A Birth Remembered

A blast from the past: I wrote this 4 years ago almost to the day about my birth experience with Honeybun.  I’ve been working on a similar post since I started Beyond Mommying 9 months ago and just haven’t been able to get it together in a way that I’m pleased with.

This is a long one, but I hope you’ll take the time to read through it as I think it’s something that’s crucially important to all mommies and babies in America.  My story is all to similar to many women birthing today.  Over 5 years later and nothing has changed.  All the talk about “women’s rights” in the Presidential Race last year and no mention of birth.  We still have a lot of work to do, mommies!

So lately I’ve become fascinated (some might even say obsessed) with the process of birth.  I guess the fascination really began when I was pregnant with Honeybun and began thinking about what I expected birth to be like.  I did my research: reading books, browsing the internet and taking a Hypnobirthing class and over the last trimester of my pregnancy developed my own set of beliefs and expectations for the birth of my child.

I quickly decided that I wanted a “normal” birth.  I wanted to labor on my own, without intervention, deliver my baby in a position that felt natural and avoid the use of pain medication.  I wanted to birth the way women were intended to birth, without all the medical “innovations”.

As I now understand though, “normal” in today’s standards of birth simply means vaginal.  Any birth of a baby born vaginally (not via cesarean section) is considered “normal”.  The kind of birth I sought is often referred to as “natural”.  But I quickly (and unfortunately) learned is that a “natural” birth in today’s medical system is nearly impossible.

I did everything I thought of at the time to achieve the birth I so desired.  I stood up to the neonatologist who at 19 weeks found cysts in Honeybun’s brain and who told me she probably had Trisomy 18 (a genetic disorder similar to Downs Syndrome).  He “highly recommended” I get an amniocentesis to determine whether or not the baby had the disorder.  I declined and signed the waiver.  I knew there was nothing wrong with my baby, I could tell.  There is no way to explain the feelings of being pregnant and knowing your body to others who haven’t experienced it and especially to a father who’s a worrier and can’t understand a “feeling”.  The next 6 weeks were perhaps the longest we had ever experienced (up to that point) but we discussed it and knew that a diagnosis would not change the desire to have the baby and therefore the risk of amniocentesis (which can cause miscarriage) were not worth it.  I also knew (thanks to a friend at the time that was also an ultrasound tech) that cysts were somewhat normal and they should disappear by 24 weeks.  And they did, by our 25 week scan they were gone.  What if I had trusted that doctor, gotten the amnio and had a miscarriage only to find out when the results came back that the baby was healthy?

I even switched practitioners at 35 weeks because my original OB wouldn’t attend the hospital we wanted to birth at (though she originally told us she would) and her choice hospital required too many interventions (not to mention the mandatory “transition period” the baby spends away from mom in the nursery which has been shown to inhibit bonding and breastfeeding).  The new practice I found delivered at a third hospital which promoted “couplet care” (in which the baby and mom are never separated) and seemed more open to allowing for choice in birth.

Hubby and I had developed a written birth plan based on what we knew and what we wanted.  I shared the birth plan at my 38 week prenatal visit with my midwife and she went over the plan with us point by point and was very supportive.  She put a copy of the plan in my file.  I took a copy to the hospital also and gave it to the nursing staff who also looked it over.

My birth plan presented me with much more opposition than I had anticipated.  I did my research, reading books and taking a Hypnobirthing class and was devastated by my family’s reactions.  My mom insisted that I would be begging for an epidural and didn’t believe in childbirth without pain.  She’d done it twice before and I don’t in any way discount her experience but I believed strongly there was another way, a better way for me.  I told her and others close to me that I would rather deliver on the side of the road on the way to the hospital because I waited too long than to get there too early and be subjected to all the interventions and she thought I was crazy.  Her lack of support and other similar opinions ultimately led to my husband and me deciding to go it alone, no one else in the room or even at the hospital.

I had a sense through my entire pregnancy that I would deliver before my due date, having an uncomplicated labor and delivery and hoped that most of our birth plan would be unnecessary.  I longed to have a peaceful, uninterrupted birth in which I could call my parents at the end and say “you have a grand-daughter” without anyone even knowing I had gone into labor.  My parents live in Colorado and Hubby’s in Massachusetts.  I requested that my parents not come until after the due date (June 24) and Hubby’s parents were set to come just after the July 4^th holiday.  My sister had recently lost her job and came to visit just before the due date.

I was desperate to get the baby out before she arrived.  I wanted my peaceful birth and some time at home with just the baby and Hubby before the hustle-bustle of visitors arrived.  I bounced on my exercise ball and did laps in the living room.  I timed every contraction hoping a pattern would emerge.  Nothing.  My sister came. My parents came.  My sister left. Nothing.  That’s when it all began.

The downward spiral started at my 40+6 week prenatal appointment. That Monday I had an ultrasound which showed Honeybun was healthy, growing and my fluid was fine.  I measured 6 weeks small throughout my pregnancy so there was constant concern that she wasn’t growing or that I didn’t have enough fluid but neither case was ever true.  I then waited patiently in an exam room for a doctor whom I had never met before.  The doctor entered and without even introducing herself, slammed my chart on the counter, crossed her arms and declared “you’re late, we need to induce, like tomorrow.”  I could barely hold back the tears.  I had previously been working with two wonderful midwives who had been supportive of my wanting to avoid medical interventions.  I knew that I wasn’t “late”.  Full term is considered between 37 and 42 weeks therefore a woman is not “late” until after 42 weeks (I wasn’t even 41).  I begged for time.  I asked to have until Friday to get things going on my own.  She initially agreed, and then realized Friday was the 4^th of July so we’d have to do it Thursday (“we couldn’t do it on a holiday”).  The only saving grace at the time was that one of the midwives I had seen and really liked would be on call on Thursday.  I was dilated to 2 ½ and really hoped labor would happen naturally before Thursday.

I went home that day and immediately began trying every natural suggestion I could find for starting labor.  I ate spicy food, I did laps around my living room, I gently bounced on an exercise ball for hours at a time, I even made a (normally) 20 minute drive in rush hour traffic to get raspberry leaf tea.  I tried EVERYTHING.  Wednesday evening I was distraught.  I did not want to be induced; I knew my baby would come when she was ready.  If she wasn’t here yet that meant she wasn’t ready, so why rush her?  Before bed I began having very mild contractions that lasted through the night, 9 minutes apart for nearly 10 hours.  Hubby and I got up at 5:45 to get ready to go to the hospital.  I even called the doctor’s office to say I was having contractions and to see if I still needed to go in, desperately hoping they would call and tell me to wait.  But no call came and at 6:30 we got in the car and drove the hospital, the beginning of the end for my ideal birth.

Then next 15 hours were somewhat of a blur, time escaped me and I still have little knowledge of how things progressed.  This is what I remember:

7:00 am     I checked in and the nurse (a novice) began the intense questioning process and I was hooked up to an IV for fluids and blood pressure cuff

8:30 am     my midwife stopped by, I was dilated to 2 ½ (the same as Monday)

9:00 am     I requested to have my water broken (in lieu of man-made chemicals entering my veins).  Meconium was present in the amniotic fluid (Honeybun had had a bowel movement)

9:15 am     I was hooked up to an Electronic Fetal Monitor (now four wires attaching me to the bed, limiting my movement)

12:00 pm   another doctor I had never met stopped in to check on my progress.  3 centimeters but Honeybun’s head was high.  The five words I had dreaded and done everything to avoid: “We need to start pitocin”

7:00 pm     nurse shift change-the novice left and I got a wonderful, caring, patient, experienced nurse

10:12 pm   Honeybun was born.  I had a “mild” perineal tear which was sewn up

Between 9:00 and Noon, I rested as best I could.

Between 12:00 and 7:00 I rocked in a rocking chair and then tried to rest, knowing I would need my strength and energy.  I woke up with excruciatingly debilitating contractions (notice I did not say “painful”, I never felt pain with my contractions).  I also received Stadol (an IV narcotic) during this time.

Sometime between 7:00 and 10:12 I completed dilating and began pushing.

I have no idea when things happened between noon and Honeybun’s entrance into the world (other than the nurse change).  These, however, are the things I do know:

• My novice nurse would not let me lay in bed on my back even with the bed fully raised.  She insisted I stay on my side with a pillow between my knees.
• I was attached to the bed by four different wires, limiting my movement and requiring me to unplug three of the wires and carry a pole with me to the bathroom.
• Honeybun had a tendency to curl up in a ball when I rested (which is how she still sleeps today) so when I was checked at noon, her head had gone up instead of down which lead to pitocin.
• When I woke up with the strong contractions, I could not move or breathe through them.  In fact, I could not breathe at all.  The contractions did not build up slowly; they hit me like a semi-truck.  I did NOT feel pain, I felt debilitated.
• I wanted to labor sitting criss-cross-applesauce, leaning on a stack of pillows in front of me.  The novice nurse wouldn’t let me stay there because she kept loosing Honeybun’s heart tracing.  This ultimately led to my decision to get the Stadol.
• The Stadol did not help.  It made me feel woozy and out of control while the contractions raged on.
• The novice nurse never informed me of my progress.  She checked my cervix regularly but never told me how I was progressing.
• The nurse change was the most amazing part of the experience (other than meeting my daughter, of course).  The Stadol was beginning to wear off and the first thing the wonderful nurse said was “you get comfortable and then I’ll place the fetal monitor.”
• Shortly before I began pushing I felt the need to go the bathroom.  Hubby and the nurse tried to help me get up but I was struck with terror when I was unable to move and Hubby noted “there’s a lot of blood.”  This was the sign I was complete and the wonderful nurse told me I could start pushing when I felt the need.
• My midwife arrived a short time later and waited patiently, everyone in silence (Hubby, the midwife and wonderful nurse) while I pushed Honeybun out on my own time and in my own way.
• After the delivery Honeybun was immediately given to me and Hubby cut the cord when it was done pulsating.  The midwife delivered the placenta and repaired my perineal tear.
• Honeybun didn’t cry right away, she looked around contently at Hubby and me.  We then realized we didn’t know the sex and saw she was girl and we were overcome with happiness.  Then Honeybun pooped on my arm.
• After about 10 minutes of bonding and attempted breastfeeding (Honeybun was too busy looking around to bother) we allowed her to be measured, weighed and she was administered a vitamin K shot and eye ointment.  7 pounds, 7 ounces: typical weight.

The hospital policy stated that mothers and babies were never to be separated except in rare medical cases.  However, that day there were women laboring in the hall and therefore not enough staff.  Hubby escorted Honeybun up to the nursery while I had some soup and went to the bathroom (I had to pee before they would move me to a recovery room, to make sure everything was working right).  Hubby came back down to help me with our bags and Honeybun met us in the recovery room where Hubby and I called our parents and we enjoyed the precious new addition to our family.

My midwife cleared me to go home Saturday morning and the hospital pediatrician cleared Honeybun shortly after.  However, the nurse who was caring for us that morning refused to do the paperwork.  Honeybun was a sleepy newborn and wasn’t that interested in waking up to nurse.  I had been visited by the hospital’s lactation consultant twice during my stay (I asked to see her shortly after delivery) and she was not concerned with things.  In fact, the first time she came to see me I was in the middle of feeding Honeybun and she was impressed that we had gotten a good latch since I was a first time mom.

The nurse was concerned that Honeybun was not eating enough.  I attempted to wake her every two hours or so to nurse but she wasn’t very interested.  Honeybun had a lot of gunk in her lungs and had gagged on it more than once (the first time she actually turned blue and I had to call the nurses in) so she had been frequently suctioned which can cause discomfort in a newborns mouth and throat making feeding uncomfortable.  In addition to Honeybun’s lack of interest I think the constant suctioning diminished her appetite.  But the nurse refused to let us leave until Honeybun was nursing well, flat out asking me what I was going to do if I got home and she wouldn’t nurse.  This woman actually believed that I was so stuck on breastfeeding (based on my requesting no pacifier or formula) that I would let my daughter starve instead of giving her a bottle if she wasn’t nursing well.

I had stood my ground already and knew what I wanted, so why when it came time for the actual birth was I unable to stand up for myself and Honeybun’s life (which I was ultimately responsible for)?  I am a naturally non-confrontational person.  I avoid arguments and am always trying to lighten the mood and ease tension.  I think this was my downfall in Honeybun’s birth: I didn’t want to overstep my grounds.

Our society puts special trust in the “all-knowing” knowledge of doctors and we are trained not to doubt them.  However, when armed with our own knowledge, why are we not encouraged to stand up for ourselves?

The mark of a successful birth in American obstetrics is that of a “healthy baby and healthy mom”.  Honeybun was the healthiest and happiest a baby could possibly be (and continued to be so) and apart from my perineal tear and a few hemorrhoids, I was physically healthy also.  However, little emphasis is put on the emotional well-being of the mother.  None of my hospital checks (by a midwife I had never met before) included “how do you feel about your birth?”  But instead consisted of “take your pain medication and call the office if you have any concerns” (I still don’t know what the pain medication was supposed to be for, I never had pain and therefore never took any even though I was sent home with a prescription for heavy duty narcotics).

Even at my 6 week postnatal check up I discussed postpartum depression with the midwife who attended Honeybun’s birth but never what some call “birth trauma”.  I didn’t even realize until Honeybun, Hubby and I settled into a nice life pattern how upset I really was by my birth experience.  I feel like I made a lot of mistakes in the process by not standing up for myself, demanding the care I desired and declining interventions which I received but did not want.  I would have gladly signed a waiver declining induction similar to the one I had signed for the amniocentesis had it been presented.  Most importantly though, we should have asked for a new nurse as soon as the novice demanded I lay on my side.  I still feel that was the biggest mistake Hubby and I made in Honeybun’s birth.  The idea never even came into our heads, though.

I spent 14 months feeling sad about my birth experience and guilty at the same time.  I was sad for the forced, violent way my daughter was brought into the world, sad that I had not stood up for myself, yet guilty for feeling sad when I had a perfect, healthy daughter and also guilty for not doing more to save us both the trauma.  When Honeybun was 14 months old, Hubby and I hired a babysitter for a night out, the first time we had done so.  We went to a nice dinner and then to a play titled “Birth”.  This experience single-handedly sent me into my birth obsession.  The play portrayed the birth experiences of eight American women.  One of the last lines of the play will haunt me forever “But what about me?”  So much emphasis is placed on the healthy baby (that’s all anyone can ask for, right?) that we, as mothers, are made to feel guilty about our feelings on our births.  But really, what about ME?  What about how I feel, what I wanted, the way I was treated?  I knew my baby was fine inside of me (that “feeling” again) so why was I forced to jeopardize the health of both of us?  Why was I not trusted to know what was right for ME and MY baby?

After seeing the play and processing my feelings with Hubby (which I had generally suppressed except for a few random outbursts for 14 months), I began my quest for knowledge, for support and for answers.  For probably the first time in my life, I read a 316 page book cover to cover in four days.  The book (Pushed by Jennifer Block) is subtitled “The Painful Truth about Childbirth and Modern Maternity Care.”  The book took me through moments of sadness and anger, but never guilt.  I came to realize that I don’t have to feel guilty about the way I feel about my birth experience.  There are thousands (maybe even millions) of women around the country who feel just like me.

I was made to feel like a bad mother before I even gave birth because I fought an induction.  The “health” of the baby was at risk and any doctor was willing to tell me so.  But no doctor (or midwife for that matter) was willing to tell me that pitocin carried risks too and that labor induction often led to cesarean section.  I was made to feel that their outcome of a negative birth (an unhealthy baby) was more important than my standard of a negative birth (medical intervention) and their “knowledge” was far superior to my maternal “feelings”.

I often wonder how I would have felt if I had fought more, declined medical interventions and labored and birthed the way I wanted and something had gone wrong.  I know I would have felt immense guilt and responsibility for the outcome.  I would have been going against doctor suggestion (as I had done with the amnio) and would have ultimately had to take responsibility for the consequences.  But would I have blamed the doctor, midwife, nurse?  No.

Many practitioners do “routine” interventions in order to leave a paper trail, to prove (if needed in court) they did everything they could to provide for a positive outcome.  Due to my small for dates fundal height, I had an ultrasound done every week from 37 weeks forward to ensure Honeybun was growing and fluid levels were good.  One midwife plainly told me “I know everything is fine, you’re tall, you have a large abdominal cavity and are carrying your baby inside but I have to prove everything is fine.”  I understand these concerns and in our sue-happy society everyone has to watch everything they do.  Again, I would have gladly signed a waiver declining induction had it been presented.

I also understand medical practitioners carry malpractice insurance and these insurers often dictate practices by limiting what is covered by the insurance.  Practitioners in Florida’s Broward (where I live) and Miami-Dade counties find themselves paying upwards of $200,000 a year for malpractice insurance[1].  How many births must they attend a year, just to break even?  So it makes me wonder, who’s really in control of how women birth?  It’s clear that it’s no longer women, but are practitioners really in control or are insurers holding all the cards?  And why are people (presumably mostly men) who are not familiar with the process of giving birth being allowed to decide how, when and where millions of women give birth?  No wonder so many women are opting for home births if available or risking an unassisted birth if home births are not available: many women feel they have been left with no other choice, the system has failed us.  What was created to protect all parties involved is now harming freedom of choice.

Pregnancy and birth are not medical conditions or emergencies.  Women were created to birth and our bodies (when allowed to) know how to birth.  This notion that modern women can’t hack it is complete nonsense.  Women, with enough support and positive portrayals of birth (not the screaming, medicated births as seen on TV) can achieve peaceful births as many women have (even recently).  However, few of these births are seen and the ones that are seen are deemed outrageous or even dangerous.  How is something that is inherent to human nature and has been happening for thousands of years dangerous?

The response I got from my own mother (and others) when I told her I wanted an unmedicated birth because women have been doing it since the beginning of time: women died back then, babies died back then.  But guess what, women and babies still die (and the rates are rising).  Women who have a cesarean section are four times more likely to die.  And women who are induced could increase their risk of a cesarean section by as much as two times[2].  So why take the chance?

Doctors and society as a whole have generally come around to the idea that breast milk is the best source of nutrition for infants.  This is based on the fact that breast milk is made especially for each specific baby and contains nutrients and properties which can not be reproduced in a lab.  Labor is much the same.  The hormones excreted by a woman’s body in labor can not be recreated; they are made for each woman in doses which are optimal for her labor and delivery.

Natural oxytocin not only causes the uterus to contract but also reacts in the brain as a sort-of narcotic which calms and relaxes the body.  Artificial oxytocin (pitocin) does not contain the latter part of the hormone.  Oxytocin is also produced naturally in amounts that are optimal for the job: enough to progress labor efficiently without overtiring the uterus and stressing the fetus.  When pitocin is administered, the body does not make its own oxytocin because it believes it is already receiving the hormone.  Therefore, doctor administered pitocin not only enhances and speeds up contractions, often to an unnatural dangerous pace which can (and often does) cause fetal distress, it lacks the calming properties which are natural to labor.

Why would I knowingly choose to have an artificial substances pumped directly into my bloodstream which can cause fetal distress if I’m not even going to get the soothing aspects too?  These are consequences of pitocin induction and augmentation which are very rarely discussed with women who receive the medication.  Pitocin is generally gradually increased until the doctor deems the contraction pattern and strength to be “sufficient”.  At my last prenatal appointment I asked if the pitocin could be turned off or turned down once labor was established and I was told no because generally once the pitocin is stopped, labor stops.  Does that not mean that my baby is then not ready to be born?

While there are not definitive answers as to what causes labor, recent studies have shown that a fetus excretes a protein from the lungs which triggers labor to begin.  This protein is found in surfactant which is essential to successful breathing[3].  Newborn babies lacking surfactant can suffer from respiratory distress and collapsed lungs[4].  So one could conclude that inducing labor (in the absence of other medical conditions or emergencies) is dangerous to the unborn fetus who has not yet signaled that they are ready to survive outside the mother’s womb.

Hospitals all over the country have banned VBACs, vaginal breech delivery and vaginal twin deliveries and finding a doctor that is willing to attend these births becomes trickier every day.  However, there is plenty of research out there to show that a vaginal birth (in the absence of other risk factors) is safer than surgery in all of these cases.  Women are being forced into major surgery for no medical reason and women who resist or refuse are ridiculed, demonized and in some situations even criminalized.

Women who feel like there are no other options and opt for an unassisted birth or home birth with unrecognized midwife can face scrutiny not only from family, friends and society but are also often visited by social services and sometimes legal authorities.

A woman has the right to have an abortion but a woman’s right to deliver her children in the way she chooses is at stake.  I can choose if and when to end my fetus’s life but I can not choose when and where to start it.  There are many organizations out there supporting “women’s right to choose” in the context of abortion but no one fighting for women’s right to choose in the context of labor and birth.

In the 1970s women took a stand and demanded change: they wanted their husbands present, they wanted to be awake and aware, and they wanted to have their babies with them after birth.  I believe that the unconscious births of the 1950s, instead of being rethought to better suits mothers and what they want, have simply been reformatted without giving mothers any more authority in the process.  Women are now awake and have their support teams with them but the choices in how they labor and give birth are still not theirs.  Instead of being knocked out cold, they’re awake but still strapped to a bed.  Instead of babies being forced out of a mother’s body by forceps and fundal pressure, babies are being forced out by pitocin and commands to “PUSH, 2, 3, 4, 5, 6, 7, 8, 9, 10, AGAIN!”

I believe it is time again to take a stand and demand that we get the care we deserve.  We, as mothers and women, need to take back our bodies and our freedom to choose and demand that we be given an opinion in the care of ourselves and our children.  I can refuse immunizations for my child, why can I not refuse medical interventions that harm both me and my child?  No one woman can make a change alone, but together we can get back what should have been ours all along: the birth process.

[1] http://www.applesforhealth.com/HealthyLifestyles/obisaoi3.html

[2] http://findarticles.com/p/articles/mi_m0CYD/is_1_38/ai_96891958/

[3] http://www.utsouthwestern.edu/utsw/cda/dept37389/files/158762.html

[4] http://www.merck.com/mmhe/au/sec23/ch264/ch264g.html