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Your Birth Stories

Traumatic Birth, Healing Birth: Melissa’s Story

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By Melissa Brennan

imageMy name is Melissa, and I am a mama to four kiddos. I’ve been an Attachment Parenting mama since before I knew it was a phrase. For me, having the “perfect birth” with my first baby was The Most Important Thing Ever. I really can’t stress enough how tied up I was in having a perfect birth: dim lights, soft music, soft voices, at home, with just a doula and my then-husband. I would catch the baby in my arms, and we would cry and laugh, and I would heal so quickly, and life would be perfect.

Editor’s Note: As one of the Eight Principles of Parenting, Attachment Parenting International encourages parents to prepare for pregnancy, birth and parenting, which includes informing themselves about healthy birth and birth options. API birth stories are published for the purpose of giving parents a voice in telling their birth stories, and these stories include decisions and understandings that represent various levels of understanding about optimal birth choices. The author’s description of her experiences should not be considered medical advice or representative of API Principles. Representative of the API Principles in this birth story are the pursuit of education, knowledge, and empowerment as a parent to guide the choices that suit the well-being of one’s own family.

Then reality struck. At 20 weeks pregnant, my baby was diagnosed with intrauterine growth restriction, and I was told I had a placenta previa. This meant immediate bed rest with the strong possibility of a Cesarean section later. I was crushed.

At 35 weeks, though, my spirits were renewed when the doctor found that my placenta had moved, so a vaginal birth was now a possibility. However, since my little one still wasn’t growing very well, I would remain on bed rest and would not be allowed to have a homebirth. My now ex-husband was in the Marines, and “allowed” is the exact word for how pregnancies were handled by our military hospital at that time.

No one asked about my birth preferences, but I had a printed birth plan. It is my understanding that my husband was asked about circumcision, but neither of us was asked about formula, sugar water or pacifiers. My husband was aware of my feelings about circumcision, that I preferred the baby be left intact. I explicitly stated in my birth plan that I wanted to breastfeed within an hour of giving birth and that the baby was not to receive bottles or pacifiers.

Labor came on quickly one night when I was nearly 40 weeks along. I had no pain or even real discomfort, and then suddenly, BAM, full-blown labor. I managed to call my husband, who came home from his second job, saw how very in labor I was, freaked out and called the ambulance. By the time I got to the hospital 20 minutes later, I was 7 cm dilated and fully effaced.

The hospital handled my birth in the same controlling way they handled my pregnancy:

“No! Of course you’re not allowed to get out of bed!”

“What? Why would you want to eat or drink right now? You’re in labor, get back in bed!”

“Yes, you HAVE to have an IV.”

“This is your first baby; you have no idea what you’re doing.”

That last line is what I heard when I said that I thought labor was going a lot faster than I thought it would, and I didn’t think it would be too much longer before baby got here.

Hearing those words was the final straw. I was 19. I was in horrific pain. I was tethered in bed with the IV, monitor and cables so I couldn’t get up or move. I was being talked down to. I started to cry. Then I started to yell. That’s when a nurse walked in and said, “The doctor says you can have this for the pain.” With that, she stabbed me with a needle and emptied a syringe of what I later discovered to be Demerol into my arm.

I remember I was on the phone with my mom, trying to tell her what was happening, but as I was speaking to her, the room became dark, and I suddenly couldn’t hear anything. I was blind, deaf, mute and in horrible, horrible pain. Pain was all I could feel. I passed out.

Then three things happened simultaneously: I awoke; my water broke, gushing green, smelly, meconium-filled fluid everywhere; and I screamed involuntarily.

Nurses came running, the doctor came in and everyone started yelling at me, “Stop pushing! Stop pushing!”

I gritted my teeth and yelled back, “I’m not pushing!” The baby was coming. I couldn’t stop it. I wasn’t pushing.

At that point, I reached out for my husband, who was standing off to the side in shock. I put my hand on his arm. A nurse slapped my hand away from him. She said, “He’s your husband, don’t do that to him.” My husband just stared, his jaw agape.

Then, with one tiny push (the only one I was “allowed”), out came my beautiful baby boy. And I passed out.

When I awoke four hours later, my baby had been through the hospital’s baby assembly line: immunization, circumcision, bottle of formula. (Despite my feelings, my husband made the  decision to have the baby circumcised.)

I did eventually establish breastfeeding, but due to the lack of support and lactation services in the small town where we moved just after the birth, breastfeeding was very difficult. We dealt with a month of thrush, hyperactive letdown and oversupply issues. Eventually, Riley went on a nursing strike, and I ended up switching to formula.

I suffered severe postpartum depression lasting over eight months following Riley’s birth. I was in the last days of my marriage, only 19 years old and very much alone. I received no support and no help. I didn’t even know where to go for help.

I am still dealing with the emotional trauma of Riley’s birth. The hospital left me feeling powerless and small. Telling my story helps me feel like I’m doing something about it. I’ve had three more children since Riley, and each birth has been immeasurably better than Riley’s, which has definitely helped a lot.

My second birth was with Mason, a late baby born at just over 42 weeks. It required two procedures and three days to get labor started. I had a pretty aggressive doctor, and I was too overwhelmed to speak up and ask for the C-section I felt I needed. Mason nearly died at birth from complications of shoulder dystocia. He was in the NICU for a few hours, but luckily he recovered quickly and was back with me by the next morning.

I don’t compare Mason’s birth to others, because of the complications. The doctor had no way of knowing that there would be an issue of dystocia. That whole situation came down to what was necessary, and not what anyone “wanted.” I don’t feel bad about his birth or particularly good about it–I’m just thankful he survived.  As far as circumcision goes, Mason’s dad and I discussed it at length, and I agreed to let him make the decision. He chose to circumcise. I am at peace with that decision because I know that someone who loves my son very much made that choice with love. While I don’t think it was the best choice, it was his dad’s choice, not the hospital’s.

My fourth birth was a scheduled early induction to avoid complications, because the doctor and I both suspected that Harry was going to be a big baby. Given the situation with Mason’s birth, we felt good about proceeding with an early induction. Labor lasted just over two hours. I asked for an epidural, but it failed, so I felt every second of those two hours. Overall, I feel good about this birth, too. And I’m happy to say that Harry is an intact [uncircumcised] baby. He just turned two and is still nursing, thanks to all of the wonderful support I received from La Leche League and the local lactation consultants.

However, I think the birth I felt best about was with my daughter, my third child. On my due date, my water broke on its own at around 10 a.m., before contractions started. I took a shower, got dressed, called the sitter, cleaned the house, and just generally took my time getting everything ready for the baby. At about 3 p.m. my husband and I headed to the hospital. I was started on some Pitocin, and things moved fairly quickly after that. I labored while moving around, walking, eating freely, drinking water and juice whenever I felt like it, with my husband holding my hand and rubbing my back. We watched movies and played cards. Labor was intense but manageable, and the nurses were happy to leave me to it. I had telemetry monitoring, so I could go wherever and do whatever I wanted.

By about 9 p.m. the pain was bad enough that I couldn’t walk or talk or move, so the nurse offered to check me. I was at a very disappointing 3 cm, so I asked for an epidural. The epidural must have made my body relax because my daughter was born less than an hour later after only two pushes.

The doctor laid her on my tummy, and they left the cord alone until it stopped pulsing. The nurses asked if they could please take her to clean her up. They had her back to me, weighed, measured, wiped down and swaddled within 10 minutes. The staff cleared the room fairly quickly, and the lactation consultant stopped by to offer support. I was given a breastfeeding kit (not formula), as well as information on renting a pump and getting an SNS (supplemental nursing system) “just in case.” After that, I was left alone with my daughter and my husband for the rest of the night.

No one questioned my authority in making the decisions regarding my care or the care of my daughter. The two interventions I had were both necessary, and I have no regrets about them. I had good friends who offered advice and assistance in the months leading up to Lana’s birth, and I had a husband who wasn’t afraid to stand up for me.

Having what I considered to be a nearly perfect birth experience gave me hope. For the first time, I stopped blaming myself for the way things went with Riley’s birth. I had always felt like somehow I was the problem in that. But I realized it was just those particular nurses and doctors.

I guess if I had to sum it up in one sentence, I’d have to say that the biggest difference was that with Riley’s birth I was treated poorly and I was the least important person in the room, but with Lana’s birth I was part of the team and the person with the most input.

1. Pregnancy & Birth, Your Birth Stories

Every Birth is Natural

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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.

1. Pregnancy & Birth, Your Birth Stories

The Importance of Sharing Birth Stories

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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.

1. Pregnancy & Birth, Your Birth Stories

Birth Story Guidelines

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Share Your Birth Story

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Parents, we invite you to share your childbirth experiences. Sharing birth stories can empower parents to educate others, to break down barriers and help others become more accepting of experiences very different from their own, to heal from the disappointments and emotional pain of their own childbirth, to learn about birth from an Attachment Parenting perspective, and to celebrate the profound experience of childbirth.

Whether you had the perfect birth or one fraught with worry and complications, whether you chose pain relief or birthed naturally without medication, whether the birth was at home or at a hospital, every story is a valuable teaching tool for others and us.

A special note to expectant parents: The remarkable journey of new life is a positive, transformative experience. Pregnancy offers expectant parents an opportunity to prepare physically, mentally, and emotionally for parenthood. Making informed decisions about childbirth, newborn care, and parenting practices is a critical investment in the attachment relationship between parent and child. You can read about API’s Principle of Parenting: Prepare for Pregnancy, Birth and Parenting here: http://attachmentparenting.org/principles/prepare.php.

Birth Story Guidelines

As you write your birth story, we invite you to reflect on the following questions. Not all of the questions may apply to your situation. Rather than answer all of the questions, please incorporate some of your reflections within your story, if they are applicable.

  • How did you educate yourself about birth and parenting? What were helpful resources? If you read the API Principle on Preparing for Pregnancy, Birth and Parenting, what did you find helpful?
  • What did you think would be a certain way, only to find out it was different after you began learning about childbirth, parenting and attachment?
  • What are your beliefs about childbirth and parenting, and how have they made an impact on your choices?
  • What impact did your previous childbirth experiences, if any, have on your thoughts, feelings and decisions?
  • Did you have any negative emotions or fears surrounding pregnancy and childbirth, and how did you process them before the birth?
  • What kind of health care providers and birthing options did you choose and why?
  • What did you hope your childbirth experience would be like?
  • What kind of support did you receive during pregnancy from your partner, family or others? Did you join any support groups or forums?
  • Were there times during pregnancy or childbirth when your instincts were in conflict with what your health care providers suggested or demanded?
  • The childbirth experience: what happened, how did you feel and react, what role did others play in the process?
  • Were there aspects of “routine” newborn care that you felt strongly about, such as bathing, circumcision, eye drops, blood samples, collecting cord blood, and so on? Did your health care provider honor your choices?
  • Did you want to breastfeed? If yes, were you able to? How did your health care providers help or hinder this process?
  • Were there aspects of your pregnancy or birth experience that you regret or would like to have changed? How have you processed and healed negative emotions related to childbirth?
  • What kind of support did you receive after the birth from your partner, family, friends, health care professionals or support groups?

 

1. Pregnancy & Birth

What Goes into a Family-Centered Cesarean Birth Plan

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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.

1. Pregnancy & Birth

Be Prepared for These Common Childbirth Interventions

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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 →

1. Pregnancy & Birth

Rates of Unnecessary Childbirth Interventions is Alarming

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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.