By Tracy G. Cassels

I should preface this anecdotal article on my birth experience and the lessons I learned from it by explaining my past a little.  Me and my siblings were all born at home (you can read the story of my birth as written by my mother in the 2nd installment of Re:Birth, linked here).  My mother hates doctors, hospitals, and anything to do with the medical community, which turned out just dandy for her births, though definitely posed problems later in life (but that’s a story for another day).  Because of these views, I grew up indoctrinated against the medicalization of birth and until friends started having babies (and really until one of my best friends’ gave birth), I firmly believed that the hospital was no place for anyone and that epidurals were just plain bad.  I had friends who had babies the “normal” way by today’s standards – hospital, epidural, pitocin, baby – and just couldn’t fathom it.  I tried not to think about it because it bothered me to think of.  There was just simply no question they were getting epidurals because that was part and parcel of what it is to have a baby and many couldn’t tell you why they had them, except they didn’t understand why they should be forced to feel pain.  Then one of my best friends had her first baby in England and had an awful labour – over 50 hours and very painful – and though she had aimed for a natural birth (part of why her experience was so relevant for me), she had an epidural.  It helped her along and she gave birth to a very healthy, adorable, and (as we now know) rambunctious little boy.  She praised the epidural for helping her through that labour, though when she was pregnant a second time, she went all natural and had her second very healthy, adorable, and (thus far) not quite as rambunctious little boy at home with a midwife in the USA.

Her experience meant that my schema about birth had to change.  I felt conflicted over it at first; my life up to this point had been filled with the view that hospitals and epidurals were just plain bad.  But her story gave me a piece of information I hadn’t had yet – that there are times in which the epidural will be helpful, something my indoctrination had failed to provide.  I had already known of real emergency c-sections and had accepted that these can be life-saving procedures or necessities for breech babies (though that’s a fact that’s readily changing).  But I also have read enough to know that they can end up as “emergencies” primarily because of the interventions given in the hospital.  I’m still settled on the view that the vast majority of medical interventions in birth are unnecessary and that women rarely have the amount and type of information they should prior to giving birth, but readily admit that there is a place for the medical in birth after all – just not the place it currently holds.  I’ve written on the option for homebirth and why I firmly believe it needs to be a real option for all women and why they deserve to know the real risks and benefits.  I wrote about the epidural debate (see here) and I stand by everything I said – they can be amazing when necessary.  The question that seems to have led to though is what is “necessary”.  How much pain is too much?  Because pain is subjective, the only answer I can give is one based on conversations with friends, midwives, doulas, and one doctor: a trained individual who has witnessed many births (I include doctors who aren’t the “check out” type waiting for a golf game, midwives, and doulas – in some cases they witness much more of the laboring process than any other professional) seems to know when a woman has hit her threshold.  Something changes and they start to sense that things can go downhill at that point.  As someone who likes the clean answers that research usually provides, I’m sad to say this is all I have – it’s kind of like pornography for the birthing professional, you can’t define it but you know it when you see it.

What is the point of this?  It’s all to say that the discussion of birth is a contentious one these days and people feel very strongly about the practices surrounding birth.  Many people reading this will firmly fall in the camp that a natural birth is better, that home birth should be an option for everyone (not that it will be the option for everyone but that a choice should be there), and that our bodies have evolved (or were created) to birth and that we do best when we listen to them.  Most people reading this will also know that these are not commonly held beliefs and certainly not common practices in Western society today and to suggest them is to lead to attacks on the self and your sanity.  Because of this, there is an obvious extremism that takes root in the birthing debate.  For example, I’ve come across people who think that anything other than natural birth is bad and many more who think birthing at home is tantamount to child endangerment or abuse.  When my husband and I went for our ultrasound with my daughter, we were told by the technician that she felt home birth should be made illegal “because that’s how babies die”.  Another woman I know told me her partner was giving birth in the hospital because “safety was our main priority” (as if it wasn’t mine – in fact, I informed her that I chose a home birth “for the same reason – safety”).  I’ve also heard of women who had wanted home births and when they had emergency c-sections or transfers to the hospital, felt like failures, feelings that weren’t helped by comments made to them that somehow they could have controlled the situation better by having a more positive attitude (yes, that actually has been said).  I’m very squarely in the camp that older parenting and birthing practices are generally better, but I’m even more in the camp that providing education about pregnancy, birth, and parenting is always better.  So, with that, I will share my own experience and what I managed to learn from it…

Pre-birth:  I have planned a home birth and would like to deliver in a birthing pool.  I know too many people that had the pool, but never made it to it or got out for a bit and then delivered to think too much about whether I’ll actually deliver in the water or not, but I want it there to labour in.  We have decided that we want my husband to catch the baby (if possible) and thanks to my doula, we have had endless discussions about how I a) do not want to transfer to the hospital unless absolutely necessary – that is, if my baby isn’t in distress and if I don’t meet the “must” criteria outlined by my midwives, I’m staying home, and b) if I do end up in the hospital, I want only the absolute necessary interventions and I feel very strongly about not wanting pitocin.  My doula and husband are ready to ask the questions about what is “necessary” if I’m otherwise in disposed; and again, if my baby isn’t in distress, then there’s no need to do any intervention.  These discussions become more important as we discover around month 8 that babe is sunny side up meaning I have a higher chance for back labour which is related to much more painful and longer labours.  Hoping babe turns (and I continue to swim and walk which my midwife has told me are helpful), but aware that things may not turn out as rosy as my mom’s labours were.

Saturday June 19, 2010: Due date is 2 days away and we’re just waiting.  Both my husband and I had thought the baby would come earlier, but didn’t happen; so much for parental intuition.  We decide to get out of the house and go see Toy Story 3.  During the movie (which was fabulous and made me cry), I started feeling occasional pain in my lower abdomen, but more so in my lower back, which seemed a bit weird.  Movie ends, we walk home, and as the night progresses, these pains start lasting longer and coming more frequently.  We know it’s early yet, and my husband is thrilled to think that we will most likely have the birth on Father’s day.  Into the evening, we call our doula who says that although they’re lasting 30-45 seconds and only 5 min apart, we still have lots of time.  She tells me to take a gravol and try to get some sleep.  I obey and am out faster than I thought possible.

Sunday June 20, 2010: We wake up and it must be around 9am.  Somehow the contractions I’d experienced the night before have lessened, but are still there and still being felt in my lower back.  It’s painful but not unbearable.  We go through the day walking and timing contractions.  In the later afternoon, two friends who will be there for the birth arrive and we set up the birthing pool.  Starting at around 9pm, the pain is becoming much more intense and my back is starting to feel like someone’s trying to break it.  What’s worse is that there doesn’t seem to be much of a break at all; even when a contraction stops, the pain in my back continues, just to a very slightly lesser extent.  My husband calls our doula who, upon hearing me in the background, heads on over.  She feels me and says the baby is still sunny side-up and we have to try and turn him/her.  For hours we do lunges up the stairs and who-knows what other exercises, and finally, around midnight, the pain in my back is gone.  I start experiencing contractions and can’t help but think – I can deal with this – it’s intense, but nothing like what I had been feeling before.  My doula is convinced baby is coming sometime during the night, but suddenly a tiredness hits me like a ton of bricks.  I just keep telling everyone I need to sleep and finally I’m allowed to go upstairs, take a gravol, and lie down.  I can feel contractions continue, but I can’t keep my eyes open and I’m out before I know it.

Monday June 21, 2010: We wake up and our doula is gone.  One friend is still here and she tells us that our doula left in the middle of the night but we should call her later today.  The contractions are gone.  My friend goes home and we go through the day wondering what the hell is happening.  Starting at around 8pm, contractions start again and so does the back pain.  A couple hours later, we try to go to sleep.  My husband falls asleep but the pain is such that I can’t sleep and so I spend the night doing all the exercises I could remember from our doula to help turn the baby again.  Nothing works.

Tuesday June 22, 2010: By 6am I can’t take it and have to wake my husband up.  The pain is getting progressively worse and it’s all in my back – like someone is stabbing me in the spine and then twisting it every so often.  Hubby’s up and calls my friends to head over to help out.  Pool is set up and I’m now lying in the pool watching Roseanne.  The water helps a bit but not enough.  My husband calls the doula who is teaching so her back-up comes over and starts trying to turn the baby, to no avail.  We call an acupuncturist who comes over with a tens machine as well.  The needles do nothing but the tens machine helps quite a bit.  Before she leaves, my friend runs out to rent a tens machine so we can use it once the acupuncturist is gone.  For a couple hours, the tens machine makes things bearable, but I’m in such a state I honestly can’t tell how much time is passing.  My doula arrives and says it’s time to call the midwives.  One arrives and says everything is looking okay despite my obvious pain.  She tells me about water shots which she’s hesitant to give now because women get them once and then that’s it (apparently they hurt so much to get, women prefer the pain of back labour) so I have to wait.  At one point my second friend takes over from the first who’s been holding the tens machine and adjusting the levels during contractions.  I go into a contraction and she puts the remote under her arm.  Suddenly it feels like I’m being electrocuted on my back and it keeps getting worse.  I can’t speak and I hear my husband yelling at the friend to turn it down as it had accidentally been turned way up by her arm hitting the up button.  She doesn’t understand and does nothing.  My other friend just rips the sensors off my back and that’s it for the tens machine for me.  My midwife’s shift is over and the other midwife arrives.  We do an exam – I’m only 4 cm dilated.  She says we’ll give it another hour and agrees to give me the water shots.  They hurt but nothing that bad.  I can still feel the pain in my back, but it’s dulled – like a radio on high that’s being muffled, the sound is there, but it’s not as glaring and sharp as normal.  The hour passes quickly enough and we do another exam – 5 cm dilated – and my midwife recommends breaking my water.  My doula reminds me that this could be it for my hope of a home birth – if there’s too much meconium then I have to transfer.  I think about this and agree to have my waters broken.

The moment it happens and I hear that there’s tons of meconium, I can feel my stomach drop away.  But oddly it’s not really because I won’t get the birth I’d hoped for, it’s because I know that it’s a sign of fetal distress and I’m terrified for my baby.  How great a toll has the last few days taken on him or her?  My doula explains that I am someone who would benefit from the epidural; that my body needs to relax in order to get my baby into the right position and move things along; that the pain has been so much that it’s keeping the birth from progressing as it should.  My husband tells me later that he’d been watching the midwife and my doula huddled in a corner, talking, with concerned voices and looks.  This whole time he’s been terrified that something is going very wrong and I’m just unaware of it all.

We have no bag packed and nothing ready to go to the hospital – though we knew it was a possibility, we got so caught up in making sure we had everything for home, we forgot to pack a back-up bag.  My husband throws some things together in a bag, we get in the car, and drive.  It’s about a 10 min drive (if that) but the water shots have worn off entirely and the pain is escalating to a crescendo.  By the time we arrive at the hospital, each contraction literally brings me to my knees.  At times I’m not sure I have a back anymore and at no time did I feel a thing in the front half of my body.  I’m told I’ll get the epidural shortly, but the minutes turn to half an hour, and then an hour.  Finally I’m in the room, but we’re still waiting for the anesthesiologist.  About an hour and half after arriving, the needle is in, I’m lying in bed, and the pain is gone.  It’s midnight.

Wednesday June 23, 2010: I’m told I should rest before I have to push.  I’ve been up for too long and my body must be exhausted and won’t be able to handle the pushing phase if I don’t rest.  But here’s the thing – I can’t sleep at all.  I feel a rush and a high that’s impossible to ignore.  With the pain finally gone, my body is feeling the effects of the mad rush of endorphins it had been building up while going through the pain of the last few days.  So I chat with the nurses who are there.  They’re checking baby and saying that babe is doing wonderfully – strong, strong heartbeat, no signs of any distress at all.  Nothing has ever sounded sweeter.  My hubby rests, one friend leaves to go home, one stays for the rest, as does my doula.

Two and a half hours later, my hubby rested, me not so much but I don’t care, it’s time to push.  At first I can’t feel much of anything as the epidural hasn’t worn off (though I haven’t added more), but I try and do the pushing the way I’m told.  After an hour, I can now feel what’s happening, but not much progress has been made.  My midwife informs us that it’s hospital policy to now administer pitocin to speed things up because “they” don’t like women pushing for more than a couple hours.  I’m still pushing regularly but manage to give my hubby the look so he asks if my baby is okay and am told by the nurse that the baby is fantastic; in fact, the heart rate hasn’t decreased at any point yet, something that typically happens during pushing.  He says I don’t want the pitocin, something I’m able to echo after a contraction, and I ask what I can do to naturally get things going.  My midwife goes to find the doctor who’s now overseeing my case and the nurse explains that squats would normally help things along but the hospital view is that I am too weak to do them given that I’ve had the labour I’ve had (note that this had nothing to do with me personally, just the assumption that women aren’t capable of anything after a long labour).  Try me.  The nurse, a former midwife herself, says okay and tells me what to do (given I have the IV attached, I can’t just get up and squat).  Next contraction I roll myself up to the bar placed across the bed and squat down.  I can now feel my baby moving in me – it’s unbelievably intense but incredible.  Three more squats and it becomes so intense I have to have a break from doing one.

My midwife has returned with the doctor and when they go to check, everything is now moving.  The squats did it and everyone agrees there’s absolutely no need for pitocin, but the doctor reminds me that if this doesn’t continue, “they” will want to administer it.  Honestly, my thought here was Fuck off.  But it did ignite an even stronger desire to push this baby out without another intervention because I knew my baby was healthy and strong (as the nurse continued to tell me) and I knew that administering anything else at this stage could only make him/her worse, not better.  Around three hours after I started pushing, I hit the ring of fire and just wanted it done, and while I had hoped for minimal tearing, I had no idea how that was possible as I looked at the mirror placed at the foot of the bed and saw that massive head pulsing out.  The nurse now said I should cough my baby out to avoid tearing and my midwife told my husband it was time to get to her so he could catch our baby.  So I coughed with my friend, my nurse, and my doula by my side and my hubby and midwife at my feet and my little baby came out – all 8 lbs 12 oz – without a single tear (for which I consider myself very lucky).  My hubby immediately placed our baby on my chest and it was a good couple minutes before someone reminded us we still had no idea if it was a boy or girl.  I checked and started laughed given my husband had been convinced it was a boy and declared her a girl (my husband didn’t believe me and picked up her declaring, “Let me check that!”).  The rest, as they say, is history.

My Lessons:  The first thing I learned is that I can see how easy it is for some women to feel bad about their birth situations when it doesn’t go as they want it.  Especially when they want the natural, home birth and they end up with something completely different.  But the health of our babies is always paramount and it should be that way so feeling bad about circumstances beyond your control is fruitless.  One thing that I think helped me feel just dandy about my own birth is that I went into it being flexible, thanks to my midwives and doula.  I didn’t write out a plan, I didn’t get set in my mind that it had to be one way or else, and thus while I had a preference, I also was able to get my mind around something else.

The second thing, relating to the first, is that I think those bad feelings can stem from simply not knowing enough ahead of time and losing control of your birth.  And by “knowing enough”, I don’t mean that you need to have a midwife’s level of knowledge around the birthing process, but you should be aware of what the processes are that will affect you.  Typically this involves knowing more bureaucratic information than anything biological.  I saw how ready the hospital was to put me on their clock, their schedule, and their way of doing things without a single consideration of what I wanted, how my baby was doing, and what I was capable of.  While birth itself is usually a long-ish process, it’s amazing how quickly decisions get made, and if you don’t have the knowledge or a plan set up ahead of time, you can find yourself lost in the fray.  If the woman is in control and making informed decisions, I find it hard to imagine a birth that she feels badly about.

Finally, and most importantly, I learned just how valuable the education I received surrounding the birthing process was.  This included what would happen at a hospital, what the reasons were for hospital transfers and interventions, how to tell/ask if an intervention was necessary or simply procedure, and how to set things up such that I was not my only advocate.  All of these things I learned at my prenatal class (which was taken by the woman who would be our doula) and were reinforced by my doula during our pre-birth meetings and by the midwives on my team.  It meant that I left my birth feeling empowered.  Weird, right?  I would have expected to feel less, given I didn’t get what I had wanted, but the fact that I stood up to the system and took control in their house was thrilling.  I wasn’t going to risk my daughter’s well-being by staying at home in what was apparently becoming a dangerous situation, but I was not going to let a system dictate what I did when it didn’t fit with our particulars.

This last lesson is part of why I feel so strongly about providing information to those who want it – people deserve to know the research out there in order to make informed decisions about what to do.  I know I don’t have a pro-epidural or pro-hospital article out there, but it’s because I firmly believe we don’t need it.  Every day we’re bombarded with the message that that is the way to do things – the few benefits are firmly advocated for.  What isn’t there is the other side – the side that tells you that you are capable of so much more than they give you credit for, that you have a choice in where you birth and that the choice of a home birth is just as safe if not safer than a hospital birth, and that you, of all people, know your body better than anyone.  Like me, you may not get the birth you had planned, but you don’t have to have one you regret.  And I strongly believe the key to that is to educate yourself – especially the policies in place where you live either for home or hospital births – and to make sure you have an advocate.  In short, don’t sell yourself short and don’t let others control one of the most important and amazing experiences of your life.

If you would like to share your birth story, I would love to publish it!  Moms and dads, please write it up and send it along to tracy@evolutionaryparenting.com or if it’s short you can write it in the comments section here.  I hope to make this a regular thing where families can come and read about the myriad ways our kids entered the world.