the underworld

thoughts on birth as I approach it for the third time

I am thirty weeks pregnant with my third baby. They are healthy and vigorous, kicking me near constantly. In approximately 10-12 weeks, I will have one wild day that will act like a hinge in my life. I will find myself at a threshold, a doorway, and I will pass through. More like I’ll be flung through. I will give birth, come face to face with this child who will be one of the great loves of my life. It will be so hard that at times I will feel like I am dying, or even that dying could be preferable to enduring the raw experience of birth. People will help me, reassure me, accompany me, hold me up. I will put my trust in these people, and I will try my best to trust myself. I will labor however long, with whatever twists and turns await me. I will feel frightened in some moments, and confident and determined in others. It will be terrible. It will also be extraordinary, an unmistakably rare and real experience — unmissable. I will use every part of myself, cross all of my boundaries into uncharted territory. Birth will be all-consuming, like fire.

All of this struggle is in the best case, with no surprises or complications that take us down a different path. We are planning our third out-of-hospital birth center birth, in the same room where my other two babies were born. I was reflecting on choosing the birth center for our birth back with my first, realizing it was a little bit out of character for my risk-averse self to choose something with objectively more risk than a hospital birth. I can’t quite remember every thing that went into the decision, but I think it was mostly my gut, to be honest. I learned I was pregnant with our first baby just as the covid lockdowns were starting, so that was certainly part of it too. In that moment, a hospital felt scarier than a freestanding birth center. But I also knew enough about birth in America to know that I wanted to move toward a certain experience too. Of course I knew about all that could go wrong in birth (though I knew less then than I know now), but that knowledge didn’t sway my decision. I wanted midwifery care, and I wanted something different than what I assumed the hospital had to offer. I say assumed because I didn’t know. I wasn’t a doula yet then, I had no personal experience with birth either in or out of the hospital. But, I will say, with more experience now, that my gut feeling was fairly accurate for me and what I knew I wanted and needed out of birth. I wanted to feel everything. I wanted expectant rather than active management. I wanted to move through the experience in my body with full range of motion, with my husband beside me and the wise help of experienced women. You can do all of that in the hospital, but I also didn’t want to have to fight for the birth I wanted or “swim upstream,” so to speak. The birth center felt like the place where my own hopes for birth and the usual protocol aligned. And now here I am, the third time around, returning again to the same care team, same room, same hope. I think I carry more fear and more confidence, both. I trust my care team, and I know birth is not controllable or predictable. Birth always carries risk. We do it anyway.

I have had a much harder time in this pregnancy than I expected. I felt it coming immediately, looking at the positive pregnancy test. In one breath, I thought, this is going to be so hard. In the next I thought, I am powerful. That isn’t a fictionalized version of my thoughts, it is verbatim memory. That honest progression of thought has defined this pregnancy for me. The awareness of true difficulty, followed by resolve. It has been so hard, and I am powerful. I expect birth this third time will be similar. But how can you have expectations for birth?

This pregnancy has certainly been challenging physically (especially in the first trimester), but it has been even more challenging mentally. After a huge wave of perinatal anxiety brought me to my knees early in the second trimester and then never lifted, I decided to return to meeting with the birth center’s in house therapist. After our most recent meeting, these are the notes I jotted down:

This is so hard but I’m doing it because it matters to me and it is worth it.

I feel humbled.

Return to the underworld.

After looking at the pregnancy test, I told myself “I am powerful, I can do this.”

Inanna loses something at every gate she crosses.

The notes bring up Inanna and the underworld, two references to a story I’ve been thinking about since I started my doula training with Birthing from Within. Inanna’s stories are ancient. She is a deity of the ancient Sumerians, and the first goddess in recorded history, her myths predating the Bible by thousands of years. A certain myth, “From the Great Above to the Great Below,” is used in BfW’s framework as a sort of story-based metaphor for birth as a heroic journey. In it, Inanna journeys to the underworld where she is killed, hung on a hook for three days, and then brought back to life and slowly drawn back to the surface with the help of her family and friends. There’s much more to it than that, but that’s the gist. When I heard the story for the first time, I felt located. I’ve been to that underworld. I’ve come back up. I’m going down there again. Why would I do that? And how could I not?

a lightbulb moment

There have been moments in this pregnancy where I have felt so bad, and so confused about that bad feeling. I think I thought this time would be easier, and maybe even exemplary, like somehow becoming a doula and being so immersed in thinking about birth and walking through it with others would exempt me from challenge in some meaningful way. I expected to write so much, so brilliantly, to come up with all kinds of new resources for my clients, to spin the straw of my pregnancy into some kind of gold. Instead, I’ve mostly felt flattened, hung on a hook to die deep in the dark and scary underworld — and I haven’t even made it to my birth or postpartum experiences yet. I have felt humbled to be perfectly honest, feeling like I don’t know anything at all. But could it be any other way? Talking with my therapist, who is so gentle and wise, I remembered what I know to be true: This is so hard but I’m doing it because it matters to me and it is worth it. Why am I doing this again? Not because it’s easy, and not because it’s interesting, and not because there is some gold to spin. I’m doing it because we want another child, and to me that is worth everything hard about pregnancy and birth.

That wanting a child feels different now than it did the first or even second time I descended to the underworld. The first time, I didn’t know why, and I didn’t know what I was getting myself into. It was raw newness, with no prior experience to lean on. The second time felt almost experimental — what would be different? How had I changed? In a way, I had not even left the underworld by the time I went back down. The second birth is what helped me climb back up. I spent a little time in the light, and now I’m back down again. This time, I know, with the full weight of knowledge, what it means to step into this experience of pregnancy, birth, postpartum, and raising this child into the future. There is a weightiness, an acknowledgement of all that is vulnerable and tender and unprotected on this path. The full weight of love is felt. Before her descent, Inanna gathers many precious items to take with her to the Great Below. A crown, her dark thick hair, lapis beads, a royal robe, precious ointment, a breastplate, a gold ring, and a lapis measuring rod and line. One by one, she loses all of these things as she crosses through the seven gates of the underworld, descending lower and lower — until she is naked at the bottom, unprotected. I have felt myself passing through these gates, losing all the things I’ve gathered, things I thought would protect me. Experience, conversations, book after book I’ve read, tools, tips and tricks, birth stories, interviews. I know so much — none of that will help me, not really. Did I think it would be easy? This is not easy. Did I think descending to the depths of experience to fetch my child would come without cost? Did I think that somehow I would cross over these coals feeling no pain? Even the goddess loses everything — and I am no Inanna, I am just myself.

All of this to say, I feel humbled. In this humility, I seek comfort. Will it be ok? What will happen in our birth? How can I protect us? There are no answers to these questions, for me or anyone. All of us scramble to sit with this uncertainty, all in different ways. I’ve seen this play out culturally and experientially, witnessing firsthand the way hospital birth can spiral out of control, and, on the flipside, watching closely the fallout of the freebirth movement, and everything in between. I’ve seen births go smoothly and births take terrible turns. I’ve heard people from every ideology of birth make their case for why their way is right. I’ve heard all the birth stories, watched all the documentaries, read book after book. Nothing changes the fact that, like all of us, I have to sit in that answerlessness and no one “doctrine” of birth will soothe it.

When I try to decide if I want to do anything differently, I try to predict the future. I don’t have a crystal ball! I only know what I know now, I have no way of knowing what will happen. At every appointment, my risk assessment is 0. By all accounts, my first two births were wonderfully uncomplicated births. Spontaneous labor, following normal patterns, within normal limits, everyone healthy and happy in the end. I wish this again. Why do I feel like I’m tempting fate? Do I know too much, have I heard too many stories, seen too many twists and turns? I think the hardest thing about my perinatal anxiety has been the sense of impending doom I’ve felt wrapped around my neck like a leaden weight. I guess I just want whatever is true, and I want to trust my team, the same as last time and the time before. And whatever it is, I know it won’t be easy. My births didn’t feel “textbook” when they were happening, they felt like getting dragged through stormwater and spat out somewhere dark and unfamiliar. A rough passage from one life to another. That is to say that though they were uncomplicated births, they were not easy. I don’t know what to expect this time. I resist the sense of impending doom, knowing it isn’t true. I feel the hormonal twist of my serotonin, everything in my brain askew. Anxiety is an underworld. Birth is too. In some ways, I crave birth’s pain, the crushing downward energy. At least then something will be happening. The waiting, and my brain’s tendency toward catastrophizing while it waits, is what feels unbearable right now.

I want to meet and hold this baby, and then spend our life together. I want to get there now, and feel less of the tension. The temporality of birth is so intense — this is a thing I can never get over. In no other time of my life have I been more aware of time passing than when I have been pregnant. On any given day, I know exactly where I am in the pregnancy, how many weeks, how many days, how much time has passed and how much time is left. I can’t escape the little metronome in my mind. The body becomes a clock, and it changes so rapidly and so slowly, both at once. With only ten weeks left, that feeling feels even more intense. So little time but I know it will feel crushingly long. I don’t want to wish this pregnancy away, though. In some ways, I have enjoyed this pregnancy more than either of my others. I have felt myself relax into it, feel curious, and proud. Every movement my baby makes feels satisfying — you’re really here. Along with the weightiness comes relish. This is so special, truly, and important. I don’t want to give all that is good over to fear. There is so much we don’t get to choose, even how we feel. But in any given moment I can choose to return to right where I am and what is true right now. Here is me, here is my baby, we are both here together now, and the future is still out there ahead of us, a “benevolent black hole.”

Anyway, I started this essay intending to write something about my birth plan or hopes for this birth, but I’m realizing I truly haven’t even thought that far yet. Or maybe I’ve thought about it so much that there is nothing left to think — I just have to live it. Practically, I am planning another birth center birth, where there is no anesthesia, but there is nitrous oxide and wonderful birth tubs, both of which I will use. I have a TENS unit this time which I’m excited to try in early labor and I will see if I like it. I hope labor will begin spontaneously again, I intend to labor at home until it’s clear we need to go, and then at the birth center things will get quite serious and intense and then we’ll have a baby. Ben was born in the water — I haven’t decided yet if that’s what I want for this baby or not. I expect it will be an in-the-moment decision. I have a whole other set of preferences for hospital birth and/or cesarean birth, but that feels like a hill to climb if we come to it. After experiencing hospital births as a doula, I feel less scared of the hospital than I did before, but I also feel more aware of the way things can go sideways. I carry all of that in my body, and I hope it won’t come up during my birth. I can’t know that yet. All I can do is keep traveling down and down and down to the depths of the underworld, doing what I know is required, one step at a time. All I can do is keep trusting what I know to trust, and to not get too far ahead of myself. I steer myself to beginner’s mind, to a sort of unknowing. I cannot control this, I can only keep taking it day by day.

Talking with the midwives in the midwife group I’m working with has felt different this pregnancy. Now that I’m here for the third time, I feel them regarding me differently. I feel them trusting me, just as I trust them. There’s less education, more curiosity. Because I’m a doula in the community, sometimes we even talk shop a little bit, which feels fun and good. I feel recognized, remembered, which isn’t necessarily a given. They see a lot of clients, they deliver a lot of babies. It’s not the same as a one-on-one midwife-client relationship like you might have with a homebirth midwife. The practice has seven staff CNM’s, and you don’t know who will be on call for your birth. In this pregnancy, I feel new agency in the room, new authority over my own experience, my own body, my own birth. I feel new confidence, like I can almost answer my own questions. In many ways I can. It’s a good feeling. But that confidence will only take me so far. Will it follow me into the birth room? Will it stay with me in active labor, in transition, in the second stage? I expect to “lose it,” like everyone does. I feel grateful for this safe space, these safe people, to do that with. That mutual trust is important to me. If I have any birth plan, it’s that.

It’s so funny, my thoughts on birth feel less clear than they ever have been before. I could give myself the whole spiel I give to my clients, all the education about the stages of labor and coping methods and comfort measures and self-advocacy and “next right thing” and leaning into the unknown, and, and, and. All of that is already downloaded into my mind. But what I really offer my clients beyond that preparation and a willingness to listen to what’s on their mind is my presence in the birth room. That presence is what really matters in the end. I pay very close attention to them, I bear witness, I stay by their side. My ideas and “expertise” feel like the least of my offerings in the birth room, though I offer those too as needed. But the attention is the biggest thing. Can I pay close attention to myself in my birth? Can I stay by my own side, can I bear witness? That’s what feels important to me, that this birth will be something that will really happen in my life, and I want to move through it with the kind of awareness that honors all I have experienced, all I know, all I fear, all I hope. I know I’ll lose my lapis beads, my measuring rod, my breastplate. But can I bring my whole self into that room, even the frightened parts? Can I welcome every part of me down in the deepest chamber of the underworld, hung on the hook? Can I trust everyone I love to draw me back up to the surface where the light touches everything? It will be so hard. I am powerful.

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Thanks so much for reading. I love to hear your thoughts — please leave a comment with anything on your mind!

Birth photos are from my second birth. I’ll be back in that room in approx. 10 weeks, ahhh.

Writing about birth is a special interest of mine. I seek it out in literature and I have spent quite a bit of time doing it myself too. I wrote this essay shortly after my second birth. I also have published my second birth story as a zine, here.

I’m working on getting the birth prep zines that I use with my doula clients ready to be published this summer! They should be available soon. Believe it or not, I do think birth preparation is very important, it just looks different for everyone and for every birth! A first birth is different than a second is different than a third, etc. We need different things at different times.

More zines about birth and matrescence here.

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xoxo, more soon