The Birth Scale


In the wee hours on Saturday morning, I was reading a post on Longreads titled, “A Birth Story” – so you know it piqued my interest. It’s a long story, and I applaud Longreads for publishing it in it’s entirety. All too often, we’re only given sound bytes, just sexy headlines and maybe a short summary of a story. Longreads stories have a ticker that tells you how long it will take you to read through a piece. In the case of “A Birth Story,” the estimate was 57 minutes – much too long for me to read at one go before heading into work that morning. But that was completely okay by me, because about halfway through the post, I just wanted to stop. The story completely depressed me.

According to the subtitle, the author of this piece “had the perfect pregnancy and the perfect birth plan – and then she went into labor.” Given my personal belief that birth is too big to plan, and that I very rarely meet a woman who has had a birth go perfectly according to her Birth Plan, you might think that I was eagerly wanting to read a story that supported this viewpoint. But nothing could be farther from the truth. I braced myself for what would be yet another woman’s sad tale of a birth gone wrong. Another woman’s retelling of how she expected this, but in the end, got that.

Our birth system in this country is broken on so many different levels, and I was prepared to read this story and again feel like our system had somehow failed another woman. But as I read on, I realized something else. I’m not sure that we’re adequately equipping today’s expectant woman with enough of the right information to even begin to realize the birth they’re hoping for.

I met with some labor and delivery nurses recently at a training for advanced labor comfort skills and many of them expressed frustration. They’re frustrated that when they first walk into the L&D room, they already feel like they need to be on the defensive, as many of today’s laboring women are entering the hospital with an attitude of “us against them”. The nurses expressed that they really do want to be advocates for these couples and help them to achieve the birth they’re hoping for, but feel like they’re often met with suspicion. Some nurses expressed understanding why there might be feelings of suspicion and thoughts of having to “fight” for the birth they wanted. But they also sensed that many of these women were not prepared to fully participate in a birth that they wanted to be free of intervention or medication.  

In reading this woman’s story, I felt sad for her, because even though she frequently stated that she was fine with whatever happened next, I didn’t believe her. I could be wrong, but I think she has a lot of unresolved pain and trauma from this birth. On the one hand, I’m happy that she wrote about her birth and maybe experienced some level of catharsis in doing so. On the other hand, I consider my expectant families and feel like this might be just one more “horror story” writ large. Where are the good ones? Where are the positive stories that can lift expectant families up and help them have hope for a birth story they’re happy to tell others about?

At the same time I’m left feeling sad for all of us – hospitals, providers, nurses, doulas, natural childbirth advocates, childbirth educators, Mommas and their partners – because in this birth story there were too many cracks, too many places where this birth could have had a very different ending. Let me be clear. I am not offering any information here to negatively reflect on this woman’s experience or her choices. There is no judgement intended. I only wish she had a different story to tell and these are some thoughts about how it might have been different.

This is what the author has to say about her relationship with her provider:

“I don’t even particularly like my doctor. I love her as a character. I love her from afar. I admire her. I would never choose to interact with her. She makes me uncomfortable. She is cerebral, nervous, she over-explains and my jokes are off-putting to her, but I think she likes them. Every interaction with her I am left feeling like, What was that?! Why was that so hard? We don’t connect, she and I. Somehow, this helps me trust her better. Our relationship is strictly professional, unmuddied by affection.”

When you’re giving birth to your baby, there has to be a level of trust between you and the other members of your birth team. Otherwise, when it’s time to make big (or even little) decisions during the actual birth, you won’t feel like they’re working on your behalf, that they’ve got your back. Everything they say you’ll second-guess and wonder if it’s true or medically necessary. With a trusting relationship with her provider, this woman could have had the exact same end result to her birth, yet she might have felt very differently about how things turned out. But maybe she never received the message that it’s always okay to switch providers.

I’m not saying that it’s easy to switch providers – it’s not. But if you feel at any point during your pregnancy that you have issues of mistrust with your provider, then by all means express those issues! Give your provider the opportunity to win back your trust, and move on if they can’t. Fire them and find a provider that you can have a trusting relationship with. You would never have a guy in a repair shop rebuild the engine of your car if you didn’t trust them – why would you have a provider that you don’t trust be in the room with you during your baby’s birth? You’re not a “difficult patient” for making this hard decision – you’re just an active participant in your healthcare.

The author mentions that she’s gone to “natural childbirth classes” – but did these classes do an adequate job of preparing her for the reality of her birth? I’ve already talked about how I think it’s perfectly okay to say that birth, for most women, will be painful. I’m happy when I hear a woman say that her birth was not painful. But I don’t think that we need to sugar-coat birth. I think we should be straight up about it and make sure that women who want a birth without medications or interventions are prepared for the level of sensation they will likely feel and the participation that will be required of them to get through it.

I’m concerned that the childbirth classes this woman took didn’t prepare her for that level of participation. And she expresses such a negative relationship with all interventions and medications even before labor has begun that when she makes the decision once she feels like her body “was washed up” and she gets the epidural, she writes, “Bring on the cascading interventions. And they came.” But it’s almost as if the outcome had been preordained and there was no other way around it. She even questions at one point “Was I walking the plank?” toward her unplanned Cesarean, and then “(I was always walking the plank.)”

This makes me wonder if her classes had covered interventions and medications at all. Had anyone taught her how to use the B.R.A.I.N. decision-making tool? This is the acronym that I and many other Childbirth Educators use when discussing interventions and medications in birth.

B = Benefits: what are the advantages in choosing this intervention or using this medication at this time?

R = Risks: what are the potential risks or drawbacks in choosing this intervention or using this medication at this time?

A = Alternatives: are there any alternatives to try avoiding the use of this intervention or medication? Are there any alternatives to try and achieve the same intended result?

I = Intuition: what does your gut have to say about using this intervention or medication at this time?

N = Nothing: what would happen if you did absolutely nothing at this point? If you just took the approach of “watch and wait?”

This part of classroom teaching can be tricky for some educators – they are committed to making sure that their Mommas have a birth that is free of complications. And this is most likely to be the case when there are no interventions or medications used during birth. Unless they become medically necessary. There are times when using an intervention or medication makes the most sense, no matter what the birth plan says.

But an educator must make sure that the objective of the B.R.A.I.N. activity is realized. Women must understand that there is a scale upon which they must weigh every decision of their births in real time. They need to realize that every suggested intervention has a true benefit, a true alternative and a true risk.  And the scale that they use to weigh decisions in the classroom or at their desk while typing up their Birth Plan is one thing, but the scale upon which they’ll need to weigh these decisions during the actual birth might be something else entirely. Unless this objective is achieved in class, a laboring woman has not been given the tools necessary to be a participating decision-maker in her own birth.

Stay tuned for part two of this post, where I will compare this experience with a similar birth story from one of the Mommas from my own classes, who’s unplanned Cesarean Birth had a very different outcome.


6 thoughts on “The Birth Scale

  1. Hi Barb

    I’m continuing to thoroughly enjoy your blog, and I passed it along to my mom, who is so excited for me and my new pregnancy. I’m just at week 10 and having days where I almost feel normal, though tired. Meaning, a few days with almost no nausea and less of the foggy brain. I still nap every day and love my sleep! I’m thrilled to have some moments without nausea, as that is really a drag!

    I’m starting to have questions about next steps and finding the best providers and when to do what. A few questions I thought I might direct your way. If you have resources to point me to, that would be super, or if you have thoughts on the topics, that’s great too!

    1. I really like my midwife. However, she is at a hospital (Prentice hospital in downtown Chicago) that has two disadvantages: first, its about 10 miles away from us. During rushhour, that could be a significant drive. Two, Prentice is known for its high intervention rate and top of the line medical facilities. The reputation is that the hospital is the place women go who want their cesareans to best fit into their schedules. Julie Omar, my midwife, assures me that her group is very different from the rest of the hospital and focused on meeting the woman’s needs with as few interventions as possible. They have a couple of birthing tubs and rooms with available hookups. The tubs are almost exclusively used by her group. So, I’m wondering, should I look around at other hospitals that are closer and also have a reputation for being more natural friendly? Or should I trust the fact that I already like her and have a good relationship with her?

    2. When do we start looking into birth classes and how do we find one like what you teach? The hospitals in the area just teach one day classes, so I’m guessing we’ll be looking outside of those facilities for more in depth classes.

    Many thanks! Marta


  2. Hey Marta! So good to hear from you! The two questions above are really great things to be considering this early in your pregnancy. In fact, I wish that there were more offerings of “Early Pregnancy Classes” available for women and their partners to explore these types of questions.

    My first thought is that it’s great that you have a trusting relationship with your provider – so incredibly helpful now and in the moment of truth in the labor and delivery room – but I’d encourage you to press her a little bit to make sure that everyone in her group of midwives feels the same way that she does about birth. And understand that unless she guarantees to be at your birth 100%, you will have the midwife who is on call in attendance when you are ready to give birth. It’s super important as your pregnancy continues that you meet with any/all providers that might end up at your birth so that you’ve met them at the very least. Most provider groups will encourage you to meet with them primarily, but then also meet with their colleagues for that very reason.

    I won’t joke – 10 miles in Chicago rush hour would not be a fun ride, but there are ways you can get around that as well. Including going in early and just not getting admitted, but this might mean doing more laboring in the hospital than you would like or would be conducive to the progression of your labor. The fact that you are posing the question makes me think that it wouldn’t be a bad idea to explore your other options. I think if you look elsewhere and are really feeling solid about the place and the providers, this won’t be a hard decision for you to make. In other words, go ahead and see what else is available knowing that you always have the midwife you are with currently as a good option for you based on your personal connection with her.

    As for childbirth classes, I will try and put out a call to my birth peeps in Chicago to see who offers classes that might be more private or at least offer more than just a quick weekend option. Having said that, I still think it’s a good idea to also take a hospital based class if that is where you will end up giving birth so that you know what to expect at that hospital (this can also really inform your choices about where to give birth!) Most couples who come to my classes are due about 6-8 weeks after the 4 week series comes to a close. But the classes can fill earlier, so make sure to register earlier than that to guarantee a spot. You want enough time to complete the class, but not so much time that you forget everything you’ve learned! :O)

    Hope this helps to answer your questions. I’m loving the connection to my Midwest roots, so keep in touch and let anyone else you know who’s pregnant and looking for some support to come and check out the blog. I’m so happy you’re here and reading! Take care – Barb


  3. Pingback: The Birth Scale Part II | Birth Happens

  4. I love you, Barb, and the kind, compassionate way you approach this woman’s story. You ask such good questions, and I’m continually surprised how much your deeply caring while pragmatic approach applies to other areas of life too.


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