The Trap of Idealizing the Quiet Birther (Part 3)

Last April, I wrote a short Birth Idealization Traps series.  I would actually like to continue that series now, with  some new perspective on The Trap of Idealizing the Quiet Birther (Click to read Part 1 and Part 2) that I gained from my third birth.

In my third birth, my midwives acted as lifeguards, watching carefully (using some technology as tools to assist in watching) to make sure nothing pathological was happening, and encouraging me to do some preventative measures due to the risk factor of pre-labor rupture of membranes.  Because of PROM, risk of infection was a good reason to limit/avoid cervical checks, and it turns out that there wasn't any reason to do them. 

My midwives saw no need to check to "make sure I was complete" before pushing.  They encouraged me to follow my instincts and push only when I had no other choice but to push.  I instinctively bore down at the peaks of the pressure waves for a while, until I felt an unmistakable urge to push.  "Urge" isn't even the right word.  "Takeover" describes it better.  I couldn't do anything but push.

Like I suspected when I wrote my other two posts, during my third birth, I was, in fact, a very vocal pusher.  Unlike in my second birth, I was not told to hold my breath and put my chin to my chest to push.  In following my instincts, I did not hold my breath or curl my head forward.  I opened my mouth and let sound escape my body, and boy, did it!  Watching the video now, I am even a little surprised with how loud I was.  I have some technical difficulties with my digital camcorder (I think I need software to load the video, but I must have lost the CD), so I don't have the video to share, but believe me when I say I was LOUD. And no, I was not screaming in pain.  Hypnobabies was absolutely working for me.  There may have been some pain when I lost my rhythm in reaction to changes in how things felt as my body first began pushing, but I experienced the sensations of my baby emerging as mostly stretching and fullness, and  I did not experience burning or a "ring of fire" sensation at crowning.  It was really like I couldn't help making noise.  It was what came naturally to me, and I wouldn't change a thing about it.  

The Trap of Idealizing the Quiet Birther (part 2)

I think it is a common misconception that a goal of using hypnosis is to have a quiet birth. I think many natural birthers are quieter using hypnosis than they would be without it. Partly I think this is because they often experience less pain because of the high endorphin levels they are able to create for themselves. I think many women not using hypnosis get too caught up in pain and tension to get to a place where they can birth in a focused state that may be natural for them. Sometimes, the screaming or moaning is a response to pain (and its not a bad response, if the woman finds it helpful), but not always. I have read many birth stories where Hypnobabies mamas have said that they reassured their birth companions that the noises they were making were not because of pain. Less pain may often equal less noise, but it does not always equal no noise.

The clear impression I got when I was studying Hypnobabies is that instinctive vocalization is good if it helps you. They actually call the type of pushing they advocate "Gentle Ahhhh Pushing," which is not the"Breathing the Baby Out" that I read about in Hypnobirthing by Marie Mongan (which I, for one, find confusing) nor is it the provider-directed prolonged breath holding of the Valsalva("purple pushing") method. Hypnobabies advocates pushing when and as long as feels right, and says that your instincts will guide you to you use breathing, vocalizing, holding your breath, or some combination of these. The Hypnobabies materials explain that many women instinctively vocalize with an "ahhhhh" sound when they start to feel their babies moving down. This is what I did, and having read that, I was not afraid to do so.

Hypnobabies actually doesn't teach that being quiet is the only way to have a good birth, but I think there may be some contribution to the idealization of quiet birth with the videos that are used to promote it. While videos of quiet birthers do a good job of showing one type of birth that is possible with hypnosis (and I believe possibly more common with hypnosis than without it), they may not necessarily show the whole spectrum of what a good birth with hypnosis can look like. I looked through the Hypnobabies birth videos that I could find online. A few did not include video of pushing (totally understandable if the video shows the baby emerging and you don't want your "bits" on the internet!). Of those that did, there were some where the mama was mostly quiet during pushing, but they were not all like that.

Sierra's Hypnobabies Homebirth video shows her "ahhh" moaning transforming into a powerful roar as the baby is born, and is beautiful.

I think that if I had the freedom to follow my body's instincts instead of being instructed to not push and later, to hold my breath, I can see how making birthing sounds similar to Sierra's would likely have come quite naturally to me. I hope that when I am a Hypnobabies instructor, that I will be able to help my students know that being loud (or having the expulsive reflex trigger an "out of control" feeling, like I talked about in Part 1) is not failure. I want then to know that what happens to your body when you give birth is incredibly powerful. While for some women, the best way to respond to the power may be to be quiet and focused the whole time, others may find at some point that it helps to release some of the power with their voices (I would be surprised if I am not one of these!), and this is okay. In fact, it is more than okay. It is another wonderful way to give birth.

The Trap of Idealizing the Quiet Birther (part 1)

Rachel, a midwife in Australia who writes the blog, Midwife Thinking, recently shared her thoughts on the habit our society has of Judging Birth. I really liked the second section where she talked about judging birth choices. My last post, The Trap of Idealizing the Intervention-free Birth covers some of the same ideas. I also generally agree with the ideas of the part about judging women's behavior in birth, though at first I wasn't sure I did. As I was looking through the comments on the post, I came across this:

I find the general rule of thumb for making noise has to do with a woman’s sexual style. If she is a noisy lovemaking person, then chances are it will feel natural for her to express herself loudly while in labour. If she is a quiet lovaking [sic] person, then she will follow suit when she is in labour. We birth in accordance with the way that we live.

My reaction was, "There are really women who can be quiet during sex?" (I guess that shows what my "sexual style" is!) At first, I didn't think this rule of thumb applied to me, because, using Hypnobabies, I was rather quiet. But then I remembered that wasn't exactly true. I began to spontaneously vocalize as I felt the pressure of my baby beginning to come down. I wasn't moaning in pain, it actually felt better to make noise, and I remember saying so. I was also very vocal while trying to wait for the cervical lip to move.

At first, I was a bit put off by a mention in the post of feelings of failure caused by "childbirth preparation programs aimed at learning how to be quiet and in control during birth" and some more direct implications of hypnosis for childbirth by some people in the comments. I went back to the post later and saw some new comments and a discussion between Rachel and a mom who used Hypnobabies that clarified some things. Here is part of one of Rachel's comments.

You did something based on your prior birth experience that worked for you… an individual… which may, or may not work for another woman. There is nothing wrong with learning to relax during birth with the help of breathing or any other technique. These techniques are extremely helpful for many women. However, if they become prescriptive and women feel like that is the only way, or that they must not lose control then they can cause harm. As you found in your own experience the techniques can work up to a point for some women. You did not worry that your body took over at the end of labour. However I know some women how consider their body taking over at the end as a failure to remain in control. It makes me sad when women express disappointment because they ‘lost it’ just at the end.

I also had a "losing it" experience at the end of my birth with hypnosis. I still attribute some of that feeling to confusion about not knowing whether to listen to the instructions on pushing (and on "not pushing yet") or to try to do what I had learned about in Hypnobabies and my own research. However, I now realize that it is highly possible that the panic, that feeling like I was drowning, at the very end might just be the way birth happens for me. That sudden "swept under" feeling might be just what I needed to...push me into pushing, I guess. I don't think it is that way for everyone. But it being that way for me doesn't mean there was anything wrong with me or with my level of preparation. It doesn't mean that I failed to use hypnosis correctly during that part of my birth. I had kind of hoped that I would be able to "calmly breathe the baby out" thing with my next birth, but maybe I will and maybe I won't. If I don't, then maybe that is the way it needs to be for me.

My thoughts will continue in Part 2.

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!

Birth Idealization Traps--Intro

In my opinion, the only ideals in birth are

• the best outcome for mom and baby possible under the circumstances, AND
• the best (meaning promoting empowerment and avoiding trauma) experience under the circumstances.

Because every woman and every birth is different, this may look different in different births. For one woman, promoting empowerment and avoiding trauma might mean a homebirth after prior negative hospital experience, for another, it might mean a scheduled repeat c-section after a traumatic VBAC, and yet another may find getting an epidural the best way to avoid trauma. For one birth, minimal intervention may lead to the best outcome possible, while for another, interventions may help lead to the best outcome. For one woman, being quiet and peaceful during her birth may be empowering, while another my find loud vocalizing to be her way to be empowered.

The problem comes when we compare birth experiences and look at one type of birth as if it is the "perfect" birth and all others are somehow second-rate. I believe that this is a harmful way of thinking. In my next three posts, I will explore some of "idealization traps" that the natural birth community sometimes falls into.

Oh, and guess what? This is my 100th post!