What Did Your Doula Do For You?

Giving Birth with Confidence has launched a blog carnival focusing on doulas! I’m psyched about this, because I love doulas, and this is why. It’s an older post, but it still is really the best way I can express what my doula did for me, and why I am such a huge believer in this kind of labour support.

Like Cara at Giving Birth With Confidence, Ialso want to shout, “Every woman deserves a doula!”  Doulas are awesome. And I’ve been learning a ton about how many different kinds of doulas there are over at The Radical Doula. I used to think it was just birth doulas and postpartum doulas, but I’ve discovered that there are full-spectrum doulas who attend women through a variety of experiences including pregnancy loss and termination, doulas who work with women in custody, and so many more who provide women with much-needed personalized support. 

So if you are pregnant or know someone who is pregnant, or going through a pregnancy-related experience and need support, consider finding a doula. If you can’t afford to hire one, there are often student doulas who are happy to provide services free of charge in order to gain needed experience. You can find a doula through DONA International among other professional organizations, or by asking your doctor, midwife or other birth professional.  If you’re local, ICAN Cowichan Valley keeps an up to date list of local birth and postpartum doulas, so comment here  if you need help finding the right support person for you.

Simple

It all really just comes down to this:

Stop pathologizing my body.

About that school registration form in California…

Since this story came out the other day, about an elementary school in California asking parents to indicate on an application form whether a child was born vaginally or by c-section, I’ve had a blog post brewing.  But I’m spurred to actually write it now because of discussion currently ensuing on The Unnecesarean’s Facebook wall.  Evidently, a lot of people believe that it’s both acceptable and wise for a school to ask this question on a registration form. 

To be frank, I first read about this story on The Onion, and was sure that it was a joke.  It struck me as particularly funny-weird because I was asked the very same question on the application form for Annika’s first daycare, and I thought it was kind of hilarious that The Onion would do a spoof of something I thought couldn’t possibly have actually happened to other real-live people. 

At the time when I was asked, I recall doing the head-scratch and wondering why on earth the daycare needed to know this information.  When I asked, the daycare provider told me that it was so she could assist my child with healing from her birth.  Cue vomit.  

It’s no big secret that I hated my c-section and that I wish that my daughter’s time on earth could have started differently.  But the truth of the matter is that my sadness is more to do with me than with her; I’m big enough to admit that any concerns I’ve had about her experience of those first hours of life are more projections of my own experience of trauma than genuine worries about her.  All evidence suggests that she’s fine and has been from the start.  The c-section really sucked for me:  and that matters enough on its own without trumping up some story that my daughter is forever damaged by the way she came into this world.  

This is not to say that the circumstances of a birth are never relevant.  It’s certainly possible for a child’s birth to have an impact on cognitive function, and that is something of which schools need to be aware.  A friend who is a school psychologist explained this to me when I started ranting about the ridiculousness of asking the question.  People who are trained in assessing such things need to ask questions about birth to ensure that they don’t miss any clues that could help them assist a child in need of educational intervention. 

But there are at least two major differences between what my friend described and what I’m talking about now.  The first is that a specialized psychological or educational assessment, performed for a child with an identified need, is very different from a general school application form, which is circulated among a wide variety of people.  The second is that the question rests on an irrelevant dichotomy rooted squarely in the ideology of the person asking.

If the goal of asking about the circumstances of birth is to understand whether or not a child needs particular kinds of support, the question needs to avoid the red-herring, limited c-section vs. vaginal birth dichotomy, and instead be open-ended:  how was your child’s birth?  A vaginal birth can be chock-full of potentially traumatic complications and/or interventions.  Moreover, while I certainly advocate allowing the physiological process of birth to proceed unhindered (some people call this natural birth), I also acknowledge that unhindered processes can sometimes be really hard on everyone involved. 

The point is:  vaginal or natural birth does not necessarily equal peaceful birth, and c-section does not automatically equal trauma.  A question that assumes that one type of birth is inherently more traumatic than another type of birth with no qualifications or consideration of individual circumstances is asinine, and the response to it is irrelevant.

**Edited to acknowledge the school’s appropriate response to the controversy.

Q: Why make such a big deal about birth? A: Feminism

People often ask why I invest so much energy in birth activism, and why I care so much about how women have babies.  After all, babies are born every minute of every day, all over the world.  Why make such a big deal about it?

I started caring about pregnancy and birth when I started linking it to my identification with feminism.  I’d always known about both:  for the duration of my childhood, my mother was a family doctor with a busy obstetrical practice, and she was (is) a feminist.  I don’t recall her linking the two explicitly, at least not to me.  (Although we did have a book about Judy Chicago’s Birth Project on our coffee table, and I understood without any doubt in the 1970s that the fact my mother was a doctor at all was because of this feminism thing that she and her friends sometimes discussed.)  But I knew from the time I could be conscious of anything that supporting pregnant and birthing women was worthwhile and that feminism, defined very simply as empowering women to do whatever we wanted to do, was good.

I got that birth mattered, and that women deserved to be treated with care and respect.  I remember little things like my mother’s answer when I asked why she had short nails without nail polish:  so she wouldn’t scratch her patients when she was delivering their babies.  That made deep sense to me as a child, illustrating in an utterly comprehensible and practical way the things we can all do to make women more comfortable when they are vulnerable and in need.

Birth mattered and it also seemed absolutely mundane, and often annoying.  I was not amused as a child by having trips to the park and the pool interrupted because my mother was on call and some lady was having a baby.  I did like making pictures with all the colourful tape at the nurse’s station in the hospital where I sometimes had to wait for my mother while she worked.  But I didn’t like having to wait. And sometimes I was impatient:  I once told her to “just do a c-section” when a patient seemed to be laboring for an awfully long time, interfering with whatever it was I wanted my mother to do for me.  Yeah.

It was all very matter of fact until after my first baby was born.  I realized then that birth might be common but it’s actually never mundane, and that all the care and respect that I received as a pregnant and laboring woman—that I took for granted from a family doctor who my mother had trained—was not necessarily the norm.  I learned after the fact that I was lucky to have grown up believing the things I believed about women and to have had the kind of birth I had, and that my total, unfailing trust in my doctor and my mother’s medical angle on birth might be worth questioning, even though they believed in the medicine they were practicing and my outcome was good.

My daughter’s birth almost fifteen years ago radically altered the way I understood women’s relationship with medical approaches to childbirth.  The high I felt after giving birth, the incomparable sense of accomplishment and power, was so incongruous set alongside my unquestioning willingness to let my doctor manage my pregnancy and to accept—even anticipate—interventions simply because they were ‘normal.’  I began a long process of reframing and rethinking, asking questions, demanding justifications, searching out evidence of benefits and risks, wondering what ‘normal’ even meant and why anyone automatically believed, in the context of intervening in pregnancy and birth, that it was good.

It didn’t take long for me to recognize that the framework for my analysis was feminism.  Feminist thinking made it possible for me to de-center medicalization without demonizing individual doctors, and to explore other approaches such as midwifery without romanticizing them.  Feminist thinking encouraged me to look at pregnancy and birth first from the perspective of the women who experience it, and consider the ways in which ‘normal’ pregnancy and birth are constructed by particular social, historical, political and economic contexts.  Feminist thinking made it impossible for me to look uncritically at any action that interfered with women realizing or being supported in realizing the unhindered potential of their bodies, and allowing their bodies to take up space, and be noisy, messy and inconvenient.

It probably comes as no surprise that this has all led to some *cough* interesting conversations between me and my mother.  We agree on the fundamentals:  birth is not a medical emergency, interventions should be kept to a minimum, and women deserve respect.  We agree on many critical points, including a shared sense that today’s skyrocketing caesarean rate is a problem and the importance of supporting all women in making truly informed decisions about their own reproductive health.  But then there are other topics, such as the relative safety and advisability of homebirth, where the discussion gets a little more complicated and I have to remind her:  intentionally or not, you raised me to think this way.

Believing in women’s bodies and their capacity to grow, birth and feed babies without undue intervention, and in women’s right to control their own reproductive labour—not only whether they give birth, but how they give birth—is central to my belief in women’s capacity to be agents in their own lives and effective political actors.  I don’t reject medical intervention when a woman needs it.  I do reject the dominant medical model that says intervention is almost always necessary.  And I reject the notion that just because birth is common we shouldn’t care about it or that birth activism makes mountains out of molehills. Minimizing issues that are unique to women is a time-honored tool in the war against us.  And it’s often in the struggle for autonomy in our everyday lives—including what some consider the mundane, uninteresting work of pregnancy, birth and mothering—where we discover what power really means.

Are women stupid?

It strikes me how often choices around birth—especially women’s choices (as opposed to choices made by doctors, midwives and other professionals)—are reduced and simplified, boiled down to the overall message that women are stupid and can’t be trusted.   

I remember distinctly during my second pregnancy when I’d tell people I was planning a homebirth being met with horrified gasps, and comments along the lines of, “Aren’t you scared?  What if something goes wrong?!”  Aside from the obvious responses (anything unknown is always a little bit scary, and something could go wrong at any moment of any day—it’s more likely I’ll get hit by a car crossing the street than have a catastrophic homebirth), I often found myself wondering if the people asking the questions actually thought I was stupid.  I got to the point where I would just retort, facetiously, “Oh, wow, I hadn’t thought of that because I don’t care at all about my health or my baby’s safety.  I’m just having a homebirth because I don’t know any better.  Plus, all the cool the kids are doing it.”  I’m not very nice when I’m pregnant.

There isn’t a lot of room in conversations about birth for the women who are actually having the babies and the reasons why we do what we do.  Our voices get drowned out amidst so much politics and ideology, and we’re left looking like idiots who really can’t manage our own lives.   For example, I read a comment in an article earlier this week about women being birth copycats:  a celebrity gives birth in this or that way, stupid sheep women follow suit.  So easy.

Spare me.

Yes, celebrities are influential.  To wit:  I became a vegetarian when I was 12 because of Howard Jones, and I joined Amnesty International in grade 8 because there was a membership table at the U2 concert I went to that year.  I bought white jazz shoes because Duran Duran wore them in several of their videos, and I still favour black clothing because of The Smiths.

But I did not plan a homebirth when I was 34 because of Ricki Lake or Cindy Crawford.  Nor did I have a c-section because of Britney Spears or Gwen Stefani (even though I do like the latter’s music, and appreciate how easy she has made it for me to teach my children to spell “bananas”). 

Celebrities can do a lot to normalize certain birth choices, and sometimes they launch advocacy campaigns of their own.  Widely publicized elective inductions and c-sections can make those procedures look like no big deal and help to strengthen a culture that encourages non-medically-indicated intervention in birth.  Similarly, Ricki Lake’s The Business of Being Born has encouraged critical thought about the birth industry to come into the mainstream, instigating conversations about things like homebirth that might otherwise never have taken place. But none of this automatically translates into women deciding to do x or y with their bodies during birth.  Taking such a reductionist approach really misses the mark. 

It seems to me, and some research appears to support this, that the notion that women make birth choices based simply on celebrity behaviour—or because it’s ‘what’s cool’ on MDC or Babycenter or among their circle of friends—is patently absurd.  It’s an assumption that allows a convenient side-stepping of the problems with the whole notion of choice in childbirth. 

There are multiple reasons why women make particular birth choices, and—libertarians be warned—those choices are rarely autonomous. More often than not, they (we) are ‘choosing’ the least problematic of the limited options available, with partial or flawed evidence plus heaps of personal constraints informing/directing the decision.  Reducing decision-making to one variable is the surest way to silence birthing women and to cut off any meaningful discussion about how to support women—how to change what is currently in North America a very, very flawed system—so that all of us can give birth in the scenario that is most comfortable, most safe, and leads to the best possible outcomes.

The painful point is:  none of us can make really good choices in a system that condescends to women as a group, and holds our integrity in contempt.

Rather than judge women for their choices, it might be more fruitful to question the professionals who control access to the bulk of the information (most women don’t have privileges at academic libraries and wouldn’t be able to read the professional journals, even if they had the time or inclination to do so), who interpret the scientific data for non-scientific audiences, and who market various forms of birth with motives that have little to do with women’s best interests.  It might be useful to bust open the false doctor-v.-midwife/vaginal-v.-surgical/home-v.-hospital dichotomies, and remember that real women’s bodies are the battlegrounds for what often come down to professional, ideological, and corporate wars.

It’s hard to make confident choices when you are doing so in the midst of a firefight.  I had a doctor literally throw my chart at me when I told her I was choosing midwifery rather than physician care for my second pregnancy.  I have been castigated for accepting interventions that supposedly led to my c-section, and accused of false consciousness for having felt empowered by my first birth because it was induced and thus not natural.  I’ve seen the same things and more happen to dozens of other women, often by professionals, but also by other mothers, many of whom react from a place of anger  or frustration with a system that may have mistreated them and/or betrayed their trust.  All of this is unacceptable.

Each one of us makes the best choices we can with the information we have available.  Information is rarely perfect or complete and knowledge is always partial, and sometimes choices made with the best of intentions turn out to be the wrong ones.  Rather than assuming that pregnant women are idiots, why not assume that they—more than anyone else—want to have their babies safely, in a setting that is appropriate for them and their families?  Why not admit that the system in which we give birth is adversarial?  What would happen if we didn’t blame women for being stupid or vapid, and instead looked at the reasons why they’re putting their trust in Ricki Lake instead of their midwife or OB?

After a surgical birth

I spent a lot of time today thinking about how women and babies are treated immediately following caesarean deliveries.  This topic is often in my thoughts because of my own post-op experience.  For reasons I still don’t understand, I was not allowed to touch or hold my perfectly healthy newborn daughter until we were out of the OR and in recovery, about 45 minutes after she was delivered.  In the OR, both of my arms were strapped down, and everyone present just ignored me when I asked repeatedly to touch her.  Being completely stripped of power as an individual, as a woman, and as a parent in the first hour of my daughter’s life is still one of the worst memories I have of that day.  The resulting anger and loss is almost indescribable.

Two things today made me think about this even more than usual.  First, I made the mistake of watching A Baby Story on TV at the gym this morning while working out on the elliptical machine.  (My theory is that watching shows that inevitably piss me off will raise my heart rate a little more, increasing the value of my workout.  Totally bunk science, I know, but it’s my way of justifying really bad TV choices.  Anyway.)  In the show, a woman who had hoped for a vaginal birth gets a c-section.  The hospital staff dismiss her sadness and fear prior to the surgery; afterward, they ignore her as she calls for her newborn baby, who she can hear but not see crying somewhere beyond the curtain separating her head and chest from the rest of her body.  Her baby is brought close to her face for a minute or two—already clean, dry and swaddled—but then whisked away, leaving the woman lying there with a stunned and wounded look on her face that resonated just a little more than I would have liked. 

It wasn’t easy to get the images from this morning’s A Baby Story out of my mind, and then later in the day, by coincidence, I happened upon this post at Cesarean Parent’s Blog.  The author describes a situation that should be the norm post-op in cases where a baby and mother have no health issues requiring immediate attention.  Just like after a vaginal birth, women who have had caesarean surgeries should have the opportunity to have skin-to-skin contact with their newborn babies.  Not all women will want this, and in some cases it won’t be appropriate.  Obviously women and their health care providers need to make smart decisions responding to the specific context and requirements of each birth.  But barring the need for immediate medical procedures, offering a woman the chance to hold her baby—and keeping the baby close to her/his mother— is the humane thing to do.

I write about this here because the reality of a 30-40% caesarean rate means that more women than would otherwise expect or require a c-section need to be ready for the possibility that they will have one.  For those for whom the birth process is important or who want to see and feel their babies fresh from the womb—before they have been sanitized, weighed, measured, poked and prodded by a succession of strange hands—it might be worth spending some time thinking about how an ideal post-op period would look and feel and what the hospital staff, attendants and others might be able to do to support their wishes.  None of this guarantees a positive experience, and achieving an ideal is far from the point.  The point is not to stay ‘in control’ (no such thing in birth), but simply to remain subject instead of becoming object.  For some women, preserving those post-birth skin-to-skin moments amid the challenges of a surgical procedure (especially one with such a troubling political context) can make all the difference in terms of their overall feelings about their births, their babies, and themselves.  If doing so poses no medical risk to mother or baby, and, indeed, has myriad proven benefits, why not?

ICAN of the Cowichan Valley

Forgive me, readers, for it has been many months since my last post.  I took a little professional detour (can you detour from an already diversified path? hmmm…).  It was interesting, and among other things, gave me an opportunity to reevaluate my values and priorities. 

And now that I’m back from my sojourn, I’ve re-prioritized my work around birth advocacy.  To that end, I’ve (finally!) gotten around to doing something I’ve been talking about for years:  I just started a new chapter of ICAN, the International Cesarean Awreness Network, here in the Cowichan Valley.  ICAN of the Cowichan Valley, like other ICAN groups, will offer resources and information about cesarean sections, and provide support to women who are recovering from a c-section or trying to avoid an unecessary surgery. 

After I had Annika, I attended one ICAN meeting down in Victoria.  But for a variety of reasons, including distance (it was a 2-hour drive, round-trip), I never managed to get to another one.  I’ve always regretted that, and wished I’d had a practical option beyond suffering in isolation with the aftermath of her birth.  I did have a wonderful circle of online friends who helped me through those years, but there is a lot to be said for face-to-face, local connections, especially in the postpartum phase.  And there is also a lot to be said for a specialized group like an ICAN support group.  It’s often hard for women to talk about their experiences with surgical birth, as many people still trot out the ‘but you have a healthy baby!’ dismissals, and unecessary c-sections have become normalized in our society.  ICAN groups can offer a safe place for women to connect with others who are likely to empathize, and willing to listen without judgment to their stories.

I’m still in the process of getting the group up and running–it was only officially registered yesterday, and I have yet to plan any actual events or meetings!  My hope is to find a central space where we can gather, perhaps beginning in late May or early June, and go from there.  So, local folks, please help to spread the word and encourage people to contact me at icancowichan@gmail.com.  Local and far-flung, like our Facebook page. Thanks to all of you for helping me let people know about this important new resource.

An epidural is not the only way to protect your pelvic floor

There has been a lot of discussion this week about press coverage given to a new study suggesting that epidurals may prevent trauma to the pelvic floor during delivery. Basically, the idea is that an epidural relaxes the muscles such that they don’t tear. I don’t know whether or not that is true. I haven’t read the study itself, only representations of the story in various places. I know that Amy Romano at Science and Sensibility is sceptical, and I think she is a pretty trustworthy source of information. It has been interesting to follow the discussion between her and the study’s authors in the comments section of her blog. (And ire-provoking to see the known ideologue Dr. Amy Tuteur’s $.02 popped in there, too—but I digress…) Whether or not the study’s conclusions have merit, the coverage of the study, particularly in the Globe and Mail, has been quite atrocious.

I’ve said it before and I’ll say it again: I don’t think there’s anything inherently wrong with epidurals. They have an appropriate time and place, and the only person who can really say for certain whether or not an epidural is indicated is the woman with the baby descending through her pelvis. I’ll trust her to be the judge of how she wants to manage those sensations. So, this is not an anti-epidural rant. Hell, I was practically desperate for one with my first baby—got to the hospital in transition and begged for one. I was too far gone, at 8 cm, to qualify—and in retrospect I’m glad that was the case, as it was a very cool experience to give birth without drugs—but at the time, if someone had tried to suggest that I was wrong to ask, I’m sure I would have wrung his or her neck with my own bare hands. That said, there are definitely risks involved with an epidural, just as there are risks with any invasive medical procedure. Risks v. benefits. That’s the name of the game.

So, there may be benefits to epidurals that we didn’t know about before. That’s awesome. It’s always good to learn new ways of preventing women from lasting harm to their bodies. Women want good options when it comes to health care. But a) this study isn’t saying epidurals prevent tears—it’s saying epidurals may play a role in preventing some kinds of pelvic floor damage; and b) the uncritical coverage of this study has not explained that there are also many other steps women can take to safeguard the health of their pelvic floors. The point is: there is nowhere near enough data to say that epidurals are necessarily the best approach, and they certainly aren’t the only one, either.

What else can women do? There are the often-cited birthing strategies that include not giving birth on one’s back, but instead choosing a position that is more in synch with physiological processes occurring and can benefit from gravity; avoiding fundal pressure; and pushing spontaneously, rather than following directions for pushing. But there are other things women can do as well, before they get to the moment when they are actually in labour—a moment when they may or may not want/be able to think about those strategies.

Women who perform simple pelvic floor exercises during pregnancy and after delivery can greatly reduce their chance of pelvic floor trauma and the speed of postpartum healing. The stronger the pelvic floor, the more flexible; the more flexible, the more likely those muscles will get up and out of the way and not tear while a baby passes through. A strong pelvic floor can also prevent/reduce the significance of other common pregnancy- and birth-related concerns, such as hemorrhoids, prolapse, and urinary incontinence. And as a bonus, contracting the pelvic floor automatically gets the transverse abdominus to co-contract, helping to tone the abdominal muscles. These are seriously awesome exercises that can be done anywhere, at any time of day, with no special equipment.

 So, what do you do? Basically, you want to do a modified Kegel, which can then be performed in various series, at various speeds, and in various patterns. If you’ve never done a Kegel before, the idea is to draw the muscles of the pelvic floor (PF) up and into the body, as if you’re stopping yourself from going pee. Draw them in, breathe, hold for a few counts, breathe, relax. Once you get the hang of that, you can move on to combine PF work with other core strengthening exercises such as curls (unless you have diastasis recti), superwoman, and cat-cow. You can do them sitting on a chair or an exercise ball, standing, lying on your side, on your hands and knees, in child’s pose—there are many positions that work, all of which have a slightly different benefit.

The bottom line (pardon the pun) is: strengthen your pelvic floor. Pregnant or not, this is a good thing to do. But if you’re pregnant or contemplating giving birth at some point, strengthening your pelvic floor is a noninvasive, key step in minimizing the risk of tearing and other significant trauma to the perineal region.

Why I love doulas

I had dinner on Friday night at a friend’s place where, entirely by chance, half of the women were trained birth doulas.  I was thrilled.  I love doulas.  So much.  

There is a ton of research showing how beneficial it is for women to have doula support during labour and birth, and yet most women still don’t hire them and, from the sound of it, many prenatal health care providers still aren’t recommending them to their clients.  I don’t feel like I’m exaggerating when I say that this is a terrible situation.  I try not to reduce every situation to my own experience, but then again, I also care about this particular issue because of my own experience, so… 

I had a doula with my first birth.  I first learned about doulas soon after I got pregnant, although I can’t remember where, when or from whom.  At the time, an old friend of my husband’s was in midwifery school, and the plan was for her to attend our birth and act as my doula.  Since she was commuting a long distance for school, she also arranged a back-up doula for us (another friend of hers, who had been a doula for some years by then) just in case she wasn’t able to get to us in time.  In the last few weeks of my pregnancy, both our friend and her back-up came to my house a number of times to talk, to help me write my birth plan, to give me massages, to help me cope as my EDD passed and day after day after day after day I remained pregnant. 

When I was finally in labour, as luck would have it, our friend was busy attending the labour of her sister-in-law, so her back-up came into play.  

13 and a half years later, Lolli still holds a special place in my heart.  When I think about my labour with Clea, her image comes to mind every time.  It’s not that I think she made the birth a good birth—it had its own path and its own energy, and it was just good in and of itself.  But she helped me, a first-time mother, to experience it in the most positive way.

That was no mean feat.  My labour with Clea was induced with Cervidil at 41 weeks 3 days.  There was no medical indication for the induction; I was just done with being pregnant.  Leaving aside the problems with that line of decision making (of which I was not aware at the time and I’m grateful didn’t materialize), inductions tend to stimulate harder contractions.  Many women are not able to manage labour unmedicated after an induction for exactly this reason.  Sure enough, for much of my labour, the contractions were hard and strong, piggy-backing one on top of the other for three or four hours.

I remember sitting on the kitchen floor when I realized it was time to call Lolli.  (My doctor gave me a dose of Cervidil and then sent me home to labour in peace.)  My mum and dad were there, with my husband.  When Lolli arrived I was just drifting into that labour zone where time no longer has any meaning and the whole world kind of disappears.  I remember being on the couch, feeling mildly anxious, when she came in the door sometime around 10 or 11 pm.  The first thing she did was send my mum and dad home (“time for everyone to go now”) and walk around turning off lights and closing curtains.  “It’s night time,” she explained to me, simply.

I have no idea about chronology after that point, what happened when, in what order.  All I know is that Lolli was there.  She ran me a bath and sat quietly beside the tub as I slept between contractions, and she was ready and waiting to pour water over me when each contraction crested.  Out of the tub, at some point, I remember that she took my hands, put her face close to mine and said firmly, “Open your eyes.  Look at me.  Don’t let the contractions swallow you up.  Keep your eyes open and look at me.”  I remember that moment like it was a lifeline, locking eyes, re-centering myself.  I remember her tucking Paul and I into bed at some point, telling us to try to rest—again, “It’s night time.”  And I remember being woken by the “pop” of my water breaking, having no idea what the sound was, and Lolli laughing gently, and explaining to me with a smile what had happened.

Of course, that was the point at which the piggy-back contractions began.  Transition—those last few centimeters of dilation, which most women experience as the most intense part of labour—came soon afterward, and I really went far into the alternate realm that is hard labour.  Lolli wiped the toilet seat lid when I barfed on it, unable to wait till—frankly, not caring if—it was open.  She helped me down the front stairs to the car when it was time to go to the hospital.  She instructed my husband to run the red light at the intersection of 25th and Oak as there was no traffic anywhere in sight, and the backseat of a car is not the best place to manage transition contractions.  

She laughed with the labour and delivery nurses about my choice of music to play at the hospital—a mixed tape (please—this was 1997) that included everything from Duran Duran to The Smiths to the soundtrack to Evita (London cast).  She didn’t laugh at me when I requested an epidural, even though she knew it was way too late for that, and she saved the waiver that I signed during a contraction—my signature drifting up and off the top right hand corner of the page—and gave it to me the next day to tuck into Clea’s baby book. 

She called my mother when I decided, at the last minute, that I wanted her there.  During the pushing stage, I was absolutely focused, totally unaware of anything outside of my own body.  Lolli was conscious for me.  At one point, she poked me in the shoulder hard enough to jar me to reality, just long enough for me to hear her say, “Your doctor is going to cut you.  Your birth plan says you don’t want an episiotomy.”  In that brief moment of clarity, I sat straight up, told my doctor, “Do not cut me.”  And she didn’t.

Lolli helped me nurse Clea right after she was born.  She made sure that the hospital kept us together.  “But,” the nurse said, “we have no free beds in postpartum yet—we’ll take the baby to the nursery until we can find a bed.”  “No,” Lolli told her, “keep them together.”  “But we have no diapers!”  “It doesn’ t matter.  Keep them together.” 

She stayed with me while Paul went home to shower and change.  She stayed until I fell asleep, snuggled up with my newborn.  She came to my house the next day when I was home again, to talk about my labour, to go through it all with me, to make sure Clea was nursing well.  She returned a few days later to check in again.  I remember sitting on the living room couch with her—the couch where I’d been sitting when she first came in the door—and the way she gazed at my baby and put her arm around my shoulders, and just feeling like she was this incredible gift.

I still feel that way now.  I didn’t hire a doula for my second birth, as I didn’t think it was necessary.  I was planning a homebirth, and would have two midwives there; a doula would be redundant, right?  Wrong.  So wrong.  I can’t say that a doula could have prevented the complications that arose or the surgery that resulted.  And our midwife (since the labour/delivery ended up being at the hospital only one midwife was there) was incredibly attentive not only throughout the day, but through the stress-filled, complicated week that led up to it.

But I could have used a doula.  I could have really used someone who was there only for me—not for my baby, just for me.  Who had nothing more invested in the scenario than to support and help me.  Who wasn’t watching monitors or checking dilation or recommending any procedures, but who would have been watching my face and hearing my voice, doing laps around the hospital with me and my husband, or maybe urging me to stop doing laps, stop trying so hard to make things happen and instead just look me in the eye and help me experience each moment for the moment it was.  Who knows what a doula might have been able to help me do? 

Doulas are indispensable.  Hospital birth, home birth, birth centre, midwife, doctor…doesn’t matter.  Hire a doula.  If I could do my second birth over, that’s the first thing I would do differently.  I can’t say with any certainty it would have made a difference to the progression or outcome, but I am pretty sure it would have made a difference to me

Hire a doula.

Resisting erasure

This post by Courtroom Mama makes me want to stand up and cheer.   It confronts a common tendency to counter natural birth advocacy with the claim that any critique of mainstream birth practice is automatically a self-righteous judgment and denigration of the women who move through that system.  This line of argument declares natural birth advocacy irrelevant—or worse, anti-feminist—by claiming that those who work to expose the problems in the mainstream system are actually working to limit women’s birth choices.

Courtroom Mama takes on an issue that has great personal relevance for me.  My own advocacy work really started after having my second baby by c-section, when I realized that the current system makes it virtually impossible for women to know whether or not they are receiving appropriate maternity and birth care.  Unnecessary interventions are so common—in both medical and midwifery models of care—and misinformation and fear are so ingrained as the basis on which both health care providers and the women they serve make decisions that I’ve begun to wonder if “informed choice” in prenatal and birth care can ever be more than a pipe dream.

Part of my struggle to come to terms with my c-section has been acknowledging that no matter how educated an individual woman is (I knew a lot) or how skillful and trustworthy her providers are (my midwives, and the OBs on call at the hospital the day Annika was delivered, were awesome), the system sucks.   Although unassisted birth is not for me, I can understand why some women choose to move as far away from formal prenatal and birth care as possible, to try their damndest to get outside of a fundamentally broken system.  Because however risky birthing unassisted might seem to many of us, the fact remains that the mainstream system is just as risky in its own unique ways.

And it’s this denial of risky-ness in the mainstream that has been at the heart of my struggle.  It’s the fact that if you walk into a hospital in labour you are all too likely to come out with unnecessary stitches, or to be treated like an object instead of a subject at the moment when you are most vulnerable, and then to face a world that denies not only your right to complain but to even acknowledge that you’ve been treated like crap. 

It seems that the mere acknowledgment that it is normal for women to be treated poorly during pregnancy and birth—to be treated with disrespect, to have their bodies manipulated unnecessarily as a result of, frankly, bad science—is so threatening that there is a veritable cottage industry dedicated to erasing our complaints. 

One of the most powerful forms of erasure is to flip the argument and claim that women who speak out against mainstream practice are just self-righteous whiners with nothing better to do than try to make other women feel bad about their birth experiences.  There’s no doubt that there are a lot of self-righteous whiners out there.  However, the world of natural birth advocacy certainly doesn’t have the market cornered on that.  Moreover, as Courtroom Mama puts it so succinctly, “just because someone is ambivalent about their birth experience,” it does not mean she thinks “that everyone MUST give birth in a certain way. This is horseshit.”

So, let’s put the name-calling aside where it belongs and focus on the more important issue here:  that women are speaking out of turn,  and that telling us to shut up, for whatever reason, just isn’t going to work anymore, especially if it’s because it makes you have to think about your own experiences from a critical perspective.  That is not self-righteousness; that is unapologetic analysis allowed to make whatever impact it makes as individuals digest and apply it. 

Ultimately, as Courtroom Mama explains, advocacy in this context is not about telling anyone what to do.  There are political implications when women choose medicalized births.  Those choices shore up a system that does as much harm as good.  But would I ever deny a woman the right to choose that kind of birth?  Absolutely not.  Yet I will still critique it.  Why?  Because the only way to make change is to take the risk of questioning the status quo.  Those questions might hurt sometimes.  Believe me, I’ve been on the receiving end of the hurtful questioning, so I do understand.  And at the same time, the questioning must continue because I don’t believe women really do get to make choices unless we actually have options, and the only way to actually have options is to be sure that we have good information from trustworthy sources.   Right now, when it comes to pregnancy and birth, most of us just don’t.  And those of us who think we do (or in my case, thought we did) can’t even really be sure because the whole system—the research designs, the funding bodies that control the research, the peers who review it, the journals that publish it, the providers who put it into practice—is so completely twisted and separated from what should be fundamental, which is giving all women appropriate and safe care. I wish it were different, but wishing won’t make it so—questioning might.

My favorite part of Courtroom Mama’s post is where she writes, “there is an ideal way to give birth, but not a right procedure. The right way is the way that leaves the mother feeling at peace with the birth. If she’s at peace with her elective cesarean or her epidural or her water birth, that is the right way. If she’s left feeling disempowered, scared, unsure, this is the wrong way.”  Indeed, this is the crux of my argument, and the sentiment that motivates my work.  Women deserve to feel at peace with their birth experiences, and confident about their birth choices.  When I question common birth practices, it’s not to make anyone feel bad—there is already more than enough sadness and pain going around in this context.  Rather, it’s to make that peace and confidence possible for more women, to insist that regular women—not only doctors and midwives—have the right to be part of conversations about birth, to say what we like or don’t like, what works or doesn’t work, and to be heard, whether or not people like what we have to say.

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