A divide between priorities for birthing

by Maree

Why don’t we trust our bodies?  Why don’t we trust ourselves?
Why don’t we trust the birthing wisdom that is innate in all women?
Why do we choose care providers who provide less than ideal care?

I have pondered these questions and many more after birthing my babies.  Prior to my first pregnancy I was so much more concerned about my hospital experience than how I would birth my baby.  I chose my private health fund based on the hospital I wanted to go to, to minimise the out of pocket costs, to get the best food available!  I chose my care provider because I wanted a female obstetrician who had had her own children… thinking this would make her much more understanding and enlightened.  I was wrong, wrong, wrong about it all. 

The hospital had a caesarean rate of around 40%, in other words almost half the women birthing at the hospital have a caesarean.  In fact the hospital was nicknamed by many in healthcare as “Caesar’s Palace”.  My obstetrician was not an advocate for natural birthing… in fact I am almost certain now that she would have had elective caesareans for her own babies.  I was right about the food though.  It was delicious but it did not make up for the things that caused me angst with my first birth and hospital stay.  That my wishes were not respected, my perception of what I wanted out of my birthing experience was not upheld still brings me distress.  What went wrong?  We felt we had it all planned so well and yet the experience did not go at all to plan.  Some may say I had unrealistic expectations; some may say I made bad choices.  Both would be right.  It shouldn’t be but it was unrealistic to expect that the hospital would listen to my wishes and honour them or that I would be allowed to retain some sort of control over my birth.  Choosing to birth in hospital was definitely a bad choice in retrospect.  Choosing an obstetrician for an uncomplicated pregnancy added fear and stress to my pregnancy plus put me in a position to receive very unnecessary medical procedures.

My husband loves the Confucius quote: I hear and I forget, I see and I remember, I do and I understand.  This was completely true of my birthing experiences.  I heard horror stories… I forgot them or denied that it might end up happening to me, I saw the hospital and sensed that it wasn’t right and remembered what I really wanted, I birthed in hospital and I understood that it was probably the least ideal place to naturally birth a baby.  I remembered and understood and changed things for my second baby’s birth.

It frustrates me no end that I had to learn this the hard way, that I couldn’t see what was bound to happen.  That my “care providers” would prove harmful to my birthing experience, cause problems and distress for both my baby and I.  Even more frustrating is seeing other “first-timers” going down the well-trodden path that I too have walked.  They, too, are deaf to my assertions that they won’t get what they want with their birthing experience. They, too, are not learning from the experience of others who have been there before them.  I cannot be angry with them, frustrated yes, because that too was me, once.

As my first pregnancy progressed naturally and without a single issue, I began to sense that I needed to fight for my “natural birth”.  The desire to not drug my baby in the process of being born became stronger as my pregnancy progressed.  By the time I was approaching my baby’s birth it was incredibly important to me.
My obstetrician suggested that birth plans were a waste of time “they go out the window at the first hint of pain in labour”.  I wrote a birth plan anyway, so that my wishes would be easily known.  The plan was essentially ignored.  My carefully thought out plan was a waste of my time, not because I changed how I felt at that first hint of a contraction, but because the hospital staff and my obstetrician did not care to read or honour it. 

As I left the delivery suite the staff at the desk gave me a round of applause.  I was congratulated on a job well done “no one comes in here planning a natural birth and does it!”  Horrifying enough but my “natural birth” wasn’t so natural in my eyes.  As time has worn on, it became even more un-natural.  At the time I was exhilarated that I had birthed my babe without drugs… that was the biggest hurdle in my books.  And I did, but along with it went artificial rupture of membranes “because they will make a mess later”, birthing in a reclined position (and not being allowed to move despite every instinct in my body screaming at me to change position), a longish second stage with lots of coaching to not push when I had an almost overwhelming urge to do so and to push when I had no urge at all, episiotomy, early cutting of umbilical cord (wrapped tightly around my baby’s neck), no immediate skin to skin contact (my baby was wrapped as soon as she was born) and separation from my baby in the first hour after birth for weighing and washing.  A vast distance from the natural birth I had envisioned.  I had felt threatened from all angles; my power and that of my birth support team had been left at the entrance to the hospital, my wishes needed defending and we were all powerless to defend anything, my instincts faded into the background, my labour slowed, my birth was far from my ideal.

In addition to all of the birthing issues our hospital stay was fraught with difficulty too.  My baby was sleepy, had been separated from me shortly after birth and establishing breastfeeding proved very difficult.  A less than ideal nurse used emotional blackmail to gain consent to unnecessarily feed my baby formula.  My birth plan had encompassed the post birth stay.  The plan specified “no formula” and requested a lactation consultant if there were difficulties establishing breastfeeding.  My baby had been referred to a paediatrician due to our issues with breastfeeding and some concern for her wellbeing.  Afterwards the paediatrician was mystified as to why she had received formula, it was contrary to the instructions he had left for her care and I had made it very clear that I wanted to comp feed with expressed breast milk rather than formula.  I spent a whole day sobbing and traumatised by the incident. 

Looking back and having heard many more hospital-birth-gone -wrong stories I realise that my experience was not as awful as it could have been (a small mercy perhaps) but in my shoes it was harrowing and difficult.  It made the transition from pregnancy to motherhood much more difficult than it needed to be.  It took a long time for me to feel confident that I knew best what my baby needed.  It took a long time to feel at ease in my breastfeeding relationship with my first child.  I am still not completely healed from the trauma caused by that hospital birth, though I am somewhat down the track in my healing journey. I haven’t forgiven myself for allowing it to happen.

With my second pregnancy in the planning I was suddenly desperate to do things differently and petrified of ending up in the same situation.  My biggest fear was that I would have to go back to hospital.  We began investigating home birthing before I was even pregnant.  It made sense.  As my second pregnancy progressed with some minor issues I was reassured rather than traumatised by my care provider.  I didn’t write a birth plan this time but we spent hours talking about what I wanted from my second birth and had a birth plan meeting with all my birth attendants present.  I was heard; my care provider understood and, even better, followed my wishes to the T.  There were no bogus medical reasons for unnecessary procedures.  Better still I felt protected and safe, able to birth instinctively, able to listen to my body and baby, able to let go of all fears and concerns and be in my birth space, free to ride the amazing journey of birth.  My second baby was large, almost 5kg, but my care provider did not stress me about his size.  My body easily birthed him, my support team were empowered to protect my birth space.  I was free to birth the way nature intended.  This birth was incredible in its contrast: instinctual, safe, protected.  My new baby and I had immediate skin-to-skin contact and breastfeeding was easily established.  I was exhilarated; this was the way birthing should be.  It was a journey to remember, to be proud of, to revel in, to celebrate.  It was everything my first birth was not.  It showed me the yawning chasm between the priorities of my first baby’s care provider and what I wanted/needed and could have had.

My birthing experiences showed me the difference.  If I can change one first-timer’s mind about the wisdom of choosing a hospital birth when wanting a natural birth… then the hospital experience I had would be less terrible, some good will have come from sharing the experience.  I truly admire women who see the sense of home birthing with their first baby, who are smart enough to understand that it is a safest option and the best way to get the birth that they want.