by ROBIN BERZIN, MD
Founder, CEO & Physician
JUNE 1, 2020
On February 20th at 7:44 am, I welcomed my baby Dachs into the world. The experience was not pretty, but it was beautiful.
I wanted a “natural birth.” To me that meant a vaginal delivery, not C-section. I cared about a vaginal birth for many reasons including the benefits to the baby’s long term health (microbiome, immunity), because C-section comes with higher risk of infection and other complications, and because a vaginal birth typically means a faster healing process for the mother.
“Natural” also meant I wanted an unmedicated birth, ideally avoiding unnecessary antibiotics, labor stimulants like Pitocin (a synthetic oxytocin) and even an epidural, which numbs the lower body and slows contractions, increasing rates of C-section.
Finally it meant creating an atmosphere of positivity, not fear, which is hard to do in the hospital setting where you are hooked up to monitors and where the focus is generally preventing the worst, not necessarily achieving the best, outcome.
However, as a physician I also went into my birth open to all of the above medical interventions if I needed them.
I felt zero guilt or shame around the idea that if I needed a C-section or pain killers there would be a good reason to have them. That’s why I elected to deliver in a hospital, not at home, with a private practice called Village OB, whose philosophy is to offer an experience akin to “home birth in the hospital” to women with uncomplicated pregnancies, and whose practice-wide C-section rates—20%—are far lower than the national average, which is of 33% across the board and closer to 50% in large sophisticated hospitals like New York Presbyterian and Mount Sinai Hospital, both of which my doctors and I trained in and the latter being where I delivered.
Why did I choose this? Every day at my practice, Parsley Health, I see the consequences of people’s early lives on their long term health. From C-sections and early antibiotics to lack of breast feeding and poor diets, what happens in those first few months and years does matter.
Children who are born via c-section for instance have a higher risk of obesity, asthma, allergies, food sensitivities, celiac disease, and Type 1 diabetes. Frequent antibiotic use as a child also leads to higher long term weight gain and obesity risk. Even maternal use of antibiotics during pregnancy leads to childhood weight gain, perhaps by permanently altering a baby’s metabolism and microbiome.
Of course, I wanted to set my child up for as healthy a life as possible, knowing he would inevitably someday eat processed foods, take medications and spend too much time looking at screens. That’s just the world we live in.
But having a “natural” birth has ironically become a rarity and in many cases a luxury. In the US, over 98% of births occur in a hospital and C-sections are happening too often than is good for us according to both ACOG, the American College of Obstetrics and Gynecologists, and the World Health organization. Again, nearly 33% of US births are via c-section, when the goal, per the WHO, should be 10%.
In fact the WHO recommends midwifery and homebirth as the safest form of delivery for uncomplicated pregnancies. In the Netherlands, one of the most sophisticated and modern countries in the world, over 40% of children are born at home or in a birthing center, not in the hospital. Dutch women have universal access to health care. They aren’t delivering at home because they have to. They are doing so because it’s safer and preferred.
In many ways we have medicalized pregnancy and childbirth here in the United States, confining it largely to the hospital, where time clocks and pressure from lawsuits have created very strict protocols around what’s considered “OK” and what’s not allowed during childbirth. The emphasis on safety and high level prenatal care is wonderful as a result.
But maximizing safety doesn’t always equal optimal outcomes or birth experiences. Rather it often results in too many surgeries, the overuse of medications, the pressure on providers to “keep things moving” versus letting birth occupy its natural time course, which doesn’t always conveniently align with hospital shifts, or even patient preferences.
In my case, the fact that I was able to deliver at a top tier hospital under the guidance of a small private two-physician practice committed to having the delivery I wanted, if at all possible, was truly a luxury.
I went into labor around 5 am, the contractions were close together almost right away. By 3pm they were 2-3 minutes apart and strong. My doctor, who knew I wanted to try to have a vaginal birth, asked me to come to the hospital to be checked. She felt there was a risk I was closer to delivering than we thought and she couldn’t be sure without seeing me.
Our doula met us at Mount Sinai. I could barely walk through the door during a contraction (a nice lady on the street saw me holding on to the pole supporting the entry awning, nearly crying, and said, “Breathe Mami, Breathe!’) Unfortunately I was only three centimeters dilated, so it wasn’t time to check in. If I wanted to have a natural birth, the best thing I could do in my doctor’s experience was to stay mobile and close to the hospital, but not be admitted right away, so we checked into a nearby hotel to continue labor.
My doula helped me breathe deeply through each contraction and showed me how to use an exercise ball in a variety of positions to support me. She taught my husband how to give counter pressure to my back and hips, and mainly, helped me mentally stay present with cues like, “Stay ahead of it, breathe low.” Each time I started to get anxious she looked me right in the eyes with total confidence and said “You’re OK. You can do this.”
Had my husband and I been by ourselves we would have convinced ourselves to go to hospital sooner, or worse, that something was wrong. Having someone experienced and confident with us to help us know that everything was normal and OK was invaluable.
We packed up around 9 pm to go back to the hospital. The contractions were lasting longer and coming in waves of three. I was at 6 centimeters, nowhere near the 10 centimeters I needed to start pushing. My doula, my husband and I resumed our teamwork, getting me to stay mentally above the physical pain so I could last longer without medication.
At one in the morning I was done. White flag raised. I was only at 7 centimeters, not ready to push, and was literally crying from the pain. I thought I was tough. I am tough, but I was hysterical and losing my ability to breathe through the contractions. We called my doctor and ordered the epidural. I was 100% sure it was what I needed at that moment and I had no regrets.
The night call anesthesia resident was a young guy in his late 20s with a buzz cut. He had no bedside manner. He was all speed, and that’s all I wanted.
“I’m going to inject lidocaine around the area, cool?” Cool.
“I’m going to insert the catheter through the dura surrounding your spinal cord, cool?” Cool. He was everything modern medicine should be. Efficient, exact, competent, well trained and by the book. The epidural was in 2 minutes and took effect 10 minutes later.
It turns out it was exactly what I needed. Relieving the pain let my body relax, and I dilated fully to 10 centimeters. I also dozed off from around 2am to 4am and got my energy up. When my doctor woke me up I was ready to push. My contractions had softened and spaced out but were still enough to move forward.
My doctors worked as a team, but they traded being on call every 12 hours. Even though she was “off” Dr. Worth came in before her shift in the office to help Dr. Mussalli with the delivery. At that point the baby had been in the birth canal some time, and they were up against a clock. The nursing staff watched the monitors closely for drops in the baby’s heart rate that would signal we needed to go to the operating room to get him out faster.
My doctors however were experienced enough to know we were still safe. The baby’s head was rotated slightly out of ideal alignment, so they had me push alternating between my side and my back. They also got out a mirror which they placed at the foot of the bed to show me how I needed to push to get his head out. The doctors and nurses coached me to “get angry” giving each push all I had. With my husband holding one leg, and my doula another, we got baby Dachs out in the nick of time, right before a C-section might have been needed.
Right before the last push, with his head nearly out, the pediatric team came in, and the hospital staff got ready to meet him. I looked at David in total disbelief – are you sure this is it? It’s happening, I asked him? I honestly thought we weren’t getting there and I was going to have a C-section, which I would have accepted, but would have made me sad having worked so hard to avoid it. I literally couldn’t believe it when one push later the doctor was placing him on my chest, skin to skin, flailing and already screaming at the world.
For me, my birth experience embodied everything I stand for at Parsley Health. We deserve doctors who know us, our story, our preferences and our goals and who honor them, while also working to help us stay safe and well. We deserve the best of both worlds—natural, minimally invasive approaches that for most people solve for most problems—with the option of the latest, cutting edge medicine when we really need it.
For me, laboring without medication for as long as I did meant my labor progressed enough that the epidural didn’t arrest the process too early, leading to a C-section. Also, having doctors who were dedicated to keeping me and my baby safe and pulling out all the stops and tactics to get the baby out without surgery (if possible) made all the difference.
At Parsley Health, the best of both worlds means recognizing that most people don’t need medication. You’re not having insomnia because you have an Ambien deficiency. You don’t have high blood sugar because of a Metformin deficiency. Rather, the right foods, exercise, stress management and supplements are usually what people need to allow their bodies to heal sustainably.
This is why at Parsley our prescription drug per encounter rate is only 10%. Compare that to the 70% national average in primary care medicine. 77% of members reduce the number of necessary prescriptions.
And yet, we use the most cutting edge testing, far beyond what primary care doctors use—from genomics and the microbiome to hormones and toxins—to understand how your body is working today and to get to the root cause of your problem so you can get well and thrive.
We are not anti-medicine. We are simply what medicine should be. Natural first, medication second, with room for kale and meditation on the same prescription pad as an antibiotic or an order for an X-ray.
by ROBIN BERZIN, MD
Founder, CEO & Physician