Expectations

I’m not sure how I feel about this story: http://offbeatmama.com/2010/06/caesarian-empowerment

Basically, a woman describes the days leading up to her c-section and her son’s birth, and concludes that it was an empowering experience.  I have no argument with that.  I do not argue with people’s descriptions of their own experiences; only they know how they felt/feel, and it’s not for me to question.

Indeed, when I read this bit, I could really identify with this mother’s words:

My entire self was not raging with ‘oh no! my mother-club-initiation might not be possible’…the only thing rattling and screaming in that entire infinite few minutes was, ‘Get him out. Get him out. He can not die. No way. Not now. Out,’ my oxygen masked face eyes blazing alternately into le bebe’s soon-to-be-father and the doula’s eyes, both extending their ferocious and magnificent support. Because this was no longer about my precious experience. It was about le bebe getting the hell out of my body now to survive.

I remember that moment so clearly from when I had Annika (second baby).  After months of planning a homebirth, and years of commitment to physiological birth, the moment came in my labour when what started as mild fetal distress the night before became serious, and I knew–from the feeling in my body, to the looks in my midwife’s eyes and the eyes of the OB on call–that she wasn’t going to be born according to plan. I remember telling the doctor to “fix it!  fix it!” and I was ready, at that moment, to let them kill me before allowing any harm to come to my child.  There are few times in life when I’ve felt as certain and full of purpose as I did at that moment.  (Interestingly, it has been difficult to remember that in the 3.75 years since…but more on that another time.)  So, I get the part about knowing for yourself what you and your baby need, and I am not in the slightest bit questioning that aspect of this story. 

The part that has me ruminating is the idea that a surgical birth is something that women should not grieve.   This mother writes,

But the point is the birth of the child and the child was birthed. I pride myself on appreciating and respecting other people’s perspectives and beliefs, but on this matter, I am unwavering. A caesarian is a powerful birth unto itself, without need for apology, and with only reason to celebrate. Those who do not agree are grappling with expectations and not reality.

A caesarian can be a powerful and legitimate way of bringing a baby into the world, and there are ways–particularly when a surgery is planned in advance–that one can make the most of the situation, personalize it, and so on (on that note, I wishI had read the chapter in Birthing from Within  on this before my c-section, but I was in the it will never happen to me  camp–live and learn…).  But I am not sure that is really possible in emergency situations where you have minutes before the first cut.  This woman seems to have had a full night to think about it and ready herself mentally for what was about to take place.  I had less than half and hour between the Moment of Terror and seeing my baby outside my body. I wish I had spent those minutes calmly connecting with my body and my baby, etc., but the reality was I spent them sobbing out of a) fear for my baby, and b) deep, deep sadness.  Maybe I needed a reality check, but I started grieving the loss of a physiological birth the moment I realized it was not going to happen.  

No woman needs to apologize for the way she gives birth.  Ever.  But I have trouble getting behind the idea that a caesarian is something for which there is only reason to celebrate.  A baby is a cause for celebration.  A healthy baby even moreso.  But in a context where interventions are overused, iatrogenic complications rampant, and c-section rates skyrocketing far above recommended levels, it is hard to isolate a surgicalbirth–however justified and legitimate it may have been–as a straightforwardly joyous event. 

 I do not mean for a moment that a woman cannot feel joy when she has a c-section.  I was thrilled to have my daughter born safely.  I was relieved that she was healthy and that any distress she endured during labour seemed to have had no lasting impact.  I remain grateful to the people who supported me that day, even though I still often question the decisions they guided me to make leading up to the Moment of Terror. Ibelieve that this woman felt empowered; I, too, felt very sure of myself on the day of my surgery, sure that it was the right thing to do, and not in the slightest bit victimized by any part of the process.  

And I also grieve my c-section–as necessary as I knew it was in the moment–because it was a loss for me as an individual.  My baby and I are separate entities; we always have been, even when we were linked by an umbilical cord.  My experience was tied to hers, but it was not about her alone.  Her health did not cancel out my trauma.  Perhaps the root of my grief was expectations–that is one way to look at it.  But I am not certain that there is anything inherently wrong with expecting to birth a baby without the use of a scalpel.  Obviously in some cases that expectation remains unfulfilled.  But I do not believe that the outcome–the necessity of the scalpel, the presence of the scalpel, the action of the scalpel–cancels out the legitimacy of the wish, the plan, the belief in the possibility that a body will work as a body is designed to work. If we lived in a world where we could be certain that medical intervention in birth only did good, I might be more easily persuaded. But when 40% of women are giving birth surgically, I have to question the situation.  I think the problem is less my unrealistic expectations of my own body, and more a system that makes intervention and surgery the new normal.

Every woman will experience birth–surgical or otherwise–in her own way, and each individual experience deserves respect.  I am struggling to figure out how to support women in a way that emphasizes empowerment (as the story in this link does) and yet also does not erase legitimate sadness or grief or a political context that is hostile to physiological birth.  I know I made the right decision when I locked eyes with the OB and did not even have to tell her to cut; we both made the decision at the same time.  Both of us knew.  And I still hate that it had to happen, wonder if there was anything we could have done differently that might have prevented it, and will go to my grave doing what I can to ensure that no woman ends up cut unless there is really no other way.

Okay, here we go…

My original plan for this blog was to focus solely on pre and postnatal health and fitness.  Then I realized that one of the requirements for my Childbirth Education course is to keep a journal of the process of my training.  I thought for about half a second of writing a journal on–gasp!–paper, and then realized that was not going to happen because every piece of paper I own gets scribbled on by my 3-year old or lost in the shuffle of my crazy life.  The only sacred place for my writing is in the electronic realm, and preferably on the Web where no one can accidentally delete my file.  (Right?)  I also realized that if I started a blog devoted to birth-y stuff, I might save a lot of my Facebook friends from the constant barrage of birth/pregnancy-related articles that usually launch from my profile. 

So…this blog will have lots of posts on fitness, including exercises that are appropriate and useful for women who are pregnant or postpartum, and information about health and wellness during the childbearing year.  There will be posts in which I discuss the challenges I experience as a pre and postnatal fitness specialist, and where I can hopefully add value for my clients, who may be inclined to pop by after they take my classes.  There will be posts about prenatal, birth and postpartum care (including breastfeeding), and posts spreading the word about evidence-based practice, which will hopefully help women to make the right choices for their own bodies and babies.  I have lots of birth-y bees in my bonnet.  They will buzz here.  Feel free to listen and comment; feel free to challenge me if you think I’m full of it.  I love a good debate.  Bottom line:  I’m learning all the time, I have no desire to tell anyone what to do, and I respect women enough to believe that women can make choices about how to manage their own bodies, whether or not their choices are the same as mine.  

With that said, full disclosure:  I support physiological childbirth (see “About”), and keeping interventions to an absolute minimum.  Pregnancy and birth are normal.  Pregnancy is a state of health (albeit one that can make some women, such as myself, feel like utter crap…but more on that later!).  Midwives are fantastic.  Doctors are fantastic.  Doulas are indispensable.  Women should give birth where and with whom they feel comfortable and supported.  I question the medicalization of pregnancy and birth.  I respect birth.  I’m in awe of birth.  And I don’t romanticize pregnancy or birth.  I had hyperemesis with both my pregnancies–hence the nearly 10-year gap between them.  My first baby was born in a hospital:  an uncomplicated five-hour labour and normal vaginal birth after a Cervidil induction at 41 weeks 3 days, supported by an amazing doula and fantastic family doctor.  My second baby, nearly 10 years later, was an entirely unexpected emergency c-section at 41 weeks 4 days after a planned homebirth.  I was schooled, to say the least.   (I’ll write more about both of those experiences later, too.)  

 I remember my first child’s birth as the most amazing day of my life. I’m still trying to integrate the trauma of my second child’s birth into my life in the present.  I’d be lying if I said that none of this blog–or my work in the birth field–was cathartic. 

And now for the legal disclaimer.  I’m not a health care professional:  I grew up observing my mother (a family doctor) care for pregnant women and deliver babies, I’m well-read in the history and practice of pre- and postnatal care, I’m certified to work with pre- and post-natal women by a major fitness organization, and I am a student with Lamaze International.  And while I may rightfully be called Doctor, I’m not a physician, nurse or midwife, and this blog is no substitute for the information that an experienced clinician can provide.  Nonetheless, I hope the information and commentary I offer here can be a useful part of some women’s journeys through pregnancy and birth and into parenthood.  It’s a roller coaster, to say the least.  I hope some of you will join me.

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