IN the months of excitement leading up to the birth of my son, I had visions of a natural delivery, something simple and quiet. I prepared for the event by taking classes sponsored by the big teaching hospital where the birth was to happen. I also read voraciously, though admittedly I skipped the caesarean chapters because I foresaw no reason why I would need the surgery. I was intellectually and emotionally prepared for delivery. I understood about rotation and dilation and various lmethods? to handle contractions. I never really considered home birth because the hospital in Boston, US boasted about its cutting-edge medicine and liberal birthing practices that allowed mothers to squat, have friends in the room, or labour with a specially made playlist of songs to drown out the blipping noise of an electronic foetal monitor.
Lulled by the Burger King-like marketing pitch of lbirth any way you want it?, I was flummoxed when I arrived in active labour and a nurse immediately wanted to stick an intravenous line in my arm (nobody told me that would happen). Then she began pushingtheepidural,whichIinitially refused but consented to when the pain spun out of control (nobody told me that would happen). Then, after three hours of pushing and no sign of progress, they told me I needed a caesarean (nobody told me that would happen).
As they wheeled me into the operating room, anger gave way to exhausted submission. I felt like a torture victim during the surgery as I vomited and shook uncontrollably (nobody told me that would happen). When it was over, or rather, when they were stitching me up, I cried as loud as my son was crying when I first laid eyes on his gorgeous little slime-coated body (OK, I did know he was going to look like an alien).
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But the point is that my birth experience was completely out of whack with my expectations, despite or perhaps because of the birth plan Iad been encouraged to write. On that sheet, I had written three simple wishes: to keep my husband by my side, medical students out of my room, and the epidural needle out of my spine.
The first request was pretty much granted. I have no idea about the second one. And the third, totally disregarded. While birth plans were invented as a way of helping mothers feel in control of the process, I think the documents can lead to unrealistic expectations. And if the birth does not go as planned?, the woman feels as if she failed, or if someone else failed her.
For me, the unexpected C-section was such a shock I felt that I and everyone around me had somehow mishandled an opportunity that I wrote a book about the history of childbirth as a way of giving context for modern maternity. I needed to understand if I was better or worse off than my ancestors. True, Iam less likely to die in childbirth, and so is my baby, but I am still grappling with what the right answer is for the rest of labour and delivery.
YetinthethreeyearssinceIbegan researching the book, hundreds of women have told me their birth stories, usually tinged with surprise, resentment or outrage over how the process unfolded. In fact, if Ihavelearnedoneuniversaltruth about childbirth in Western culture, it is that what actually happens during labour and delivery is rarely what one expected, becausefewofusareevertoldthe whole truth about what really goes on.
Why? Birth remains a political battleground. And neither side letas call this fight thenaturalistsversus the medicalists wants to cede an inch by lfrightening? women over to another camp withthereal-life scenario of a birth undertheircare insteadofthebest-case scenario.
On one side are SheilaKitzinger, Michel Odent and JanetBalaskas, with their books and lectures urging women to let nature take its course. On the other arehealthcarepoliciespushingmore women into hospitals, and Posh Spice and Britney Spears serving as global examples for casual caesareans. Many women buy into one camp or the other, leaving little room for the vast grey area that is childbirth.
Contributing to this problem is the fact that our own mothers, sisters and girlfriend often give us bad information perhaps because they had a healthy baby, either at home with a midwife or through an elective caesarean, and believe so strongly in their chosen route that they want to proselytise about it to others.
Alternatively,theymaynothavean accurate memory of the birth. For my own mother and grandmother, their fuzziness was due to the injections nurses gave them of scopolamine, an amnesiac which was combined with morphine to take away the pain as well as the memory of birth. And for good reason. Both of them, young and scared, were left to labour alone in a hospital room for many long hours.
Forotherwomen,thereisanatural amnesiathattakesovershortlyafter delivery.Surelythisisanevolutionary phenomenon, where we are programmed to recall the glorious rush of seeing a son or daughter for the first time, without being able to really remember what the pain felt like. But as with most war stories, birth tales grow more fantastic with age.
Which leads many of us to seek out professionals authors, doctors, midwives, doulas, teachers for lreal? information about what to expect. WhenIsignedupfor pre-natal classes, it never occurredtomethatan educational tool could have the subtle agenda of indoctrinating pregnant women with hospital routines, with the instructor explaining in a chipper voice, as if she were selling a miraculous cleaning product, how an epidural works. She even joked about how all that hee-hee-huh breathing exercises that Lamaze disciples are taught can make one dizzy. I think I even laughed along with the class when she delivered the punchline.
However, in retrospect, that eight-hour class was also remarkable for what it did not discuss. There was no detailed explanation of what happens during a caesarean section, even though one out of every three women who gives birth in that hospital ends up with the operation (the Scottish rate is one in four). There was no discussion of how the nurses would insist on sticking my arm with an IV as a precautionary measure. There was no talk of how, although the hospital allows natural birth, everyone working the floor would scoff at the idea. There was a conversation about birth plans, but nothing about how those plans are meaningless when the pushing phase lasts too long or the staff are overwhelmed with other mothers or the doctorisfeelingdefensivebecausehis malpractice insurance rates are increasing.
On the other side, Iave talked to so many women who have felt duped by their natural childbirth classes. Fifty years ago, Grantly Dick-ReadandtheFrenchobstetrician Fernand Lamaze were trying to convince womenworldwidethatbirthcouldbe painless if the mother was in the right frame of mind, that is, not scared of birth. lPressure, not pain? became the mantra for a new generation of pregnant women who believed that if all of womankind could delivernaturally,theywouldfeelso empowered that gender inequalities would be eradicated. But with the vast majority of women giving birth in hospitals today, often with some sort of pain relief, it is clear that few women nowadays believe in what Lamaze or Dick-Read preached.
Of course, if natural birth advocates want to regain widespread respect and I wish they could they should instead say that some women, say those with large pelvises or babies with small heads or those attended by midwives with an endless stream of encouragement and tricks, can get through birth just fine without drugs, and you and your baby will be better off for it. They should say that you wonat be considered a failure if your home birth becomes a hospital transfer case. And they should say that while it is always best to breastfeed, if you have inverted nipples or low milk supply or are miserable trying to perform the task, your baby will not die if it drinks some formula.
But you wonat hear any such remarks from them because there is no place for minor concessions to the enemy in the heat of battle. Meanwhile, expectant mothers are being used as human shields in this war and itas tragic. If I were writing a peace treaty I would insist that the naturalists and the medicalists both recognise the following truths: Birth can be tricky. Birth can be a breeze. Birth can be dangerous. Birth can be a simple physiologicalprocess.Midwivesare invaluable. And obstetricians are invaluable. Birth should be about the mother and the baby, not about your job or your own agenda. And we all need to tell the truth about what an expectant mother can really expect.
Tina Cassidyas book, Birth: A History is published by Chatto & Windus, £12.99 A Mother's Story
When I became pregnant for the first time last year, I was keen to deliver naturally and decided to try for a home birth. Epidurals are only available in hospital, and I didnat want this form of pain relief, which can interfere with the ability to move around and retain control over the birth position. Some people like the reassurance of being in a maternity unit, but I didnat want to be stuck in hospital with people I didnat know, and felt that after the event, Iad be more comfortable at home with my husband Stephen.
When I asked about a home birth during my first scan, I expected theyad try and talk me out of it. A friend had fought hard to give birth at home five years previously. But the midwife said: lOK.? Later, I found out Iad been lucky. Home birthing mothers are allocated a standby ambulance and a midwife on call two weeks before and after their due date, so the hospital can only do one a month. A request made an hour after mine had to be turned down.
Statistically, a planned home birth is safer than a hospital birth. Staff explained what would happen if something went wrong, and that I could opt for hospital at any point before or during labour. My only worry was that they wouldnat let me give birth in our house, which at the time was virtually a building site following an attic conversion. But it was fine. The hospital antenatal classes I attended did little more than outline how things are done at that institution. I also attended National Childbirth Trust classes, which were much more geared towards helping parents make informed choices: taking us through the process of birth, the effects of different types of pain relief, the options available if anything went wrong.
A fortnight before my due date, the hospital delivered boxes of equipment: sterile blankets, oxygen and gas and air cylinders. Morphine was available, but I didnat plan to use it. At 11.15am on May 16, Scarlet was delivered onto my tummy, and Stephen was invited to take off his T-shirt to allow skin-to-skin contact with his new daughter. He was shown how to bath and dress her, and by 3.30pm, I was sitting up in bed emailing friends and family with the news.
I would definitely opt for a home birth again. The midwives were fantastic, I felt completely safe and in control before, during and after the birth, and that is exactly what I wanted.