readings for jaundice and she was in the danger zone for being dehydrated. When the nurse called both cell phone numbers over and over and no one answered she did what she felt she needed to do. She called Child Protection and explained her concerns, which were bordering on dire at that point. The baby had to be rehydrated immediately and under bilirubin lights right away.

A police car and an ambulance pulled up in front of the commune and I got another call. Later that night I went to the hospital and sat with Juliette for a while. She was nursing her baby in the NICU. The hospital gave her a room with a real bed so she could stay right there. She told me that she and Pierre just assumed newborns slept a lot and thought she would let them know when she was hungry. I explained again that preemies need an extra level of special care. She said, sounding surprised, “Oh. That is what the doctor kept telling us, too.” She was still pretty shaken by the whole experience and totally exhausted. She was going on day four without sleep. She also told me she had decided to stay in the hospital this time until everything was taken care of and they understood what they needed to do, even if Pierre didn’t agree.

I still see them from time to time. Luna looks too big for her tiny mama to be carrying her around anymore. She is very sturdy and has gained beautifully. Juliette is feeling well and taking care of herself. It was another example I could chock up to education. I still don’t know what I could have done differently. I wanted to respect them even when our values differed and I wanted to advocate as much as possible for her wishes. I did not feel at any time that it was my place to act as marriage counselor, either. They were two adults whose ideas were different from mine, which did not make mine better or more valid. I come away from experiences like these convinced we must, above all, respect each woman we work with and allow that their points of view may not be our own. But I have also learned that I must set my own boundaries and equally respect those. I am just very, very grateful everyone is okay.

 

 

 

“Giving birth should be your greatest achievement, not your greatest fear.”

~Jane Fraser Weideman