[This post was originally published on May 9, 2012.]

This on-going interview series shares the experiences of expat moms who have given birth in Florence. The aim is not only to tell their stories but also to provide pregnant foreign moms with an informational resource on the different birthing options in Florence and what to expect, from natural home birth to fully medicalized hospital birth and everything in between.

Miriam is from Oregon and first came to Florence as a student in 1994. She came back often for long stints, teaching English in one case. After she started translating (from the U.S.) in 2000 she went back and forth before moving to Florence full time in 2004. In IT>EN translating circles she’s known for her Peskies—helpful solutions for pesky words (www.miriamhurley.com).

Why did you decide to have a home birth?

I wanted to be with a midwife. After my miscarriage [a traumatic experience with an incompetent doctor at Torre Galli], I didn’t trust the standard system. I also come from Oregon where it’s much more the norm. I started out with doctors—and not that they were bad doctors, I just felt treated like a cow. They tell you all the things that can go wrong. It’s too mechanical. I went to a doctor that my friend suggested at seven weeks. I had miscarried two years earlier. I said, I don’t know if I want to see an ultrasound—because it makes it harder if you miscarry later. She basically insisted and when I saw the printout I started crying because it reminded me of the printout from after the miscarriage (of my empty womb). She was totally freaked out and tried to prescribe me all these random things. I was thinking, You’re a gynecologist and you’ve never seen a woman cry?

Oh dear.

It just felt out of synch with what I wanted and what I thought was best for the pregnancy. So I decided I needed the midwife approach, because the point was not home birth vs. hospital birth but this approach to the whole person. I interviewed two midwives and liked Gabriella better. The first interview was for having her as a midwife, not necessarily for a home birth, because she can accompany you during the hospital birth.

How did you find these midwives?

Word of mouth.

Gabriella asked me about my medical history but also about my fears, what I’d been dreaming since I’d been pregnant. So it’s much more holistic and thorough than through a mechanized system.

So your original plan was to have her help you labour at home and then go to the hospital with her. Were you planning to go to Ponte a Niccheri?

Yeah, I’d heard good things about it. But then I gradually changed my mind. I took a pre-natal course with her, which was really helpful. It was with different women, some of whom weren’t going to use her at all.

Where does she hold this class?

Near Piazza Savonarola. People either like her or they don’t. She has a really strong personality. I think you have to. She has thirty years of experience and she’s a very strong believer, very impatient with doctors. She’s on a mission to protect everyone. All my friends here in Florence who had children after me made me feel like her feelings were justified. Everything home birth advocates say they do too much of, they did to almost everyone (vacuum suction, ungentle treatment, fetal monitoring, screaming that the baby is in crisis and has to come out NOW, high c-section rate, not listening to mothers). When I was reading your description, there are parts of it where she would get really upset. They should know better. There are studies in the medical system, without being at all alternative. But instead they establish facts by doing old-fashioned techniques.

So at a certain point you...

One factor that made me change my mind was that I obsessively studied it. Having a job on the Internet is a blessing and a curse in that way. I studied home birth really, really in-depth. Through my research I learned it was no more dangerous than in the hospital, not for the worst-case scenarios but in terms of cesareans—that kind of trauma is much less likely. Tragically, after my home birth, a friend of mine in Oregon had a home birth and her baby died during the birth because the midwife was negligent. My friend almost died herself. Her midwife did not at all follow home birth protocol and is under investigation. With my midwife, we were five minutes from the hospital and she was very absolute that if there is a problem, we go to the hospital. In America, problems are aggravated by the insurance and healthcare cost problem. If you have a home birth and need to transfer to the hospital (in about 5% of cases), in America that can mean enormous debt. You Canadians have it better! But the statistics are the same for home births and hospital births. They can have bad outcomes for different reasons. If there are problems with home births—and most of the time those aren’t real emergencies—a good midwife has everything with her. Being pregnant and having a child requires you to do this constant risk assessment which is really hard because you care so much…When I consult with the African and American members of [Esme’s] family, plus Italians and the Internet, I get all this conflicting advice. You have to decide how you’re going to make decisions, whom you’re going to trust. So it helped a lot for me having this midwife whose opinions I trusted. She has a lot of experience. I would go with almost everything that she said, with some exceptions. I read a study about how fans cut down on SIDs [Sudden Infant Death syndrome] by 50%, but Italians think that having a draft will make you sick. She was like, Un ventilatore?! [in a horrified tone]. So I’d turn it off when she came over and then turn it back on!

Oh gosh that’s funny.

I’d have weekly classes with her where we did exercises and then talked about how things were going afterwards.

Weekly?

Yeah, which is nice and interesting because we all had different problems. Every single time somebody would cry. Everyone for different reasons. …

Anyhow, the reason I decided against a hospital birth because of the low likelihood of problems, my very negative experience when I had the miscarriage and then the stories of the people in my group who’d had babies before. A major factor too was that you can’t choose who’s there. And because I’m single the father wouldn’t be there. Even if we had been together he probably wouldn’t have been there because it’s not in their culture for the father to be there. I had two close friends there instead and I wouldn’t have been allowed to have the friends and the midwife, because you can have the partner and one other person. Just the idea that they would decide all these things didn’t sit well with me. In the hospital the best case scenarios are always kind of traumatic and often really, really traumatic and then people blame themselves. My friend who went to Torre Galli says I’ll never forgive myself for not having been able to see him during his first moments(because they put her completely under against her explicit wishes). And I’m like, You will never forgive yourself? How about them? This was before they changed having the nursery and when I went during visiting hours, to see this baby crying to the nurse and he’s a day old and he can’t nurse because it’s not nursing hours for them? It’s really upsetting; it goes against all the studies. It’s just for their convenience. …They shouldn’t be doing this. It makes me really angry that the interests of the babies and the mothers are not there. I’ve talked to a lot of people about this and there are a lot of good professionals in Florence, but it’s hard to compensate for the less good ones and the systemic problems as far as people doing things in old-fashioned ways or the mighty power of the doctor; of it not being a system to have enough feedback and remove the ones who are traumatizing their patients. Because there are a lot of them, a lot of women [who’ve gone through this]. In my ideal world the medical system would really, really listen and learn from the wisdom of the home birth movement. It doesn’t have to be at home—though when I was in labour I thought, Thank god I don’t have to go anywhere, travelling is the last thing I want to do right now, so I was really grateful at that moment. Obviously the most important thing is for there to be a healthy baby. What I don’t like is the overuse of cesareans, and that’s not supported by the medical studies either. They need to update things.

You told me how you prepared for the birth because you did these classes with your midwife. And they were every week. Starting when?

As soon as you’re pregnant.

Oh really? So you could do it every week of your whole pregnancy?

Yeah.

Wow.

Some people were in their first trimester but normally you’re too tired to get anywhere.

Yeah, exactly.

It was interesting to hear everyone’s stories. Actually I didn’t see most of them afterwards except for by chance, but just recently we’ve been getting back in touch because our children are at ages where we’re a little freer.

So tell me about the birth!

I started having contractions and I had my friend coming from Rome, so I had to identify how close I was to giving birth. I’d heard that in the very early labour you should keep on living your life and walking around and doing stuff so I went out to dinner [laughs] and every 20 minutes or half an hour I’d go, Ouch! Then by the evening of the next day they started getting stronger so I called the midwife and I’d already had my friend come from Rome and people were coming and hanging out with me. And [the midwives] came over. She asked me if I wanted to take castor oil to help it go faster. I thought I was in labour because it hurt but the contractions were so far apart. I think they should not call that false labour; they should just call it labour because you think it’s going to hurt a lot worse later but it was about the same.

I didn’t realize they called it false labour. What did I call it? Non-active labour.

That’s a better term. This was one of the more traumatic moments of my positive birth experience, when I was like, Ok, this isn’t so bad, I can do it.My midwife and her apprentice midwife were there rubbing my back, my friends were in the other room and I was doing what I’d learned in the preparation—opera-singing instead of screaming.

Huh! I’ve never heard that one.

It’s kind of comical [demonstrates].

Yeah [chuckling].

But then they turned me over at a certain point and they said Non è travaglio. And I was like, What do mean it’s not labour?! They said, Call us when the contractions get closer together.

Wow.

Apparently this is fairly common. Later when they started to get more painful, that was a little hard because I knew they weren’t close enough together and my friends were sleepy. I joke about it now with my friend Cecilia. It was the middle of the night, she was in bed and I would go over to her every 20 minutes or so and [does loud opera-like singing].

My goodness.

Finally at around six in the morning I called Gabriella and said, I don’t think I can take it anymore, I don’t have the energy if this keeps on going…She and the other midwife came at eight and by then it was official labour. I remember my thoughts quite well, my intellectual thoughts. My grandmother, who’s a little new-agey, said Just imagine that your pelvis is opening and your cervix is expanding. And I honestly think this helped a lot because you can control your outer body by thinking about it, it does affect things. And I thought about Patti Smith, because I’d been to her concert right before when she played in Santa Croce. And I happened to read about her life and her suffering the loss of her husband and brother but that she decided to go on tour and open herself up. So I thought about how you have to go through the pain of opening up to invite the new life.

Wow.

That actually went quite quickly, it was like four hours, though it didn’t feel that long. It was actually three hours of the active labour and like an hour and a half of pushing. The pushing hurt more. With the pushing my friends came in. They’d been in the other room. They were my birth chairs, supporting me while I pushed, helping me while I squatted. One big contrast with hearing about other birth stories and television births, which are extremely unrealistic—when you’ve actually given birth and you watch television, you’re like, It’s so not like that!

I know.

Them telling you when to push…

Right, exactly.

Because they shouldn’t tell you when to push. Only if you have an epidural and you can’t feel it, then they have to. Otherwise, you can’t not push when you really need to. I also can’t imagine pushing when I didn’t feel like it. I do have a little bit of the effect of the pain memory not being as bad. I mean, I also remember thinking, I’m never doing this again. If I want other children I’m adopting. But now I would do it again. Another comical moment—my midwife has a bossy personality and during the classes with her, you do these squats and I’d get uncomfortable and get out of the position and she’d say,Non puoi nasconderti dal dolore durante il travaglio (you can’t hide from the pain during labour)! I had this image of her being more in control, so at one point, I thought I was still lucid, but I said, Posso fare una pausa (can I take a break)? I remember really believing that she could give me permission.

Really [laughing]? That’s so funny.

She said, Right now the baby has to be born, you can rest later. Then she said, Qualche spinta di piu’ e saluti la tua bambina (“a few more pushes and you can greet your baby”). I remember this well because my only thought was how many “qualche” would mean, not seeing my baby. Then she came out, obviously. That’s an amazing moment. Then my friends started crying. That was 12:30. I remember she had a scared look on her face when I first saw her. And the midwife said, I think the gravity scared her. I nursed her.

Did you have that whole experience of having her right on your belly and her climbing up to the boob?

Yeah, well, I was sitting up so I put her to the boob and it was immediate.

And, sorry, how long did the pushing last? Did you say an hour and a half?

Yeah. It felt longer. I was one of those [for whom] the contractions didn’t seem as bad as the pushing. I just had a slight tear. They put some antiseptic on it. I think of my friends who had stitches, which was almost all of them, and it hurt so much going pee just with my little tiny tear. My friend who had—she wouldn’t say it was a really traumatic birth but it was right after mine so there’s this contrast and I know that she and her husband thought I was crazy for having a home birth—but their baby was in crisis, vacuum extraction, episiotomy…and it was all super traumatic. To my mind it was unnecessarily traumatic. Her husband says, Well, you know, she’s a lot smaller than you and the baby was bigger. But you don’t want…people blame themselves so much, especially women, that anything you say either way…I was shocked by all the births [I heard about] afterwards, with the exception of one at Ponte a Niccheri.

How does home birth work financially?

I was particularly lucky with the cost because it’s not covered by the Italian system, so most people pay out of pocket and I know a lot of people who wanted to do it but couldn’t. I have insurance that is only for expatriates. It’s based in America but you have to not live in America because of the healthcare costs there. It has a low maximum for American healthcare costs, which are out of control. But for me it covered everything so I got fully reimbursed. That included the prenatal classes. Although I did get an ultrasound in America, which was the most expensive part. The most useful thing, which unfortunately is lacking in traditional births, is the care afterwards. For the week afterwards they came every single day to my house. They’d ask me questions, check on her, check on me and give me a massage.

Wow.

And all the new mothers I know here across the board had a really rough time at the very beginning

Yup.

Your hormones are in flux, you don’t know what you’re doing, everything freaks you out. So the midwife came every day for a week and then every few weeks for another little bit, to help with breastfeeding.

When I was pregnant and talking to someone else who had a home birth in Florence, she mentioned something that was new, some kind of financial assistance from the state, but I don’t remember the details. That’s something to look into.

It was interesting because obviously American healthcare costs are very high, which is why this insurance exists for expatriates. The maximum for pregnancy and birth related costs is $5000. In America a natural birth with no problems in the hospital averages $13,000. That’s without complications, and there’s always a complication in the hospital.

Is this something you can get when you’re pregnant?

No, I happened to have it for other reasons. There’s a twelve-month waiting period before it can cover a pregnancy, specifically for that reason. It costs about $800 a year and reimbursed me for $5000. I was really fortunate because that would have been hard for me to pay out of pocket. I probably would have just done the pre- and post-natal care, but I’m not sure.

So this course you took, was it mostly with women who wanted the midwives there or did they choose it for other reasons?

Some people weren’t going to do the home birth for financial reasons, so I think it was a little hard on them. But I also had the advantage that I’m not in the Italian medical system so I didn’t have the libretto sanitario (health booklet provided by the state).

Really??! I didn’t think you could even do that!

It was helpful for me because everyone else had the libretto saying they had to do all these tests, some of which Gabriella has strong feelings about. Like the one for the blood sugar level, where you drink a bunch of sugar. She thinks it’s really unhealthy. So for me it was no problem because I just did what she told me to do. Whereas other people always had that conflict of different expert opinions. Like I say, her personality is very forceful and her opinions are very strong so your doctor would say you have to do something and she’d say, Ma per carità! For most things I felt like she had a point, so I was grateful. My friend almost fainted during the [glucose test]. I’m convinced it’s unnecessary if you don’t have other indicators, because in other [Italian] regions they don’t do it as one of their standard tests. All the different opinions can be so stressful. You have the internet, you have yoursuoceri (inlaws), and it matters so much to you.

I want to make the point that I don’t think everyone should have home births. I’m not a fanatic. It’s important everyone feels comfortable; it depends on your beliefs and your fears. But I also think that conventional hospital births really have a lot to learn from why home births have the same outcomes without all those interventions. For everyone I know that’s had a caesarean, you never know, you could be one of the 5% when it’s really necessary. But it’s 35-40 %, so there’s something going on. And it’s way more painful and difficult for the mother. I feel like people under-evaluate that. They think it makes no difference. But it does, it makes an emotional and physical difference.

It matters how your birth goes. There are a lot of factors that are out of our control but how the birth goes, you think about it a lot. It’s not irrelevant. It’s not like fixing a broken hand. It’s nice if you get good treatment and are treated nicely. When I fought with this doctor [at Torre Galli] who misdiagnosed me and said I had twins during my first pregnancy, I said I wanted to write a letter of complaint and he came down and confronted me, started calling me crazy, and this [female colleague of his] said to me, Ma non si può pretendere troppo degli uomini, sono uomini. Well, then he can’t do his job. Put him behind a desk.

Who was this doctor?

Dr. Guerri did the ultrasound, and Dr. Gioia agreed with his “twin-to-twin transfusion” diagnosis, which is impossible at 8 weeks pregnant. It was probably a wadded up umbilical cord. I think I would have miscarried anyhow, but being emotionally traumatized didn’t help. I think it’s useful for future birth-givers to actively avoid them both (which means avoiding the hospital since you can’t choose). I hold the same two doctors responsible for my close friend’s traumatic birth and c-section (she still has pain six months later) and felt mad that there was no way to protect her and others from their incompetence and insensitivity. I feel bad for the midwives who work there. I hear they’re good, but they have to defer important decisions to the doctors.

Would you have a home birth again?

Yes, if I were in Florence, I would definitely go back to Gabriella because I trust her completely. I think that a possible risk of home births comes from the decision-making being done by one or two people, so you have to have a really good midwife. If I were in the U.S., I would go to a midwife-run birth center. I think there are risks to home births, but that they are statistically balanced out by the risks of hospital births (infections), plus the much higher risk in hospital births of things that don’t cause death but cause unnecessary pain and trauma. If the Margherita here were attached to Ponte a Niccheri and it didn’t have its too rigid rules, I would do it there. In reality, there are two Ponte a Niccheri births that didn’t horrify me. In the second one, they induced which led to much more pain, but it was because she had high blood pressure, which I think is a good reason (in my layperson judgment).

Cross-posted at Firenze Moms 4 Moms.