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Archive for the ‘Birth Trauma’ Category

How did we go from what was once Woman-Centered Birth to Protocol-Centered Delivery?

I have my own rather cynical view.

Once there were women who learned to support women during birth. They witnessed the power as women brought their babies into the world. Midwives offered skilled hands, in addition to a reminder of the power already present in each woman.

But in a patriarchal society, women had a rightful and dutiful (and humble) place to fill. And removing power from women, via birth, would help this cause. But how?

We’ll tell you we’ve got a way to save your life. Birth is dangerous – fact is women often die from infection after birth (because there were no antibiotics at the time). And if we tell women we can make it safer, that will definitely get them thinking. And if we can convince the men, their husbands will insist we take charge.

If we’re going to make an impact, we have to change how birth is viewed- starting with how we talk about it. We’re going to call it a delivery. There. That’s better. Now it doesn’t really even involve women, except that they’re present.

“We’ll deliver your baby.” There’s action in that phrase. We are doing this delivery!

And it sounds a bit like a rescue doesn’t it?

Oooh, what a great idea! We’ll make every delivery seem like a rescue! Then women will believe that everything that we do is important. Really, really important, and necessary to rescue them from themselves. After all they got themselves into this mess…

Moving into more modern times with some women actually asking for choice, a patriarchal view continues.

You may think you want to avoid certain procedures or protocols, but really, we know what’s best for you. We’re the experts. You can’t possibly know what we know. You’re not a doctor (and even if you are, you’re too emotional to think clearly.)

And as long as you understand what we do is for your own good, we get to have it our way. (Wait that’s a different ad…)

We do lots of things that work well for us, but may not work as well for you. Most of us aren’t doing those things because we want to make you uncomfortable. We’re not really thinking specifically about you at all. We’re focused on the outcome- keeping you and your baby safe.

We believe that our place is to rescue you. We’ve been taught that birth is dangerous. It’s a crisis waiting to happen. And we’re here to avert that crisis. We have learned the best way to keep you safe is to protect you from yourself.

This is important enough to repeat: We’re the experts here. You’ve been here once, twice, three times? We’re here every day. We know what goes on. The stories we could tell if HIPPA regulations were not in place. (Well, we tell a little bit, but not enough to identify people. We don’t want you talking to those patients anyway- we’re using the story to prove our point, not as a reference for our services.)

We know the best way for you to deliver is on your back, so we can see. I mean really, how are we supposed to see anything if you’re squatting? Ok, the bed does allow for that. But that’s a selling point the marketers wanted. We don’t actually use that stuff. We use the stirrups. We can see; a light can be positioned to shine directly on the baby as it comes out; and who doesn’t like lying down?

I don’t think doctors (or men in general) are malicious. Men are goal-oriented thinkers. Attention to the life-process of birth may not even make sense to them.

But I know managed delivery and I know powerful birth. And as a life-process, powerful birth (the opportunity to be supported in whatever choices you make for your body and your baby) has a profound and lasting positive impact, that patriarchal society should fear a little.

I know what I’m capable of now.

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There are people who really believe that having a baby is inherently dangerous. Maybe more dangerous than extreme sports.

Not just people watching A Baby Story on TV, where women are routinely whisked away in a panic for surgery. Not just people regularly watching women on soap operas faint, only to find out they are pregnant. Not just the drama made for television and the movies, teaching us visually that clearly most women just aren’t up to the job of birth- it’s way too hard, too painful, too scary.

According to some medical providers pregnancy and labor (but especially labor) are accidents waiting to happen. And for these practitioners, the idea of a woman giving birth outside of a hospital setting is selfish and extremely dangerous. For all who believe birth is inherently dangerous, I bring you Birth – an Extreme Sport.

Welcome to the Birth Arena.

First in the line-up is Mary Averagemom. A generally low risk pregnancy, Mary’s fundal measurements were on target with her estimated due date throughout her pregnancy. Her practitioner began discussing induction at her 35 week appointment, to prepare her for this eventuality. He also offered to schedule an elective c-section at the same appointment.

When Mary made an appointment, at about 5 months along, specifically to discuss her written birth plan, her provider reviewed all the items and agreed to all of the options, as long as there were “no complications during labor” and “assuming hospital policy allows it.” This included intermittent EFM (15 min on, 45 min off), no IV, no induction/Pitocin, no epidural, eating & drinking during labor, husband and doula present, squatting for the pushing phase and baby presented to Mary skin to skin at birth.

Hospital policy did deny food during labor, but Mary was told the other requests listed were the doctor’s prerogative. So begins this Extreme Birth– because shouldn’t these be Mary’s prerogative?

Throughout her time in the hospital, even with the support of her husband and doula, Mary was bombarded with pressure from staff (nurses and OB) to consent to protocols. Mary refused the unnecessary IV line 4 times before being told she could not decline. Although she had discussed intermittent use of the EFM for monitoring well in advance of labor, (and agreed to 15 minutes of monitoring per hour) she was regularly scolded for detaching the belt and getting out of bed to change position. (The staff did not respond to Mary’s call button at the agreed removal time- another example of ignoring her limited consent.) Pitocin was brought up multiple times (at least 4) although Mary was clear she would not consent to Pitocin during early labor.

When it came time to push, Mary was told not to push(!) because the doctor was delivering another baby down the hall. When pushing did not go according to the count, Mary was scolded and told her wasn’t trying hard enough. (This all followed an argument about the use of the squat-bar on the bed -part of the original birth plan, which the doctor had affirmed agreement to at 8:30 am that morning. It’s extreme that a doctor would attempt to argue with a woman in labor, ready to push, and expect a discussion. Words don’t come easily during pushing and I believe he expected Mary would be unable to defend herself at all and simply yield to his preference- which eventually she did.)

Following “delivery”, minor tears were sewn while baby nursed. Nursing staff refused to speak to Mary after she’d been so difficult. (Doctor also left the room without a word.)

This is extreme treatment. Ignoring consent. Condescension. Mary’s discovery that her doctor had no intention of honoring her birth plan- finding this out during labor!Extreme measures that disregard the definition of CARE for women.

Care- to be concerned or attentive; have thought or regard; with the opposite being indifference. But this “care” was indifferent, and the fact that this is the standard of care, means the standard is indifferent to women.

Contestant number 2:

She’s mom to a young toddler, pregnant with baby number 2, and views birth as a physiologic process designed by God. She’d like to birth in an environment where she is respected, her choices are honored, and no one is trying to rush things along. She’d also like the option of having child #1 present to witness the birth of her younger sibling. Meet Hannah Homebirth.

During her first birth in a hospital, she experienced care like Mary’s. She wants to avoid a repeat of that routine treatment and has chosen a homebirth midwife for prenatal care and to attend the birth.

Hannah read several books about birth during this pregnancy: Henci Goer’s The Thinking Woman’s Guide to Better Birth, Pam England’s Birthing from Within, Ina May Gaskin’s Ina May’s Guide to Childbirth.

She discussed with her midwife reasons a transfer to a hospital might be needed. Which hospital, admissions through ER, the potential reception by staff. Hannah and her husband have discussed reasons to birth at home, concerns, risks with each other & their midwife.

The time for labor came on naturally, 40+ weeks. Hannah drank some water & ate a granola bar. Contractions just begun, a walk around the block brought Hannah into active labor. Doula & midwife arrived to find a relaxed, focused beginning labor. Hannah headed to the birth ball and asked her husband to fill the tub.

The water- the heat and buoyancy- relieved a lot of pressure. Contractions became closer, stronger. Hannah requested no vaginal exam & although the midwife legally had to offer and document findings, the exam was presented as an option. She refused each time, feeling no pressure.

Encouraging words spoken through labor- “You’re doing a great job!” “The baby is doing great” (after intermittent Doppler check.)

Pop! Water bag spontaneously broke at 9:15 pm. (Light on.) A quick check revealed no meconium in the fluid. (Lights back out. Candles flicker.) Relief of darkness & relief at clear fluid.

Time to push. On hands and knees, semi-upright, Hannah roars her baby out slowly. No one else present makes a sound. Once her head is out (and midwife checks for cord), 2 pushes bring her fully into the world. To Hannah’s breast, a beautiful baby girl! 9:45 pm.

Perhaps these are the extremes: from indifference to genuine love. But it’s an extreme worth looking into. I don’t want my birth to be part of someone’s routine. I want my birth to be part of someone’s passion.

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Women experience birth. Every life experience leaves an imprint. It’s really that simple.

The experience of birthing a new life (vaginal or c-section) can have a profound impact on the woman. It can be as much of a life-changing event as parenting a new baby. For some, birth results in a new awareness, confidence and purpose. And for some, it can mean insecurity, depression, and fear.

Giving birth- especially the first time- is a pivotal point in a woman’s life. She is transforming from woman to mother. She is often confronted during pregnancy with fears and insecurities about being a good mom, knowing how to respond to her baby’s cues, and wondering how life will change.

And anyone with children knows that life will most certainly change, in many wonderful ways.

The process of giving birth- the birth experience- can impact women positively or negatively based on the woman’s perception of what happened. What many care providers see as routine, women are experiencing for the first time. Because labor and birth is largely hidden from our modern society, women have their own expectations as they approach motherhood. And many expectations are based on individual factors like self-image, education, self-confidence, and the experience of autonomy women enjoy in our contemporary culture.

I have heard first-hand from women who were so traumatized by the birth of their first child that they are purposely preventing pregnancy, even though they once dreamed of many children. I read online the blogs and stories of women coerced into submitting to interventions they initially refused, trying to figure out how to advocate for their children, when they were not able to stand up for themselves.

So what happened?

In a nutshell (and in my opinion, of course) women don’t expect the world to be turned upside down because they are pregnant. If a woman generally makes her own decisions in her life, she expects to continue making her own decisions during pregnancy and labor.

Women expect, and rightly so, that being intelligent, autonomous persons, they will be permitted (and expected) to make their own healthcare decisions, even during labor. They believe that trusting their care provider equates to being cared for. Why would a doctor or midwife attempt to manipulate or rush labor? Certainly these professionals have enough experience to understand labor can occur any time of day (or night) and last as long as it will?

The relationships women form with their providers are often based on assumption, because communication is often difficult during 5 minute appointments. But women have reason to feel confident about asserting their right to informed refusal. They are often educating themselves during pregnancy, reading books that help prepare them, mind and body, for birth. Armed with information about possible complications and procedures, they expect to discuss benefits and risks with their provider if circumstances warrant.

And when situations arise, in the office or in the hospital, where the woman’s voice is ignored, where she is discouraged from asking questions, where she is told she is endangering her baby (selfish, bad mother!), where she is manipulated or coerced in submitting to procedures or tests… then she is upside-down.

The world has suddenly shifted and she’s lost the ground. All her life, she’s been told to speak up, ask questions, try harder, think smarter. Now she’s been told she’s a bad mother for expecting to have a say about her own body.

When women with stories like these speak up, they are often told to get over it; that they are making a big deal over nothing; that they are scare-mongering other women; that they are selfish for wanting to feel whole AND have a healthy baby. (And this time, it’s usually other women/mothers calling her selfish!)

Every pregnant woman wants a healthy baby. And it’s ok to want that.

But when you say a healthy baby is ALL that matters, you disregard the mother. Mothers matter too.

Mothers want to feel cared for during pregnancy AND BIRTH.

Mothers deserve to make their own healthcare decisions- even during labor.  (Are other patients also treated with disrespect when they decline routine, but often unnecessary, tests and procedures?) Mothers deserve clear communication and to be approached with respect, as living, thinking, feeling human beings. Women are trusting midwives and doctors (and L&D nurses too) to provide safe care- to hold this trust, and help us be active participants in our care so we are making informed choices for ourselves (powerful, not powerless!)

And when women are offered a relationship of trust and care, when they are afforded the respect to make choices, when they are encouraged to trust themselves during birth, often they learn they are capable of amazing things- including mothering.

Mothering relies heavily on following your instincts. Babies don’t come with instructions and we all worry about knowing what to do. Having a birth experience where you trust yourself can give you confidence to trust yourself to meet your baby’s needs when s/he is born.

If you have experienced birth trauma, you are welcome to comment here about your experience. Also be sure to check out today’s episode of A Labor of Love for more information.

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