Birth Story

The birth Jan. 7 of Blue Ivy Carter, daughter of hip-hop stars Beyonce and Jay-Z  (Shawn Carter), had Lenox Hill Hospital in Manhattan in a tailspin this week.

Beyonce

Other new parents complained of disruptions and even security breaches as the celebrity family reportedly took over part of the hospital's sixth floor for a private, customized labor-delivery area for $1 million-plus. (A hospital spokesman said the Carters occupied an "executive suite" and paid the standard rate for it.)

Neil and Rozz Nash-Coulon were upset at being detained in the neonatal intensive care unit after visiting their newborn twins, while Edgar Ramirez reported he was refused entrance to visit his baby in the the NICU unit. Windows were covered, private security guards issued orders, and security cameras were even disabled, families complained.

"The security of our children is at risk when you cover security cameras," Ms. Nash-Coulon told Nina Bernstein of the New York Times.

And, all the secrecy fed rumors. Beyonce's website states that "Baby Blue" was "delivered naturally," while portions of the blogosphere ran with a report that the birth was a C-section. And there's even a contingent that holds that Beyonce's pregnancy was a fake, that a surrogate mom bore Blue.

Tina Fey and Jane Krakowski, stars of the sitcom 30 Rock on NBC, told The Today Show's Matt Lauer that they both had their babies at Lenox Hill Hospital as well. Said Fey, "My celebrity treatment at Lenox Hill involved taking a group breast-feeding class in a closet."

How great would it be to be able to tell in advance whether a particular birth would go smoothly or need intervention!

A French team of physicians reported this week at the annual meeting of the Radiological Society of North America that it has developed a new computer model that uses magnetic resonance imaging to predict whether a birth will go smoothly or have problems.

Olivier Ami MD told a session of the RSNA meeting in Chicago that his team applied the new software, called Predibirth, to 24 MR images of pregnant women, and created a three-dimensional model of the woman's pelvis and the fetus. Using these images, Predibirth calculated the likelihood that the babies could find their way out of their mothers' bodies without assistance.

Of the 24 women studied, 13 delivered normally. Predibirth had predicted normal births for all of these women. Predibirth had tagged three women who opted for elective Cesarean sections as being at risk for dystocia.

Of five women who had emergency C-sections, Predibirth had predicted three might have problems — all three involved instructed labor. However, Predibirth had given thumbs up to two of the mothers, whose problems involved heart arrhythmia.

Predibirth had declared "mildly favorable" three additional moms who wound up resorting to vacuum extraction during birth.

Not perfect, but not bad.

"With this virtual childbirth software, the majority of C-sections could be planned rather than emergency, and difficult instrumental extractions might disappear in the near future," Dr. Ami told his audience in Chicago.

Dr. Ami M.D. is an obstetrician in the radiology department at Antoine Béclère Hospital, Université Paris Sud, France.

Image by Petteri Sulonen

The birth in Twilight: Breaking Dawn Part I was not as scary as I thought it would be. (If you don't want to read about the film's ending, stop reading here.) Breaking Dawn is a preteen fantasy through and through, so the birth of Bella's half-human, half-vampire baby winds up looking fairly tidy and vaguely menstrual, even if it does involve blades and teeth. (No trial of labor for Bella.)

Kristen Stewart as Bella Swan

Will Breaking Dawn leave a generation of young girls with tocophobia — fear of childbirth? My guess is that it will not. The birth happens fast, for one thing, and it's all pretty implausible. The baby appears to be a normal baby, though about six months old, and functions for the rest of the movie in a doll-like capacity.

But Bella Swan — the teenager who falls in love with the vampire Edward Cullen (Robert Pattinson) and marries him in this, the first half of the screen adaptation of the fourth and final book in Stephenie Meyers' Twilight saga — does die in childbirth in the film. Her death has been prophesied, so it isn't unexpected, but the sight of her still, gray form on the table where her baby was born is upsetting.

However, the second half of Breaking Dawn is scheduled for release one year from now, so let's just say that birth for Bella is a defining moment. We haven't seen the last of her.

Breaking Dawn is rated PG-13.

It is officially the silly season, the last days of summer, when news traditionally slows down to a trickle and publications fill their pages with stories so fluffy they practically float.

Koi

My candidate for this year's silly-season birth story is "Koi-Assisted Birth," a winsome website about a couple, "Jane" and "Shane," who are planning a water birth in the fall. The two have decided to enlist their 15 koi to help them and their midwife usher their new baby into the world.

The website has generated some controversy. My guess is that Jane is pulling our leg.

She says that "koi are excellent birthing partners," their skills honed by giving birth to thousands, or even tens of thousands, of baby fish, with help from koi dads.

"That's exactly the kind of birthing energy I want!" Jane writes.

But Shane will have a net at the ready to catch the baby, just in case.

Image courtesty of Wikimedia Commons

My daughter Nora lives in Los Angeles, Cal., so I am aware that Angelenos are so dreading the shutdown of 10 miles of the I-405 expressway there for road work this weekend they have dubbed the event "Carmageddon."

Nora is going to walk or take buses as much as she can this weekend, and being from Chicago, she is comfortable with those activities. But many Angelenos are famously more car-bound than she is.

Los Angeles commuter traffic

Crosstown airline flights between the suburbs of Long Beach and Burbank are sold out this weekend and the police department is asking celebrities to urge their Twitter followers to avoid the expressway and, indeed, to drive in the city as little as possible.

But Jenny Benjamin, writing in The Stir today, brings up an interesting and, to her and other expectant moms, urgent point: What happens if your baby decides to be born in L.A. this weekend?

Pregnant with twins, less than two weeks shy of her due date, a 30-minute drive away ("without traffic") from the hospital she carefully chose for its neonatal intensive care unit, Benjamin considers the possibility of an early labor and aks, "For the love of all things good and holy, what am I going to do?!?!"

Will her husband wind up delivering the twins (one of whom is in a transverse position) on the side of the road? Should she call an ambulance? "Ambulances aren't hovercrafts -- they're going to get stuck in the same traffic!" Benjamin notes.

Her doctor lives close to the hospital. "Good to know at least one of us will be able to get there," she writes.

"Aargh, it's times like this that I really wish that Segways had caught on!" Benjamin frets.

The best solution, she notes, is not to have the babies this weekend. "I have about as much control over that as I do the traffic," Benjamin writes. "Maybe I should see how much my husband knows about home birthing."

Everybody knows that obstetricians are one of the most-sued medical specialties, but nailing down the details on that truism can be difficult.

CRICO Strategies, an international firm that provides risk-management software to hospitals and insurances companies, last month released a "benchmarking report" on malpractice risks in obstetrics that helps fill out that sketchy picture.

The report looked at 800 obstetrics-related medical-liability suits filed between 2005 and 2009.

Families dealing with the death of a mother or child, a severely damaged infant, or some other effect of a childbirth gone awry most commonly charged "communication failures, judgment lapses, and faulty technique as the reasons behind their injuries and their malpractice cases," the report states.

Sixty-five percent of cases involved "high-severity injuries."

Across the board, about one in 1,000 births involves a "preventable adverse outcome," the report noted.

While those can occur throughout pregnancy and birth, most suits in the study concerned allegations that birth assistants had mismanaged labor and delivery, particularly the second stage of labor — the actual birth.

"Substandard clinical judgment" was the top complaint in the suits, accounting for 77 percent of claims. Most of the suits named an attending physician.

The most common reason for suing was "birth asphyxia," a potentially injurious lack of oxygen, which accounted for 27 percent of the suits, and the most common allegation was that of a "delay in treatment of fetal distress" (25 percent of claims involving small hospitals, 19 percent involving large ones).

Fathers who pushed to be included in their children's births beginning in the 1950s have brought real change to the modern birth, according to historian Judith Walzer Leavitt's 2009 book Make Room for Daddy.

Buoyed by changing perceptions of how men should function in society, fathers have created "unprecedented new roles for themselves in a traditionally women's event"  and have "helped to make hospitals more flexible in how they handled birth," Leavitt writes.

Dads' participation in birth has helped to break down the "mystique of modern medicine and further opened the world of obstetrics to lay participation and interpretation," she writes.

Fathers often report that witnessing a child's birth is one of the best experiences of their lives.

"It was better than any game I've played or any big hit I've had," said Ian Desmond, the Washington Nationals' shortstop who recently took advantage of Major League Baseball's new paternity leave to attend the birth of his son, Grayson.

However, the journey has not always been easy for men, who in their public lives often are far more in control than they feel attending the birth of one of their own children.

Leavitt quotes the writer Stephen Harrigan, who wrote in Reader's Digest in March, 1979, about attending the birth of his son. Before the birth, Harrigan worried that he would be no more than a spectator metaphorically holding out Gatorade to his wife, the "athlete who would finish the race."

Harrigan found the experience to be more profound and involving than he expected, but some other fathers feel "at sea, abandoned and out-of-control" at birth, Leavitt writes.

Some fathers cringe at the idea of watching their wives in pain or perhaps fear the experience will damage the desire they feel for their wives. Fathers attending birth are now so ubiquitous that a reluctant dad may well feel pressured to go.

Nevertheless, men's foray into the birth process, which may begin with their attending prenatal classes, has led to their increased participation in their families' lives and experiences, compared with those 1950s dads who began the process, Leavitt writes.

Dads who don't attend their children's birth lose a crucial opportunity, according to researcher Jessica Weiss, who goes so far as to say they risk having "missed the boat of shared parenting."

American fathers began making their way into the childbirth picture in the 1950s, according to Make Room for Daddy: The Journey from Waiting Room to Birthing Room, historian Judith Walzer Leavitt's 2009 book. Birth had migrated from home to hospital by that time.

Two developments helped bring dad into the birth process, Leavitt writes — the growing influence in this country of British obstetrician Grantly Dick-Read's 1933 book Childbirth Without Fear and the "natural birth" movement it helped launch; and the development of regional anesthesia for childbirth.

Dick-Read's book inspired couples to begin exploring ways to experience childbirth together. The introduction of regional anesthesia meant that women were conscious during birth, but often alone for long periods during labor.

Women asked for their husbands to be allowed to attend their births, and doctors and hospital officials eventually realized that the fathers' presence could make birth safer and more satisfying for mothers.

The phenomenon of fathers attending their children's birth was not just new, it was news. For the June 13, 1955 issue of Life magazine, photographer Burton Glinn snapped reporter John Stouffer gaping in amazement at the birth of his son at Virginia Mason Hospital in Seattle.

Here's one Q & A exchange — the last one, in fact — from an interview Tara Parker-Pope, who writes the "Well" blog for the New York Times, conducted last year with Randi Hutter Epstein, physician, mother of four and author of the 2010 book on childbirth, Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.

Q (TPP)  Should the care of women during childbirth be reserved for other women?

A (RHE)  I look at it as a doctor-patient relationship history, more than a man-woman kind of thing. When you hear women say, “I’d much rather give birth with a midwife than a doctor,’’ I think, “Why?” I love my ob-gyn. It’s sad people think you’ll have a nicer person if you avoid the medical system. That’s the feeling you get when you talk to women. I think if women had better relationships with their doctors, I think that would help. They would be more informed. They would believe the information their doctors tell them.

I agree with some of what Dr. Epstein is saying. I loved both my ob-gyns, too. I believe, though, that to choose a midwife for a birth attendant instead of a doctor is to opt for, or at least to attempt to have, a qualitatively different experience.

It isn't just a hope to deal with a nice person. It's embarking on a whole different journey.

What do you think? I would love to hear from you.

A study released this week on home birth in America shows a substantial increase in the still very small numbers of women who are choosing to have home births.

The study, released online in Birth: Issues in Perinatal Care, shows that of the 4.2 million births in the United States in 2008, 28,357 were home births. That is 2/3 of one percent of the total, but it represents a 20 percent increase, from 0.56 percent in 2004.

Non-Hispanic white women accounted for most of the growth, with an increase of 28 percent between 2004 and 2008. More than 1 percent of those women now have their births at home.

The study was based on United States birth-certificate data.