It was a surreal moment last week when I scheduled my c-section. I am so far from where I started in my first pregnancy as a home-birth-hopeful. But at the same time, little has changed. The circumstances and birth choices I can make, sure. But as far as where I stand, even back then I advocated for women to know more about birth and birth choices, even if all our choices are not the same. If you are navigating these waters or know someone who is, I hope this is a positive and informative post for you to read or share. Any links in this post to books are affiliates links to Amazon.
One of my favorite parts of studying abroad in England was the public transportation. I’m a fairly independent person and there was nothing like the freedom of picking up a morning transit pass and then getting on a train, no real destination in mind. With the pass from Surbiton, an out-lying area of London, I could ride any bus or train all through the city. No matter where I went in the city from The Globe Theater to Hyde Park to Camden, there was one constant: the cheery British voice saying, “Mind the gap” every time a train whooshed into a station. The purpose is to keep people from falling between the train and the platform, but it seems more like it has become some iconic, never-changing part of British culture.
Just like all the gaps between the various communities when it comes to birth choices. Gaps between the medical community and the midwife community. Gaps between women choosing different kinds of births. Gaps between plans and realities, hopes and actualities. Even sometimes gaps between research and practice. So with such muddy waters and such stark differences between camps of people, research and opinion, how can we close some of these gaps and have a good understanding of birth choices today?
I think the most important thing is to be informed and then to make the best choices for YOU and YOUR baby. I’m going to keep coming back to that idea again and again. But as far as being informed and making those choices, here are some suggestions.
Read Far and Wide.
Ever noticed how people of one particular political persuasion talk about those in the other camp? Or even how they discuss the issues—they are usually very black and white, or close to it. We are right and they are wrong. We have the information and they are making silly choices based on insubstantial information. The same is true when it comes to birth choices.
The very first book I read on home birth was The Thinking Woman’s Guide to a Better Birth
and even the title makes assumptions: it assumes that if you’re a thinking woman, you’re going to be choosing an alternative to a hospital birth. Also, “better” implies that the choices Henci Goer suggests are somehow more valid than the alternative. I actually liked the book, but it’s very strong position allowed me to realize the point of view right off the bat and take a bit of a step back to think for myself. The danger in that kind of book is that it is totally one-sided. Goer rakes the entire medical community across the coals and I think the medical community would (and did) have strong responses to her as well. If you’re going to read one very staunch perspective, cross that gap and read something on the other side as well. That is, if you really want to be a thinking woman.
Find Reputable Sources.
Don’t just scour the internet. PLEASE. While it’s great to get a blogger’s birth story or personal experience or opinion (hey, I’m giving you mine after all), for huge choices, you want to make sure you are hearing from people that have valid credentials and real research. This can be difficult today especially as there are so many voices talking. Ask your doctor for suggestions of what to read. Ask your midwife. Ask your friends. Check the bio of the authors. Check the notes in the back of the book. Don’t find some self-published book by a no-name author and assume that they know all. Be smart and make sure you are reading smart people’s work.
Try Not to Set Up in a Camp.
I grew up camping and love it. Everything from the smell of fire in your clothes to the sounds at night and then gray dawn light that sneaks through the fabric of the tent in the morning. Sitting around a campfire with friends or family is intimate and special. Great conversations can be had. Stories can be told. But often when we talk of camps, we really mean groups of people who gather around an opinion and fire rocket launchers at people who gather around another. I remember some very respectful conversations between my midwife and the nursing staff during my first birth after we transferred from home to a hospital. I was sort of saddened (even in my hazy labor fog) by the fact that the medical and midwife community are so out of touch. I believe beautiful things could happen if real conversations occurred there. But it’s not likely.
Even if you have a very strong viewpoint and come to land somewhere firmly, don’t make war camps. Make the kind of camp that invites conversation around the fire. Respectful conversation with the sharing of stories and the understanding that we are all different and our experiences and choices and lives are different. That kind of camping is amazing. The kind of camping where we stay on our side and try to kill other campers? Not so much. This creates gaps between women and women, between women and doctors, women and midwives, and midwives and doctors. Let’s ditch the different camps for one respectful campfire.
When I encourage women to be educated in terms of birth choices, it’s not be create antagonistic environments. I actually heard a hospital doctor say that often when a woman comes in with a birth plan written out, the doctors want to run because they assume that they are in for a battle over birth. They shouldn’t assume that, but I think the reason they often do is because they’ve seen it. They have experience people coming in with almost antagonistic viewpoints, unwilling to budge, yield, or even discuss. You don’t want to be armed with information about birth choices so you can be right. You want to know these things so that when a doctor or midwife tells you they want to do A,B, or C, you can ask why. You will feel confident to say, “I know that induction often increases the likelihood of complications, so why are you recommending this in my case?”
I think this is one of the most important reasons you want to have information. Perhaps your care provider will have a great answer to that question, or perhaps they won’t, at which point you can strongly but respectfully ask for an alternative. (By the way, I definitely recommend finding a care provider that you trust to make decisions. But since we are all human, knowing enough that you can ask “why” is still a great tool, even with a trusted professional.) My favorite book for giving you an insight as to what risks or benefits various procedures have is Creating Your Birth Plan. Even if you DON’T create a birth plan, the book is helpful so that you know what you might be getting into with things like induction or even an epidural. Your care provider should give a good overview, but if they don’t, you already know. And if they suggest a course of action, you’ll have a basis for knowledge.
If there is one thing I would tell women in their first pregnancy, this is the one thing. For all your planning, preparation, and learning, birth goes its own way. Very few women have the luxury of writing out a birth plan and then finding that their labor and delivery ticks off every box at every step. There are far too many variables. Every woman is different and every baby is different. I’ve had very different births with all three of mine. It is a wonderful thing to arm yourself with knowledge, think about your choices and reasons and hopes. But then you need to be ready to toss it out the window when things take a sharp turn to the left.
Take my first birth with Sawyer. I had this whole home birth planned out (though I did leave lots of flexible room in my birth plan), but ended up transferring to the hospital after an insanely intense labor with no real progression after 12 hours. First deviation from birth plan. Once there, I had an epidural. Second deviation. After two hours of pushing and total exhaustion (24 hours after I went into labor), I asked for an episiotomy. Third deviation. Those weren’t even ALL the changes from plan. But I felt confident still in the choices I made because I knew the risks, the benefits, and what each choice entailed. I wouldn’t have chosen an episiotomy early in pushing, but after such a long time with no progress and no energy left, to me it was a choice I felt like taking along with the risks and recovery. I knew from reading that I was less likely to tear more with an episiotomy after being fully stretched out from those hours of pushing than if I had one at the beginning of pushing. Knowing the various things that can happen in labor in and out of the hospital will allow you to make better informed choices, even in the moment. Things will not go according to plan. Assume that and prepare for anything.
My husband was fabulous personal support for me. But I also know Rob and know that he wouldn’t have been who I needed in the hospital when I was planning for a VBAC with Cooper. And so I chose a friend to act as a liaison when I went into labor. She was to come and basically be the go-between to communicate for me and with the doctors as things happen. Labor puts my brain in a fog. I feel very aware of what’s going on, and yet I don’t speak as well (or at all) and I don’t always hear what is communicated to me. So my friend (hiiiiiiii, Shank!) was to help make sure I understood the things the doctor or nurses were saying and also to make sure they understood my wishes in those crazy labor moments.
If you don’t know someone who does this, you can hire a doula. I would recommend looking for someone who is gracious and speaks respectfully to both you and your staff. Seems like this is a no-brainer, but just like birth plans, often doctors balk at doulas because they have experiences those who have caused friction and tension in the room. The last thing you want in labor is more conflict. Your body is already in an epic struggle of its own—that should be enough.
Ignore the Horror Stories.
Inevitably, while you are reading or talking with actual people, you will begin to read a story that one side uses to incite fear. Or you’ll have some mom who feels compelled to tell you about her very traumatic and horrible birth. There is a difference between reading the possible outcomes of birth and having someone hash out gory details of a very specific case. You don’t need more fear. Fear is the enemy of birth, which is a natural process your body was programmed to do. Politely ask that woman to refrain from telling you. Skip the chapter of the book filled with terrible stories meant to scare you into one particular camp. Knowing risks is important. Knowing every detail of a one in a million case is not helpful to you. Stay positive and stay away from horror stories.
Give Yourself Grace.
I’ve personally struggled with guilt and rehashing things that have happened during birth and I’m not alone. There are support groups all over the place where women voice their own anxieties over things that happened and over what they could have done differently. When it’s all said and done, you make the best, most informed choices for your baby and for you, and you give yourself grace where it goes awry. Because, like I said, it will NOT go according to plan. You cannot control every detail. Heck, you can’t even control what your own body does. So as you move into this process and move toward birth, give yourself grace and let it go.
Last week when I saw my doctor, he came in heavy-hearted. That week he had seen two traumatic birth outcomes, one a hospital birth and one a home birth that transferred to the hospital after birth. We had a long, therapy-like appointment where we talked about birth and birth choices and the gaps that exist in the landscape of birth. There are doctors who will plan induction around their vacation, even if that’s not necessarily the best choice for the mom. There are women who will hold so firmly to their idea of ideal birth that they might endanger themselves or their baby. Hopefully those are extremes and exceptions to the norm, but the goal would be for us to bridge all the gaps and land on the same page: wanting the best, safest birth for mom and baby.
Where once I think I distrusted the medical community a bit too much, my doctor gives me hope. Because I know that he cares, REALLY CARES, about women and their babies. Just as the midwife who saw two of my births beginning to end cares about women and their babies. And yet, there are gaps between the type of care I received from each. There are gaps between what my doctor and midwife might recommend or might suggest. There are gaps between what I might think and what my also-pregnant next-door-neighbor might think in terms of birth choices. Often these gaps are more like chasms you better watch that you don’t fall into.
Though I wish we could all be on the same page, that will never happen. But I think what I can realistically hope for is that we try for this campfire vs. camp idea: gathering around to have reasonable and respectful conversations as we all strive to make the best birth choices for our particular situations. If you have any questions, I’d love to have a conversation! Leave a comment or better yet, send me an email.