I Think, Therefore I Am Getting the Goddamned Epidural

On midwives, metaphysics, and intensely natural births.

Rebecca Schuman | Longreads | November 2017 | 16 minutes (3989 words)

Until I was 34 weeks pregnant, I only considered the act of childbirth in blurred, vague terms, and this meant I was unusually impressionable. Hence, the entrée in week 35 of one Ina May Gaskin, legendary midwife, and successful deliverer of eleventy-dillion babies at what definitely didn’t seem like a very creepy commune in the middle of Tennessee. “You must read Ina May,” explained my friend Charlotte (not her real name), who’d recently driven 80 miles across state lines to push out her second child in a midwifery center. “She will make you SO CONFIDENT about what your body can do,” all caps in original. I was intrigued — and, a few hundred pages deep into Spiritual Midwifery and Ina May’s Guide to Childbirth, equal parts tentative and enamored.

Both books consisted primarily of first-person accounts of sublime natural birthing. “The ecstasy of birth was so wonderful,” wrote one mother, named Kim, after her daughter simply “slipped out.” Another went for a two-hour hike in the middle of labor. “I could feel my baby move me open, and when the intensity of the rushes increased, I just leaned on a tree.” First-time mother Celeste, furthermore, wouldn’t call labor painful — she’d call it “INTENSELY NATURAL,” all caps, once again, in the original. Then there was my favorite, Mary, who “visualized [her] yoni as a big, open cave beneath the surface of the ocean,” and “surrendered over and over to the great, oceanic, engulfing waves. It was really delightful — very orgasmic and invigorating.”

In her beatific appearance as a talking head in Ricki Lake’s documentary The Business of Being Born, Ina May describes the act of birthing without medical intervention as flipping on a light switch that takes you to the moon. That sounded pretty good! Plus, one of my Facebook friends posted a link to a very convincing blog post, by a lady who didn’t want an epidural, but then got strong-armed by the for-profit medical industry. It gave her permanent nerve damage. How badly did I want to risk permanent nerve damage — not to mention my baby basically coming out a zombie, already addicted to Real Housewives and Hot Pockets — just to avoid an intensely natural occurrence?

Ina May and the other midwifery books also, weirdly, reminded me of something else. Something I’d pushed to the farthest reaches of my back brain, to make room for pelvic-floor strengthening exercises and ten-point comparison lists of alleged baby carriers that cost $150 but seemed, to my untrained eye, to be 20-foot-long strips of cotton jersey. This was the curriculum of the freshman humanities sequence I’d taught in my third year of graduate school — specifically, the godfather of modern philosophy René Descartes, Monsieur Cogito himself, and his foundational text Meditations on First Philosophy, wherein he claimed that his mind was distinct from his body, and could exist without it.

Descartes had grown disenchanted with all of his previous knowledge and felt like the only proper recourse was to disavow everything he’d learned. He found himself “beset by so many doubts and errors,” he wrote, that he figured the only thing he’d gained from his education was “increasing recognition of my ignorance.” Sure, it had been 375 years since Meditations, but wasn’t that basically what Ina May and all the midwifery enthusiasts were telling me happened to them? They were, after all, subject to all of the “knowledge” of childbirth the medical establishment had to offer for their first births in the 1960s and early 70s. It made them realize how little everyone seemed to actually know. Sure enough, they discovered — after being shoved down on their backs for labor, ignored and yelled at, maybe even put into “twilight sleep” — that all they’d learned about the birthing process from the doctors was how alienated the doctors were from the birthing process.

How badly did I want to risk permanent nerve damage — not to mention my baby basically coming out a zombie, already addicted to Real Housewives and Hot Pockets — just to avoid an intensely natural occurrence?

Unbeknownst to them, Descartes had left them a blueprint: He “abandoned the study of letters,” instead resolving “to seek no knowledge other than that which could be found in myself or else in the great books of the world.” He spent the rest of his youth traveling and “gathering various experiences, testing myself in the situations which Fortune offered me, and at all times reflecting upon whatever came my way so as to derive some profit from it.” Three hundred years later, Ina May packed her friends into a bunch of yellow school buses and caravanned around the country to learn the art of midwifery — not from a sterile school, but from hundreds of women and their laboring bodies. In fact, every midwifery book I read kept coming back to my friend Charlotte’s mantra: Your body already knows how to birth a baby.

But what about the, uh, you know, pain? “The construct of pain is entirely mental,” sneered another midwifery-obsessed friend of mine, Marta, a mother of three who was always trying to get me to vote for her in a photo contest of people doing something called “babywearing,” which I very much hoped was not a Silence of the Lambs-type situation. This brought to mind another part of Descartes’ Meditations, where he explains just why his “first philosophy” — his new system that would tell us how we know what we know, and would also tell us that our minds and bodies are separate — required severe skepticism of all he’d taken for granted as true. His new promise to himself was to “never to accept anything as true if I did not have evident knowledge of its truth” — if, that is, he wasn’t certain of it. And it turns out the chief purveyor of untruths was his own senses. “I have occasionally caught the senses deceiving me,” he explained, “and it’s prudent never completely to trust those who have cheated us even once.”

This seemed to be exactly what the midwifery-types were saying about pain: don’t trust it. And it was especially crucial to keep repeating it to myself, given that being blessed with a blissful, transcendent, natural cave-birth was going to be nothing less than war. Since I lived in a state where midwife-assisted homebirth was illegal, with no birthing centers within a 200-mile radius, I’d have little choice but to go to the hospital, where they would be salivating to drug me up.

It was all right, though — my books had a plan. That plan involved laboring at home until the baby crowned. If, said my books, I had to bend the truth to my obstetrician, Dr. Holtzbrink, about when my water broke so that I could stay home longer, so be it. It was better than risking a hundred totally unnecessary interventions, all of which would beget other interventions, and culminate in the worst possible nightmare. No, not a birth complication, worse: a Cesarean. An alarming number of the narratives in the midwifery books were cautionary tales from hospitals, full of pushy MDs and C-sections that resulted in not having really given birth.

* * *

When I wasn’t busy being incontinent, I spent the final weeks of gestation drawing up my own groundbreaking philosophical meditation, a Gesamtkunstwerk whose rigor would make my doctoral dissertation look like a post-it note in the bathroom reminding people to jiggle the handle: my Birth Plan.

Please do not offer me drugs at any time during labor, I wrote, with the confidence of someone who has never been in labor. We have a predetermined “secret word.” Only if I say this word is medical pain control to be administered. The Secret Word was not a word so much as a phrase, namely, the one Jerry and George come up with on the episode of Seinfeld where they hatch an ill-conceived plot to retrieve an incriminating message off George’s girlfriend’s answering machine.

Rebecca would prefer not to rate her pain. I mean, since when is a nonexistent mind-construct that only happens to weak-willed victims of modern medicine quantifiable?

Unfortunately, the birth plan itself didn’t have any specific footnotes citing Descartes’ founding document of Western metaphysics (i.e. the study of what is real, man), but it still depended on the most prescient connection between it and what the midwives were telling me: that there was a separation between mind and body.

When Descartes decided to doubt everything in the world, he realized there was one thing he couldn’t doubt — that he existed. After all, if he was thinking, even if he was doubting, that meant he was there. And more importantly, it meant that the self he was discovering was not a body, but a mind, or rather, a “thinking thing.” Everything connected to his thinking thing — his food, his movement, and yes, his senses and therefore his pain — could be an illusion, impressed upon him by a mean and nasty God who just wanted to fill his noggin with garbage.

“I am, I exist,” Descartes wrote. “That much is certain. But for how long? As long as I think — for it may be that, if I completely stopped thinking, I would completely cease to exist.” It was plausible, Descartes allowed, that he indeed possessed a human body that was “very tightly bound” to him. “But,” he argued, if he had a “clear and distinct” idea of himself as a “thinking and unextended thing,” and also a distinct idea of his body as “just an extended and unthinking thing,” that meant one thing was certain: “I am really distinct from my body and can exist without it.” You hear that, Big Pharma? Without it.

The Birth Plan was completed, printed, duplicated, and distributed to my entire unimpressed obstetrics team. The yoga poses were posed. The meditations were meditated. The mantra was mantra’d. I was blissful. I was empowered. I was ready.

And then, I went into labor.

***

“You know what this means!” I said.

“But I don’t really feel like watching Forgetting Sarah Marshall,” my husband said, in clear violation of the solemn promise he’d made me a few weeks prior. (“We can watch that together when you’re in labor, all right?” “You promise?” It had been in context of a soliloquy I’d given about how some scenes are only funny if they contain full-frontal male nudity.)

This left me to roll myself like a human Indiana Jones boulder into the spare bedroom, where I resumed the definitive mind-body divide, i.e. timing my own contractions with a contraction-timer app. The only problem was that as the intensity grew, it became increasingly annoying to tap the little start button, and then work through the probably-illusory, INTENSELY NATURAL sensation, and then recover, and then remember to tap the stop button again.

Still, though, I tried to enjoy the cold silence of the room, the last time I would conceivably be alone for the foreseeable future. I breathed. I timed. I gave up on Sarah Marshall. I looked at the moon. I tried to bliss out. But what really happened was that I suddenly realized I was a 38-year-old first-time mother and amateur metaphysician in labor all alone, on the business end of an act whose intensity I could never have predicted without experiencing it (though that’s phenomenology, which came quite a few centuries after metaphysics).

Had my mind finally decided my body was connected to it? Or diverged from it completely? Who cared? I needed a physician, meta be damned. And so, shortly after Tuesday turned into Wednesday, I waited until my latest contraction ebbed, waddled back into our bedroom, leaned over my husband’s barely-sleeping visage, and told him to get the fuck up so we could go get a baby.


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In the frigid January darkness, at one in the morning, with the beautiful, exhilarating rushes of mother-goddessdom descending upon me every three minutes or so, my husband and I managed to transport my bag o’necessities and all 200.8 pounds of my writhing person the half-mile to the hospital. In the whisper-quiet lobby, the guard said, helpfully, “You look like you’re about to explode.”

After we were ushered into one of the cubicles of the Pregnancy Assessment Center and I was subjected to the first of innumerable “checks” (a euphemism for the definitely-not-metaphysical act of light fisting), the verdict came: three centimeters. I was officially in “early labor,” a.k.a. “the easy part,” and so it was only after I willed my rushing yoni to pry itself open one measly centimeter more that I was officially admitted.

Another hour, another set of cave-rushes gaining mightily in physicality. Another hour, another emission of pathetic moan-screams as my husband put his years of weight training to use and steadied me on a birthing ball. If, as Descartes insisted, my mind was independent of my body and could really exist without it, this was a really good time to start doing that. And yet: another hour spooled by, coordinated with more prodigious widening of my cooperative cervix, mind and body stubbornly fused together. The sun came up, the hospital’s shift changed, and a cheerful technician came in with a tray of torture instruments — the “birth kit,” she explained, since I was already at seven centimeters and pushing was imminent.

Until, six hours and zero centimeters later, it wasn’t. The obstetrician on call was my practice’s boss, Dr. Beech, a soothing fatherly figure who was probably the same age as me. And Dr. Beech, being the nicest person ever, was nicely suggesting that, during our next session of light fisting, he nicely maneuver into the body cavity in question what looked like a very mean crochet hook, and break my water on my unthinking extended thing’s behalf, so that we might — and I believe these were his exact words — get on with this, already. “The contractions,” he murmured as what had to be a twenty-gallon gush flooded the birthing room, “may intensify now that the water isn’t there to cushion them.”

Something about hearing that my pain — and there was no more pussyfooting around; this felt like I was being torn apart from the inside out — was definitively going to get worse broke something deep inside my thinking thing. The news traveled into the part of my brain that controlled the goddess gates of my yoni, and everything shut down. Plus, the flood must have soaked my Birth Plan, because now the dreaded interventions came fast and loose. Pitocin. Constant monitoring. A thingy they wanted to clamp, somehow, into my uterus to measure the exact intensity of the contractions, since apparently “PRETTY FUCKING INTENSE” (all caps in original) was insufficient medical evidence.

Finally, after twenty-one hours of intensely natural unity with the universe, I turned my blanched face to my husband, and I said it.

“Tippie toe,” I whispered, barely audible. Tippie toe. It was only fitting. George Costanza, world’s biggest yutz and perennial coward, had nothing on me, who had officially failed to let her all-knowing female body carry out its own innate wishes.

If, as Descartes insisted, my mind was independent of my body and could really exist without it, this was a really good time to start doing that.

As my husband stood stunned, the lights of the room flipped on, and in pranced the anesthesiologist, who looked like a perturbed high-school sophomore, heavily made-up with waist-length black hair and manicured nails. She could barely disguise her scorn as I screamed through one last endless contraction. She was on her phone, and I’d clearly interrupted a very important conversation. “Ugh,” she said, one hand on her device, and the other fiddling with the rocket-sized needle she was about to stick into my spinal fluid, “I’ll call you back.” Thirty seconds later, my body tingled all over, and then, sweet merciful Christ on a pony, relief. The pain was gone, in its place the managed euphoria of many, many coursing drugs. It felt so good, in fact, that I barely minded how gutted my husband was.

“You promised this was something we’d do together,” said the person who had 100 percent not just spent the previous 21 hours in agony.

“Well, you promised you’d watch Forgetting Sarah Marshall with me. Plans change.”

As a compromise, I managed to wrest my anesthesiologist from her Instagram for long enough to get the epidural on its lowest possible setting. The result was that the contractions still came through, only at my preferred semi-intense, semi-natural register.

With the pain dulled, I had the opportunity to reconsider my situation’s particular illustration of what professional metaphysicians (a thing that exists) called Descartes’ “mind-body problem.” Clearly, the only real way to ensure that my mind was independent of my body and could exist without it was to deaden that body below the waist.

My philosophical reverie was again cut short when, at long last, my cervix had the decency to disappear. I had my husband swap out the woo-woo Sanskrit chanting music for Salt-N-Pepa’s “Push It” on repeat. This was charming for approximately the first 90 minutes I attempted to excrete, at long last, the valiantly kicking miniature human inside me. A miniature human, it turns out, who would not budge, no matter how hard I pushed.

After three hours, Dr. Holtzbrink, who had taken over for Dr. Beech what she assumed would be a quick push-out, had tapped out the last of her patience. She pried my legs open one last time, for one last “check,” not of dilation but of the baby’s position. Literally elbow-deep in my person, she delivered not a baby, but bad news: my child was, apparently, “sunny-side up,” a.k.a. occiput posterior, a.k.a. her big fat noggin was turned in such a manner that it would not squeeze its way past my pubic bone.

A C-section? The literal worst thing that could possibly happen to a woman delivering a baby? What was my husband going to say? If a little needle was enough to break his heart, how was he going to feel about us (well, me) not actually, really giving birth? He grabbed my hand, and I saw that he was tearing up. “It’s your body,” he said. “It’s your decision. But I think if this is the way she needs to be born, this is what we should do.”

“Well,” I said, with the sort of studied scholarly prose that would have made Descartes proud, “let’s cut this little fucker out.”

The whole thing took less than half an hour, and most of that time was spent with me complaining about getting the shakes, which apparently is a common side effect of the hormones of end-stage labor that I would have known about if I’d read anything besides orgasm stories.

“She’s a little linebacker!” proclaimed Dr. Holtzbrink, who had executed some major-league surgical maneuvering to extract our daughter’s impressive shoulders from the relatively small gash that was now going to grace my pubic area forever. Meanwhile, my husband had ceased to grip my hand, because apparently he was busy bawling his eyes out as he cut the umbilical cord of a squirming, screaming, giant-nosed, eight-pound human who bore a shocking resemblance to my deceased Jewish grandpa, who would have been celebrating his own hundredth birthday at exactly that moment.

My philosophical reverie was again cut short when, at long last, my cervix had the decency to disappear. I had my husband swap out the woo-woo Sanskrit chanting music for Salt n’ Pepa’s “Push It” on repeat.

After she was briefly checked over and ruled to be in aggressively robust health, the inexplicable creature was placed onto my splayed-out chestal region, and one of the residents pried my phone out of my husband’s hand and took a picture of the three of us — which remained the only existing such photo for months. In it, our daughter, fluorescent pink and hair caked with gook, is smooshed against my chest; my husband, eyes still moist, is holding her in place because my arms are strapped down in what I assume doctors call the C-Section Crucifix Position. I, surgical cap askew and oxygen tube running cockeyed in the general vicinity of my schnozz, am somehow managing to smile. Because you know what? I was out of my goddamned mind on drugs. If indeed, Descartes had been right, I would have ceased to exist somewhere around the first incision.

Ah, Descartes. In failing Ina May and the midwives, had I also thwarted the founding notion of Western philosophy? Sure, technically I was unable to rely on my mind’s independence from my body and remain skeptical of the delusional sensation of “pain.” Technically the only solution to the mind-body problem was to anesthetize my body to Kingdom Come.

***

Was Descartes wrong? Well, while Meditations is what put him (and the entire discipline of modern philosophy, for better and worse) on the proverbial map, it was not the only thing he wrote about the human body — in fact, most of what I gleaned about pain from Meditations was just about the senses in general. For Descartes’ real theory of pain, however, one has to dig a bit deeper to the odd Treatise on Man, which appeared in 1633, eight years before Meditations — and, had its author decided to stop writing then, would have ensured he be at best lost to the annals of time, and at worst relegated to the annals of quackery.

Because, all right, I realize it’s not fair to dump on the anatomical theories of a scientist working at a time when bloodletting was the primary form of primary care and everybody still believed in witches. And hey, the theory of pain in Treatise on Man (which is definitely not called the Treatise on Woman) is actually not that bad on its face: Descartes posited that the body is a machine and the nerves send messages to the brain through the machinery. And while modern physicians (and, I suppose, metaphysicians) mainly take issue with Descartes’ mistaken idea of where the pineal gland is located, I mostly lost him with all the talk of the “animal spirits” that … cause all our sensations, maybe? (They live inside the pineal gland, at any rate.)

All of this is to say: Why the hell did I care what Descartes thought about pain? That guy didn’t know anything. But that’s just it! His value was not so much in his anatomical work, but in his exploration of just why he didn’t know anything, and what it meant to know at all.

“But what then am I?” he asked. “A thing which thinks. What is a thing which thinks? It is a thing which doubts, understands, [conceives], affirms, denies, wills, refuses, which also imagines and feels.” These might not seem to be questions (or answers) that one naturally associates with the act of giving birth, but perhaps they should be. The midwives in my books were asking versions of these questions, after all, and they shouldn’t be the only ones who got to. Indeed, what makes all that mother-Goddess-yoni-orgasm stuff disquieting is not actually its medical dubiousness. It’s the decidedly un-philosophical certainty of the operation.

Descartes ends the Meditations by reminding us that because we often don’t have enough time to think things over carefully, “we must confess that the life of man is very frequently subject to error […] and we must, in the end, acknowledge the infirmity of our nature.” So, while Meditations is ostensibly about what is and isn’t certain (metaphysics, man), it ends with a confident reassertion that we should always be uncertain as a default state.

This is what makes Descartes both enjoyable and annoying to read: His insistence that we really can’t be certain about much. And this is the crux of why he can be not full of shit, and the midwives who wrote all my books can be decidedly full of shit, even though their arguments are both based on the mind-body divide. What makes the midwives I read both enthralling and, in the end, toxic, was the bare-knuckled certainty of their operation. It is a certainty that offers no introspection of its own infirmity. It leaves the exhausted, shaking new mother of an eight-pound baby girl in the most ridiculous, unnecessary quandary: She is left uncertain about whether she has truly given birth at all.

* * *

Rebecca Schuman is a St. Louis-based writer and translator, and author of the literary memoir Schadenfreude, A Love Story.

Editor: Ben Huberman