Tag Archives: childbirth

On Childbirth And Bodily Autonomy

29 Oct

A friend of mine recently gave birth. She’d planned on have a natural, drug-free childbirth, but instead wound up having an emergency c-section. After 30 hours of labour, her son’s head still wouldn’t (or couldn’t) engage, and his heart rate started to plummet frighteningly low. After a few minutes of discussing their options with her midwife and the on-call OB, they decided that a caesarean was her best option.

Her son was born not long after that, a whopping 9 pounds 5 ounces, with a full head of dark hair. He was beautiful and healthy, but instead of feeling as if she’d made a decision that could potentially have saved his life, she felt as though it had been her fault that she’d had to have a c-section. She thought that if she’d just somehow tried harder, or prepared better, she could have had the birth she’d wanted.

I talked to her a few days after her son’s birth, and, of course, asked how she was feeling. “I feel like I failed,” she said, sounding as if she was about to cry. “My son is only a few days old and I’ve already failed him.”

I knew what she meant, because I’d been there. When I’d found out that I would have to have a caesarean, I also, irrationally, had felt as if it was my fault, as if I was already failing my son. I still feel weird about my son’s birth, even now, nearly two years later, or rather I feel like other people are weird about it. I can’t tell you how many times I’ve had someone ask about my childbirth experience, only to shut down the whole conversation when I tell them I had a planned c-section. I often get the sense that other people think that I haven’t really given birth, or that I’ve taken the easy way out.

If you don’t have kids and/or haven’t spent a billion hours on the internet debating all things baby, you might be wondering why natural childbirth is such a big deal. Why does anyone even care?

For starters, giving birth without drugs or interventions means that you and your child will not have to experience the side effects of sedation or the potential harm from invasive procedures. Babies born naturally are more alert, which will make bonding and breastfeeding easier. Plus, not having an epidural means that you can get up and walk around during labour, or find the position that works best for you when it’s time to push. Without drugs, the mother’s recovery will be faster, and she can often leave the hospital the same day, if she wants to. And, of course, there’s the persistent idea that childbirth is more of a “real” experience if you are able to feel every sensation associated with it.

Many people advocate for natural births these days; even the nurse who taught our prenatal class was pretty anti-epidural. Part of this comes as a backlash against the medical model of childbirth, which, not that long ago, saw women in labour being put into a Twilight Sleep, a drug-induced state in which women were conscious but not lucid, and, though these women still experienced pain, were not able to remember it afterwards. In many ways, natural childbirth is an attempt to reassert control over our own bodies; to tell the doctors (most of whom were and are still men) that pregnancy is not a disease, and should not be pathologized. Another part of  the desire for drug-free childbirth comes from the assumption that “natural” is better, or from the idea that our bodies are designed to give birth without the aid of drugs or interventions.

Unfortunately, it’s hard to have a natural birth, and I don’t just mean the physical pain and exertion associated with drug-free childbirth. Hospitals make many people anxious, and trying to give birth while surrounded by beeping machines and scary-looking medical equipment is challenging, to put it mildly. On top of that, you have a regular rotation of people coming in and out of your room, wanting to check how far you’ve dilated, what your heart rate is, what the baby’s heart rate is, and a whole laundry list of other stuff. So giving birth in a hospital setting isn’t exactly conducive to that whole Mother Earth Goddess ideal that many of us hold.

So why not give birth at home? Good question. The answers range from being worried about not making it to the hospital in time if there are complications to not want to have to be bothered cleaning up the mess afterwards, and everything in between. One response that I hear very frequently form Ontario women is that they weren’t able to find a midwife; this was my experience as well.

When I had my first prenatal visit with my family doctor, I was eight weeks pregnant. She asked if I’d thought about how I wanted to give birth, and I told her that I wanted a midwife rather than an OB. She looked at me like I was crazy, and said that there was no way I would be able to find a midwife this far into my pregnancy. But I’m only eight weeks! I said. Technically I’ve only been pregnant for six weeks, if you take into account the fact that the first two weeks of  a 40 week pregnancy happen before a woman ovulates.

My doctor just shrugged and said that there weren’t enough midwives in Ontario, then asked what hospital I wanted to deliver at. When I told her, she frowned and said, Oh, I don’t know if we’ll be able to get you into Mount Sinai this far into your pregnancy. I honestly thought that she was exaggerating, but it took three referrals before we were able to find an OB at Mount Sinai who was still taking patients for my due date.

That was how I learned how insanely competitive giving birth is in Toronto.

There are 540 registered midwives in Ontario, serving a total population of 12,851,821. 1 in 10 births in this province are attended by midwives; 4 out of 10 pregnant women in Ontario would like a midwife but can’t get one. That obviously makes having a midwife-assisted birth in general, and a home birth in particular, pretty challenging. Which, as I said above, can make having a natural birth difficult or even impossible.

That being said, you would think that the natural birth community would be pretty understanding of the fact that most women still end up using the medical model of childbirth. While I would say that the majority of us are pretty chill no matter how your kid comes into the world, there seem to be a lot of people passing judgment on how women give birth.

It’s bad enough that some proponents of natural childbirth make women feel as if they’ve “failed” if they end up having unplanned interventions, but that’s nothing compared to their treatment of women who know ahead of time that they want an epidural, or those who choose to have a planned c-section. The funny thing is that these are often the same women who are very pro-choice and will throw around the phrase “my body, my choice”.

Well, is it our choice, or isn’t it?

It’s different, they’ll argue, when there’s a wanted child involved. It’s not your body anymore. You need to act in the child’s best interests. They’ll send you scary news articles, like this one, which references a study showing that children born before 37 weeks are 5 times as likely to have autism. That particular article is one that someone sent me when they found out I was going to have a planned c-section at 36 weeks; when I told her that the article had upset me, she said that she wasn’t trying to be mean, just giving me the “facts”.

Here are the facts: if I had had a natural childbirth, my son could have died. If my pregnancy had progressed past 36 weeks, my doctor felt that there was a good chance that my water would break, which could have lead to an umbilical cord prolapse, which would have meant death or brain damage to my son.

The thing is, no matter whether or not you are carrying a child, it’s still your body. You still have bodily autonomy. I’m not saying pregnant women should go out and do lines of coke chased by vodka shots, but I do think that we need to allow women to make choices regarding childbirth without judging them.

The argument that I hear most from people decrying women who choose the medical model of childbirth is that they’re selfish. They want an epidural because it’s easier for them. They want a c-section because they don’t want to have to go through labour. They’re planning to be induced at 39 weeks because they want to skip out on the last week of pregnancy. If these are thoughts that you enjoy thinking, here’s something I really, really want you to keep in mind: you do not know the whole story.

You don’t know why someone wants an epidural, I mean, not really. You don’t know why they might want a c-section. Sure, they might give you a reason, but what they tell you may not necessarily be the whole truth. They might have a medical condition that indicates a c-section, or they might be a survivor of sexual abuse and feel triggered by the idea of a vaginal birth. Or they might just not want to have a natural birth, and that’s okay too. Know why? Because bodily autonomy, that’s why.

The thing that frustrates me the most about this judgmental behaviour is how purely anti-woman it is. It stems from the idea that most women aren’t capable of making decisions regarding how they want to give birth. It assumes that a woman who chooses to have a planned c-section hasn’t done her research, has been brainwashed by the medical establishment, or is uneducated when it comes to birth options. It plays into the idea that women are irrational, thoughtless and downright selfish. It promotes the idea that, being left to our own devices, we will make choices that are harmful to us and our children.

These are the same ideas that lead to the body policing that many pregnant women have to endure. We’re told to eat more, but not gain too much weight. We’re cautioned not to exercise too hard, but also to stay fit and healthy. We have people watching every bite we eat, and I even know someone who was denied service at Starbucks because the barista didn’t think that she should have caffeine. When are we going to let women be responsible for their own bodies?

Look, I’m all for natural childbirth. That was what I wanted when I was pregnant with Theo, and if I ever have another child, I would like to try for an unmedicated VBAC. But that’s my choice, based on research that I’ve done and what I’ve heard from friends. If another woman makes a different choice, then I’m sure as hell not going to tell her she’s wrong. Your child’s birth is one of the most important days in your life (I mean, probably, right?), so why would you want to make someone feel bad about how theirs went down? Shouldn’t we be celebrating the fact that we all went through hell, in one way or another, to bring our children into this world?

I think a big part of the problem is that we still haven’t really figured this childbirth stuff out. We still don’t know what works best for us, both as individuals and as a society. The medical model of childbirth has seen the infant mortality rate decline 90% in the last hundred years, and the maternal mortality rate has declined by 99% in that time. On the other hand, within that medical model women still feel as if they are being bullied into interventions and procedures that they don’t want, and often come out of childbirth feeling as if they were coerced into accepting “help” that they felt they didn’t need.

I don’t know what the answer is, I really don’t. More midwives, for a start. Better education about birth options and the possible complications of interventions would also be good. Above all, though, I think we need to put more trust in women. I think we need to allow women to make more of their own choices, and we need to believe that they are capable of making the right choices, not just for themselves, but for their children.

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How To Have A Good C-Section (or, how I learned to stop worrying and love major surgery)

26 Oct

I woke up the morning of January 8th, 2011, and lay in bed, waiting for Theo to kick me good morning. I was 34 weeks pregnant, and this was our wake-up ritual: he would wriggle around like a maniac, and I would spend a few minutes lying on my side, rubbing the outline of his body and telling him what we were going to do that day. Sometimes he would stick his feet in my ribs, and I would tickle his toes. Sometimes he would take a big stretch and I would try to map out how he was sitting inside of me.

That morning, though, I didn’t feel anything.

No big deal, I figured; he was probably asleep. Surely it wouldn’t be long before he was awake and kicking up a storm.

I had a bagel and coffee for breakfast and then lay on the couch with Matt, waiting for the caffeine to pass through the placenta and jolt Theo awake. We were watching a movie, but I couldn’t concentrate on it; all I could think about was the absence of movement inside of me.

I tried everything I could think of to get Theo to move – I drank ice water and lay on my side, poked and prodded him until I worried that I might be bruising my baby in utero, had Matt put his mouth up against my belly and talk to his son. Nothing worked.

We decided that we should go to the hospital.

When we got to the labour and delivery ward, I had to sit and wait for a bed to become available. Then we discovered that I hadn’t properly registered, so Matt had to go back down and re-do the paperwork. I was becoming increasingly anxious, and I was frustrated that the nurses didn’t seem to share my sense of urgency. Finally, they got me into an examining room and asked me where my OB usually found the baby’s heartbeat. I said it was loudest on the left side of my belly, so they put the doppler there.

Silence.

I started to cry. Matt tried to say something to calm me down, but he had tears in his eyes, too. The nurse frowned and moved the doppler around while the continuing silence made me sob harder and harder. This must have only gone on for a few seconds, but it seemed like hours. I was sure that Theo was dead; I pictured having to call my mom to tell her that her grandchild wouldn’t be born alive. I pictured myself having to be induced and delivering a cold, white baby.

Finally, way over on my right side, the nurse found a faint but steady heartbeat. The nurse smiled and said that she’d known all along that he was fine. I still couldn’t stop crying.

The nurse brought in a portable ultrasound machine, since I still wasn’t feeling Theo move. As she moved the probe over my belly, she asked me if I knew that he was breech. No, he’s not, I said, he’s been head down since 26 weeks. In fact, I had seen my OB three days earlier, and he had confirmed that the baby was head down. Not anymore he’s not, said the nurse.

They brought in the on-call doctor who confirmed that no only was Theo breech, he was footling breech, one of the rarest fetal positions and the most dangerous to the baby. On top of that, his umbilical cord was hanging down by his feet, which meant that, if my water were to break, he would be at high risk for a cord prolapse.

They hooked me up to a contraction monitor and told me that I was having strong contractions (none of which I could feel, by the way). They checked my cervix and I was 2 cm dilated and 100% effaced. Not a big deal, they said – some women dilate early. Two hours later I was 5 cm dilated.

At 34 weeks pregnant, I was in labour with a baby who wanted to meet the world feet first.

They wanted to do a caesarean that night. They would have, too, except that two emergency c-sections came in, tying up all the operating rooms. While we waited for an OR to open up, I sat in my bed and tried to use Jedi mind-tricks to stop my labour. Think calm thoughts, I told myself. I stared at the printout on the contraction monitor and willed the jagged lines to smooth themselves out. I stared at my belly and willed Theo to stay put.

Whatever I did must have worked, because by the time they checked my cervix again, I was still 5 cm dilated. My contractions continued, but were definitely less frequent than before. I made a deal with the on-call OB – if they would agree to delay my c-section, I would stay on bed rest in the hospital until I was full-term and/or my cervix started dilating again. She wasn’t thrilled with the idea, but she agreed to admit me for the night and check with my doctor. Luckily, he was a super cool dude, and when he came to see me on Monday morning he said he thought I’d made a good suggestion, and was totally fine with me hanging around the hospital until whenever.

This gave me some time to figure out what I was going to do. Up until this point, I’d planned on having a natural birth; I’d read books like Ina May Gaskin’s Guide to Childbirth , Martha Sears’ Birth Book and Henci Goer’s The Thinking Woman’s Guide To A Better Birth. I’d looked forward to giving birth, imagining that I would have some kind of mystical earth goddess experience; I’d been weirdly excited to know what real contractions felt like. I’d spent months participating in online pregnancy forums, decrying the medicalization of childbirth and the deplorable c-section rate in the western world. I hadn’t even read anything about c-sections, because there was no way that I was going to have one.

Except now I was.

I started to look for online resources for moms who were having caesareans but still wanted the whole touchy-feely earth goddess experience. I discovered, to my chagrin, that there weren’t many. Most people seem to think that a good birth and c-sections are diametrically opposed. Many people in the natural birth community are very, very anti-caesarean (one woman even went so far as to send me a video of a midwife delivering a footling breech birth, like, hey, thanks for your support), and many of those who support the medical model of childbirth tend to see birth as something that you just endure and get through, rather than a positive experience. I think that it’s totally possible to have a c-section and still have a good birth.

I’ve put together a list of things that worked well for us and resources that I found helpful:

If You Are Having A Planned Caesarean:

1. Educate yourself. This one is huge. Read as much as you can about c-sections, both about the procedure itself and what recovery will be like. Talk to other women who have had c-sections, and ask your OB for a run-down of how the procedure typically happens at your hospital. It’s also a good idea to read about the possible emotional effects of a c-section.

2. If you plan on breastfeeding, consider contacting a lactation consultant (the nice thing about being in the hospital was that the lactation consultant came to me), or else join the La Leche League and talk to women who have had similar experiences. Find out what kind of resources your hospital offers breastfeeding mothers – for example, mine held a breastfeeding class twice a day and had a lactation clinic. Make sure you get yourself a nursing pillow, because I promise you that you will be SO THANKFUL for it. Also,there are some good resources online here and here and here.

3. If you plan on breastfeeding, do so as soon as possible after surgery. I was able to breastfeed in the recovery room, less than half an hour after my son’s birth.

4. Make a birth plan of what you would ideally like to happen. You can ask for things like playing your own music during the surgery, doing skin-to-skin in the OR, and delaying (or even forgoing) the application of the eye gel. Remember that it doesn’t have to be the mother who does skin-to-skin – your partner also has some important bonding to do.

5. Eat really well at your last meal before your surgery (this will typically be 8 hours earlier). Make sure you get a lot of protein and that whatever you have is really filling, because they won’t let you eat afterwards until you fart (not kidding).

6. If you are having a c-section because your baby is breech, consider trying an external cephalic version. I wasn’t able to do this because I continued having contractions right up until my c-section (and we discovered during my surgery that I have a heart-shaped uterus, so it wouldn’t have worked anyway), but it’s definitely worth trying.

If You Are Planning On Having A Vaginal Birth

1. Educate yourself about c-sections anyway! It won’t hurt, and you’ll be prepared in case you do need one.

2. Include a “Caesarean Contingency Plan” as part of your birth plan. Sure, chances are that you won’t have a c-section, but if something goes wrong, it’ll probably go wrong pretty quickly, which means that it would be better to have what you want written out ahead of time.

3. Make sure that your partner is clear on what you want if you need a c-section – in the craziness of the OR, you’re going to need them as an advocate more than ever.

For Everyone

1. Allow yourself the time to mourn the birth you didn’t have. Some women feel that they’ve “failed” if they end up having a c-section; some feel that they haven’t really given birth. Talk about your feelings with your partner, and remind yourself that your experience was just as important and valid as anyone who had a vaginal birth.

2. Keep in mind that women who have c-sections are at a higher risk for postpartum depression. Make sure to watch yourself carefully for any of the signs and talk to a healthcare professional immediately if you think you might be showing some of the symptoms.

3. Take all of your medication on time. Trust me, you will feel way worse if you delay or skip a dose. The vast majority of medications are safe for breastfeeding; if you’re not sure, ask your doctor, nurse, pharmacist or La Leche League leader.

4. Hold a pillow against your incision whenever you cough, sneeze or laugh. I don’t know why, but this helps.

5. Take a shower as soon as you are feeling up to it. It will be the best shower of your whole life.

6. Accept help. If you have someone willing to do everything for you, let them.

Theo’s birth wasn’t what I had planned for, and it wasn’t the birth I would have chosen, but it was still good. I sometimes think that this was my first real lesson in parenting: the idea that not everything would happen on my own terms, that there would be times when I was not in control of the situation, but could still try to make the best of things.

So no, Theo’s birth wasn’t ideal, but I do think that it was the best birth that it could have been. And I’m thankful for that.

If you follow the simple steps that I have outlined above, then you, too, can look this happy while having a giant gash cut in their abdomen.

If you have any other suggestions, please feel free to add them in the comments!