Tag Archives: cesarean birth

Every Birth is Natural

By Kelly Coyle DiNorcia, API Leader. Originally published in the 2009 “New Baby” issue of Attached Family magazine

Photo: Bas Silderhuis
Photo: Bas Silderhuis

When I became pregnant with my daughter, I had every intention of having a “natural” childbirth. I wanted to labor at home without pain medication, to fully experience her entry into the world. I left my obstetrician’s practice and found a midwife whom I loved and who assured me that the birth I wanted was within my reach.

Of course, life does not always turn out the way we plan. Complications arose, necessitating interventions that eventually led to a Cesarean birth. The whole birth experience was traumatic, and I was angry and disappointed. I spent the first several months of motherhood feeling inadequate and depressed, and missed a lot of the joy that new babies can bring. After much reflection, I came to recognize my two biggest mistakes:

  1. I treated my pregnancy as an impending deadline—Instead of embracing the coming transition, I used those nine months to finish up projects. I was a student, I worked full time, and I was an active and dedicated volunteer –and all these things were important to me. I struggled with the idea that once I added “mother” to my list, something else would have to give because I wasn’t willing to sacrifice any of them. I insisted on plowing on … when I developed gestational diabetes, when I broke my foot in the seventh month of my pregnancy, when my feet swelled so much that I couldn’t put on shoes, when my blood pressure began to rise. I refused to stop and rest.
  2. I believed that my body would be permitted to give birth as it was built to do—It is certainly true that women are built, from a biological, physiological, anatomical and evolutionary perspective, to have offspring and that most of the time this can be done safely without intervention. However, what I did not realize was that the modern medical system is not designed to allow that to happen for most women, and that it can take a great deal of education, effort and willpower to fight for a natural birth. Most birth practitioners see birth not as a natural process but a necessity to be endured and sped through if possible, using whatever means are available to move things along. Avoiding this pitfall requires a great deal of preparation and soul-searching.

Deciding on VBAC

With this in mind, I began preparing for my Vaginal Birth After Cesarean (VBAC) within weeks of my first baby’s birth. I quizzed the surgeon about the location and orientation of my scar, the reasons for my daughter’s failure to descend and my chances for a future vaginal birth. He assured me that the surgery had gone well, and there was no reason I couldn’t attempt a VBAC. At the time, I didn’t know this was doctor-ese for “But your chances of success are about nil.”

I joined support groups. I read. I wrote in my journal. I entered therapy. I learned about the current medical model of obstetrics. I researched how I could take care of myself to prevent many of the complications I had experienced. I waited, and when the time was right, I became pregnant.

“By no means is it justifiable for anyone to be made to feel negatively about whatever birthing options they choose or for whatever birthing experience they have had. We all deserve to have our birthing choices and experiences validated.” Read more by Tamara Parnay in “The Importance of Sharing Birth Stories

Unfortunately, my former midwife was no longer attending VBACs, so I was forced to start from square one and find a new provider. I was frustrated that I had to tell my story over and over and face so many negative reactions from providers who were pessimistic about my chances for success, but I came to realize that this was really a gift. I had the chance to start fresh, carefully consider my options and know that I had given myself the best chance for my desired outcome. I ended up going with the first midwives I interviewed – their VBAC success rate was very high, I felt instantly at ease with them, I liked their office and their hospital, and their backup doctors were incredibly supportive of natural birth and even collaborated with most of the homebirth midwives in my area.

I also asked a close friend of mine who is a doula to be with me during my birth. During my first pregnancy, I thought a support person was an unnecessary luxury, but this time, I knew better: having a woman there who was supportive and knowledgeable, and whose only responsibility was to help me through the process, was a necessity.

A Second Chance

I spent this pregnancy resting, eating well (when I wasn’t vomiting) and preparing myself and my family for the impending arrival of my son. I was able to avoid the medical complications of my previous pregnancy, I attended Bradley classes and when the time came, I was ready.

After a few false starts, labor started on a Friday at about 11:00 p.m. Unlike many of the videos I had seen of women giving birth surrounded by family and friends, I preferred darkness and solitude. While my family slept, I paced, showered, squatted, groaned and bounced. When daylight came, I called my midwife, doula and mother and then woke my family.

By the time I got to the hospital, I was 6 centimeters dilated and was having strong and regular contractions. We were given the room with the birth tub, which I was not able to use because there was meconium in the amniotic fluid, and I was allowed to use a fetal monitor that worked by telemetry so I could change position, walk and even shower.

I’m not really sure how long it took, but as darkness fell, the time had come to push. I walked around, squatted, laid on my back and side, and pushed for several hours. Eventually, I looked at my midwife and said, “Check.” But I knew that my baby hadn’t moved, that he was stuck high in the birth canal, that I was headed to the operating room again.

The nurses prepared me for surgery, the surgeon and anesthesiologist came in to introduce themselves, and my midwife helped my husband and friend pack all of our belongings as I struggled against the urge to push, waiting for an operating room to open up.

A little after 9:00 p.m. on Saturday, Harrison “Harry” Herbert Francis was born weighing 9 pounds, 1 ounce. He was healthy and robust, and the surgery went well. As soon as I was in recovery, my doula came in to check on us, and my midwife brought my son so I could nurse him, which he did easily and with gusto. He accompanied me to our room, where he stayed for our entire hospital stay.

Every Birth is Natural

When I met my first midwife, she had told me of her disdain for the term “natural childbirth.” She prefers the term “unmedicated childbirth,” because “natural” implies that there exists an unnatural way to give birth. However it happens for you, she said, is natural for you.

“Yeah, whatever,” I thought at the time, “be that as it may, I am going to give birth naturally, like our foremothers did, with no medication, no intervention, just me having a baby.”

Now, I know exactly what she meant. My second birth was not natural in the sense in which that term is commonly used, but I feel like it was as natural as possible under the circumstances.

I am still bitterly disappointed that I will probably never know what it is like to bring new life into the world on my own power, and I regret that I could not spend my children’s first moments of life snuggling and counting digits. Sometimes I feel like a marathon runner who fell within inches of the finish line and just … couldn’t …make… it … across. I hate that I am another statistic of a failed VBAC attempt and that I was unable to support other women for whom this opportunity is becoming increasingly scarce.

On the other hand, I am incredibly grateful to live in a time and place where the medical technology was available to bring my son and me safely through labor. I am empowered to know that I was strong and determined enough to at least make it to the finish line even if I couldn’t cross. And, of course, I am thankful for my two beautiful children. I won’t say that all the rest doesn’t matter as long as we are all healthy, because I believe that our birth stories do matter and that we are entitled to mourn the loss of the birth we wanted but couldn’t have. After all, whenever a baby is born, so is a mother. But in the end, I also believe that we all have the birth we need to make us better parents and people, and I am no less a woman or a mother because of the way my children came into the world.

To read more birth stories from our growing collection–or to find out how to share yours–visit Your Birth Stories on The Attached Family.com.

The Importance of Sharing Birth Stories

By Tamara Parnay. Originally published in the 2009 “New Baby” issue of Attached Family magazine.

 

Photo: Benjamin Earwicker
Photo: Benjamin Earwicker

Birthing is a hugely important subject for parents and parents-to-be. We have a great deal to learn from and share with others, but with this subject, due to its potential contentiousness, we may struggle in our attempts to tap into our collective wealth of knowledge and experience. While the purpose of this article is not to sway readers one way or another about where and how to give birth, it does intend to point out the availability of a wide range of firsthand birth stories, which—perhaps more effectively than any other form of childbirth education—encourages and enables expectant parents to inform and prepare themselves.

Cultivating an empathetic environment for the sharing of our birth stories is a first step towards returning to women the wisdom and control of giving birth. These stories are powerful and empowering. Childbirth is one of life’s most marvelous, miraculous experiences. Giving birth is not only about having babies; it’s also about motherhood. In the same light, sharing birth stories is not only about providing or collecting information; it’s also about community.

As for anything so personal, we need to start by providing a non-threatening environment conducive to open, heart-to-heart participation.

The topic of birthing is highly charged. The contention seems to arise mainly between those who have had natural births or homebirths and those who, for whatever reason, haven’t. One side may come across as patronizing, smug and self-serving. The other side may seem insecure, defensive, envious and even ill-informed.

The Best Birthing Option

Expectant parents who have researched and considered all the birthing options available to them, while taking into account their own values and beliefs, are making an informed, proactive decision. They may plan on any combination of options, such as an assisted or unassisted homebirth, a birth center birth, a natural hospital birth, a hospital birth with minimal pain relief, a hospital birth with maximum pain relief, and even a planned Cesarean section. Of course, there may be unforeseen events that could change Plan A to Plan B, and these changes may be completely out of anyone’s control. So, for instance, those planning on a natural homebirth would need to consider the possibility, remote as it may be, of ending up in a hospital having an emergency Cesarean section.

Maternity care providers in all steps of the process, from pre-pregnancy through postnatal care, need to move more in the direction of assisting people in having personalized birth plans and helping them to safely realize these plans. In other words, maternity care providers must consider the family to be an integral part of the decision-making process.

With informed planning, financial considerations need to be taken into account: Some families may not be able to afford private care. Risk factors must also be considered: It may not be advisable to plan a homebirth for a high-risk pregnancy. Some women might desire pain relief, even considering it to be a crucial part of their birth plan. They may not want to experience the pain of birthing. Pain sensitivity may vary greatly from one person to the next, which would mean that some women may not be able to cope with pain as well as others. If pain relief wasn’t available to some women during labor, their birth experience could be overshadowed, even complicated, by their overwhelming inability to cope with the pain. We can never know what another’s experience is truly like. Parents-to-be need to be realistic about their circumstances and thus deserve to be free to make informed and unfettered decisions about their birth plan. Once they have become informed, the best combination of options for any family is that which they feel best suits them at the time.

Natural vs. Medicated Birth, Hospital vs. Home

Some mothers who have experienced a natural birth may find it difficult to understand why others have not, cannot, or do not desire to do so. Some natural birthers have described to me how they were successful at getting themselves into the right zone, pointing out that they had made the right choices; they emphasized that they hadn’t given up when the going got tough; and they described how they felt in complete control during their birth experience.

For some who chose or needed medical intervention, doubts and “what ifs” may creep into their thoughts when they hear natural birthers’ stories, even if they have processed their birth experience and have come to terms with any disappointment they may have felt, assuming they were disappointed at all. I have heard comments such as, “I must not have been able to get myself into the right frame of mind,” “I think I made some bad choices,” and “Maybe I didn’t try hard enough.” Their insecurities and defensiveness may actually end up reinforcing and perpetuating the attitude that all women can control every aspect of their birthing experience and its outcome if they really want to.

For some who choose a homebirth, they may feel misunderstood, even humiliated, by hospital birth advocates who consider home birthers to be reckless with their baby’s and/or their own well-being. Comments such as, “It’s risky business to birth at home” or “Something could go wrong, and then your baby’s and even your own life could be in jeopardy,” may undermine the confidence of those who are considering a homebirth.

Competition at the Root of Contention?

What might cause these misunderstandings and ill feelings to develop? Perhaps the answer lies in our culturally driven need to compete.

Western society emphasizes individual competition. Competition is not only prevalent in mainstream settings, it also exists in alternative communities and social circles. Society instills in us the need to compare the many things in our lives in order to determine what’s better or what’s best. Then we generalize that “What’s best for me must be best for you, too.” In setting up a better than/worse than dichotomy, competition stifles our ability to empathize with each other.

According to the article “Competitive and Cooperative Approaches to Conflict” by Brad Spangler on BeyondIntractability.org: “Obstructiveness and lack of helpfulness lead to mutual negative attitudes and suspicion of one another’s intentions. One’s perceptions of the other tend to focus on the person’s negative qualities and ignore the positives.”

Unspoken irrational comparisons might take place, such as: “I had the shortest and least complicated natural birth,” “Oh! My natural birth took longer than hers” and “Oh no! How can I share my birth story? I didn’t even have a natural birth!” For many reasons, everyone loses in competitive situations like this. One unfortunate consequence is that non-natural birthers may feel uneasy about sharing their birth stories. We may all lose out on their valuable input, because we don’t end up having the chance to view the bigger picture.

A competitive atmosphere that develops surrounding the sharing of birth experiences is a clear sign that on an individual level, everyone needs to reflect more on their own birthing experience. If individuals find themselves proving others wrong in order to make themselves feel right, then they need to have a look at possible reasons why. They need to give themselves—and then each other—credit where credit is due, as well as acknowledge their good fortune.

According to Spangler, cooperative conversation is characterized by “‘effective communication,’ where ideas are verbalized and group members pay attention to one another and accept their ideas and are influenced by them. These groups have less problems communicating with and understanding others. … Friendliness, helpfulness and less obstructiveness is expressed in conversations.”

Sharing with Empathy

A practical idea for encouraging a less competitive environment is to discover what we do have in common. So, it would make sense to emphasize the ways we have promoted bonding with our newborns from the time they entered into our lives. It is helpful to “fast forward” to the present time and talk about what we are doing now—and tomorrow—to remain securely attached to our children.

When we can get beyond our feelings of competitiveness, we are able to foster a healthy dialogue because we are more receptive to what others have to say. In a cooperative setting, “members tend to be generally more satisfied with the group … as well as being impressed by the contributions of other group members,” writes Spangler. Through empathic listening, we are less likely to make assumptions about others’ views, motives and feelings and more likely to give them the benefit of the doubt. We are able to:

  1. Reflect on others’ birthing experiences
  2. “Try on” their situation—their “truth”—by imagining ourselves in their place
  3. Give validation and empathy, but not in the form of an unsolicited therapy session
  4. Increase our own knowledge of and sensitivity to birthing issues
  5. Help each other move on to our current parenting situations by sharing ideas for remaining as securely attached as possible to our children today, tomorrow and in the years to come.

In a fully accepting and flexible atmosphere, people are safe to make themselves vulnerable by sharing their feelings, needs, disappointments, triumphs and dreams. Natural birthers are able to view non-natural birthers’ experiences and concerns with sincere, unbiased interest and empathy, and they will softly share their own birthing experience. Mothers who did not experience the birth they had hoped for will feel understood because their own birthing stories are validated, and they will be able to share in the joy of other parents who had the birth experience they had hoped for. Feelings of satisfaction we derive from feeling superior are fleeting; the good feelings we receive by helping other people feel good are long lasting.

Even the most informed people can run into unplanned, and sometimes serious, complications during the birth process. By no means is it justifiable for anyone to be made to feel negatively about whatever birthing options they choose or for whatever birthing experience they have had. We all deserve to have our birthing choices and experiences validated. Through our positive and non-judgmental contributions to this contentious topic, we create a collective harmony that enables everyone to leave the discussion feeling good. We bring these good feelings home to our families. Thus, the empathy we have given to each other touches the greatest gift we all receive in our birthing experience: our own children.

To read our growing collection of birth stories–or to find out how to share yours–visit Your Birth Stories on The Attached Family.com.

What to Do When a Cesarean Becomes Necessary

By Michelle Smilowitz, CD-DONA, reprinted with permission from International Cesarean Awareness Network, © ICAN-online.org

Baby born by CesareanThe birth of a child is one of the most significant events in the lives of families. It is considered a rite of passage by many women and involves the first interaction between parents and their baby. There is much buzz today about the necessity of making birth a “family-centered” experience, where the focus is often on creating a special environment for bonding between parents and child in the first moments and days of life. But what if you are one of the  women who experiences your baby’s birth as a Cesarean section? Is it possible to make your surgical experience into a family-centered birth?

The answer is a resounding yes. While planning a family-centered Cesarean is easiest for the woman who must, for whatever reason, schedule her baby’s birth, there are a number of ways that a woman who encounters an unplanned or even emergent Cesarean surgery can make her experience into a celebration of her baby’s birth.

Become Familiar with the Procedure

It is first important that every pregnant woman and her partner become aware of the procedures that surround a Cesarean surgery. Many women who experience unplanned Cesarean deliveries lament that, “I skipped the section of the book on Cesareans; I assumed it couldn’t happen to me!” Having some familiarity with the procedure and all that it involves can help reduce much of the surprise and fear that can surround the unknown.

For More Information on Cesarean as a Procedure

If your Cesarean is planned, it is important that you have the opportunity to fully discuss with your care provider the reasons for your surgery. Knowing that this surgery is the best choice for your or your baby can create a less tense environment for the delivery. If you desire a vaginal birth and feel that a Cesarean surgery may be unwarranted for you, consider getting a second medical opinion that all medical consumers are entitled to.

Write a Birth Plan

Next, plan this birth just as you would a vaginal birth. Write up a birth plan including your preferences for the surgery as well as for yours and the baby’s postpartum care. In the case of a pre-planned Cesarean, it is usually possible to schedule an appointment ahead of time with your anesthesiologist. He is the person who actually controls the environment of the operating room. For example, generally, women’s arms are strapped down for their surgeries, so that they do not dislodge IV wires or sully the sterile surgical field. Ask if you can have at least one of your arms free or have your support people hold your arms in place.

Discuss the pros and cons of both epidural and spinal anesthesia as well as the effects of various other medications you may receive both during and after the surgery. Some of the medications that treat specific symptoms such as trembling and nausea may cause extreme drowsiness or amnesia. You may decide that you would rather tolerate these symptoms than be asleep for the first few hours of your baby’s life.

When you write your birth plan and discuss it with your care providers, there are a number of things you may want to consider. Many women negotiate to have two support people with them in the operating room, generally their partner and a doula or friend and family member. Doulas are a great addition to a Cesarean birth team. They are familiar with the process and can reassure you and your partner. Additionally, if you and your baby need to be separated at any point, your partner can accompany the baby while your doula stays with you. Doulas also often have some expertise in post-Cesarean breastfeeding and can help with this.

Many women ask for and are given the right to play music of their choosing for the birth – this can soothe you and serve as a pleasant way to welcome your baby into the world. Feel free to ask those at your birth to refrain from extraneous conversation, and request that if possible someone (generally a member of the medical team) narrate for you exactly what is going on throughout the birth. Ask if you can take photographs or videotape the birth – many women enjoy the opportunity to “see” the birth later on. Sometimes, black-and-white pictures are preferable for this – they preserve the drama of the birth while eliminating a direct view of blood, troublesome to some.

Many women feel a disconnection from their Cesarean baby because they did not actually see or feel the baby born. If you are interested in actually seeing your baby as he emerges from your body, you can ask to view this by having the drape across your abdomen that blocks your view lifted for the actual delivery or by using a mirror.

Before the Cesarean, ask that the medical personnel not announce the sex of your baby — instead allowing you or your partner to discover this. Request that all necessary newborn exams be done in your line of vision or even on your chest, and to make physical or verbal contact with your baby as soon as possible. Your baby has been accustomed to hearing yours and your partner’s voice for the past nine months – even if you cannot touch your baby, you or your partner can soothe your baby with your voice. With the help of an excellent nurse or doula, some women are able to nurse on the operating table, while others wait until the recovery room. Regardless, ask to touch your baby as soon as possible, and to keep the baby with you in recovery if all is well.

Get Help After the Cesarean

During the immediate postpartum period, you are going to need a lot of help! After a Cesarean surgery, women are often confined to bed for as much as a day or two. Once you have been given permission to get up, even such simple movements as rolling over in bed can be quite painful. Clearly, trying to take care of yourself as well as a new baby is generally too much. Having a partner, friend, or relative stay with you in the hospital can help ensure that your baby will room in with you. This person can help with changing diapers, bringing the baby to you to nurse and positioning the baby at the breast, as well as assisting you with your needs.

Once you are home, extra help will enable you to have a more rapid recovery, as well as give you the opportunity to nurture yourself and bond with your new baby. Many women find that they need extra help with breastfeeding after a Cesarean, and there are a number of resources for this.

Not all of these suggestions will work for every situation, and of course, in the case of the emergencies that can occur during surgery, plans may need to be changed or abandoned. Nonetheless, using some or all of these suggestions can help your surgery feel more like your baby’s birth!

Originally published in the Birth Journeys newsletter of ICAN of Seattle, Summer 2004.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

What Goes into a Family-Centered Cesarean Birth Plan

By Connie Banack, CCCE, CPD, CLD, reprinted with permission from International Cesarean Awareness Network, © ICAN-online.org

C-section birth plan basicsFamily-centered birth is used to describe a birth that is more family oriented, allowing the new family to experience their birth more fully. Many believe that this cannot apply to a surgical procedure. This is not true. Even with a Cesarean surgery, you can have a family-centered birth if you know your options and choose to apply them. Some of the options will be the same as for a vaginal birth. You may have to work harder to have a family-centered birth in the event of surgery, but planning ahead — even if you don’t foresee a Cesarean — can go a long way. Make a birth plan! They won’t know what is important to you unless you let them know, and a birth plan is actually a legal contract as it is providing your wishes in a document provided to your birth team.

Very few women would choose a Cesarean for their birth experience. However, it is important that every pregnant woman is aware of the procedures that surround a Cesarean section. This will give those who do birth by this process more choices and hopefully less fear.

A Word about Doulas

The continuous support of a doula has been found in numerous scientific trials to positively affect obstetric outcomes and the women’s satisfaction with their birth experiences. Many women and couples choose to have a doula because they want and need this extra assistance. During labor, an intense bond develops between the doula and the couple, and if a Cesarean becomes necessary, it is very distressing for the woman to have to choose only one person to be with her. Mothers will hire doulas even during a scheduled Cesarean birth to provide the consistent professional support a doula provides.

A 2001 article by Penny Simkin, “Doulas at Cesarean Birth,” details the benefits of a doula during a Cesarean, which include:

  • Doulas are familiar with Cesareans and do not find them upsetting.
  • The doula’s familiar presence can calm and reassure the mother who is likely to be very frightened and worried.
  • The doula can reassure the partner, who is also likely to be worried and frightened.
  • The doula can explain what is happening.
  • Once the baby is born, the partner usually goes to see the baby, leaving the mother’s side. The doula remains with the mother, tells her what the baby is doing, and helps the mother feel less alone.
  • The doula goes to recovery with the mother. If the partner has gone to the nursery with the baby, the mother still has a support person with her.
  • The doula does not get in the way or behave inappropriately.

Check with your doctor to see if your doula is allowed into the operating room and recovery to support you.

Birth Plan Preparation

In preparing a birth plan, each point needs to be discussed with your caregiver, even if he may not be at your birth. He will be able to tell you if what you would like is an option with him or at the hospital you have chosen. Start early and discuss a few points each prenatal visit rather than trying to cover every point in one or two visits. This will help you in providing more time for questions about each point and reduce confusion for both you and your caregiver.

Communication is vital in learning about philosophy, options, and rapport. A good way to communicate with your caregiver in putting together a birth plan that will be read and followed is through the “Who’s the Boss?” Method:

  1. Acknowledge provider’s expertise
  2. Add personal information
  3. Listen and consider
  4. Summarize
  5. Respond in appreciative and authoritative mode.

Example:

  • You: One of my friends was telling me about avoiding post-operative pain medications just after her baby was born, which made her fall asleep, and I wanted to get your professional opinion on the subject.
  • Doctor: Routinely, a pain medication is given to you after the baby is born to help you relax during the long suturing process, which can take up to an hour. It can make you sleepy or even relax you enough to put you to sleep. You can then wake up refreshed when you meet your new baby.
  • You: Is it possible to ask not to have this given?
  • Doctor: Absolutely.
  • You: OK. Thank you for discussing that with me. Now I understand, and I’ll think about what you said before I decide.

When writing your plan, start by introducing yourself through a prologue. This provides a familiar base on which to build a rapport with your nurses and attending caregiver. This is followed by your wishes, which have been discussed with your doctor prior to your birth. Point form is the most efficient way to list these, as you don’t want your birth team to become mired in your plan looking for a lost point. Wording is crucial in a birth plan. It can make all the difference between a supportive or hostile atmosphere during your birth. Yet it is also a legal document.

“The language ‘I do not consent’ may sound harsh but, in fact, is the only statement that has clear legal power so I encourage you to use it for things that you feel strongly about,” emphasizes Gretchen Humphries, editor of BirthTruth.org. “If someone does something to you after you state that you do not consent to it, legally they have committed assault and battery on you. Hospitals are well aware of this, but they assume you are not.”

Make your birth plan short, preferably one page long. Include only those points most important to you. Providing two plans, one for birth and one for your new baby, is an excellent way to ensure that both you and your baby are cared for as you wish. The birth plan stays with you, and the newborn plan goes with your baby if he not able to stay with you. Have several copies with you and give it to everyone involved in your Cesarean. And finally, after you have finished discussing the points with your caregiver, consider having him sign it. This helps ensure that it will be read and followed during your birth.

Basics of a Family-Centered Cesarean Birth Plan

  1. Prologue — Most nurses and doctors appreciate a prologue to a birth plan. A prologue introduces you to your birth team and can give insight into the choices you have made in the plan itself. For instance, parents who have had a former general anesthesia Cesarean experience could include this in the birth plan as an explanation as to why they are choosing an epidural for this birth.

Example:
We understand that there are times when a Cesarean delivery is in the best interests of the mother and infant. We also understand that Cesarean delivery, as a surgical procedure, is common and even routine in most maternity centers. However, we would ask that the staff respect that this individual surgery is a unique and never-to-be-repeated event in the life of our family. For us, it is neither common nor routine, but rather is an event that will have effects lasting a lifetime. We have already experienced the Cesarean delivery of our sons and, because of that, have certain requests and requirements to be taken into account.

  • Pre-operative Preparation — If an elective Cesarean is necessary, then you should request that you be able to begin labor naturally before the Cesarean is done. That is, you do not want a date and time preset; you wish for your baby to decide the day on which it is ready to be born to avoid any problems with prematurity and for both of you to reap the benefits of your hormones. It is also important for your benefit in both recovery and in establishing your breast milk. Labor signals your body to start producing breast milk about two to three days after your baby is born and this is thwarted when baby is removed surgically without labor, often prolonging the production of milk by several days. If a scheduled Cesarean must be performed, then you should request preoperative blood work and tests to be done on an outpatient basis, and hospital admission on the day of the birth not the night before. There are several preparation procedures that are done before you enter the operating room such as establishing an I.V. and giving a bolus of I.V. fluid, placing the epidural catheter and ensuring adequate anesthesia, inserting a urinary catheter, checking of vitals (blood pressure, heart rate, temperature), and checking fetal heart tones. There is no reason why you cannot have your partner and others there to comfort and support you during any of them. One procedure specifically, inserting the urinary catheter, can be quite uncomfortable and many mothers recommend delaying the insertion until after the epidural or intrathecal is in place.

Example:
I do not consent to placement of a urinary catheter until after regional anesthesia is in place, unless it has been discussed with me in advance.

  • Anesthesia — Women have three options for anesthetic during a Cesarean section: general anesthesia (mom is unconscious), epidural anesthesia, and intrathecal anesthesia (with both of the latter, mom is awake for the delivery). Please research each option, both for availability and benefits and risks of each to find which is right for you. What many women do not realize if they are awake is that medications are often given before, during, or just after the baby is born to relax the mother, but the postoperative medication especially often puts the mother to sleep. You will need to decide if you want this or not and include it in your birth plan if you want to avoid further pain medications during or after the surgery.

Example:
I do not consent to any pre-, peri-, or postoperative medication without prior verbal consent from myself, or my spouse if I am incapacitated. I wish to discuss the complete anesthesia protocol with the anesthesiologist prior to any medication administration. I desire postoperative analgesia to be administered via epidural before any use of systemic analgesics, sedatives, or tranquilizers. I have used this protocol in the past and was pleased with the results.

  • During Surgery — It is the anesthesiologist who makes the decisions in the operating room. It is important that he reviews a copy of your birth plan and discusses it with you prior to your birth. Ensure you include in your birth plan who you would like to attend during and after your birth in the operating room. Some anesthesiologists allow only one person with you in the operating room; others allow two or more. Find out what your options are and prepare accordingly. If only one is allowed, one alternative may be having your partner be with you until the baby checks are completed and then have your doula or another support person come in when your partner leaves with baby, assuming baby is moving to the nursery. Routinely, your hands are strapped down to prevent tangling of the various cords to the medical equipment that is monitoring you and to prevent your arms from falling off the narrow boards they are placed on. You can ask to not have your hands strapped down, so as to better receive your baby when he is brought to you. Would you, and your partner, like to view the actual birth? Then make sure your obstetrician realizes this. Explain you would like the option of viewing the birth, either by lowering the screen or by positioning a mirror. Maybe your previous Cesarean is still a bit unreal, as you never have actually seen a baby leave your body — they tend to just appear from behind the green screen and be held up for a quick look before they disappear to be wrapped up and tested. Make sure that the operating room staff realizes that you would appreciate a verbal description of the birth as it occurs. You may have previously felt left out of your past Cesarean as your body and labor might have been discussed as though you weren’t there. Would you love to meet your new baby in his unclothed, naked newborn state — a wet, slippery baby? Request that the baby be placed on your chest with a warm blanket over you both. It would do a lot to make this surgical delivery a bit more natural for mother, father, and baby. And it may even resolve a few inner conflicts that are faced after the birth. In addition, ask that no screen be placed in the way as you will be able to see the baby as he emerges from your body immediately and even be placed on your chest for the baby checks and to cut the cord. Other options include taking pictures or videotaping the birth, having or even choosing background music to be played during the surgery, and your partner cutting the cord. What about that placenta? Most women who birth vaginally get to see it. If you would like to, too, make sure operating room staff knows you want to view the placenta. Make sure they realize the importance of this, and let them know not to just discard a part of you that you have carried for nine months as insignificant. You may like to take the placenta home, to plant under a tree, or even to eat (it reduces the incidence of postpartum depression), so please tell them to be sure to make suitable arrangements with you to see that this happens. If an emergency Cesarean is necessary, under general anesthetic, then you can have your baby given to your partner as soon as possible after birth and held by him (hopefully next to his naked chest – skin-to-skin contact) until you are awake and can be told of the baby’s sex and well-being by your partner. As with any surgery, there are risks and sometimes those risks can have drastic consequences. Some obstetricians remove the uterus to solve a problem like hemorrhage. Is this a concern for you? Many times, a hysterectomy can be avoided using other treatments. Have you considered the option of tubal ligation during the surgery? Many women have been asked on the operating table this question and have answered hastily only to regret it later. Make the decision before your surgery. Also, with any surgery, administration of blood products may be an option when there is excessive bleeding. Many have fears or religious considerations surrounding the dispensation of blood and blood products. Options may include banking your own blood or refusing blood products and building your own supply back to normal in the days following your birth. Finally, there are two methods to closing the uterus. Highly recommended is the double suturing method (suturing of both the inner wall and outer layer of the uterus) to further ensure scar integrity for subsequent pregnancies and labors. Closure of the skin layer can be done either with staples or with sutures. If either of these is preferable, note it on your birth plan as well.

Example:
I do not consent to having my arms strapped down unless I am physically unable to control them. I am familiar with surgical fields and understand the necessity of maintaining a sterile surgical field.

  • Infant Care — How about breastfeeding your baby straight away, rather than hours later? Let them know that you would like to feed your baby while you are being sutured, if you feel up to it, and you would like your baby to stay with you throughout the surgery and even during the recovery. Your baby should remain with you at all times, no disappearing off to the nursery with your partner. This simple routine can seriously affect your bonding with your child. If your baby must go to the nursery, then do send your partner and encourage skin-to-skin contact. Your baby will be much less stressed when with someone he recognizes, as baby will respond to your partner’s voice. Let them know that your partner would be delighted to hold his child within your view throughout these procedures, if you feel unable to participate in the bonding. Newborns are also subjected to various interventions, too — routine health checks using the APGAR assessment, vitamin K injection, eye ointment application, PKU test, weight and height measurements, a bath, and possibly Hepatitis B or other vaccinations. It is highly recommended you research each of these and make an informed decision on allowing, delaying, or not allowing these procedures. You can also ask that the procedures that are done right after baby’s birth be done while in your presence rather than in the nursery. If you are planning to breastfeed your baby, you may want to include in your birth plan that you would like your baby to avoid artificial nipples or supplements including water, sugar water, or formula. If there is a glucose or nutritional concern, ask that it be discussed with you before an action is taken.

Example:
We do not consent to the PKU test until after my milk is in. We believe that this will reduce the likelihood of an inadequate sample, making it less likely a retest will be needed.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

Heal Thyself through Birth Storytelling

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Healing through our birth storiesIn preparing the Spring 2009 issue of The Attached Family, I asked a number of women to tell their birth stories who were too uncomfortable in doing so. They were still working through emotions of disappointment, fear, and sometimes guilt surrounding their baby’s birth – even years afterward.

It is obvious that emotional healing is a process, similar in many ways to grieving over the death of a loved one. In fact, the emotional healing process after a traumatic birth is a type of grief: You are grieving over a loss – having to settle for a labor and/or childbirth that may be very different than you imagined it, the loss of your expected recovery or early attachment period with your baby, even the loss of a healthy baby. For some women, the loss may not be so obvious – perhaps you didn’t get to hold your baby after your birth, or you had an I.V. or catheter or couldn’t walk around during your labor as much as you wanted to. Not all losses have to be catastrophic or major to cause a feeling of grief.

“Shock is a normal psychological and physiological response to an unknown, intense or perceived biologically-threatening situation,” according to Pam England, author of Birthing from Within, in her article, “Birth Shock,” on BirthingFromWithin.com. “Labor, even normal labor, qualifies for all of those categories. So birth shock is a completely normal response to either normal or complicated births and postpartum; it occurs in home births and hospitals births.”

Dr. Elizabeth Kübler-Ross was a doctor who spent time studying the emotions patients in Swiss hospitals go through when they learn they have a terminal illness. She wrote On Death and Dying in 1969, where she identified seven stages of grief people typically go through as they work through the emotional impact of the loss of their dreams for their life. Commonly referred to as the Grief Cycle, these stages are common with all forms of loss – such as the loss of a job or pet, and theoretically could be applied to the emotions surrounding a disappointing birth experience.

“Grief is a process of physical, emotional, social, and cognitive reactions to loss,” according to Lori Godin, a licensed marriage and family therapist in San Jose, California (ModernLife.org). “The grieving process is often a hard one to work through. It requires patience with ourselves and with other. Although responses to loss are as diverse as the people experiencing it, patterns or stages that are commonly experienced have emerged.”

The Grief Cycle

The Grief Cycle is often condensed to five stages: denial, anger, bargaining, depression, and acceptance. The original Grief Cycle created by Kübler-Ross includes actually seven stages, which are outlined on ChangingMinds.org:

  1. ShockSymptoms: At first, the person may appear to have no reaction at all, or may nod and appear to accept the news without being troubled by it. The person may need to be told several times before they understand it, which is indicative by a physical reaction such as paling of the skin, shortness of breath, and physical freezing. Treatment: The person should be sat down and given something to hold onto. Show them sympathy and acceptance. Prevention: While there is no prevention of the Grief Cycle, the reactions of the Shock Stage may be lessened some by telling the person the news in a private, safe place with the company of trusted friends or family.
  2. DenialSymptoms: The person pretends that nothing has happened, including denying any evidence that would prove the news to be real. Treatment: Show sympathy by letting the person know that you, too, find it unfair. This will help the person feel safe to become angry about the situation, which opens up their ability to deal with their emotions.
  3. AngerSymptoms: The person may swing suddenly and explosively into anger, as she asks “why me?” She may freely blame people, places, and events – anything that may have been involved in the situation. Treatment: Allow them to feel angry and don’t deny their feelings, much as attachment parents do with their toddlers’ tantrums. However, should the anger become destructive, remind the person of appropriate and inappropriate behavior and help her to reframe her anger into useful channels such as problem areas, tasks, hobbies, and other ways to move forward. Prevention: Again, while the Anger Stage cannot be prevented and is essential to move through the Grief Cycle, you should be aware of your reactions when faced with another person’s anger. Do not turn it into an argument, as this could push the person back into denial or cause future problems. Support and accept their anger, and let them be angry at you, especially if the person’s “why me?” turns into “why not you?”
  4. Bargaining Symptoms: The person feels hopeful that the situation is reversible. She seeks in vain for ways to avoid the situation. Treatment: While you can help the person seek out practical alternatives, do not offer the person any false hope. Offer new opportunities for personal growth.
  5. DepressionSymptoms: The person finally feels the inevitability of the situation and reluctantly accepts it. This can be a deep depression full of despair and hopelessness. Depression can present in many ways, from tearfulness to sleeping all the time to loss of joy in hobbies. As they turn into themselves, they turn away from any possible solution or person who can help them. Treatment: Show sympathy and acceptance. Your presence, while it may not be acknowledged, can be comforting to the person. Professional counseling may be needed to help the person recognize their depression and then find a way out of depression.
  6. TestingSymptoms: The person begins to experiment with activities to find ways out of the depression. Treatment: The support of friends, family, and sometimes professional counselors can help tremendously during this stage. Give the person as much control over the situation as possible, as you help them try different solutions.
  7. AcceptanceSymptoms: The person feels ready and actively involved in moving on with her life. The person takes ownership for their actions and emotions. They start doing things and taking note of the results, and then changing their actions in response. They appear increasingly happier and more content. Treatment: Help the person to establish themselves in their new position on life. Congratulate them on getting through the emotional healing process, and celebrate the transition of their transition.

“Knowing these stages can sometimes help in coping with the process of grief and recognizing that there is a light at the end of the tunnel,” Godlin continues. “It should be noted that although most people experience all of the following stages, they do not experience them with the same duration or in the same order or with the same intensity. It is a very unique process.”

The Grief Cycle in a Birth Story

For this exercise, I am referring to my daughter’s birth story, “The Story of Rachel,” in the Birth Stories section. Try dissecting this story and see if you can identify any of the stages of the Grief Cycle.

Here’s what I came up with:

  1. Shock – “My first thought was that I had lost the baby, but as soon as I stood up, I felt a kick. I couldn’t grasp that she was still alive when it was clear from the blood that things were not at all OK.”
  2. Denial – “I had no idea was he was trying to tell me — I thought the drugs would work, the pregnancy would last until my baby was term, my baby wouldn’t need any sort of NICU care.”
  3. Bargaining – “I braved each contraction, with the help of my dad and a nurse as my coaches since I had never been through childbirth classes, with the expectation that the drugs would work.”
  4. Depression – “It was devastating to hear the doctors say there was nothing more they could do to stop labor and that my baby’s well-being was left to fate.”

Note that I did not appear to go through all the stages. As Godlin mentioned, not everyone goes through every stage of the Grief Cycle, or through in the same order. In addition, some women may grieve their births immediately, while others may wait. Some may think they have accepted the circumstances surrounding their child’s birth but then find a trigger in another’s birth story or when a close friend or sister becomes pregnant for the first time. Many women don’t grieve until they’re pregnant again, or even just considering whether or not they want more children.

What my birth story doesn’t tell you is, I didn’t feel angry until I was pregnant with my second daughter, Emily, and then especially after her Cesarean.  As far as the testing and acceptance stages go, while I believe I’ve accepted the way my birth progressed with Rachel, I’m still bouncing in and out of acceptance and anger with Emily’s birth. Because the two births were only a year apart, it’s difficult to sort out exactly which emotions go with which birth and it’s very possible the two’s Grief Cycles have enmeshed with one another.

Why Birth Storytelling is Needed

Everyone’s birth story is unique unto itself, and every person sees disappointments, fear, and guilt in their own way. This is why it is sometimes difficult to find empathy or sympathy from others, and why it can be useful to use the telling and retelling of our birth story as therapy in working through the Grief Cycle. In the article, “Emotional Recovery from a Cesarean,” on Plus-Size-Pregnancy.org, we learn that many women who suffer from emotional trauma following a Cesarean birth often then feel additional isolation and hurt by friends and family who have difficulty understanding the need to mourn a birth when the baby and mother are ultimately healthy.

According to the article, some people don’t understand the scope of a Cesarean, thinking it’s more or less interchangeable with vaginal birth; others come from an age where interventions during birth, such as putting women out of consciousness or giving them massive episiotomies, were the norm. Some people may disregard a woman’s grief because they don’t want anything to overshadow their own joy of the new baby. Some people may be unable to feel empathy because they have unresolved issues from their own birth experiences, even seemingly normal ones, or because they happy with their interventions, even a Cesarean, and don’t understand why you wouldn’t feel the same way.

The article goes on to acknowledge the power of birth storytelling in emotional healing. In fact, the author, who is identified only as KMom, stresses that telling the birth story is crucial in starting the healing process: “This is one of the most difficult steps for some women, but it really is very important in getting the healing started.  If you can’t name what happened to you, then you can’t fully understand it or begin to make it different next time.  Name the problem, talk about what happened, then retell your story over and over and over. “

Healing Through Our Birth Stories

With the internet, it’s easier now to find ways of telling your birth story. You can share it on the API Forum, where parents are always ready to give support. You can submit your story to be included on The Attached Family online. API Leaders through your local support group, or a resource leader contact, would be happy to listen to your birth story. Some API Support Groups host special meetings specifically for women to share their birth stories. If you’d like to be more personal, write your story in a journal or on your computer where no one else can see it but yourself. Tell your story to a trusted, impartial friend or family member.

Only share what you feel like sharing, and don’t feel pressure to share all of it at once. Many women develop their stories, or parts of their stories, over time. They may remember points of their births that they hadn’t before, or are able to see it in a different perspective. You can start by writing about your pregnancy and work slowly forward in your story, or you can start at your recovery and work slowly backward. For some women, the story just falls together on its own from start to finish. For others, the story comes in little bits and may jump around.

KMom shares that it’s not enough to tell a birth story only once, that retelling it many times with different focuses is needed to be able to start processing the emotions that come with it. Lynn Madsen, author of Rebounding from Childbirth, suggests writing the birth story in two layers, resting between the layers to give time to reflect:

  1. Write down the concrete details you can remember: who, what, where, when, the sensory details, etc.
  2. Write down what was going on inside of you: where was your mind, were you aware of the baby, what did you say to yourself, how were you feeling, etc.

It is in this second layer of your birth story that you will begin facing and processing the disappointment, fear, guilt, and other emotions surrounding your birth experience. This is daunting work for most people, as KMom explains: “Some of the hardest work you will do is accessing your deepest feelings about your child’s birth.  Often, it is very difficult to do this.  People don’t like to go through pain, and facing unpleasant or difficult feelings is painful.  Feelings about birth tend to be very intense, especially the deeper you go.  Often they bring up life issues which can be even more intense.”

“It is completely normal to wish to avoid pain, but if you suppress your feelings and don’t really feel them fully, they become stronger.  Often they will present in your life again and again, each time stronger and more insistent, and sometimes in more destructive ways.  Although facing the feelings may be very difficult or feel very threatening, in the long run it is what frees you,” she continues.

Some women feel they don’t need to deal with their emotions because the experience is behind them, or because their experiences may not be as traumatic as someone else’s. But Madsen explains: “Every feeling about birth matters, no matter how long that feelings lasts, no matter how unreasonable, irrational, or out of proportion it seems.  Any feeling, no matter how strong, is easier to live with once it is named. …A woman may believe she is going to die as the feeling rolls through her, but she won’t.  The trick is to sit with the feeling until this intensity, this sensation of death passes, and light is perceived at the end of the tunnel.”

Telling the birth story, and working through the emotions surrounding a disappointing birth, is essential before a woman decides to have another baby. It is also important for women who are certain they are done having children, because their emotions may be clouding their judgment. Even if a woman is past her childbearing years, naming these emotions and working through them is needed for closure, or else, these emotions will return over and over again throughout their lives at different points and in different situations, until they are finally resolved in some way.

Get the Most Benefit Out of Your Birth Story

In developing your birth story, KMom gives several helpful tips to more fully understand the emotions you may be feeling:

  • Learn exactly what happens during the procedure you went through, whether it was a Cesarean, episiotomy, or another intervention. Search for an article on the Internet, or watch a video. Realize that you’ll likely find this distressing at first, but it really does help you to understand your emotions if you know what physically happened to you.
  • Request a copy of your medical records. Find out what really happened during your birth experience and the reasons for the interventions.  You need to understand the complexities of what happened and if there was anything you could’ve done to prevent what happened. You may feel anger and sadness as you read through your records, especially if you find unkind remarks or misinterpretations by your provider, but you can discover a lot of the behind-the-scenes reasons for why your labor and childbirth went the direction that it did.
  • Listen to your partner’s view of the birth and discuss it. Your partner’s version may be different than yours, and he may be able to offer insight. Realize that he may be working through his own emotional healing process, so understand if he is reluctant or if he tells his story in a brief way that lacks a lot of emotion and details, and ask probing questions gently.
  • Activate your anger. Unexpressed anger can destroy a person, but expressed anger opens up the healing process. It doesn’t matter whether you feel its reasonable anger or not. Women often feel angry at their health care providers or their spouses, but they can be angry toward anyone. But many women also don’t want to acknowledge that they’re angry. A good way to vent your anger is to write a letter addressed to the person with whom you’re angry – although you won’t send it – and let your anger erupt or pour out over the page.
  • Express emotions through the arts. Draw, paint, sing, write a poem, create a sculpture, even out of play dough, or write a children’s story from your baby’s point of view – do whatever your creative tendency is.
  • Acknowledge the emotional power of anniversaries. Your baby’s conception, expected due date, birthday, and other anniversaries can be both joyful times for you as well as times that bring about hard feelings toward your birth experience. Allow yourself to grieve during these anniversaries, which paradoxically, will allow you to work through the feelings and then enjoy the celebration. Otherwise, you’ll spend the day concentrating on your grief instead.
  • Share your experience with others who understand. Join a support group or seek out a mentor, such as through the International Cesarean Awareness Network, ICAN-Online.org; Sidelines National High Risk Pregnancy Support Network, Sidelines.org; Birth Trauma Association, BirthTraumaAssociation.org.uk; SOLACE, SolaceForMothers.org; and Birthrites: Healing After Cesarean, Birthrites.org. Find support through the API Forum or at a local API Support Group. Talk with a trusted friend, listen to or read other women’s birth stories, or especially if your birth was traumatic, seek out professional counseling with a therapist who specializes in birth issues.
  • Reframe the experience to focus on the positive — and on your baby. Give yourself credit for your courage and emotional strength. Think about the positive reinforcement you would give to another woman in your situation. Focus on the aspects of your birth where you did well, and give yourself credit for being mature enough to work through your emotions and to use the experience as a time for personal growth. Remember that you made the choices you made at the time because you believed them to be the best for your baby.
  • Practice self forgiveness. Forgive yourself for your choices, whether it was going along with whatever the doctor said or whatever it is that is making you angry. Tell yourself that you did the best with the knowledge that you had at the time, because that is truly the best that anyone can do.
  • Rewrite your birth in the way you wanted it to go. This is a very effective way to heal, but should be done only after you have written the birth story as it has gone and you have learned as much as you can about how the birth really went, which means looking at your medical records. Recreate your birth story with as much or as little detail as you want. Also, some women may need to rewrite their birth story over and over in order to feel a complete emotional release.
  • Tell your birth story to your child. When you’re ready, hold your child while he is asleep and whisper to him first your birth story and then your recreated birth story, what you wished had been different. Some women feel more comfortable practicing this exercise first without their child present, or by holding their child’s favorite toy, to first release strong emotions like sorrow and rage. This is especially true if there is any anger felt toward the child.
  • Create ceremonies. Some women gather friends together for a birth storytelling circle. Others write their birth stories or letters to those they are angry with and then burn the paper. Some have placental burials, affirmation declarations, or other rituals where they can either give themselves positive reinforcement or express anger in a healthy way toward others.
  • Find activities that help release your emotions, tension, and stress. Exercise, good nutrition, mediation, and massage are especially helpful, as are your hobbies or even chores if you are able to channel your strong emotions into them.

Healing is Possible

When a woman is in the midst of feeling the emotional trauma from a disappointing birth experience, it can seem like her former, happy self has gone away forever and a depressed, angry person has taken place. Healing takes time and effort, but it is well worth it in the end. Unhealed emotions from a traumatic birth experience can take their toll not only on the relationships within a family, but also on the future children (or decision whether to have more children) and on the woman.

Sharing your story through an API Support Group, the API Forum, or by submission to The Attached Family online “Birth Stories” section can be a great start to healing through your birth story – as well as helping others heal from their traumatic births.

In her Plus-Size-Pregnancy.org article, KMom explains: “Reading other women’s stories of recovery after a [traumatic birth] can be very healing.  Sometimes, confronting women’s pain or our own can be distressing, but it is running away from or avoiding the pain that prolongs it. Dealing with the pain when you are ready can be very revealing about general life issues, can help you heal many ways emotionally, and can help you face your fears and prepare for future pregnancies and births.  Remember, ‘The other side of fear is freedom.’”

For More Information

  • Birthing as a Healing Experience by Lois Halzel Freedman
  • Ended Beginnings by Claudia Panuthos & Catherine Romeo
  • Rebounding from Childbirth by Lynn Madsen
  • Silent Knife by Nancy Cohen Wainer & Lois Estner
  • Transformation Through Childbirth by Claudia Panuthos
  • Trust Your Body! Trust Your Baby! by Andrea Frank Henkart

Be Prepared for These Common Childbirth Interventions

By Amber Lewis, staff writer for The Attached Family publications

Common Childbirth Interventions“Childbirth is more admirable than conquest, more amazing than self-defense, and as courageous as either one.”
~ Gloria Steinem, Ms. Magazine, April 1981

Most pregnant women will tell you they have a plan for their labor, but just as parents cannot imagine how their children will turn out as they grow and mature, soon-to-be mothers cannot be guaranteed a perfect birth. Labor experiences are as varied and vast as the types of people who go through them and the children those experiences bring into the world. There are just as many emotions involved in this miraculous experience, and while many births are happy and uncomplicated, others can be deeply disappointing for the parents.

This leads to the question: What to do when childbirth does not go as it was planned to? Continue reading Be Prepared for These Common Childbirth Interventions

The Long Wait for William

By Amy McGovern, co-leader of API of Norman, Oklahoma

Amy's family
Amy’s family

I woke up on a Sunday wondering, again, if this was the day my husband, Andy, and I would get to meet William. After church, I tried to rest but kept waking up with repeated mild cramps. A phone call to my mom confirmed the start of labor. Contractions were ten minutes apart. Excited, we took the dog for a walk to speed labor along, but we had to stop because the contractions began to hurt. We tried to play a board game as a distraction, but I had a lot of trouble concentrating because the contractions were really hurting now. I was completely unprepared for how much they would hurt given how mild they had been earlier! And everyone I knew had very mild labors, so I did not expect it.

By the time the contractions were five minutes apart, I was convinced he was coming any minute! I quickly ate, and we dropped off the dog at our neighbors. As we drove to the hospital 45 minutes away, I called both our parents to tell them what was happening. The contractions hurt so much that I still thought William would arrive in the car, but both moms said I was talking too much for that to happen.

When we arrived at the hospital, they said I was only at two centimeters dilated. They were about to send me home but I vomited. The nurse told me that I was not very far along, and she was not convinced labor would keep going on its own. She sent us off to walk for an hour and then come back for a re-check. We started to make laps, but the area was small and we quickly got bored. We pulled out our board game, and Andy made me walk laps after every turn. We played until I was gasping from the contractions coming every three to four minutes. All that pain had to be worth at least a few centimeters, but I had only dilated one more centimeter. It was about midnight and they were preparing to send us home about midnight, when the heart monitor showed a sudden drop and I was quickly admitted. They offered me some pain medication, and the nurse told me that it would help me to dilate if I could relax. I slept for only a few hours.

Monday

Twenty-one hours into labor, the Monday morning obstetrician said I was only at four centimeters, so she broke my water. I asked for an epidural, because the contractions hurt far more than I had anticipated. I demanded that my epidural be a “walking one” without really knowing what that meant. First, they broke my water and the obstetrician said, “Oh, my favorite color.” I asked what she meant, and she said it was meconium.

When the anesthesiologist gave me the epidural, I started to relax. Then, all of a sudden, the room was filled with doctors and nurses! I was a bit loopy from the medicine and did not know what was wrong. The nurse and the obstetrician kept repositioning me, and I finally ended up on my knees before they were happy. It turned out that the epidural made William’s heart rate drop. Once he was back to normal, I was allowed up but was monitored wirelessly.

Determined to get William here quickly, we went for a walk by the nursery, which helped motivate me for the upcoming pushing. I knew it would be hard, and I wanted to see all those newborns whose moms had succeeded. We walked for a long time and stopped for a grape popsicle in the afternoon. Worn out, I walked back to my room to eat  stopping once to leak water all over the floor. Apparently, William shifted!

After some rest and another exam that showed I was at seven centimeters, I tried to get up to go to the bathroom. No one had told me that if you lie down, the epidural would go to your legs. I started to fall as I tried to get out of bed but the nurses and Andy caught me. Frustrated, I ended up in bed waiting for ten centimeters. Sometime in this time period, a nurse came in and gasped, “She’s cyanotic! She has asthma, aren’t you worried?” The other nurse just laughed and said, “No, that’s the grape popsicles!”

Finally, around 8:30 p.m., the obstetrician on-call came in, examined me, and told me that I was at ten centimeters. I was at last allowed to push! However, I didn’t feel any urge to push, so they put me on Pitocin. I was too exhausted to really argue. All I knew is that I wanted William to get here soon.

The doctor left me with two labor nurses and Andy. I tried to push when they told me. One of them helped me to stand up, and I tried to use the squatting bar. The nurse got very excited when she could see William’s hair. I was pushing as hard as I could but no other progress happened. I kept thinking, “If I push hard, his birthday will be today!”

After about an hour and a half of pushing, the doctor came back, watched me push, and said, “You are not pushing right,” and left. I wanted to shout at him, “How many babies have you pushed out? I’m doing the best I can!” but he was already gone. Besides, I was really too tired to do anything else.

After three hours of pushing with no further progress, the nurses called the doctor back in and he examined me again. He told me that I had to have a Caesarean section. By this time, it was 11:30 p.m. I was so exhausted that I barely had any energy to move, but I argued with him that there had to be another way. We finally agreed together that William needed to get here soon, for his sake and mine. As we made the decision, the doctor turned off the Pitocin drip, and the contractions immediately stopped.

Tuesday

Around midnight, as the night dissolved into Tuesday, the nurses wheeled me in the OR. I told the nurses that Andy did not like the sight of blood so they whisked him away while they prepped me. However, I was terrified and began to shake uncontrollably, but the kind nurses held my hand and told me it was just hormones. I joked that the extra anesthesia didn’t work, because I could still wiggle my toes.

Andy finally was allowed in when surgery started. I felt a lot of pulling and tugging, and the nurse and anesthesiologist narrated for me. Finally, they pulled William out, but he didn’t cry. I kept asking, “Why isn’t he crying? Is he ok? What is wrong?” They kept reassuring me that he was fine and he was being cleaned out. The Neonatal Intensive Care Unit (NICU) team was there, and I suddenly heard a loud wail. I was so relieved! Shortly after that, the NICU team announced, “We are all set! Congratulations!” and they left.

The doctor told Andy that William had been turned 90 degrees and had gotten stuck. Looking back now, I wonder if the reason labor hurt so much was that it was back labor? Apparently this was the doctor’s way of apologizing for telling me that I wasn’t pushing right: by telling me it wasn’t my fault.

The nurses finally held William up for me to see, since I was still being sewed up, and asked me to name him. I was so exhausted and relieved that I started to cry. Andy told them proudly, “William Robin.”

Around 2 a.m., I was wheeled into the very cold recovery room. We called our parents, and my mom tried to talk my dad into coming right then but he told her that he needed to sleep before driving for eight hours. She stayed up the rest of the night researching Caesarean sections, and he drove them up later that morning.

Around 3 a.m., a nurse appeared and said, “It says on your chart you are breastfeeding. Is that right?” She came back with William and said, “Ok, here you go! Twenty minutes on each side!” I had no idea what to do, so she helped to get him latched on and she left. I sleepily watched him for 20 minutes, and she came back to make sure I switched sides. Afterwards, they took him to the nursery. Around 4 a.m., they unhooked me and wheeled me upstairs. Exhausted from labor and surgery, I feel asleep quickly.

Around 7 or 8 a.m., I woke up with a start and demanded my baby now! Andy brought him in, and I finally got to examine him carefully from head to toe. He was wonderful – our sweet William Robin!

Rates of Unnecessary Childbirth Interventions is Alarming

From Lamaze International

BirthDespite best evidence, health care providers continue to perform routine procedures during labor and birth that often are unnecessary and can have harmful results for mothers and babies.

The Centers for Disease Control and Prevention’s (CDC) most recent release of birth statistics reveals that the rate of Cesarean surgery, for example, is on the rise to 31.1 percent of all births — 50 percent greater than data from 1996. This information comes on the heels of The Milbank Report’s Evidence-Based Maternity Care, which confirms that beneficial, evidence-based maternity care practices are underused in the U.S. health care system.

What the Research Says

Research indicates that routinely used procedures — such as continuous electronic fetal monitoring, labor induction for low-risk women, and Cesarean surgery — have not improved health outcomes for women and, in fact, can cause harm. In contrast, care practices that support a healthy labor and birth are unavailable to or underused with the majority of women in the United States.

Suggested Labor and Delivery Practices

Beneficial care practices outlined by Evidence-Based Maternity Care, a report produced by a collaboration of Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund, could have a positive impact on the quality of maternity care if widely implemented throughout the United States. Suggested practices include to:

  • Let labor begin on its own.
  • Walk, move around, and change positions throughout labor.
  • Bring a loved one, friend, or doula to support you.
  • Avoid interventions that are not medically necessary.
  • Choose the most comfortable position to give birth and follow your body’s urges to push.
  • Keep your baby with you — it’s best for you, your baby and breastfeeding.

“Lamaze is alarmed by the current rate of Cesarean surgery, and furthermore, by the overall poor adherence to the beneficial practices outlined above in much of the maternity care systems in the United States,” said Pam Spry, president of Lamaze International, www.lamaze.org. “We are continuing to work to provide women and care providers with evidence-based information to improve the quality of care.”

Lamaze International has developed six care practice papers that are supported by research studies and represent “gold-standard” maternity care. When adopted, these care practices have a profound effect –instilling confidence in the mother, and facilitating a natural process that results in an active, healthy baby. Each one of the Lamaze care practices is cited in the Evidence-Based Maternity Care report as being underused in the U.S. maternity care system.

A Need for Balance

“As with any drug, we need to be sure that women and their babies receive the right dose of medical interventions. In the United States we are giving too high a dose of Cesarean sections and other medical interventions, which are causing harm to women and their babies. Yet, there are many countries where life-saving medical interventions are under dosed, which can also cause harm,” said Debra Bingham, chair of the Lamaze International Institute for Normal Birth. “Every woman and her baby needs and deserves the right dose of medical interventions during childbirth.”

The research is clear, when medically necessary, interventions, such as Cesarean surgery, can be life-saving procedures for both mother and baby, and worth the risks involved. However, in recent years, the rate of Cesarean surgeries cause more risks than benefits for mothers and babies.

The Danger of Cesarean Sections

Cesarean surgery is a major abdominal surgery, and carries both short-term risks, such as blood loss, clotting, infection and severe pain, and poses future risks, such as infertility and complications during future pregnancies such as percreta and accreta, which can lead to excessive bleeding, bladder injury, a hysterectomy, and maternal death.

Cesarean surgery also increases harm to babies including women giving birth prior to full brain development, breathing problems, surgical injury and difficulties with breastfeeding.

About Lamaze International

Since its founding in 1960, Lamaze International has worked to promote, support and protect normal birth through education and advocacy through the dedicated efforts of professional childbirth educators, providers and parents. An international organization with regional, state and area networks, its members and volunteer leaders include childbirth educators, nurses, midwives, doulas, lactation consultants, physicians, students and consumers. For more information about Lamaze International and the Lamaze Institute for Normal Birth, visit www.lamaze.org.

AP in a Non-AP World

By Sophie Aitkin

**Originally published in the Summer 2008 AP in a Non-AP World issue of The Journal of API

Sophie and children
Sophie and children

My first baby, Howard, was born in the back seat of our family car on the way to the hospital. My husband continued driving, and I had precious minutes in the back of the car alone with my new baby. As the intense pain of childbirth ceased, I was flooded with an ecstatic love for this little, naked bundle, and the natural process of bonding began.

Naturally AP

From that moment, my instincts took over, and I found myself naturally following the principles of Attachment Parenting (AP), although I was not aware of the literature in this area until later. I slept with him against my body, breastfed him on cue night and day, wore him in a sling wherever we went, allowed him to sleep when it suited him, and tried to be highly attuned and responsive to his needs. I did not leave him with anyone else until he was comfortable to be left, which was when he was nearly two years old and he said emphatically, “Go ‘way, Mama!”

A Non-AP Society

However, I was somewhat surprised to discover that this parenting style, which felt so intuitively right to me, was out of sync with the way that much of society here in Australia expected me to parent. Continue reading AP in a Non-AP World

The Rising Rate of Cesarean Sections in the U.S.

By Rita Brhel, managing editor and attachment parenting resource leader (API)

One in three women (31.8%) in America is now giving birth to their children via a Cesarean section. The highest rate in history for this nation, it is also much higher than the recommendation by the World Health Organization of 5% to 10% — not to mention that the rate of Cesarean sections in the U.S. has increased by 50% since 1996.

The U.S. began at 4.5% in 1965, the first year Cesarean section rates were measured here. At 15% or higher, Cesarean section rates indicate that this procedure is being done unnecessarily, according to a study highlighted by the article “Why the National U.S. C-Section Rate Keeps Rising” on www.childbirthconnection.org.

The article outlines several reasons for the increasing rate of this procedure. But, first, there are two widespread myths about the rise in Cesarean sections to counter:

  1. The number of women asking for an elective Cesarean section, without a medical reason, is NOT increasing; and
  2. The number of women who genuinely need a Cesarean section is NOT increasing.

In a 2005 survey by Childbirth Connection, it was found that only one in 1,600 respondents in the U.S. reported she had a planned Cesarean section with no medical reason, at her own request. The article cited a study that revealed this rate to be comparable with other countries.

Reasons given for the higher rates include women waiting to give birth when they’re older and more prone to developing medical complications, and more women giving birth to multiples. But the article reported that researchers show that the rate of Cesarean sections is going up for all women regardless of their age, health problems, race/ethnicity, or number of babies they are having.

What this means is that the reason behind the increasing rate of Cesarean sections is not on the part of the woman but rather lies with changing standards in the medical community. According to the Childbirth Connection survey, one in four respondents who had a Cesarean section said they received pressure from a medical professional to have the procedure.

According to the Childbirth Connection, here are the true reasons behind the increasing rates of Cesarean sections in the U.S.:

  • Lower priority is being given to non-surgical methods of correcting potential birthing complications, such as turning a breech baby or encouraging labor progress through positioning and movement and comfort measures.
  • Higher rates of labor intervention methods that make Cesarean sections more likely, including induction, getting an epidural early or without a high dose of oxytocin, and use of continuous electronic fetal monitoring.
  • Fewer hospitals and/or medical doctors are willing to deliver a Vaginal Birth After Cesarean section, or VBAC. In fact, only one out of ten women who have had a previous Cesarean section has access to medical facilities and/or doctors who would allow a VBAC.
  • The overall attitude toward Cesarean sections is that this procedure is no longer considered the major surgery that it is.
  • Lower awareness of the increased risks associated with Cesarean sections over vaginal births, such as infection, surgical injury, blood clots, emergency hysterectomy, and intense and longer-lasting pain in recovery in mothers in the short term. In the long term, mothers are more likely to have ongoing pelvic pain, bowel blockage, infertility, and injury during future surgeries. Future pregnancies are more likely to be ectopic, result in uterine rupture, or have problems with placenta previa, accretia, and abruption. Babies born by Cesarean section are more likely to have surgical cuts, breathing problems, difficulty with breastfeeding, and childhood asthma.
  • More doctors fear malpractice claims and lawsuits.
  • More doctors are receiving incentives to practice more efficiently. Planned Cesarean sections can organize hospital work, office work, and the medical personnel’s personal lives. In addition, average hospital charges are much greater for Cesarean sections than for vaginal births, which mean more profit is gained by the Cesarean section.

About Childbirth Connection
Childbirth Connection is a national U.S. not-for-profit organization founded as the Maternity Center Association in 1918. Its mission is to improve the quality of maternity care through research, education, advocacy, and policy by promoting safe and effective, evidence-based maternity care and providing a voice for childbearing families. For more information, go to www.childbirthconnection.org.