My ultimate fantasy was to give birth into the Yuba River. Christina and I had exchanged our wedding vows in the mountains near Nevada City. The sweet scent in the air, the open sky, the smooth granite hot rocks, the clear cool water, and the quiet—that’s what seemed right to me. But since I'm over 40, have insurance with Kaiser Permanente, and come from a family in which medicated, scheduled hospital births are the norm, I sort of assumed at first that our baby would be born in a hospital. After reading from Ina May Gaskin's books including Spiritual Midwifery and watching the Ricki Lake documentaries and other online videos featuring babies being delivered, for example, by a stream in the rainforest, or in a candlelit cave, or in birthing tubs at home, surrounded by close family and beloved pets, I yearned for a home birth experience—one that was natural, spiritual, intimate, and empowered.

We’d had our ups and downs with the Kaiser system. On our first visit to the infertility clinic, the doctor asked us how serious we were about getting pregnant. When we told him, somewhat taken aback, that we were very serious, he quizzed us on the statistics for people giving birth in our situation (apparently only a 2-3% success rate) and he told us that even in "normal" (meaning heterosexual) couples, the chances of ever getting pregnant via artificial insemination were low. He said it would be a waste of time to attempt vaginal or intrauterine inseminations, and that ideally we should just go directly to IVF, which he assumed we couldn't afford. It was pretty awful. Most people going to the "infertility" clinic are heterosexual couples who have been trying to get pregnant on their own for at least a year. That wasn't the case with us. There was no reason to believe I was infertile. In fact many women in my family have successfully given birth over 40, and I was working hard to turn back my biological clock in various ways. So we switched doctors, eventually finding Dr. Janie Hirata, who was also a lesbian who had conceived via artificial insemination. And we worked with a midwife from MAIA midwifery who specializes in fertility counseling for LGBTQ individuals and families. I took extremely good care of myself by staying on a personalized fertility diet, getting regular exercise and good sleep, and doing acupuncture with a fertility specialist. Some of the inseminations were at Kaiser, and some were with another midwife at home. Each time we tried, we upped the ante by adding something new to the mix: switching to a donor with recorded births, adding more vials and multiple inseminations each cycle, and, in the interest of time, sampling a whole spectrum of hormones, fertility drugs, and alternative medicines including Progesterone, Menopur, Clomid, Letrazole, HCG, Metformin, Vitex, DHEA, herbs, and so forth. We got pregnant on our 5th cycle of IUI, after two tries via ICI, doing the inseminations at both Kaiser and at home. In the end, both our Kaiser doctor and our midwife allowed Christina to plunge the syringe, so I can proudly say that my wife got me pregnant. I had really wanted to conceive by the age of 41, and we had spent over $15,000 in the process, so we had decided that this would probably be our last try, using up all of the remaining sperm we’d purchased—and it worked. We conceived on or around Thanksgiving, and were elated.

Prenatal visits to my Kaiser ob/gyn were impersonal and insensitive. I was still categorized in the Kaiser system as infertile (due to being a lesbian), geriatric (being over 40), obese (size 14), and pre-diabetic (after a single, slightly high glucose test I'd taken years before). My age alone put me into the high-risk category, even though every single test I took (I lost count at 26) came back with favorable, if not ideal, results. I had heard that midwives wouldn’t work with so-called high-risk pregnancies, so even though going to Kaiser was stressful and discouraging, I wasn't sure if a midwife would take me on. One time when I probed my doctor about why I would be considered "high risk," she said, "Well, your chart here says that you do have coronary heart disease..." which was just a completely false, clerical error. I still have no idea where that came from. She had a real problem with my size, and asked me if I was able to stay on a diet, which was insulting considering how committed I was to the pregnancy and to good health. It also went against everything else I'd heard and read. Rather than gaining 25-35 lbs., the common estimate for a healthy pregnancy, she warned me that gaining more than 15-20 lbs. would put me at a higher risk for C-section. In the end, I gained 30 lbs. exactly, which I lost completely within the first two months postpartum. But this idea of being potentially high risk, and the accompanying threat of C-section, seemed to be following me around.

When we told our mothers we were considering working with a midwife and trying for a home birth, they were both adamantly against it. My mom developed the bad habit of filling my mind with negative thoughts, everything from having a cervix that had been "clamped shut" for forty years (?!), to the possibility of meconium aspiration during childbirth. She reminded me of my age constantly, and asked repeatedly what my doctor said about this or that, as opposed to what the midwives, or my own instincts, were telling me. She predicted I'd have a big baby, and told me that having a C-section wasn't all that bad. In fact, I'm one of four children born by C-section; my mom's two sisters and my cousin had babies via C-section; and my older sister delivered four babies by C-section as well. The fact that no one thing connected these births to each other, or to me, didn't matter. Who did I think I was to believe I would be any different? Christina is also one of two siblings born by C-section. And, sadly, her mother lost her first baby in childbirth, although a C-section might have saved the baby's life. So for her, the idea of home birth was not only a risky proposition for me and the baby, but it also triggered deeply traumatic memories that haunted their family for almost 40 years. I had read about the mind/body connection, Dick-Read's fear-tension-pain triad, and how important family birth stories are in general. It was so hard to deflect these projections. I wanted to be seen for who I am and what I wanted for my own family and myself. I wanted so badly just to be encouraged and told I could do it.

Meanwhile, I was having a very smooth, healthy pregnancy. I enjoyed being pregnant, and experienced very few of the more difficult side effects. In fact, I had never felt better in my body and about my body, and I knew our baby was thriving. I felt like I was on a hormonal cocktail that made me feel happy and relaxed all the time. And the baby was very active and responsive. We waited to see if any risk factors might emerge that would make the decision easier, but in the end we just had to go with our gut: at five months into the pregnancy, Christina and I started interviewing midwives and doulas. It took us an additional two months to decide that we were going to do it for sure. Much to our surprise, we found out that this somewhat late decision is quite common. It makes sense: you try to do what you think is practical and reasonable, just going with the flow, or maybe you automatically do what your mom did. But then, at a certain point, that "my body, my baby, my birth..." feeling (like the film) gets stronger and stronger until it finally takes over. You own this. For us, it was a process of gaining confidence in ourselves. Ultimately, we figured that, by continuing to go to Kaiser regularly, as well as doing prenatal yoga and seeing a midwife, acupuncturist and chiropractor, we would get the best of all worlds, which we really did. We ended up choosing Liesl Weimer as our primary midwife. What we loved most about Liesl was her directness, compassion, and sense of humor, on top of her obvious depth of knowledge and experience. She was our main ally at every crossroad throughout the remainder of the pregnancy and birth. And there were some major crossroads.

At 37 weeks I was ready to give birth, and started doing all sorts of things to let the baby know that, from my perspective, anyway, it was time. I passed the days keeping myself busy with my to-do list. We built a room for the baby in the storefront where we live. I did my back taxes. I fixed every broken thing in the house; I mended every piece of clothing. Finally, I had gotten down to micro tasks, like taking a fire extinguisher in to be recharged, and having the links on my mother's charm bracelet tightened. At 40 weeks, the car seat was installed. The freezer was full. The Aqua Doula was set up, with my altar of Yuba River rocks and other focal objects nearby. We made the playlist. I even bought flowers for the birth. My body was doing all of the things it was supposed to do. The baby was in the ideal position, head down. We saw our midwives regularly, and Liesl was convinced that I was going to go ahead and have a baby at any moment. We started going in for the required non-stress tests, and the baby was healthy and responsive. There were no red flags whatsoever, only a ticking clock: after 42 weeks, it becomes illegal for midwives in California to assist in home births. We tried everything to get labor started, from acupuncture, meditation, and reflexology, to tinctures and castor oil (3x), from pumping, dancing, bouncing, singing and swimming, to driving on bumpy roads, swinging on swing sets, eating the spicy pizza, painting walls (it worked twice for my aunt), and so on. I went into early labor on my own (for a total of five days), but it didn't gain enough momentum before we, sadly, ran out of time. You can imagine how disappointed we were to have to schedule an induction at Kaiser, after months of working up the courage to choose the home birth/midwife scenario, at the expense of alienating our own mothers, in order to do what we thought was best for ourselves and our baby.

The day before the induction, we set an intention to have a beautiful day. We stopped the tinctures, the pumping, and everything else to take a romantic drive out to Rodeo Beach in the Headlands. It was a special spot we'd visited when we first started dating. We took our two beagles Nola and Penny, and sat in the pebbles looking out at the ocean. Suddenly, a family of dolphins appeared, two adults and a pup, and the parents literally dove toward each other in a heart formation. We looked around at the other people on the beach, wondering if anyone else was witnessing this magical event. It seemed to be meant just for us. At that moment, I think we accepted that we would be giving birth at Kaiser. The dolphins had sanctioned it.

The morning of the induction, I called Kaiser ahead of time and asked to speak with the charge nurse. I explained that we are a lesbian couple and that we had hoped for a home birth, and I asked that we be matched with nurses who would be happy to work with a family like ours. When we arrived at Kaiser, Liesl met us at the entrance. My heart sank as we entered the delivery room, seeing the wall of equipment, monitors, and cords. We set up some things from my home altar. Liesl sat on the couch and spontaneously knitted us a jellyfish out of white yarn, which she hung on my IV stand as a "feminist spy" to watch over and protect us. We discussed our options with the doctor, and came up with a plan: hep lock, Misoprostol, Foley balloon, Pitocin. Pretty much the stuff I dreaded. But I was in pretty good spirits, surrounded by my birth team, including Christina, Liesl, my younger sibling Smith, and our dear friend Anne. The first dose of Miso seemed to work well, so we moved on to the Foley balloon later that night. The insertion was extremely painful, and felt so invasive; I cried. But thankfully, it fell out only four hours later (as opposed to an average of 12-24), and I cried again, this time tears of joy. I was now in active labor, which would last for the next 27.5 hours. My contractions were more regular and we were finally making progress.

The next morning, a new nurse arrived, Marisa. It turned out that she was formerly on track to become a home birth midwife. Amazingly, she had just returned from a weekend trip to the Yuba River. We watched a video Liesl recommended called Birth Into Being, featuring underwater births, with dolphins. We started the Pitocin and I walked the halls of the delivery ward with Anne, making little jokes and chatting as my contractions started getting stronger and stronger. After awhile I produced a bloody show, and I remember being really excited as I felt the fluid running down my leg and onto the floor. (I thought my water broke.) But from that moment onward, the contractions started coming on fast, and furious. Marisa had warned me about this. It didn't feel like pain at first, but more like a gripping feeling, from some powerful source way bigger than me. I soon got into the shower. Christina aimed the water at my low back and coached me through my moaning and growling. Pretty soon my contractions seemed to take on an aggressive character, and, although I knew I needed to relax my pelvis, it started to feel more like an epic battle, something I could only barely manage to push against. After three or four hours of this, my face pressed against the cold ceramic tiled wall, the aluminum shower seat now twisted out of shape, I stood up and staggered out into the room. I remember Liesl encouraging me, saying, "Yes…That's the way to bring a baby down...You are at cruising altitude...It's not going to get worse than this...You will have your baby by tonight..." I wanted to be checked. Although I'd made progress, it was not as much as I'd hoped, and the thought of maintaining that level of intensity until nighttime was unimaginable. It was overtaking me. And, strangely, I felt like I was performing. I was proud of myself for going as far as I did into the pain, but I also remember thinking that I didn't need to be a hero and that pushing through these crazy Pitocin-induced contractions, in order to prove something (?), wasn't what was necessarily best for me or my baby. I asked for a moment alone with Christina. I said the safe word. She suggested, as planned, that we go through three more contractions. After six, now on my hands and knees at the foot of the bed, my bag of waters broke. I remember hearing cheers. But this was a whole new level of pressure. I said the safe word again, about ten times in succession: "cacao cacao cacao cacao cacao cacao cacao cacao..."

Within an hour I was comfortable, but incapacitated, lying quietly in the hospital bed with a catheter and an internal monitor. I could still feel the contractions, roaring along, underneath the dulling effects of an epidural. I could also feel the baby moving toward the top of my belly, which was comforting. But every time they inched up the dose of Pitocin to increase the intensity of the contractions, the baby's heart rate would decelerate. Soon I was wearing an oxygen mask, and we went into the night, stopping and starting, stopping and starting. Christina became an expert at interpreting the graphs showing the fetal heart rate and contractions. There was the sound of beeping and a constant flow of nurses and residents coming in to check on us. At one point an alarm went off, all the lights went on, and everyone on duty in the ward entered my hospital room. The possibility of C-section was now on the table. Liesl coached us on our options. I met doctors Amanda Calhoun and Natalie Wilkins, and liked them both instantly. Dr. Wilkins affirmed that what we all wanted was a vaginal birth. We discussed the idea of getting some sleep and resuming in the morning. But then, late into the night, they called it: prolonged heart decelerations, cessation of cervical dilation, and fetal intolerance of contractions: urgent C-section. I felt defeated and completely at their mercy. My only comfort was that I would be meeting my baby soon. A new nurse Nancy told us her own story of being pregnant over 40 and planning for a home birth that ended in an induction and a C-section. She was like the wise grandmother you always wanted, and she showed up at just the right moment.

When the time came, I was wheeled into the operating room, spread eagle on the operating table, with a blue paper curtain in front of my face. Needless to say, this had reached a point at the polar opposite end of what I'd initially hoped for. I was now thoroughly drugged and managed to request a tummy tuck and asked for a full explanation of the history behind the term cesarean section. After they finished prepping for the surgery, a hush came over the room, and, incredibly, Dr. Wilkins asked me to call out the names of all those who I had wanted to be with me at the birth (starting with the beagles), so that we could hold them in their thoughts during the procedure. That meant so much to us. I called out their names: Nola, Penny, Smith, Anne, Liesl...When the surgery began, I could feel tugging, and I stared at the ceiling, counting to myself in order to stay calm: 1, 2, 3, 4...1, 2, 3, 4...Christina held my hand. We had asked if they would hold off on announcing the sex until Christina and I had a chance to discover it ourselves. Soon, she was whispering in my ear, "It's a male child" and after being at the warmer briefly, where Christina greeted him, he was placed on my chest. He looked right into my eyes and let out a little sigh that spoke volumes about what we had just endured. Because Christina and I had used an anonymous donor, I had prepared myself to be surprised by his appearance. But he had the face of my beloved grandfather, who had recently passed away, and red hair, like almost everyone in my family. I knew him, and he knew me. What a profound moment that was. And before they even finished stitching me up, he latched onto my breast and was contentedly sucking away. It turned out that his head had been turned sideways, which explained the lack of progress. And my placenta was slightly meconium stained and calcified, so it was good that we didn't wait any longer.

We took a day to process the experience before we sent out the announcement. I was determined to recover quickly, and was discharged after only two days in the recovery ward. We had a shortlist of baby names, but none of them seemed quite right. During the pregnancy, we called the baby Persy, for the person inside of me. Out of the blue, the name Claude came to me. We looked up its meaning, which turned out to be "perseverance," which perfectly described what we'd been through.

So that is how Claude Linden Smith came to be. Born September 9th, 2015, at 6am, 9 lbs. 3 oz.

But how does this story end? How do I make meaning from it? I have to say something about my mom, I think. She was wrong, but she was right. And my ob/gyn—also wrong, but right. And the hospital birth, it wasn’t what we wanted, but it was what we got. It included a lot of the bad stuff that we had specifically wanted to avoid. But it also included some good stuff that was surprisingly powerful and meaningful. In the end, we know we did everything we possibly could to manifest the kind of birth we wanted. And working with a midwife, with the intention to give birth at home, helped us to stay focused and positive. It was the thing that helped us maintain the natural, spiritual, intimate, and empowered aspects of pregnancy and childbirth, which ultimately complemented the Western, medical, Kaiser, HMO, hospital experience that we first passively chose, then tried actively not to choose, and, for reasons beyond our control, chose us in the end.

The end.

But also: What is passion, if not surrender? What is pregnancy, if not surrender? What is childbirth, if not surrender? Surrender, surrender, surrender.

And one more thing: I got a call one day about that first guy we saw at Kaiser. It turns out other couples had also complained and switched doctors after seeing him. He was later fired.