The Baby Factory
At Houston’s Jeff Davis Hospital, where more than 10,000 babies are born every year, charity, idealism, and bureaucracy confront the ancient instincts of the flesh.
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Zurawin and his team kept working on the woman. They performed a tubal ligation that she had requested and removed her appendix. From time to time Zurawin lifted out blood-soaked sponges from her body cavity, which the nurse who was assisting him tossed onto a piece of blue paper spread out on the floor.
All the delivery rooms were now in use. I could turn in a circle and glimpse, almost simultaneously, the births of four or five babies. Every half hour or so one of the women would be wheeled down to recovery, the room would be mopped and cleaned, and then another woman would be propelled through the doors on her bed, propped up on her elbows, her face contorted in pain, while the doctor or nurse running beside her yelled, “Don’t push! Don’t push!”
“Hey, Jim,” one of the residents called to another down the hall. “Wanna assist? Girl down here about to crown.”
“Okay,” he answered wearily, “but I’m not going to scrub until I see the whites of his eyes.”
The babies made their entrance into the world with a twisting, spiraling motion, muscling through the vaginal constriction and delivering themselves into the hands of the obstetricians, who checked them over, showed them without a great deal of fuss to the mothers, and handed them to a nurse who put them in a nearby warmer, cleaned them off, and took their footprints. The babies shrieked and flailed their arms. They seemed to deserve some kind of explanation. Once I saw a nurse walk into the delivery room and toss a hospital form into the warmer, where it landed on a baby’s head. No one bothered to remove it.
But there was room on the assembly line for moments of calm, of conventional joy. In one room a Mexican American woman gave birth in a forthright, timeless manner, letting out one small shriek and then settling back, panting and blowing in accordance with the precepts of natural childbirth. When the baby came, the young, bearded doctor held it for her to see. She lifted her head off the table, moved her lips in reply to something the doctor had said, then lay back down, looking dreamily through the window out into the hall.
At about one in the morning things began to quiet down again. I went with Zurawin to one of the labor rooms, where he conducted an ultrasound scan of a woman who had come into the observation ward fearing that she had had a miscarriage. She was a white woman of about thirty. When Zurawin attached the sensors to her abdomen, she watched the electronic image that appeared on the screen. It was like a transmission from another planet, the dark night sky of amniotic fluid, the rolling terrain that made up, to a practiced eye, the form of a human fetus.
“Well,” Zurawin said, turning off the machine and leaning over the woman’s bed, “I can’t find a heartbeat.”
The woman nodded, as if in professional agreement. He held out some hope that another scanner might pick up a heartbeat where this one had failed.
“So I think the best thing is to get you admitted tonight and have you checked out in the morning. Then we’ll decide what to do from there. Okay?”
“Okay,” she said.
“Okay,” Zurawin said again, softly.
“The baby’s dead,” he told me back in the doctor’s lounge. “She knows it too. She just doesn’t want to admit it yet. Besides, there’s always a chance the other machine will pick up something.”
He opened a refrigerator. It was full of packages of cheese and potato chips and some moldy fruit. He put a piece of lunch meat into a microwave.
“Yeah, it’s a rush. It’s a real rush,” he mused as he waited for the meat to heat up. When it was ready, he took it out of the microwave, tossed it around in his fingers until it had cooled down a little, and then ate it by itself.
“It can be very sad here sometimes,” he said. “Especially if you want to talk about the social aspects. You look at those new babies and they’re soft and warm and cuddly, and then you pick up the chart and see that the mother is fifteen years old, unmarried, and has three other kids. You ask yourself what kind of life that baby’s going to have. You know, I have this fantasy sometimes of being thirty-five or forty and walking into a Seven-Eleven. Here’s this kid I delivered holding the place up. He turns his shotgun around and just blows me away.”
Teenage pregnancy is the single greatest problem that Jefferson Davis Hospital faces. In 1978 over four thousand girls under the age of nineteen, the great majority of them unmarried, gave birth at JD. Two of these girls were twelve years old.
Teenage pregnancy is epidemic in every segment of American society, and its discovery as a white middle-class phenomenon corresponds with its recent status as a political issue. The sharp rise in teenage pregnancy is blamed on a variety of causes—the statistically earlier maturation of young bodies, meager and sporadic sex education that has not kept pace with sexual opportunities, teenage unemployment, or just a simple, unrealistic desire to have a baby.
Pregnant teenagers, as a group, constitute a high-risk category. They are more prone than the general population to pregnancy-related conditions like eclampsia and toxemia; because their nutrition is frequently so poor, they have less tolerance for the rigors of delivery and may recover less quickly; and being teenagers, they are apt to be generally bewildered.
“Some of these girls,” said Audrine Scales, the adult development coordinator on JD’s fifth floor, which is set aside for teenage mothers, “perceive babies as dolls. They’ve been taking care of their younger brothers and sisters at home and think that having their own baby won’t be any more complicated than that. The majority of them keep their babies—they want their babies. Some of these pregnancies are planned. I know that sounds a little strange, but it’s true.”
Scales’ office was filled with literature, in English and Spanish, explaining to teenage girls the importance of nutrition, of birth control, of personal hygiene. Teenagers at JD are bombarded with such services—antepartum and postpartum classes in maternity care and birth control are conducted twice daily by the Goldfarb Adult Development Clinic, a program of the Baylor College of Medicine; the Houston Independent School District holds classes for high school girls in a group of temporary buildings in the hospital parking lot; the Texas Department of Human Resources has assigned a special child welfare caseworker to the hospital.
I went with Peggy Smith, the director of the Goldfarb program, to visit two seventeen-year-old girls who had delivered several days earlier and were scheduled to be discharged that afternoon. Their names were Stephanie and Wanda. Both of them had given birth to boys who were now in the Low Risk Nursery, though no one had told the mothers what was wrong with their babies.
I asked Stephanie what she thought about the hospital. She smiled sarcastically and looked out the window.
“There’s nothin’ to do here,” she said. “There no television, no phone. The food be cold all the time.”
Wanda sat on her bed and stayed out of the conversation.
“My little baby looks so sad,” Stephanie said. “Someone’s got his eyes all covered up. How about when they sit there and cry and no one will do nothin’ for ‘em? It makes me sad. I guess they just have to estimate what they’re crying for.”
Smith explained that a baby cries different ways when he wants different things, and that the nurses were trained to recognize those different kinds of cries and respond to them.
“Their hair be dirty too,” Stephanie added.
“Well,” Smith said, “they have on their heads something called vernix caseosa. Mother Nature protects the head with this. It’s a cheesy substance, it’s not real pretty, but it’s not medically significant.”
Stephanie nodded, eager for any sort of explanation. She was doing her best. She said she was going back to secretarial school, that her mother would take care of the baby while she was in class. I asked her about the baby’s father.
“I don’t want to see him ever,” she said. “But he stays right behind me.”
At two o’clock that afternoon a group of teenage mothers began gathering in a sitting room on the fifth floor. There were a dozen of them, wearing robes and paper shoes, smoking cigarettes as they waited for their lecture on birth control to begin. One or two of them spoke to each other—“What’d you have?” “Boy”—but for the most part they were silent, patient.
A middle-aged woman in a blue knit suit came in, carrying a little utility case and a plastic model of a uterus. She set the model down on the table, then opened the case and began taking out birth control pills, condoms, diaphragms, IUDs, and various foams and gels. When it was all set up to her satisfaction, she rubbed her hands together and introduced herself.
“Okay,” she said. “I’m Mrs. Peak. I’m from the city health department, and my duty today is to tell you about the various methods of birth control.”
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