Cuts You Up

Had the Valentine's protest been on any other day of the week, Janessa Wasserman would have been there, holding one of the purple balloons that read "Bring Back VBAC" (for vaginal birth after cesarean). Adhering to her Orthodox Jewish faith, Wasserman keeps the Sabbath on Saturday, so she sat out the protest at home with her husband and three children -- the youngest delivered by Fitch less than two months before. The 30-year-old attorney/homemaker first heard about the rally when she called the midwife in a panic; her obstetrician had tried to dissuade her from having a VBAC, suggesting she schedule a C-section instead. She had delivered her first son by cesarean and never wanted to have that experience again. "I was so naive," she remembers. "You grow up and you trust doctors: 'They know you better than you know yourself. '"

When Wasserman gave birth to her son at Mount Sinai Hospital on Miami Beach in 1998, she had a fairly typical hospital delivery. She was given Stadol for pain relief and Pitocin to speed up labor. She was hooked up to an internal monitor to keep track of the baby's heartbeat. Drugged up and plugged in, she felt detached from her body. It didn't help that her family began to ignore her, watching the monitor instead. "I could be screaming, but they would say, 'It's not that bad,' because that's what the machine says," Wasserman recalls.

After 14 hours, Wasserman was informed that her labor was "failing to progress" and that she required surgery. "They said they were concerned about the baby," she remembers. "They were concerned about me." The operation went well. "The surgeon had a lot of experience," Wasserman observes wryly. (Six years ago, Mount Sinai's cesarean rate, now 38.8 percent, had already topped 30 percent.) Yet she remembers feeling "devastated." She was depressed about the delivery and says she did not fully recover physically for a year afterward; she is still numb where her nerves were cut to make the incision.

So when Wasserman discovered she was pregnant again two years later, she sought out Devorah Stein, a friend who had graduated midwifery school with Fitch. The two Orthodox women live within a mile of each other on North Miami Beach; their families worship together at the Young Israel of Greater Miami synagogue. Wasserman paid attention whenever Stein, who had survived her own unpleasant C-section, talked about alternatives to hospital birth. "I did not want to repeat what had happened to me," Wasserman explains. "I was going to do the exact opposite of what I did with [my first son] with [my second]."

Wary of depending exclusively on a midwife to deliver her second child, Wasserman hired Stein as a doula, an advocate for a woman during labor. She found a doctor, Wayne Di Giacomo, willing to give her a VBAC. Though one of the few doctors willing to perform such deliveries in South Florida, DiGiacomo is no renegade. He blames doctors' fears of malpractice suits for the rising cesarean rate. Following ACOG guidelines, Di Giacomo advised Wasserman on a Thursday, as she approached 41 weeks of pregnancy, that if she didn't go into labor by the weekend, he would induce her. "I was afraid the whole thing was being set up again," Wasserman remembers. So she took extract of blue cohosh, an herb midwives believe naturally induces labor, and drank a root beer float laced with castor oil, another homeopathic remedy. On Friday afternoon, she turned to her husband, a professional acupuncturist with an office in Aventura, for treatment. Two hours later, she began the early stages of labor.

On Saturday afternoon, Wasserman went to Stein's North Miami Beach birthing center, where she labored for 25 hours, going to Aventura Hospital only when she was on the verge of pushing out her son. Because she labored so long, she remembers Di Giacomo telling her over the phone -- again following ACOG guidelines -- that if she did not deliver by 10 p.m., "I'm going to cut you." Wasserman delivered her son Efrem at 9:59 p.m. When the baby weighed in at seven pounds and 15 ounces, Wasserman recalls that the doctor observed, "If he had been any bigger, I would have had to cut you."

Three years later, Di Giacomo, who delivers 20 or more babies a month, no longer remembers Janessa Wasserman or anything he might have said or done during her delivery. Yet he has had enough clients like her, who do not like the level of medical intervention typical of hospital births, that he opened A Birth Center last summer near Memorial Regional Hospital in Hollywood. If more women demand more control over their care, Di Giacomo says, obstetricians will have to accommodate them. "Consumer demand drives the market," the doctor observes.

After delivering her son without surgery, Wasserman remembers feeling as if she didn't need a wheelchair to carry her to the recovery room. "I wanted to run a marathon," she says. "I had so much energy." To this day, Wasserman considers natural delivery "the single most empowering moment of my life."