“Pain and blood and all the rest, you’d better get used to it if you’re going to give birth.” This was Stef, my ob/gyn. The same man who explained amniotic fluid as being “like a golden shower, but on the inside.” He also told me that, although birth is painful, half of all new mothers say they would do it again within an hour of giving birth; the remainder follow suit within the week.

I beg to differ. It was at least three weeks before I thought I could do that again.

My labor began, as so many of life’s great moments do, with an argument in a Mexican restaurant; specifically, a place called ‘Julep’s New York Mexican Restaurant,’ in Milan, Italy. This place served bar grub on white tablecloths while playing doo-wop at an uneasy volume. It was all very confusing. However, I am from Texas and therefore suffer a chemical dependence on Mexican food along with a tendency to elevate its quality and stature among world cuisines to disproportionate levels. This isn’t just my problem. Growing up in the (former) Nation of Texas, one inevitably develops a sort of state-level Stockholm syndrome when it comes to belief in the superiority of the things we taste and our taste in things. After all, we count putting sugar into iced tea and frying breaded steaks among our great cultural contributions. This may be why the rest of the country laughs at us.  That and the oversized belt buckles. Once, a wonderful, Texan friend of mine on a visit here dismissed Bottarga, ie dried caviar (a Sardinian delicacy grated in very small amounts onto fettuccini), as being not unlike ‘garbage’ or ‘cat food’—certainly not something that could hold a candle to pinto beans mushed up and then fried in pig’s lard, a staple of most Tex-Mex meals.

So there I am, a pregnant addict out with her husband, sampling the Franken-Mexican food of Julep’s (cucumber in flautas…why not?). And the conversation was not going well:

9,000 Euros for this Dragon School? Why? Because Monica Bellucci’s kids go there? She’s three years old, we’re paying them to play with her.

In English. We’re paying them to play with her in English. And Monica Bellucci’s kids go to Rome International, not St Georges. Besides, they have this whole curriculum of books they read and whatnot. And all of the schools basically cost that much.

Why can’t we just wait until kindergarten. It’s not even real school.

There won’t be any spaces by then. Anyway, when it’s kindergarten you’ll think of another reason it’s a bad idea, just like you’re doing now. You just want her to be Italian—cento per cento!

That’s not fair.

Well, you always say something is ok, and then come up with reasons we can’t do it. It drives me crazy. She’s never going to speak English; I should just accept it. By age five, I will no longer be able to communicate with my child. Have fun teaching her about menstruation.

That’s not true. She’s learning from us.

From me. And one person is not enough, as evinced by the fact that she, um, doesn’t speak English!? Ever. Even to me.

I speak English with her.

Maybe thirty percent of the time.

At least sixty.

Maybe twenty.

You can’t go do that.

What?

Go lower.

I was being generous the first time.

Marriage arguments are at once less scary and more frustrating than dating arguments. Less scary because there is little chance of either party walking out. More frustrating because there is little chance of either party walking out. The ‘her’ in question was our daughter, born almost three years ago and until now speaking almost exclusively in Italian.

Maybe it was the tension, or the way he said ‘Dragon School’ (emphasis on the Draaaagon), or maybe it was the fact that Julep’s, Milan’s New York City Mexican Doo Wop restaurant, didn’t bring me any tortillas with my fajitas, but by the end of that Friday dinner, my contractions were pulsing away every five minutes, steady as sonar.  I had been told these contractions would be ‘different’ than the Braxton-Hicks contractions very pregnant women experience leading up to birth.

Different, in this case, being the stand-in for “painful.” In birth discussions, there are a lot of stand-ins for painful. “Pressure” (pain); “cramping” (serious pain); “riding the waves” (not passing out from the pain.) The natural birth movement has even substituted the term contraction with the rather inexplicable term “rushes.” I can only imagine this is meant to convey the rush a laboring woman is in to have them stop. At least, the contractions themselves didn’t seem to be in any hurry. For my part, I would describe early contractions as swelling crotch gas—meaning they felt like bad gas pain, but in the crotch, and occurring in a distinctly soap bubble pattern: pulsing slowly outward to a shrill crescendo over the course of about forty seconds before bursting into their previous oblivion.

This was “pre-labor” the period during which the cervix thins out and opens to two of its ten centimeter goal. How does a baby’s head fit through a ten centimeter opening, you wonder. I was on my way to finding out. This first stage is supposed to take seven or eight hours or, in my case, thirty six. Might I add, thirty six non-sleeping hours, sixteen of them overnight. I would pass out for three or four minutes in the bed of our rented apartment in Milan only to be reawakened by the “pressure” (pain.)

We had been tooling around Milan for a couple of weeks at this point waiting for the baby to make his appearance. We’d been to every museum twice, including the boring ones, hoping that all the jostling would move things along. In Rome, no public hospital would allow a vaginal birth after a caesarean, and no private clinic was set up to perform an emergency c-section. The rather glorious Buzzi hospital in Milan, however, was prepared for us on both counts.

In the months leading up to childbirth I surfed the web, read books, and quizzed every mommy I knew about her “birth experience.” Two consistent themes surfaced:

  1. The majority of women, and particularly those who had done so recently, agreed that childbirth was extraordinarily painful. There was a strong correlation, in fact, between how recently someone had given birth and how terrible they said it was. New moms described it in ways like: “mind bending” “horribleHORRIBLEhorrible!” and “I thought I was going to die. Literally. Die.” Conversely, moms with several, apparently ameliorating, decades between themselves and their last birth were more apt to say “meh, it was bearable.” Bearable. I heard that word a lot. For the record, bearable should be taken as code for: “I did not die.” Vale, S’s wife, also an ob/gyn, put it in the most useful terms: “Just when I thought I couldn’t take it anymore, it was time to give birth.” That was the height of accuracy.
  2. Childbirth is extremely political. There was not a man, woman, or blog article out there without a shrill opinion on: c-sections, laboring techniques, episiotomies and, most pointedly, the epidural.

Oh, the poor epidural. A fairly simple, statistically very safe, procedure which has, in the past decade or so, become the bad boy of childbirth. The wimp’s way out. That thing that bad mommies do. Mothers who oppose it formulate in terms of a sort of sin; mother’s who had one as a sort of miracle. I did not get an epidural myself, but it was not for lack of begging.

What of the epidural? On its surface it is a spinal catheter which runs nerve-blocking painkillers to the lower body, erasing the elephantine agony of late labor contractions. In spite of it having been made the bogeyman by natural birth activists, the rate of complications with the epidural is exceedingly low. The most common side effect—a powerful and persistent headache—occurs in approximately one percent of cases. For other side effects, you have to dig in the point zero something percents—odds not unlike those of the myriad other things that can go wrong without it. There is some evidence that epidurals increase the likelihood of other interventions, but there is equally compelling evidence that they do not. And yet other evidence that, if they do, it is because they tend to be requested in more complicated deliveries. That epidurals have any significant impact on the baby is yet to be established by anything resembling science. However, given that upwards of forty percent of women receive them, it seems that, were there a big impact on nearly half the babies born, someone might have noticed.

The hippie birth activist I visited once, early in my first pregnancy, made it clear that, were I to receive an epidural, this would cause me to give birth to a zombie baby (technical term) who would be unable to nurse immediately after the birth. Thus failing to bond with me, my baby would be condemned to a future as a serial killer, or a cat food eater, or maybe Bukowski without the talent. Ok, she didn’t say that last part, but the rest she did. As evidence she played me a videocassette of a movie from the seventies where someone said this was all true…on tape!… followed by a woman nursing. A woman with a lot of underarm hair.

Speaking from my own experience: I was under heavy epidural anesthesia for my first delivery—a c-section—and my daughter came out howling like a wet cat and nursed successfully at the first opportunity. With my son–born au natural—the opposite was true.

Suffice it to say, I am not religious about the epidural. I don’t believe embracing the pain of delivery makes me or childbirth magical; nor do I believe that the epidural is the seventh wonder of the world. As S put it: “It’s a neat invention, if you want it.”

More interesting than the epidural, however, were the ways and reasons along which ranks broke in the debate over its use. Among the Americans, objections tended to issue from my beloved left-progressive corner. The same group likely to make you feel like a slug for using disposable diapers, or not breast feeding, or destroying your child’s health via juice box, could be counted on to be anti-epidural. My armchair anthropologist/Marxist-minded grad student wondered to herself: “Could this divide be reminiscent of the same wall thrown up between classes to differentiate between “us” and “them” since time immemorial?” For instance, when poor people starved, the wealthy embraced their plumper selves. When the masses labored on farms until their necks turned that fabled red, the nobles piled on snow white powder. In the Arab world, when poor women worked the fields with their hair necessarily uncovered, wealthier women wore hijab as a status symbol, not unlike early twentieth-century Americans wore white to evince their leisurely lifestyles; nowadays, when junk food fills out the waistlines of the hoi polloi, thin is suddenly in. The list goes on…

I therefore found myself wondering if ‘natural’ birth—doulas, midwives and home births (oh my!)—might be our new subconscious status symbols. Could the real shame of epidurals be not that they are a fearsome intervention, but simply that they are widely available? The Frankfurt School posited that when objects become available to the masses, they lose their mojo for the elite. Is it possible that part of the glory of midwives is that Betty Sue from the gas station can’t afford one? That she doesn’t have time to invest in natural birthing classes and will have to settle for a little dope if she can’t hack it? Is that what constitutes better this time around on the carousel?

These questions came up as I read Ina May’s (rather useless) Guide to Childbirth. Ok, let me preface that by saying there is something reassuring about page after page of women saying that natural birth is awesome and utterly doable. The second half, at least, is true. On the other hand, the horror stories it conjured of the alternative–insensible male doctors strapping laboring women on their backs in clinical white rooms, prior to doping them up and literally yanking the babies from between their legs–bore little resemblance to both my experience of a pleasantly autonomous birth in a hospital and the statistical reality of an ob/gyn specialization increasingly dominated by women. I saw a sum total of two men during my entire labor, one the anesthesiologist, the other my own, beloved ob/gyn. While the book, and others like it, did point out the need to bring down shamefully high c-section rates, no acknowledgment was given to what medical advances have done to bring down infant and maternal mortality rates, the latter of which, in some parts of the world, still reaches a devastating ten percent. Overlooking that particular accomplishment struck me as not a little disingenuous. Overall, I respect the movement’s aim of empowering women to make their own choices about birth (provided these choices line up with the movement’s ideals, of course); however, I thought it somewhat cruel when I read that the pain of childbirth is caused largely by one’s own fear (fault). I don’t doubt that tension makes it harder, but for the record I was not scared at any moment and it still hurt like the dickens.

But there’s a rub, and this only occurred to me after going through my laundry list of questions with my fellow moms at the local playground in Rome: Italian women of the same class and political attitude saw things completely differently. Almost to a one, these well-educated, liberal women recommended the epidural, even looked at me like I was smoking something when I suggested I might try to go without.

Q. What accounts for this ideological flip flop in a demographically similar group? Asked my intrepid anthropologist.

A. As far as I can tell, the Catholic Church. Specifically, the longstanding prohibition by the Catholic Church of epidurals in non-emergency situations in their big, fat, Italian hospitals.

Yes, the Catholic Church, much like the La Leche League (LLL) and its companion natural birth movement, considers the pain of childbearing a woman’s natural birth right.

How weird, that they would agree! You think.

Wrong.

LLL was founded by a group of Catholic ladies who thought women were getting too far from their breast feeding duties. What’s more, these same women were instrumental in starting the natural birth movement in the US. It was only later that Ina May and her more hippified cronies took the helm—and if you look closely at her book, you will see that spirituality peeks around the edges of her philosophy to a greater degree than does recent science. (Not that there’s anything wrong with that.)  On the other hand, for Italian women, the natural birth movement was never about feminist uprising. In the land of Catholicism, this pro-traditional stance was always dominant. The epidural itself was the insurrection.

It’s now been a month since the birth. The memory is fading as nature probably ordained. It was an unusual birth. In the worst of it, I recall a few things that probably won’t fade. That when the contractions became truly immense I could not broker noise or movement. Ina May’s tales of women dancing around and making out with their husbands suddenly seemed as likely as finding a cottage made of twinkies in the woods. In order to not succumb to the magnitude of the pain I had to close my eyes, stare deep inside myself and count. What I saw in there was more or less the unblinking Eye of Sauron. Held hostage, I negotiated with the pain, but it was as if I were negotiating not with the criminal but with the cell itself, a deaf dumb space unresponsive to my pleading.  Earlier in the day, when my contractions were ‘manageable,’ (meaning I could still hobble around between them) the nurses had walked me to the birth hall and I’d heard howling which, for a split second, brought to mind the mass slaughter of peacocks. The nurses looked at each other knowingly as it dawned on me that this was the place I was heading. Not the location, but the physical place.

“I think I want to go back to my room now,” I’d whimpered.

It was not as if I had never experienced serious pain before. The inner ear infections which visited me with an unforgiving frequency in childhood were no small matter, leaving me feeling for hours as if part of my head was about to erupt in a fireblind hell. My grandmother would blow smoke into my ear, which, no matter how you might quail as politically correct anti-smokers, worked, if temporarily. A tooth infection in Doha, which ended in a comparatively blissful root canal, had me threatening to hurl myself from our tiny, pigeon-scat-covered balcony. And in truth the pain of childbirth, on the elevator of agony, was several floors down from those experiences, and yet not so far removed.

It all really got going after they broke my water. The all-consuming ‘surges’ came accompanied by feverishness and some vomiting. “That’s good, said the nurse, it means you are really progressing.”

Oh, wow, great. I thought. Vomiting = Progress.

“I don’t think I can do this,” I gasped. She placed a hand on my forehead and with perhaps the kindest look I have ever seen in anyone’s eyes replied: “You can do this, cara.” The subtext being: “You have no choice.” ”This” was going to get done.

What neither of us knew was that my labor was proceeding at an extremely unusual speed. That pre-labor that lasted about a day and half too long was matched by an active labor which was equally brief. Active labor, the transition from two centimeters to birth, is supposed to happen over another eight hours, during which time your body releases some measure of mitigating endorphins. In my case, this stage went by in ninety minutes, with no time for amelioration, natural or otherwise.

Most of the ninety minutes were spent sitting, perched on a stool, legs akimbo, arms tense with the exertion of holding my upper body upright. It was a nice room, as places to suffer go, spacious, silent and blue, with windows open and a nice breeze filtering in. All of the accounts of women hanging out on birthing balls, sitting in tubs, attempting orgasmic births, seem absurd to me in retrospect. The labor of labor is coping with the pain. I did not want to dance with my husband—throttle him for getting me into this situation, perhaps, but dance, no.

We were alone in the room for most of it, my husband and I. I was on my stool, watching my belly convulse and grunting like a randy heifer when the pudgy little epidural man finally arrived. After being half carried to the birthing throne, the lady doctor reached in for a check while he laid out his instruments. Looking not a little alarmed, she turned and told my superhero to leave, then looked at me:

It’s time to start pushing.

I often wondered what would have happened if the anesthesiologist had gone for a coffee before coming to see me, because, unbeknownst to me, my body had already begun pushing the baby out–with noone there but me and G to enjoy it. On some level, I had sensed that what I was going through, perched on my stool, was too intense to be normal labor, but had reassured myself that every laboring mom must think it is too intense. So the top of my belly has begun to act like a wave pool–probably just more of that ‘progress.’

I would like to assure you that, no matter how long you have held in your pee on a long car trip, nothing in the world will prepare you for the relief of pushing out a baby. I yelled and yelled, but these were not the bovine grunts of the final round of contractions, these were screams of ecstasy, victory, relief, crossing the biggest finish life on offer in this life.

I’ll spare you the gory details of the next storm of pain which descended upon me, but let us just say that I reached down to bat the scissors out of the doctors hand–and she wasn’t snipping anything. Women refer to this as the “ring of fire.” You are free to look it up. I only wish to add that, when it’s over, it’s hardest of all to imagine the bliss of a lovely, crinkled new life being placed in your arms.

Women, no matter how good or bad their experience, categorically agree that in the end it is worth it. I totally agree.

That night, finally alone in my bed and in my body, my son removed for inspection and myself removed for a little rest after two days of crazy, I enjoyed a burger. I’m not a big meat eater, but as Stefano said, blood and pain is what it’s all about. I laid trembling for several, ecstatic hours and then slept, the hard work of motherhood awaiting me. Outside my window a stone angel on the adjacent church stood trumpeting in perpetuity. We all have our work to do.

When my lady friends ask me now what it was like, I don’t lie: By the time it feels like you can’t take it, it’s almost over. And shortly after that, it’s all worth it. World without end, amen. (And if you opt for the epidural—no judgment here.)