I keep reading fearful posts from mothers-to-be on a closed group page for a natural birth community. Women are saying things that start, “my doctor won’t let me,” or one asked, “what do contractions feel like…I’m scared,” and another posted “what if I get to 40w and nothing has happened?” These woman are all fans of an amazing birth blog and community, Birth Without Fear. So when I read these posts that emanate fear, I want to help. I originally posted some of what follows on that closed group page. Lots of the members “liked” that post – and several commented that I should turn it into a blog post that they could share. To those women I say, “okay.”
In response to “my doctor won’t let me:” obstetricians can’t dictate what you decide to do. Your doctor can make recommendations based on his/her experience. Your doctor may even strongly suggest that you follow a particular course of action – and some may “threaten” to discontinue care if you don’t do as s/he says (it’s rare, but it happens.) In no other realm of healthcare do we commonly hear things like “my doctor won’t let me.” Doesn’t happen. But of their obstetricians, I hear women say with alarming regularity things like “my doctor won’t let me.” There’s a long history for why this happens – and sure, I’ll go there in a bit – but it’s still kind of odd. Ultimately, your doctor simply can’t dictate your decisions. In fact, you have to allow them to do so.
A doctor – obstetrician, internist, dentist, podiatrist, whatever – is really no different than any other specialist you might hire to solve a problem you aren’t comfortable solving on your own. Sink dripping into your cabinet and you can’t fix it? Hire a plumber. Roof leaning and you have the carpentry skills of a rabid beaver? Hire a roofer. Fertilized egg implants in your womb and baby starts growing in your belly? Hire an obstetrician. Or – just as in all those other cases – don’t. No one tells you that you must not try to fix your sink or repair your roof. Lots of people will tell you it’s a terrible idea for you to try, but no one can tell you that you must hire a specialist. Sure, there’s cases where you might need a licensed, bonded plumber – because the problem might wind up being much bigger than a leaky gasket. In fact, you may discover that all your pipes are made with lead and you’re going to need to rebuild the system. It’s time to call in the big guns. So it’s probably a good idea to bring in a specialist. But guess what? Odds are good, unfortunately, that if you call in the specialist right away – before you even explore what might be going on – that what may have been a leaky gasket that needed the turn of a wrench, turns into a huge operation involving other parts, cutting things, replacing things, repairing things (that only got broken when the cutting started…) In other words, it gets really involved, really fast – and really expensive – really fast. Why does that happen? Because you didn’t check it out. You didn’t google “my sink is leaking” and read about what might cause that. You didn’t call up other people with sinks and ask their opinion. You didn’t educate yourself about the problem – so when the specialist arrives and sees that 1. there’s a problem and 2. you’re clueless, that specialist has an opportunity to do what he or she went into business to do…and it’s probably really naive to think the answer to that is “help people.” That doesn’t mean all plumbers are dishonest – of course not. They have experience. They recognize symptoms of things that, in their experience, led to larger problems later. Sometimes much later. Sometimes those symptoms didn’t actually lead to a larger problem later, but one time it did, and that one time was a very, very bad time – so now whenever that plumber sees that same condition, s/he goes ahead and treats it just like s/he wishes had been done the one time that things went very, very badly to potentially prevent that same thing happening again (not that it would have, but it might have…)
(Wait, am I still talking about plumbing? And wtf, am I really building an overwrought metaphor for prenatal care and birth around a plumbing example? I think I’m offending myself…)
Here’s the deal – obstetricians have totally seen some completely horrific things. Every worst-case scenario you can imagine has at one time or another landed at the feet of an obstetrician. Were I in that position, I’d certainly be tempted to do everything in my power to prevent those worst-case scenarios. Witnessing one maternal death would be too many. One baby that didn’t make it. That would be enough. I’d be out. That’s why I’m not an obstetrician. It’s why I’m not a midwife. Obstetricians are trained surgeons – and for an OB, there’s an illusion of control about surgery that just doesn’t exist with vaginal delivery. For whatever reason, the fact remains that America has an enormous cesarean section rate. The CDC calculated the 2010 section rate at 32.8% – but when I go to that link and do the math on vaginal delivery vs cesarean delivery, I get 48%…so not sure what I’m missing there.
Wait – go back a second. Read those last few lines again. I’ll wait.
It sort of doesn’t matter if the number is 32.8 or if it’s 48 (FORTY EIGHT!!) it’s too high. Way too high. Did women suddenly develop defective hips? Are our vaginas busted? What the hell people? Sorry – I’m sidetracked in mid-blog, but that just upset me a great deal. I’m going to need a minute.
I don’t need to go down this path. Other people have gone down this path – and there’s no need for me to reinvent this wheel. Go visit The Unnecesarean and do some research if you’d like. There’s an epidemic. This is not new information in the natural birth community. If it’s new information to you, please, please go read about it.
What I’m saying is that when your obstetrician says that he or she won’t “let” you go beyond 40 weeks, or won’t “let” you give your birth a trial of labor, the unspoken “threat” there is cesarean section. Whether or not you view that as a threat is none of my business. I see it as a threat. Sure, the early stages will include inducing labor – might be as simple as sweeping membranes – but either way, once the first intervention is allowed (by you,) you’ve made a turn down the path that leads in many, many cases to a cesarean delivery. If you don’t want that for yourself, don’t start down the path. Nobody can tell you that you must. And it doesn’t matter that one time out of 100,000 a really, really bad thing happened to a woman who didn’t have “x” done. You know who it matters to? The industry whose entire business model is built on calculated risk. Insurance companies. Malpractice and health insurance companies. They’re the only ones who care about 1 in 100,000. So who needs to be making healthcare choices for you? A board of directors (many of whom have never given birth)?
Oh, and fascinating information right here – most obstetricians have never had the opportunity to attend a home or natural delivery outside of a hospital. I once had an awesome conversation with a young female obstetrician on a flight from Chicago to Atlanta where we talked birth, I told her my birth story, she told me several of her own (she has no children yet, but has already attended hundreds of births.) She had never talked to a woman who had given birth under a CPM’s care at home. She was fascinated. She ordered Ina May’s Guide to Childbirth while we were on the plane. I like to think I may have started a ball rolling there that would end in some very happy birth outcomes for patients of her practice. She’s in Illinois, where homebirth illegal – but was going to try to hook up with some midwives to “sneak” and attend a natural birth. When your OB looks at you like you’re nuts for wanting to birth at home – try to remember that what you’re talking about is completely and entirely outside that person’s realm of experience.
By the way, I don’t mean to imply that your only option is hire an obstetrician or go it alone. All I mean is that there are other options – always other options – for your healthcare. Pregnancy is not a medical condition. Birth is not a medical procedure. It can be – because sometimes problems happen – but it’s not necessarily medical. Plenty of us have had low-risk pregnancies and have given birth without intervention or medical assistance. Sometimes we’ve hired a midwife. Sometimes we’ve had an awesome obstetrician who helped us deliver naturally. Some women have had an unassisted birth. My point is the options are there – but don’t expect “the plumber” to tell you to hire someone else. That’s not his job. Delivering as many babies in as little time as possible, with the best number of average outcomes – that’s the obstetricians job – and how s/he makes the most money. Are you comfortable being a statistic? Or do you suffer under the radical notion that women are people?
“What do contractions feel like?” Generally followed by, “I’m scared.” I’m going to take that a step further and boil it down to: is there pain in giving birth? If you’ve gotten this far in your life or in your pregnancy without realizing that…oh honey. I have read where women say they felt no pain – and I have read about (and seen) agony in child birth. Here’s the thing to remember – pain is perception. It’s not “real” – pain only happens insofar as your brain interprets the signals it gets from the nerve endings in your body. And guess who is in control of your brain? The same person who is in control of what your doctor allows you to do. YOU. It’s overwhelming if you let it be. There’s one thing to remember – the perception of pain in childbirth is nothing more than your body can handle. Your conscious mind may have trouble with it – and I’ve heard women say they passed out (trust me, there’s usually something else going on with these ladies…anxiety, other neurological disorders, etc.) But your mind deciding “nope, can’t deal” isn’t the same as your body not being able to deal. It can. More importantly, it will – if you allow it. Are there plenty of drugs available to deaden the pain? Sure. But just remember what I said above – any intervention (and anything foreign introduced into your body while laboring is an intervention) starts you down the path that more likely ends in cesarean than the path where there are no interventions. Comfortable with that? Cool – go for the drugs. Walking is overrated anyway.
“What if I get to 40w and nothing has happened?” First, what does “40w” mean? The average gestation for a human being is 40 weeks. To borrow a phrase from one of the other group members, that means that just as many women give birth at 38 weeks as do at 42 weeks. The average is 40. So when you say that you’ve gotten to 40 weeks and nothing has happened, I’m reminded of a line from one of my favorite plays (Tom Stoppard’s Rosencrantz & Guildenstern Are Dead) – where Guildenstern asks Rosencrantz what he’d think if the same coin were flipped 85 times in a row and came down tails each time. Rosencrantz says, “I’d have a good look at your coins, for a start.” So, you get to 40w and nothing has happened – how do you know it’s 40 weeks? Do you know your conception date? I know – Last Menstrual Period, blah blah blah – still, there’s a few days where an egg can be fertilized…a few…and it takes time to implant…so even under the most “known” conditions – your “due date” could be off by a few days in either direction. And how many of us really know? RELAX. Release the fear. The ‘E’ in EDD is not ‘Expiration’. It’s an Estimate. It’s a ballpark figure. You’re at about 40 weeks, give or take a day. And if nothing has happened? So what? It’s not time – that’s all. And no amount of walking, bouncing, evening primrose oil, artificial rupture of membranes (having your water broken), or anything else is going to make baby come – and baby is the one who initiates labor, not you. Not your cervix. Not your doctor (again, unless you let them – and even then, all they can do is arbitrarily cause your uterus to contract – not make the baby start moving down.) As my first CPM always told me – no matter what, that baby is coming out. LET IT COME. Release. The. Fear. If it’s your “due date” and baby hasn’t come yet – give it time. You’ve already waited 40 weeks – what’s another few days? Or go ahead and let your OB talk you into artificially ripening your cervix. Let them “sweep” your membranes or break your water. Guess what? If baby isn’t ready, your cervix can soften, your water can break, and you’ll be lying there, not “allowed” to walk, with a monitor shoved up in your hoo-ha, and no baby. Guess what happens next? ‘They’ tell you that it’s been too long – your baby is “dry” (nevermind that your body keeps making amniotic fluid – and a tear in the sac can absolutely repair itself.) They tell you it’s time for pitocin. Now you’re lying there, on your back, with a thing shoved up in your hoo-ha (and probably a catheter by now because you can’t get up to pee) and NOW you’re having horrible, artificial, earth-shattering fake contractions caused by a drug – and wow, those hurt. Here, let’s give you something for pain. Maybe something to calm your nerves – deaden your senses. Then guess what – no baby – and it’s time for a shift change – and wow, that monitor shows baby’s heart rate keeps dipping (wonder why?) and yeah, your baby is in distress, your body is broken, you couldn’t do this after all – sign this form and off to the operating theatre we go. Think I’m being an extremist? Really? Talk to the women you know who’ve wound up with a cesarean they never wanted. Ask them how it all started. Ask them where the pressure started. Ask them if their doctor decided that since nothing had happened at 40 weeks, s/he wasn’t going to let them go overdue, so they decided to sweep membranes and pop in some cervidil. I’m not pulling this stuff out of my rear end.
So if there are so many of us “in the know” – if there are so many women out there who have started to educate themselves – then why is that section rate so darned high? Why do so many women continue to hire obstetricians right off the bat? Why is “natural” childbirth considered something that happens in a hospital room with an IV in your arm, pitocin in your veins, and a team of nurses standing by to whisk the baby off to be weighed, bathed and wrapped before it’s even handed to you? Why is having a baby at home, in a birthing pool or in the privacy of your own bed, considered “unnatural?”
Now *that’s* a loaded question.
There has been a movement – oh, since the dawn of time, really – to remove the concept of self-control from women’s experience of the world. We’re “hysterics,” we’re the “weaker sex,” we’re “pussies” (could write a book about that last…many have.) “Acting like a girl” means acting weak, weepy, or whiny. It’s enormously prevalent, it always has been, and the entire medical system was built around the concept that women (and men) do not know what’s best for themselves. Before men interjected themselves into the birth process, women helped women give birth. Period. And they were fine. We used birth stools and midwives and the men stayed OUTSIDE. Did more women die in childbirth back then? Arguably, yes. But more people died of the common cold back then, too. More people died of everything back then. Knowledge didn’t get around as easily as it does today. People couldn’t read. People couldn’t share information. Men came into the birthing room, and women were suddenly put in submissive posture – on our backs – and given drugs to dull our senses. Heard of twilight sleep? Go read about that happy crappy from the same people who later brought us eugenics. Babies were pulled from our bodies, handed off to other people before they were handed to us (because we were unconscious) – all of this came about when men decided they needed to be involved. Because we’re too weak. Too frail. Too stupid. It persists to this day. Even female OB’s are products of a system that is based on the lie that women simply can’t give birth without a patriarchal system of regulation. It’s so deeply entrenched in our subconscious and group consciousness, we’ve gotten to the point that there are women who actually believe their breasts are for men’s pleasure, not for babies, and that using them for their sole and intended purpose is “gross and, like, incestous.” There are women who report photos in closed birth groups on social media sites that show other women using their bodies to nurture and give birth to their babies – because they think it’s inappropriate and gross (on a birth page – seriously.) That’s how deep this particular bit of nonsense goes. Birth is something that’s icky – and breastfeeding is something that should be hidden away behind closed doors – even when it’s being celebrated within a birth community.
So what? What’s the big deal? Lots of women have cesarean sections and are fine. Lots of babies are born while Mom is flat on her back, steeped in drugs and drooling out one corner of her mouth, and those babies are fine. Because that’s what’s important, right? The goal is to have a healthy baby. As long as we achieve healthy baby, who cares about the mother’s experience, right?
Yeah, because that’s what we hear every day, in every corner, about every possible topic. It’s not about the journey – it’s the destination that matters.
Okay, well then, in this one thing, it’s the destination that matters. Just this one. Because ultimately, who cares about a woman’s experience? Who cares about her journey? The BABY is what matters.
Want to know who cares? I care. My fellow mothers care. Yes, we’d rather everything bad that might ever happen to our children would happen instead to us – of course we would – but we matter. Our experience of the world matters. Who we are, what we feel, what we do matters. And for all you women reading this, on the cusp of your 40 week “due date” with your low-risk, perfectly “normal” pregnancy, unsure about what to say to your doctor when you go in for your final prenatal visit later this week, knowing you’ve already been told that once you hit 40 weeks, it’ll be time to “get things started” – I’m going to give you three words of advice. You’ve heard them before. Or heck, I’m pretty old, maybe you haven’t heard them before. Here goes: just say “no.” No, I don’t care to have my membranes swept. And by the way, s/he may not ask – sometimes they just do it as a matter of procedure without even bothering to ask you first. Whether or not that constitutes rape for you is up to you, but I know what I call it when someone sticks something into my body that I didn’t tell them was okay… Your best bet is to say “no” to any internal exam. No, they don’t need to “check you.” It’s not necessary. It’s not. You are probably dilated a couple of centimeters. Even if you’re not, you probably will be soon – so say “no.” Say “no” to stretching and sweeping. Say “no” to a scheduled induction just because it’s 40 weeks and nothing has happened yet. Say “no” to “getting things started.” It’s not up to your doctor to start your labor. It’s not even up to you. Baby will come – when all else fails, that baby is coming out. There’s no need to fear – there’s no need to allow anyone to feed you their fear. There’s no need to assume that the one in 100,000 case will be your case.
Trust your body. Trust your baby. Trust birth. Release. The. Fear.
**Obviously, every decision about a healthy birth is ultimately up to the pregnant woman and her chosen care provider. I’m not giving you medical advice – I’m giving you advice based on my own birth experience and that of hundreds of other women I know who have given birth naturally and without medical issue. If you have concerns, discuss them with your provider. If you’re not sure what’s going on, ask questions. If you aren’t happy with the answers you get, seek a second opinion. You wouldn’t agree to a complete rebuild of your car engine without seeking a second opinion, would you? And that’s just your CAR!