A Midwife’s Tale

Eighteen hours of labor has Aline Vaca exhausted and the nerves of those assisting with the birth of her first child frayed.

Nearly a day of contractions bring pain and cries that have intensified with each sweep of the hour hand on a nearby clock. Day has turned into night.

Aline leans against the side of her birthing tub with her head on her arms and lets out a heavy sigh. The tub, on the patio of her mother’s Kings Beach home, is filled with warm water and sits beneath the night sky in the cool mountain air.

These familiar things are Aline’s pitocin, her epidural, her spinal block.

Eighteen hours of labor without pain-relieving meds means Aline must be surrounded by skilled and loving hands. Emilio Vaca, Aline’s husband, kneels beside the tub and gently caresses her hair, comforting his wife with the only things available to him — touch and encouragement.

It’s midnight and the neighborhood is dark and silent, except for the brightly lit house bustling with anticipation of Aline and Emilo’s baby under the care of a midwife Susanne Scott.

Aline’s labor is a family event. While Emilo sits patiently by her side, Aline’s mother, sister and best friend, all dressed in pajamas, rush around the house to fetch a glass of water, prop up a pillow, hold a hand.

But the late hour catches up with some of the family. For the next hours, a few people attempt to sleep while others sit preoccupied on the couch wrapped in blankets anxiously listening as Aline’s cries of pain intensify with every contraction.

At 3 a.m. the intensity of natural childbirth has everyone up. Sounds of Aline’s pain ricochets off the walls. Midwife Scott and Sharon Mayo, a local doula, suggest different positions for Aline and coax her through each contraction.

Then the pushing begins. Exhausted but determined, Aline concentrates every last drop of energy she can summon. For hours she pushes while Scott monitors the baby’s heartbeat. Emilio never leaves his wife’s side.

Aline whispers to her mother, Sylvia Doignon, that she doesn’t have the strength to push, to work, to labor any longer. Doignon reassures her that she does.

As night fades into dawn, Scott announces that, at last, she can see a head peeking through. Only — one — more — push.

•••

“Every woman fears pain,” Aline Vaca says. “But, we’re created with the ability to deal with it.”

It’s May, 32 weeks into Aline’s pregnancy and before she will endure the unknown in her mother’s home. Aline, who is a midwife-in-training, says she wanted to experience a home birth because it was more familiar and comfortable than a hospital.

“It’s such a beautiful thing to be at home with your family,” she says during a pre-natal appointment in May.

Emilio says he was initially hesitant about having his wife give birth at home, but after educating himself about the process, he’s become more confident.

“You’re involved every step of the way,” Emilio says. “[A home birth] gives you the opportunity to literally catch the child.”

There are, however, other helping hands present.

Midwives are the guardians of normal and natural birth, says Susanne Scott, who owns Sacred Hoop Midwifery Service in Kings Beach. Scott has attended the birth of more than 200 babies in Tahoe-Truckee homes.

Scott says the alternative birthing practice, which dates back thousands of years, empowers women who wish to have a natural birth surrounded by family in the comfort of their home, rather than in a hospital.

“[Birth] is a huge life event for a woman,” says Sharon Mayo, a local doula, or birthing caregiver.

It is important, Mayo says, to give a mother the freedom to birth how and where she wishes.

Midwives offer their patients a continuum of care, both physical and emotional, throughout the pregnancy and after the delivery until the baby is three weeks old. Most often a woman, a midwife endures long, late-night hours and is constantly on-call.

The work is intensive and highly stressful, physically supporting the laboring mother and counseling her through the birth.

“[Midwifery] is a lot more personal,” Aline says. “It’s nice having someone you know at the birth.”

In agreeing to have a natural birth at home, Aline declined any pain-relieving medication, such as pitocin or epidurals that she would find at a hospital. And even though midwives cannot administer pain relievers, they have their own pain-relieving techniques, such as a birthing tub.

The warm water relaxes a laboring woman, giving her more strength to cope with pain. Midwives also use a variety of birthing positions to help ease the process, using moves that imitate middle-school slow dancing or put the mother on her hands and knees, even on an exercise ball.

A midwife’s strength is her ability to relax the mother, reducing adrenaline levels and promoting endorphins, which act as natural pain relievers.

The natural fact, however, is that a midwife is never able to fully take the pain away. But because of the pulsing nature of contractions, Scott says the pain ebbs and flows. Because of the rhythm of the discomfort, a mother can handle it, she says.

“Yeah, it is painful,” Scott says. “It’s all part of the deal.”

Hospital vs. Home Midwives and doulas have said they are grateful that relations with Tahoe Forest Hospital are uniquely cordial, that there is a friendly respect for each other, and that a relationship of this sort is not all that common in hospitals throughout the nation. “If we do have to cross paths, then there is a mutual respect or understanding,” said Lynda Walsh, a Tahoe City-based doula and midwife apprentice. Dr. Chris Richards, an obstetrician at Tahoe Forest Hospital, said that though he wouldn’t recommend having a home birth with a midwife because they do not have the medical tools or experience of a hospital, he accepts the practice. “We really have the same goal — healthy mom, healthy baby,” Richards said. It is important to not shun the home-birth community, Richards said. It is necessary to keep the channels of communication open in case home-birth mothers need emergency medical assistance. If a mother attempting a home-birth needed emergency treatment in the hospital, she would not have a bad reception, he said. When deciding which is best individually, Walsh said the mother must go wherever she feels most comfortable. “[Midwifery is about] meeting the needs of what a woman wants from her birth,” Walsh said. “But, I’m glad all of its [medical] there, in case we need it.”

•••

Aline’s pre-natal program progressed as any doctor’s regime would, except that she and her husband met with their midwife in a home office rather than a hospital. Scott checked Aline’s vitals and palpated, or massaged, her tummy checking for the baby’s position, development and movement.

Then, she listened to the tiny heart thump over a Doppler, a hand-held electronic device that amplifies the baby’s heart beat.

“That’s so cool,” Emilio says, gazing at his petite wife’s protruding stomach and listening to his child’s rapid heart beat.

The baby’s heart beat is the main way to check a child’s status, Scott says. If the heart beat starts to show signs of stress, the rate either escalating or dropping, Scott may determine to transport the birth to a hospital.

And just in case something were to happen with the birth that required emergency medical attention, Aline and Emilio met with Dr. Chris Richards, an obstetrician at Tahoe Forest Hospital, once a trimester so they would have a familiar face to turn to.

“The majority of births happen so easily at home,” Scott says. “If you couldn’t depend on it, we wouldn’t do it.”

•••

Scott saw her first birth when she was 19 years old when her roommate’s baby was born in their home. But it wasn’t until she had her own home birth that she decided to become a midwife.

“It was very empowering doing a natural birth on my own at home, because I felt my body could do it,” Scott recalls. “It was very affirming that my body worked so well.”

Scott’s midwife, who later became her mentor, was a loving voice of reassurance. She hopes to do the same for other women, including Aline.

“All I needed was a little gray-haired lady to go, ‘look, honey, I did it and so can you,’” Scott says. “I want other women to have the same great experience that I had.”

Scott, one of three midwives in the area, opened her own business in 2003. She has since kept very busy with catching babies on a regular basis. Last year, Scott caught 14 babies.

But midwifery still remains an obscure profession that many women are unsure about. It takes a self-assured, confident woman to choose a home-birth over a medical model, Scott says.

“The average woman is not socialized to give birth at home,” she says. “Usually, it’s a rare bird that feels that way.”

Vaginal birth after cesarean section The debate over having a vaginal birth after a previous cesarean section is a hot one. The risk of a uterine rupture in the c-section’s scar caused malpractice insurance companies to forbid doctors to perform vaginal births on women who previously had C-sections, denying many women the opportunity to ever have a natural, vaginal birth. “The pendulum, particularly with malpractice attorneys, has swung,” said Dr. Chris Richards, an obstetrician at Tahoe Forest Hospital. Midwifery text-books, however, argue that the chance of a uterine rupture in the C-section scar during a vaginal birth is slim, Scott said. Labor-augmenting medication also plays a huge role. Speeding up a process beyond what a mother is naturally capable of heightens her risk. In response, midwives still offer vaginal births to mother’s who have previously had a Caesarean section, which has caused many mothers who would normally birth in a hospital to have a home-birth, Scott said.

•••

As the morning sun pierced the dark, cozy room, Aline gives a final push, the last of 28 long hours worth of contractions.

Using every last drop of strength she can find within herself, she pushes with all her might, releasing the pain into concentration, and then an agonizing moan.

With her husband by her side, her mother clutching her hand, and her sister massaging her thighs, Aline squeezes her eyes shut and makes a final push — so hard the blood vessels in her eye breaks. But it’s worth it.

In a warm room with green floral curtains, a fire place and large windows that open onto a summer garden, Scott catches Aline’s daughter, Marceline Esperanza Vaca — named after her great-grandmother — at 7:51 a.m. on Monday, July 9, 2007.

Suddenly, tiny cries fill the air and one more person — a wrinkled 5-pound, 12-ounce miracle with a crop of dark hair — is in the room.

Tears of joy break the tension and relief spreads contagiously. The memories of pain fly out the window with the morning breeze.

Everyone gathers in disbelief around the new mother and father, watching Marceline’s dark eyes gaze on the world for the first time.



It is love at first sight.

Cost Hiring a midwife costs about a third of what doctors charge. Scott said she charges between $2,000 to $3,000 for a birth. However, the billing process for insurance is more difficult with a midwife than a doctor.