I know home birth or birth center transfer is a delicate subject and many women have deep, long lasting wounds and disappointment at how their birth turned out. It hurts my midwife heart to read stories of women feeling broken, disappointed in themselves and/or caregivers after an attempted natural birth, especially one that ended in C-section. I understand the feeling of loss of a hoped for experience but I don’t like that women feel “broken” when birth is largely involuntary and many factors are out of their control. Their stories have inspired me to better prepare my clients and other women for birth and the possibility of transfer and C-section because it is always a possibility. I hope to help future mothers form realistic expectations of their planned natural birth and postpartum. This is not addressed to women who feel they were abandoned by their care giver, disrespected or forced into unwanted and unnecessary interventions. To those women, I’m sorry and that situation involves a different set of emotions than what I’m addressing here and I hope you find the support you need!
Where do our expectations of birth come from?
There is a lot of unbending positivity in the natural birth community about women’s "ability" to give birth naturally. Maybe it started as backlash to the hospital’s verbal onslaught of negativity about women’s bodies during labor. I’ve sat in L&D rooms and heard the discouraging and disrespectful way that some doctors talk to women about what their bodies are or are not doing. Doctors’ tendencies to induce labor willy nilly and perform c-sections on 1/3 of pregnant mothers has certainly eroded women’s faith in their care provider’s opinion about if and when such interventions are necessary. I think this left women feeling disempowered. So doctors had tied their own ropes, Ina May Gaskin said some nice sounding things about women’s body’s not being lemons and our creator not being a careless mechanic and the pendulum swung. On the opposite side was positivity: Women are designed to give birth! Which is wonderful, true and a refreshing change in attitude, but, with it came the unspoken implication that as long as you planned a birth free of intervention and surrounded yourself with people who believe in the birth process, a gentle, natural birth was pretty much in the bag, which is not true. The other thing that I see women infer is that if you "can’t" give birth naturally or vaginally, that your body is flawed or broken. As I see all the disappointment and trauma experienced by mothers who have felt blind-sided by interventions, I believe that we need to set pregnant women up with realistic expectations and talk about when interventions may be necessary.
Phrases I hear in the natural birth community that are ever so slightly twisted:
Women are designed to give birth
Yes! Women are designed to give birth! And most of the time, if properly supported, women will give birth vaginally. But like anything in life, birth doesn’t always go as planned. Remember at the 1994 U.S. Figure Skating Championships when Nancy Kerrigan was practicing and some guy who her opponent (Tonya Harding)’s ex-husband hired came out of nowhere and whacked her in the knee with a police baton, forcing her to withdraw from the competition? Yeah, birth can be like that. You can be capable, prepared, and excited to give birth but then something comes out of left field and whacks you in the proverbial knee. Maybe a baby who is posterior and won’t/can’t turn and so, can’t come out. Maybe a cervix that isn’t dilating, fetal heart tones that tell us the baby is in distress or a long labor that has left mom exhausted, her labor dysfunctional.
Trust your body, trust birth
I like this phrase most of the time but I don’t like it when people take it to mean that birth and our bodies are infallible as if birth is the one time in life where we can trust that a process is fool proof and our bodies are bullet proof. The truth is that our bodies are mortal, not perfect. They are amazing and birth just works most of the time, but still, some babies are born with anomalies, some children get leukemia, adults get constipated, repetitive use injuries, auto-immune disorders and, following suit, 5-20% of the time, planned natural births require hospital intervention. So, why the expectation that if we plan a natural birth our bodies will perform perfectly every time? I trust bodies and birth, but, my trust is not that babies always come out vaginally and healthy without leaving a tear although I work my butt off to make this happen. My trust is that the process works beautifully the vast majority of the time but if a baby or a mom needs an intervention either at home or at the hospital they will show us through vital signs, abnormal bleeding, or the pattern or progress of labor.
Things I hear moms say that are just off enough to cause surprise and disappointment:
I’m fit and strong so labor should be pretty manageable
You are in control when you are working out. Working out is voluntary. Birth, however, is mostly involuntary (your uterus is an involuntary muscle, remember) and you are not in control. You aren’t telling yourself "just a few more reps". During labor your body takes over, and in most cases is working harder and longer than you would ever push yourself to do at the gym. Not many people work out for 24 hours straight, the average length of a first labor. Your body is strong enough to do it despite what you may think about your pain tolerance or fitness level. The real challenge of labor is more mental than physical. It is to surrender to and embrace a process you don’t control.
I’m going to manifest the birth I want
Positive thinking and manifesting certainly always have their place but your thoughts don’t necessarily control all aspects of birth, particularly the baby. A baby is another person with it’s own will and agenda and we cannot control other people, only influence them. It is their birth, too. In fact, a baby may seem to be working against your birth plan because doing so would put it in danger. One of my clients had a baby who wouldn’t turn from the posterior position prenatally or in labor despite doing Spinning Babies daily, chiropractic care, acupuncture, rebozo, and myofascial releases. Labor started with the water breaking but never became very strong and after a couple days without progress, we went to the hospital. With an epidural and pitocin she started dilating but at 5 cm the baby started showing signs of distress, a C-section was performed and it turned out the baby had a knot in her cord. Had she turned the way we were trying to get her to, it could have tightened the knot and cut off her blood and oxygen supply, killing her.
“I don’t feel like I’m doing very well”
Birth is not a performance nor is labor something you’re expected to “do well”. I hear women in labor chastise themselves for “losing it”, apologize for yelling or moaning too loudly, not feeling like they are doing very well or that they don’t have the strength and can’t do it. Although not all women express themselves this way in labor, “losing it” and making a lot of noise are some indicators that you’re letting go of your inhibitions, getting primal, and allowing labor to take its natural course. That is so positive! During their first natural births, moms have this idea that they are going to feel strong and in control. However, women usually feel as though they are drowning in a sea of contractions and trying desperately to keep their head above water. To give women a more realistic set of expectations for themselves and a gauge of whether they’re doing “well” I’ve made a list of things that they need to do in labor that they have control over:
Keep breathing. Slow, deep breaths, even through contractionsLet your body take over, don’t fight the strength of laborTry whatever positions and activities your midwife suggests that she thinks are necessary or helpful to get the baby out.
If you do these things, you are doing everything in your power to get your baby out!
If I have an epidural or a c-section, I failed
*Please note that this is not addressed to women who were rail-roaded into an unecessary c-section or an epidural, in those situations you may have been failed by the health care system or particular providers, which is a very different conversation.
Surprising to some, epidurals can be just the tool needed for a vaginal delivery. When I transfer women for an epidural it isn’t because they can’t take the pain, it’s because we need to get rid of it in order for them to sleep, regain their strength and dilate because we have exhausted all of our techniques and used all of the mom’s energy stores at home. I had a client a couple of years ago whose total labor was 84 hours. She was was stuck at 6 cm for at least a day. Once we transferred to the hospital she got an epidural and went from 6 cm to delivering her baby in ½ an hour. After nearly 3 ½ days of labor! An epidural was what she needed to get the baby out. Sometimes it is muscular tension that is preventing labor progress and without feeling the intensity of the contractions, the body can truly relax which can make all the difference.
Even when necessary, having interventions such as an epidural or C-section can be disappointing. They carry risks and the recovery is more difficult than after a natural delivery, however, I hope no one feels guilty or like a failure if they need pitocin, an epidural, a vacuum or forceps delivery, or a c-section. As mentioned earlier, birth is involuntary and an involuntary process leaves little room for personal failure. Although the speed with which doctors jump to these interventions has left a lot of women questioning whether they are necessary at all, there always have been and always will be cases where some or all of these interventions are necessary to keep mom and baby safe. Some problems don’t work themselves out with time and persistence, for example, obstructed labor (a baby that won’t come out despite strong contractions, and in the case of a midwife-attended birth, despite trying everything in our bag of tricks) that can result in both fetal and maternal death or severe damage to the vagina, rectuma and urethra. This is still common in developing countries. For more details, please read the link provided to the World Health Organization’s article on obstructed labor. http://www.who.int/healthinfo/statistics/bod_obstructedlabour.pdf
Because of situations such as this the WHO recommends a 10-15% Cesarean rate. Here in California we have easy access to C-sections and so we don’t wait until a mom or baby is on the brink of brain damage or death before we opt for a C-section so it is easy to forget that in the case of a very long labor that isn’t progressing, this is actually a life saving procedure. I hope no one in this situation or any other situation that leads to a necessary Cesarean feels an ounce of guilt or disappointed in themselves. And just to be clear again, this is not aimed at women who were not given enough time, were sent down a conveyor belt of interventions and rail-roaded into a cesarean. I know that is a different situation with a different set of emotions.
Side note: if you do end up needing an epidural or C-section, you may not have had the opportunity to finish the process naturally but I guarantee you probably put in just as much work if not more than any mom who delivered at home or a birth center. You still DID it.
Setting up reasonable expectations around you:
Couples can receive a lot of criticism from family or friends when they plan a natural birth or home birth, which can make some moms respond by feeling more pressure to have the birth they planned to prove the naysayers wrong. On the opposite end of the spectrum I’ve even seen some dads and partners put a lot of pressure on moms to have a natural birth to the point that they vehemently oppose a needed hospital transfer, insisting "she’s strong, she can do this". From the beginning of pregnancy it is good to set up realistic expectations around you. To me, it’s realistic to expect that you’ll stay at home as long as things are safe and progressing which, fortunately, is most of the time. In my mind, it’s never a question of whether or not a well nourished woman is strong enough.
The only guarantees in pregnancy and birth:
#1 When you get pregnant the ONLY thing anyone can guarantee is that at some point, what you are pregnant with (whether it be your placenta and baby, twins, triplets etc or a molar pregnancy) will come out eventually, either by vagina or by surgery.
#2 There is nothing that works every time. Inducing labor, for example: even pitocin inductions fail regularly resulting in c-section births. Spinning babies doesn’t always work, b
Even if you’ve had previous natural deliveries, every pregnancy and every birth is its own experience and while
The amazing thing:
Birth usually works just fine 🙂