The Trap of Idealizing the Intervention-free Birth

Sometimes we get caught in a trap of holding up a spontaneous, drug-free vaginal birth as an ideal, because, well, most women should be able to give birth without interventions, right? Then, we end up comparing an individual birth to this standard. I doubt anyone would actually say this out loud, but I think something like the following happens in some women's minds, though it is probably not this specific.

• Completely intervention-free vaginal birth? A+! Great job!
  
• Vaginal birth with IV and artificial rupture of membranes? B. Good effort!
  
• Induction and epidural? C. Mediocre.
  
• Epidural, episiotomy and vacuum extractor? D. It could have been worse.
  
• Cesarean? F. Better luck next time.
  

But this is not how it works. Your childbirth educator isn't going to give you a grade, because your baby's birth is not an exam! You are not "most women" and every birth is different. It is not your responsibility to prove that birth with minimal interventions is best. As a wise woman once said, "that's a pretty freakin' huge burden to put on one vagina." Interventions are sometimes needed. You can't know in advance that you won't need medical help, so it doesn't do any good to believe that getting it is a negative reflection on you.

After my first birth, I did feel like a C student. I felt like I hadn't done a good enough job at practicing tools for reducing or coping with pain. I thought that if I had prepared better, I possibly could have avoided the epidural. But how in the world can a woman expect to know how to prepare for something she has never done, having no real way of really knowing what it is going to be like for her? Can someone who has never given birth before really prepare for a long, slow, sleep-depriving early labor? An intense, lightening-fast, precipitous labor? Constant pain in her lower back that gives her no break? An emergency cesarean? How can we expect a first time mother to predict what techniques might be helpful for her so that she can practice them? How is she to know how much time she needs to put into practicing so as not to forget everything she practiced immediately when her birthing starts? And how is she supposed to devote any time at all to it when society tells her to "just enjoy the pregnancy" and "don't worry about the birth" until it is less than three months away?

I wish we could irradiate the word "failure" from our vocabulary in conversations about childbirth. I do not call doing something differently from what you wrote on your birth plan failure, I call that a change of plans. Changes of plans can be in response to medical necessity (because intervention sometimes does save lives and improve outcomes), or they can be for psychological reasons. If a woman who wanted a natural childbirth has crossed over from "coping" to "suffering," and nothing is working to bring her back, the decision to use pain medication is not failure. In that kind of situation, medication is probably the best choice to avoid trauma and allow the birth to be a good experience for the mom. As many have pointed out, a traumatized mom is not a "healthy mom."

If a woman had interventions in her birth she wouldn't have chosen with more information or if her options had been presented in a different way, it is not her fault. I hear a lot that a woman has a responsibility to inform herself, but the problem with not knowing is that we don't know what we don't know. Can we really expect a woman to be responsible for understanding all of the situations that may come up in her pregnancy and birth and all of the benefits and risks of available medical procedures? In an ideal world, her care provider (whose job it is to know these things) would present the facts about her choices as objectively as possible, and leave the decision to the woman. In most cases, reality is pretty far from this ideal, but I don't believe in blaming women for not finding out for themselves what their doctors should have told them. (Though getting angry about what doctors should do doesn't do us any good--Felice recently posted about this here.)

As always, the language we use is important. We have to pay attention to the implications of what we say--what a woman may read between the lines of our words. The phrase"sucessful VBAC," implies that a planned-VBAC-turned-repeat-cesarean is a "failed VBAC." Criticizing high rates of medical intervention by saying things like "I find it hard to believe that X percent of women's bodies are broken" implies that the body of a woman who has an honest medical need for that intervention is broken, and "Your body is broken" is not an empowering message. Besides, we don't consider it failure for our bodies to not function optimally all the time in life--I don't usually think my immune system failed me if I get a cold or stomach virus--I usually attribute that to bad luck. I think sometimes birth is the same way. Preparation plays a role in whether or not you get the birth you planned for, but so does chance.

Maybe those of us who have had that idealized birth shouldn't get cocky and maybe need to recognize that it didn't happen all because of what we did, and hopefully those of us who had a birth other than that one can recognize that it didn't happen all because of what we did either. At the same time, I do not wish to invalidate other women's feelings. If "failure" is the word you choose to describe how you feel, then that is your reality. If reading my thoughts on this does not bring you any healing, I wish you healing wherever you find it.

Stay tuned for the next post in the series!

How to get your partner on board with your birth plan

So, you want to change maternity care providers but your husband doesn't understand why you should go through the trouble? You want a natural birth, but your husband says, "why have pain when you don't have to?" You want to write a birth plan, but he thinks it is disrespectful to tell professionals how to do their jobs? You want to hire a doula but your husband doesn't see the benefit? Or maybe you want to give birth at home or in a birth center, but he thinks you should just go to the hospital like "everyone else"?

Here are a few ideas that might help him see why this matters to you:

• Get him to read a book, such as The Thinking Woman's Guide to a Better Birth or maybe a selected article or blog post, such as Dr. Sarah Buckley's Epidurals: risks and concerns for mother and baby or Navelgazing Midwife's Pointless Hospital "Rituals".
  
• If he is the kind of guy who doesn't like to read, have him watch a birth documentary with you. Some possibilities are The Business of Being Born and Pregnant in America.
  
• Set up a meeting for the two of you with the midwife or doula you would like to hire. She may be able to address some of his concerns.
• Get him to take a childbirth class with you. Choose a class that covers the benefits and risks of your various options, rather than one that only teaches what is standard practice at the hospital.
• Sit him down and have a heart-to-heart. Explain how much your baby's birth matters to you and why you want to be involved in the decisions about it.
  

I hope he becomes the supportive partner you want him to be. Or at the very least, he will decide to just leave the choices up to you and go along with it. Good luck!

The Role of Doulas and Birth Plans

Rixa posted the following comment she received on a post about the Doula Ban and OB Birth Plan at Kingsdale Gynecologic Associates: A physician speaks about doulas and birth plans. My response is a bit too long to put in a comment, so I'm posting it here.

So I am actually a physician. Doula's may be beneficial in some situations, but you all must remember that the role of a physician is to provide good medical knowledge and advice based on evidence.

Unfortunately, a lot of what physicians recommend is not based in “evidence,” but tradition and/or what looks good in court. There is no evidence that continuous fetal monitoring of low risk labor leads to better outcomes, evidence rules against restricting food and drink, physicians did routine episiotomies for years (and some still do), even though they’re were never proven to be beneficial, evidence suggests that clamping the cord right away may not be best—the list goes on.

Where Doula's may be thought of as positive most have zero training and often times may give inaccurate medical advice which is out of their scope of practice. If people want Doula's there should be a government agency licensing those individuals. As you wouldn't want just any person playing your doctor the same gaves for those helping. If they obstruct what we are trying to do they are not beneficial and can ultimately hurt you. Further, they do not have any medical liability. If you want a Doula they should accept medical liability for the 18 years that OB gyns do.

I am thinking of staring doula training soon, and I have looked at the requirements of various doula training organizations, and most are actually quite extensive. Just because they don’t have medical or nursing education does not mean they are not trained. I personally would not feel comfortable or ethical offering and charging for doula services without training or at least extensive personal research on what I was doing. If you have seen doulas offering medical advice, they are not doing their job. A doula’s role is not to speak for or make decisions for the woman, but to help her find her voice. I know I am a bit vulnerable when I’m in labor, and I think a lot of women are. Too often, this vulnerability translates into the woman’s voice being silenced. Doulas (and birth plans) are there to facilitate communication between the woman and the medical personnel—to encourage her to ask questions and be involved in decisions about her care. To me, doctors and nurses who have a problem with doulas and birth plans really have a problem with women having a voice. If what you are trying to do is not what the woman thinks Is best for her and her baby, then doulas are not hurting the woman by “obstructing” it. I don’t have a problem with the idea of having a system for keeping doulas from acting outside their non-medical role, but if they are really acting in that role, they shouldn’t need to accept medical liability

In regards to birth plans. They are all nonsense. When it comes to the delivery room most if not all mean nothing.

My OB actually encouraged me to write a birth plan for my son’s birth. I stated clearly in my plan that I wrote it to help the hospital staff know how to support me in the way that would be best for me. I think “plan” is actually not a good word for the purposes of this document—it is not designed to plan the details of your birth, but to let your care providers know what kind of care you want—a tool for communication. Then the providers know that if something comes up that conflicts with what you have written, you want them to discuss it with you. Of course, if you don't discuss the birth plan with your care provider before hand and they are not equipped or are unwilling to follow your wishes, then, yes, it is meaningless.

Women who write birth plans are sometimes accused of being "control freaks," and of trying to control something that is uncontrollable (birth). People claim that these uptight women are incapable of submitting to the power of nature that is necessary in natural birth and thus, they can't relax enough to progress and often end up with cesarean sections. However, most of what is in birth plans is actually about avoiding medical control of birth, because these women want nature to control their births, as long as nature is doing well, of course. So, is the beef with birth plans really about submitting to nature or is it about submitting to you? Maybe if physicians stopped trying to control birth themselves and quit trying to force women to follow their medical birth plans (whether written or not), then birth plans wouldn't be necessary?

Your in pain you said I don't want drugs you change your mind you get drugs. Happens everywhere all the time.

The implication here is that wanting an unmediated birth is a naive notion and most women wise up about it once they experience labor. Anyone with this attitude is someone who is likely very unfamiliar with natural birth and will not know how to support a woman in it. This attitude among physicians is exactly why we need doulas who know about natural childbirth to provide women the emotional and physical support they need.

Look the most important thing is not extra personnel in the delivery room. The important thing is a safe and healthy delivery for both the infant and mother. Any mother or father for that matter that thinks anything else is more important should not have children till they get their priorities straight.

Of course having a healthy mother and baby is important. Some people (including some women and some doctors) believe that having a birth with as little medical intervention as possible is a good way to accomplish that goal. It is not harmful for a woman to make sure a medical procedure is really necessary before agreeing to it. Frankly, the insinuation that people who are not willing to just do whatever the doctors want them to shouldn’t have children is insulting.