I hoisted myself up out of the passenger seat of our Toyota Prius, pressed my forehead against the window glass and yowled. My husband, Bryan, and I were on the way to the hospital to have our second baby, inching along Beverly Boulevard in rush hour traffic in Los Angeles. As he was extolling the virtues of a taqueria we were passing, I was seized by the urge to push. I couldn’t resist. I felt a big whoosh — then a strange absence of pain.
I looked down and saw something shaped like a watermelon bulging from the left thigh leg of my maternity jeans. I opened up the waistband. Oh my God. There was my daughter Jemma, curled up and covered in goo.
You don’t want to have a baby in a car. It’s for all the reasons you think — the pain, the worry, the mess.
But the biggest problem, it turned out, was one we would never have foreseen: getting a birth certificate for our baby.
I’ve always been a by-the-books kind of person. I floss every day; I have missed only two credit card payments in my life. My first daughter, Stella, was squarely among the 98.5 percent of births in the United States that take place in a hospital. I thought I’d be the last person giving birth in a car, the location of fewer than eight of every 10,000 births in this country.
On on the day I gave birth, May 25 of last year, I was 39 weeks and three days pregnant. I had seen my OB-GYN in the morning, and she told me I was only one centimeter dilated. I was one centimeter dilated two weeks before my first child’s birth, so figured I had a couple weeks to go.
My doctor warned me, of course, that second labors tend to go faster. Still, nobody expected me to go into labor as fast as I did. The contractions started to turn painful around 3 that afternoon; just before 6 that evening, I climbed into the narrow front passenger seat of our car as my husband took the wheel; by 6:25, Jemma was in my pants.
She didn’t make a sound when I pulled her out. I couldn’t think of anything else to do but put her over my shoulder and pat her back. Please cry! Thank God she made a sweet little mew. I tortured myself thinking about what could have gone wrong.
My husband had the presence of mind to call 9-1-1 and the firefighters and ambulance arrived within two minutes. After suggesting I might want to pull my pants up, a firefighter clamped the cord. My husband cut it while he was standing on the curb.
The ambulance took Jemma and me to the closest hospital, Hollywood Presbyterian Medical Center. There were thankfully no medical issues with Jemma’s birth — the biggest complication was actually clerical.
A perfectly professional hospital official visited me in the recovery room and passed along a packet: I was going to have to visit the county public health department on my own to register Jemma’s birth. Because she wasn’t born on the premises, Hollywood Presbyterian said it could not start my birth certificate; they couldn’t verify that I had actually given birth to Jemma. (The hospital adheres to Los Angeles County’s guidelines on out-of-hospital births, a spokeswoman later explained.)
If I had given birth in the hospital’s parking lot — as a woman a few months before had done — it would’ve been a different story, the official told me ruefully.
The California state health and safety code holds hospitals responsible for registering births at their facilities. Officially, the state says that if a physician or midwife does not attend the birth, the parents are responsible for registering their babies. But there is a modicum of discretion for hospitals in interpreting the law.
Even though I delivered the placenta at Hollywood Presbyterian and I was taken there by the people who assisted with the cutting of the cord, it is within the rights of a hospital to choose not to evaluate the nature of the evidence and send someone like me on to county public health to complete the paperwork, said Dr. Diana Ramos, director of reproductive health for Los Angeles County’s public health department.
“As obvious as it may seem, it’s up to the hospital to make the final call,” Ramos said. “They’re pushing it off to the legal realm.”
I wish I had had Jemma in the car in Chicago or New York. In Illinois, the state department of public health actually asks hospitals to assist parents by completing the birth record when babies arrive the way Jemma did. And in New York City, most hospitals will report a birth of this kind.
A birth certificate, I learned, is probably the single most important document an American can possess. As Dr. Ramos pointed out to me, it’s the gateway to citizenship, health insurance and school, so hospitals may be reluctant to put their necks on the line to confer such benefits.
That left Jemma, Bryan and me to prove we weren’t frauds. We had to collect five pieces of proof to bring to the county — that Bryan and I were who we said we were, that I was pregnant just before I got to the hospital, that Jemma was born alive, that the birth occurred in Los Angeles County, and that I had a witness. Until we could get that certificate, Jemma was nameless and stateless, invisible in the eyes of the government.
It took 35 days to get an appointment at the public health department. During that time, my husband and I zipped back and forth to doctors’ offices, sometimes with a wailing infant, collecting our evidence. We were grateful to spend only a few hours in the Kafka-esque marbled hall of the county public health department — where the line for “birth” is right next to the line for “death” — before walking out with the birth certificate we needed.
I felt a second wave of relief almost as intense as that first one in the car. A month later, I could finally apply for her Social Security number, and after that, finish the health insurance paperwork that was in limbo because I didn’t have the right documents. I wrapped up the final medical bill in early May, just before her first birthday.
What a curious detour Jemma’s birth took us on, through obscure thickets of paperwork and existential worry. I hadn’t paid attention to the surroundings when I gave birth to Jemma at the intersection of Beverly Boulevard and Serrano Avenue so I drove in that same Prius back recently to see where it all began. My car showed few signs of the rush of blood and fluid from that day — because we thought my water might break on the way to the hospital, Bryan had laid down a few Chux pads that thankfully bore the brunt of the damage. I stopped in front of the tidy bank where he had cut the cord and took in the dusty tableau, which included a Salvadoran restaurant and a tire shop with signs in Korean and Spanish.
Mine was the only car stopped at this corner for the 15 minutes I stayed. Everyone was trying to get where they were going and eventually I had to also. Jemma was at home and, as we know, she isn’t any good at waiting.