Making Predictions During Birth – About as Magic as the 8 Ball!

Magic 8 Ball

Did you ever have a Magic 8 Ball? I did. I loved that thing. I loved being able to ask a question, any question, and have the almighty oracle predict my fate. Inside the little window floated a single die, with twenty possible answers to life’s biggest questions. Some of which included: “Signs point to yes” and “My sources say no.” When the Magic 8 Ball was certain, yes or no, then that was it. But sometimes there would be the confounding response of “Cannot predict now.” That always meant another hard shake of the ball and the search for a more straight forward answer. No matter how many times it took to get one!

I think too many of us are looking for straight forward answers to one of the biggest questions of all time. We want so badly to be able to predict what is by it’s very nature unpredictable – birth.

Today, I want to speak directly to those of us who work with pregnant and birthing couples.

Could you stop setting them up? Stop making predictions? Please, I’m begging you!

I recently had a reunion with some of my families. More than once I heard the report that someone on their birth team tried to make a prediction during their birth experience. I groaned and asked, “Why do they do that?”

One new Momma said, “so then, the nurse said to me “You’re really cooking! I bet we’ll have a baby before lunch!”

A second Momma said “the doctor came in and told me to get ready for a really long night, because he didn’t think I was going to have the baby until the next afternoon!”

Guess what really happened with these two women?

The first Momma’s labor came to a complete standstill about thirty minutes after her nurse had predicted a late morning baby. She started watching the clock and when the lunch hour came and went unceremoniously, no baby to be found even considering entering her birth canal, she became despondent and discouraged. She started to freak out that something was wrong with her body – with her baby. Given the strong connection between the mind and the body of a birthing woman, it’s no wonder all of this extra anxiety shut her body down for hours! It took an incredibly long time (and a new nurse at shift change!) before this woman’s labor started moving again. She ended up giving birth close to midnight – twelve hours longer than had been “predicted.”

The second Momma and her partner settled in for their “really long night.” But soon after she started second guessing her ability to handle the contractions that felt like they were right on top of one another. Instead of recognizing that her labor had kicked in big time and she was almost fully dilated, she thought that she was “just wimping out.” She was feeling very disappointed in herself and her ability to cope with what she’d been told by her provider was supposed to be early labor. Imagine the surprise when her husband had to run out of the room to grab someone to come catch the baby! It had only been about ninety minutes since she was last checked. So much for their marathon labor!

Birth is unpredictable. It can slow down, and appear as though it’s stopped altogether. It can speed up in the blink of an eye. The issue is not the unpredictable nature of birth, it’s our intense desire to make it predictable that’s the problem! There are way too many unique variables in every labor experience to make it impossible to predict consistently what will actually occur.

But we all still do it! Why?

Pregnant Mommas and their partners hear the due date and create an expectation that this is the day the baby will arrive, instead of recognizing their due month as closer to the reality of when the baby will actually be born.

As a Childbirth Educator, I’m guilty of it as well. I teach, as most do, textbook averages for birth. But do I explain that as a first time Momma, it’s completely within the range of normal to have a birth go super fast? Do I adequately prepare them for an ultra marathon labor experience? We all need to be more on top of this, so our students understand it is possible to have active labor begin almost immediately! And it’s also possible to be in early labor for three days before any changes in their cervix occur. As Childbirth Educators we need to provide our students with realistic expectations of the unpredictable nature of the birth process itself.

But once they’re at the hospital, too many nurses and providers think they’re doing a service for these women when they try to predict what will happen next. I know that this is not born of ignorance. These are professionals who have been at this job for a long time – decades in some cases – and they’ve seen an awful lot. The laboring woman in front of them is presenting as many have before her. The mind just wants to go there. “Here’s a pattern that I’ve seen before. So I’m going to predict what will happen next.” And in a lot of other areas of life, this might not be a bad policy. But not when we’re talking about birth.

This unpredictability of birth (and our refusal to embrace it) is what trips all of us up when it doesn’t have to. In fact, I would argue that we’re missing out on the most important aspect of birth while we’re busy trying to predict what will happen next.

As expectant couples, you go into birth with a rock solid Birth Plan that you wrote a month before your first contraction. But due to circumstances you could never have predicted, your birth has gone rogue. If you’re still clinging to the plan of your ideal birth (as opposed to participating in your real birth) you’re setting yourself up for disappointment instead of moving through your birth as it unfolds. When you’re able to adopt this attitude of flexibility, you’ll be surprised at what you’re really capable of! “Wow, this is not at all what I expected, but look at us and how we’re handling this completely unpredictable experience together!” It matters how you respond to your birth in real time, as it really happens. Not based on what you had predicted (hoped, wished, or expected) would happen.

As Childbirth Educators and Doulas, we are hurting ourselves and our couples when we try to make predictions about how we think our couples will move through their births. Let’s not prejudge how the people we work with will cope with their labors. Let’s give them all the benefit of the doubt in that they will have births that are, by nature, unpredictable. Let’s try our best to prepare them better for that reality.

As for the L&D nurses and providers who encounter these women in labor and try to make predictions about what will happen next, please understand how much that undermines a woman’s confidence in her ability to know her own body. For the woman before you, it doesn’t matter one little bit how many times you may have witnessed what she’s currently experiencing. She doesn’t need predictions from you about how much shorter or longer her birth might be. She just needs your support and your listening ear – right now. Even the least experienced laboring woman will be able to provide you with clues about what is actually happening in her body. And this is so much more valuable than what you think might be happening in her body.

I completely understand why we do this whole thing of planning and discussing averages and making predictions – all of us are wanting to avoid vulnerability. But vulnerability and birth are inseparable. They have to be. Birth without vulnerability lacks the key ingredient that’s necessary for deep and lasting transformation to occur.

All of us who work in this field should be experiencing that transformation on a regular basis. That’s why most of us got into this whole thing in the first place – the beauty, the mystery, the surprise, the unpredictable nature of birth stirs something in our soul. After each encounter, we should leave that new family feeling grateful we were once again able to witness their transformation – and be transformed ourselves at the same time. This is how we can continue to best serve our families, when we recognize the sacredness of our own work with them and strive to preserve that sacredness for our families no matter how unpredictable their birth ends up being.

There is magic in birth – it’s just not of the 8 Ball variety.

Experienced parents: Did you try and make predictions about your pregnancy, birth or parenting? Did any of them come true? Did anyone on your birth team try to make a prediction about your birth? How did his make you feel?

Comparisons… Why do we do it to ourselves?

Comparison

Comparison is the thief of joy.

So said Teddy Roosevelt, our 26th President. I’m guessing that he was not talking about women and their birth experiences, but this quote absolutely applies to what can happen when we compare our own birth stories with others.

Recently I facilitated a postpartum support group for new parents and their babies. And on that particular day, the group was made up of new Mommas and babies all of whom were younger than six months of age. Some of the babies weren’t even two months old yet! So for these women, their births were fairly recent and I wanted to explore with them their expectations about birth and their actual birth stories to see where they had merged and where they were completely different.

As I imagined, all of the women present stated that their births did not match their expectations at all! But, as I also imagined, this did not mean that they had negative birth experiences. Just births that ended up being very different from what they had expected.

One of the stories that struck me the most was a young Momma who said that she’d had to have an epidural – which was not what she had expected to choose before the birth. She had planned and expected to go through her birth completely medication and intervention free. But what she hadn’t expected was a baby in a posterior position, a really long labor (close to 40 hours from start to finish!) and the intense combination of exhaustion and back pain that led her to ask for the epidural.

In her re-telling of her birth story, I was able to see that this decision to use the epidural as a tool in her labor and delivery allowed her to rest, progress in her labor and eventually deliver her big and beautiful baby boy vaginally. As she was telling her story, though, I could sense some sadness about having to make this decision to use the epidural. I explored this a little bit more with her and what she told me next, made me understand why she was having such issues about her experience and why she was feeling unhappy about how her birth had turned out. She offered this as an explanation:

Out of all of my friends, I’m the only one who had to have an epidural. I’m obviously not as strong as they were, or I would have been able to do this without drugs.

I had to ask a few more questions about her friend’s births before she was able to see clearly and then reframe her own birth story. “All of her friends” were graced with babies who were in the anterior position for labor and delivery, they all progressed fairly easily and ended up with labors that were 12 hours or less from start to finish.

But in her hurry to compare herself and her birth with those of her friends, she failed to recognize what made her story different from theirs. In her comparison, she didn’t recognize just how much more time and work she had needed to put in, and unfortunately this comparison robbed her of being proud of her hard work and effort toward the birth she was working toward. Instead, she only focused on the fact that she had somehow “failed” because she had “caved” and gotten the drugs.

When we spend our time comparing our birth stories to others, we deprive ourselves of owning our own story and finding and celebrating the accomplishment and joy in what we have just done. We’ve brought a brand new human being through our body and into this world! Whether that be through vaginal or Cesarean Birth makes no difference to the magnitude of our accomplishment. Holding up our birth story in comparison of those around us only highlights the details of what they got – and what we didn’t get. When we engage in this negative comparison, we only see our births as less than, instead of all the ways in which it was so much more than. It diminishes our own story. It shrinks it. It makes our birth experience less than the miracle that it was.

This “Comparison is the thief of joy” addiction that we all seem to have starts long before you’re pregnant, and if you can’t get hold of this and start working on weaning yourself off of this addiction, it will follow you straight into the early weeks of postpartum and then into the days, weeks, months and years of parenting that are to follow.

If you’re not careful, you’ll find yourself comparing stories of breastfeeding, baby’s sleep habits, infant development, and one parenting decision after another – until all the joy of having this baby to love and care for and raise into a productive human being has been stolen from you. You’ll be filled with self-doubt about every little decision you make. Your insecurity about making the “right” decision about what pre-school your child should go to will cause you to lose sleep when your baby is only 18 months old – a full year and half away from even being able to attend pre-school.

Stop for a moment and be grateful. Be grateful for the opportunity to have a baby inside of you, growing and developing in that perfect environment that you’ve created without even thinking about it, without analyzing and struggling over just how to achieve it, without comparing it to other women’s ability to create a more perfect environment. Just breathe and be grateful for this new life inside of you.

This little person who is coming to teach you so much about yourself – who you are and what you believe and how you will be as a new parent. Understand that for your baby, there is no comparison.

You are, by virtue of being their mother and father, the very best they could hope for. They will not be spending their time as your new little baby comparing their experience with others.

They will be doing what new little babies do so well – living moment by moment, not worried about what might have been or concerned about what could be better. This is their experience right here, right now. They have no need for comparisons. And neither do you.

Do not let anyone steal your joy.

Did you find yourself comparing your experience with others when you were pregnant? How about your birth story? It’s fun to hear others stories at times, but when it’s a negative comparison, it doesn’t feel too great. Has comparison been an issue for you as a new parent?

Either/Or? How About Yes/And?

Yes:And

During introductions on the first night of class, Janet* sat up, told us her name, and added: “I’m planning on getting the epidural – and you can’t talk me out of it!” She pointed straight at me when she said this and I threw up my hands in mock defense replying, “I’m not going to try and talk you into or out of anything! That’s not my job! My job is to provide you with as much evidence-based information as I can, so you can make the most informed decisions for yourself.”

Her statement was not a surprise to me – most women come into a Childbirth Preparation class thinking that every decision they make about birth is “Either/Or.” Never is this more true than in the case of pain medication and birth. Most women believe that it’s either “Get the drugs!” or “Go without!” I try, when I’m able, to coax them away from this Either/Or thinking toward a more Yes/And approach to how they’ll give birth.

I’m not always successful.

We form opinions in almost every aspect of our lives. Some are based on past experiences, or what friends and family have to say, and sometimes our opinions are based on actual facts and evidence. We tend to read, listen, watch and agree with information that supports what we think we already know. This is called confirmation bias. It makes sense, then, that we might go to a Childbirth Preparation Class unconsciously seeking out the information that already supports our established point of view, while ignoring the information which does not.

This happens all the time with different couples in the same class. As a Childbirth Educator, it’s important to teach from an evidence-based, benefit/risk stance in order to speak to everyone in the room from a place of non-bias. This allows me to hope that when challenging topics are discussed, my couples are better able to take in all of the information – even if it challenges their established point of view – so they can make the most informed decisions for themselves.

I have evaluations from the same class that read: “Appreciated the support of an unmedicated birth” and “Felt supported in my decision to have an epidural.”  Every time this happens, I have two reactions: I’m glad that my presentation seems to be well-balanced, but I’m also a bit puzzled. I’ve shown the same movies, cited the same studies, shared the same stories – yet these two different people have walked away with their two very different perspectives validated. It’s fascinating to me!

It’s also the reason why I encourage my students to have realistic expectations about the birth they’re hoping to have, as well as the actual birth they might end up having. I want to discourage them from ignoring any information presented in class just because it doesn’t line up with their established point of view about birth. If they end up shutting out information that doesn’t support their personal views, there is the possibility for great disappointment as their birth unfolds. This is what happened to Janet.

Janet wanted a very controlled birth experience and was planning on getting an epidural the instant she started to feel uncomfortable. This is not conjecture on my part – she was very vocal about this in class. While I applauded her ability to know herself so well and to be willing to voice her opinion in a class where many others had reported wanting to try for an unmedicated birth, I was also concerned about her hardline stance on this subject.

There are many different ways to increase comfort and the ability to cope with contractions in labor: breathing, position changes, hydrotherapy, birth balls, heat/cold, massage, encouragement, etc. We spend time practicing these techniques. I want every woman in my class to recognize these good self-care practices and learn to use them outside of birth. I also emphasize the need to rely on these methods in the early phase of labor when medication is not a realistic option.

Janet wasn’t very keen on practicing any of these comfort measures – especially the breathing. She would laugh, roll her eyes or talk through every practice contraction. I was concerned that she’d put up a wall and wasn’t letting any other information in. She saw no need to practice any other labor coping tools – she was going to get an epidural, after all. Eventually, I called her on it. “Janet, if you or anyone else in here is choosing an epidural for pain relief, I want it to be the best epidural that’s ever been given to anyone, anytime, anywhere!” And I meant it! “But, sometimes, the epidural is not all it’s cracked up to be and you might really need these tools as back up to continue to cope with your contractions.” I’m pretty sure she rolled her eyes at me.

Fast forward to our reunion together many months later. When I asked Janet to share her birth story, she wasn’t happy. She’d gone in for an induction and was put on a Pitocin drip to try and get her labor to start. Her contractions began soon after and she was making good progress. Her L&D nurse asked if she was ready for an epidural. Janet had shared her desire to get an epidural as soon as she felt uncomfortable, but she decided to hold off for a bit longer. Soon after, her contractions kicked in and she was in hard labor. Janet called the nurse back so she could get the epidural, but unfortunately, the anesthesiologist had been called into a Cesarean and wouldn’t be available for at least the next hour.

Janet’s labor was on the fast track and she ended up progressing from 4 cm to 10 cm in about an hour – all without the medication that she’d been counting on. Because of the induction and epidural, she was confined to bed and on continuous monitoring, so position changes were limited and using the tub or shower for pain relief was out. And because she never practiced the breathing – in or outside of class – this incredibly useful comfort and coping tool was of no help to her.

Janet suffered through her labor feeling helpless as this especially fast and challenging labor overtook her. Because she saw this as an Either/Or decision, she felt like there was no other way to cope with her contractions when the epidural “failed to deliver.”

I really want women to have positive birth stories – experiences where they feel confident and a sense of pride at what they’ve just accomplished. This doesn’t have to be an Either/Or experience. She can feel this way with or without medication and intervention, through a vaginal or a Cesarean birth. But Janet had suffered through most of her birth because she had placed all of her trust in the promise of a perfect epidural. She paid very little attention to practicing the other non-medicated coping techniques because they seemed to be in opposition to her plan of getting an epidural.

Women feel they need to “make the decision” about medication before labor even begins. When it comes to medication in birth, thinking about this as an Either/Or proposition is setting women up for disappointment.

Women wishing for an unmedicated birth, might find that after a particularly challenging and long labor, they need to make a different decision. In the retelling of their birth stories, these women will say something like, “And then I caved and got the epidural.” Like they somehow failed birth by asking for pain relief when it became necessary.

On the other hand, there are women who joke about the other coping techniques practiced in class, thinking to themselves, “As soon as I feel real pain, I’m getting the epidural. I won’t need any of this stuff.” Their disappointment is very real when the epidural doesn’t provide them the relief they were counting on. Now they feel forced to endure contractions without access to other tools to help them cope.

In both cases, the ideal birth story has gotten in the way of being able to adequately prepare for the actual birth story. One is disappointed that she “wasn’t as strong as she thought” while the other “never wanted to be a hero”.

Birth is something that very rarely goes “according to plan.” Preparing for birth means going into the experience willing to be open to all of the information provided (as long as it’s evidence-based!) Especially the information that might challenge you and your established point of view about birth. Women need to realize the importance and appropriate use of coping techniques – medicated and non-medicated – as valid and useful tools that can help them have a more positive birth story to tell for years to come.

So in birth, it’s very rarely an Either/Or proposition as much as it is a Yes/And proposition. “Yes, I have an established point of view about the use of medications in birth. And I realize that I might need to shift my point of view on the day I give birth to reflect what is happening in real time. I will try to remain open to all comfort and coping techniques available to me – medicated and non-medicated – so that I feel best prepared to cope with my labor however it unfolds.”

Did you have an established view about medication and birth? Were your beliefs challenged at all during your pregnancy and birth? When you gave birth, did you have to make a different decision around this particular birth choice?

*not her real name.

The Birth Scale Part II

Birth Scale II

This is a continuation on a piece I published the other day about “A Birth Story” blogpost I read in Longreads. If you’d like to read part 1, it’s right here.

With no judgement placed on the author or her birth story, there are some things that might have been very helpful for her and for anyone else preparing to give birth and hoping to avoid a Cesarean. I share some of them here.

I think the author’s birth could have been helped immensely by the presence of a doula. At one point, the author even acknowledges this by saying, “‘Oh, this is why people get doulas.’ But I was my own doula! I would not forget how to assert my right to a natural, unmedicated childbirth.” But that’s not always possible, acting as your own doula! Especially when you’re in the middle of an extremely long birth, or a birth that has caught you off-guard in its intensity.

A doula could have suggested that they not head to the hospital too soon, she could have given her partner a break, or normalized what was happening for them so that any feelings of panic or confusion would remain temporary and not take permanent hold of the labor. She could have offered suggestions on unmedicated comfort techniques and provided additional support for both the woman and her partner. A doula could have acted as a go-between and an advocate for this couple when questions started to come up and big decisions needed to happen. To feel like there was at least one person in the room acting as her personal advocate, providing her with the tools to move through labor and ask the necessary questions to make the best decisions in real time, might have made all the difference in this birth.

Writing a PCBP (Positive Cesarean Birth Plan) might have also been a help to her when it became a reality that this would be how her baby was going to be born. This is an idea that I’ve posed to all of my students over the years. Me, the woman who really discourages an actual “Birth Plan”, encourages everyone to write a PCBP. It allows you and your mind to go there – to consider Cesarean Birth. You can prepare your mind and your body – not for this inevitability, but for this possibility. When you allow your mind to even consider Cesarean Birth, you can begin to prepare for ways in which you can make this a positive experience instead of a negative one. Your partner has an actual plan to follow if Cesarean Birth becomes necessary. It gives them something concrete to do in an uncertain time and allows you to have some sense of control over a situation that can feel out of control. Writing a PCBP does not mean that a Cesarean Birth will happen to you. Women who are most at risk for having a negative experience with an unplanned Cesarean Birth are those women who never considered it. A Cesarean Birth is still birth. And even if it’s not what you might have wanted or hoped for, there can still be joy, excitement and anticipation of your baby’s arrival if you have a plan that makes this experience as family centered as possible.

In today’s environment, where we have rates of Cesarean Birth hovering at or above 30%, we need to push our hospitals and staff to consider how the management of birth and the policies of our institutions are contributing to that too-high statistic. But we also need to ask how we can work toward bringing down that percentage for ourselves? How can we reduce our own personal risk of Cesarean Birth? Can we have a back-up PCBP in case this is how our baby needs to be born?

Entering labor in the best health possible can reduce your chance of Cesarean Birth. So, begin taking care of yourself – mind and body – even before you get pregnant. Attending all of your prenatal appointments and continuing to care for yourself throughout your pregnancy will help. Taking part in evidence-based childbirth preparation classes that discuss all aspects of pregnancy and birth – not just natural childbirth techniques, but also interventions, medications and Cesarean Birth options – can best prepare you for the birth itself. Letting labor begin on its own, unless there is a medical indication for induction, will lower your risk. Staying at home through early labor and coming to the hospital or birthing center when you’re in active labor can also reduce your risk for unnecessary interventions and Cesarean Birth. If you are wanting an epidural, waiting to get one until you have an active labor pattern well established is an important step. And finally, understand that birth is hard work. Knowing that birth will require all of your strength, both mental and physical, to help you get through your labor should be something that every woman understands before she ever feels her first contraction. Providing the laboring woman and her partner with all the necessary tools, support and encouragement throughout their labor should be standard care in all of our hospitals and other birth settings.

I read this birth story several times, and each time I reacted in one of two different ways. My heart aches for this this woman and any other birthing woman who has ended up feeling like her birth was not what she wanted or hoped for. But it also made me stop to think whether or not I’m doing everything I can to live up to my own tagline: “Saving birth one story at a time.” I need to make sure that I’m doing my part to help women have positive birth experiences.

I taught a wonderful class of students over the weekend – and I wanted for them what I want for every birthing couple I come in contact with: that in the retelling of their own birth story, they are proud of their own participation and feel empowered in their own decision making. Even if, especially if, their birth ends up looking like nothing they would have expected. My hope is that through my classes, women and their partners feel like they’re actually receiving all the tools that they need to feel prepared to participate fully in their births, to ask questions, get those questions answered to their satisfaction and then feel empowered to be decision-makers in their births.

About eight months ago a Momma from one of my classes ended up with an unplanned Cesarean Birth. She realized in her actual birth that the scale that she was using before labor had changed and she used her B.R.A.I.N. throughout to make the best decisions she could for her labor, her baby and herself. She wrote me her birth story, and I want to share excerpts of it here in contrast to the one written for Longreads.

Hi Barb,

So the birth story…I ended up inducing labor at 41 weeks and 5 days. My doctor was fine with waiting two weeks past the due date, but no longer. And I wasn’t comfortable waiting any longer myself. I went in to have the baby monitored twice during that last week and the heart rate was great and there was plenty of amniotic fluid. We opted to induce two days before the two week mark as my doctor was 1) on call for a 24 hour period and 2) I wanted to have the baby before I hit the two week mark….That said, I had been dilating well and was over 4 cm dilated when checked 3 days before we induced. I saw my acupuncturist three times during those last two weeks to help induce labor as well. Jay and I were very reluctant to induce labor but my intuition told me that it was time.

The Pitocin did its thing rather quickly and my contractions started within an hour of induction. (6 hours later) When the doctor arrived I was still at 7 cm dilation…I had been at 6 cm during the last check. The doctor was perplexed though as the baby still hadn’t descended into my pelvis. She also noted that the baby was facing forward and that the head was tilted sideways at an angle… I managed for several hours but eventually asked for the epidural… In hindsight I am very glad I did. In the moment I was also very glad I did. I could sense a bit of disappointment from my doula but I didn’t care…I had decided this was going to be my birth experience and I was going to enjoy it and feel empowered. 

So I labored with the epidural for another 6 or 7 hours and didn’t dilate much more than 7.5 cm. The baby still never descended. The baby’s heart rate was very steady the entire day so there was no sense of emergency during my labor. At about 16 hours in the doctor started expressing concern that the baby was not going to descend properly…they went in with that probe device and verified that my contractions were more than strong enough to push the baby down…therefore had deduced he was stuck.  At that point I was ready for the C-section. 

I was able to talk to Jay, my doula, and the doctor and get a feel for what the procedure would be like. The anesthesiologist was fine with letting both Jay and the doula in the room. All agreed to put the baby on my chest immediately after birth to let him nurse. The operation went great…it ended up being all women (with the exception of Jay and Baby Sean)…the doula took tons of great pictures. The doctor and staff were in great spirits and all were laughing and joking when Sean arrived at 11 pounds!! The doula even told me later that it was the warmest, non-clinical-feeling Cesarean she had ever witnessed. Sean was huge, his head was 15.5 inches in diameter and at the angle he was hitting my pelvis, there was no way he was ever going to descend. In my opinion, the induction was necessary to start labor…but that baby was never going to have been born vaginally. In a different place or era, I don’t think he and I ever would have made it without Cesarean being an option. 

I hope if I have a second child that I will have a successful VBAC, but I must say that the experience wasn’t that bad and that I was grateful that surgery was an option. I have zero regrets.

I was fortunate to experience labor and also fortunate to accept medical intervention when necessary. I look back at my birth and time at the hospital so fondly…when I drive by (the hospital) on the Interstate my heart swells with sentiment every time 🙂

Thanks for listening and for being such a great instructor. Jay and I felt strong and empowered and we owe a large part of that to YOU!!

Steph, Jay & Baby Sean

I include that last line of her story, not to reflect on me as their Childbirth Educator, but so that you can see how she claims feeling strong and empowered for herself. I might have played a part in that, but she knows that I only played a small part. This is the best line in her whole story as far as I’m concerned. I absolutely love this birth story! This Momma was clear-eyed and owned every decision she made throughout her birth. The way Steph gave birth might not have been what she’d wanted or intended to have happen, but she’s still proud of herself and her story. And both Steph and Jay will continue to remember their baby’s birth as a special and beautiful experience. There’s nothing more that I could hope for!

Is it possible to have a birth not go according to plan, but still feel very positive about it? What are your thoughts on creating a PCBP (Positive Cesarean Birth Plan)? When you gave birth, did you feel prepared or not? What would have helped you?

The Birth Scale

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.

Between expectation and reality lies potential disappointment

Expect

What are your expectations for your birth? I have been teaching for 16+ years. That equals thousands of couples, and not one of them has had the birth that they expected. Don’t misunderstand me, they haven’t been disappointed necessarily, they just didn’t have a birth that went “according to plan.” I’m concerned about the gap that exists between expectations and reality – especially when it comes to giving birth.

When I first started teaching, I was a cheerleader of the almighty Birth Plan. I wanted women to declare what kind of birth they were wanting to have and then go out and achieve that exact birth. But at our class reunions, each one of the women who were anywhere from 6 weeks to 3 months postpartum would give the same answer to my question, “How was your birth?”

“Well, it wasn’t what I expected, that’s for sure!”

After hearing this a few hundred times, I had learned to not write a birth plan for myself when it was my turn. It made sense to me to go in with zero expectations and no real written birth plan so that I wouldn’t end up disappointed in a birth that went “rogue.” Don’t get me wrong, I definitely had my own idea of what I wanted to occur. My ideal labor would have been one that had no medication and no interventions – one where I would grunt my baby out and go home a couple of days later. That is definitely not what happened for me. But somehow, because I’d not written up a lengthy birth plan and went in with pretty broad expectations of all the possibilities, I wasn’t disappointed. I found that I wasn’t wedded to any particular outcome and this allowed me to remain flexible and ready to make decisions on the fly. 

Easier said than done. I’m concerned that some might misinterpret that I’m suggesting women forego the birth plan altogether and just be happy with “whatever they get.” But nothing could be farther from the truth! I want women, all women, to have a positive birth experience. I want them to be able to tell their birth stories with a sense of pride and satisfaction in their voices. I want them to feel confident and secure in their new parenting abilities – and this begins at birth.

But what also begins at birth is the roller coaster ride of parenting. Talk about something not going according to a set of expectations! You might have expectations about how breastfeeding will go, or how much your baby will sleep at night, or what their temperament might be. Guess what? You can have all the expectations you want about this stuff –  and “Que sera, sera!” translation: “Whatever will be, will be!” The same is true for your birth. 

I had a reunion this past weekend and 5 couples were able to make it. None of them had a birth that went according to their plan or set of expectations. Two of the Mommas had been wanting a medication free labor, and close to the end, changed their minds and got an epidural. One Momma had been fully hoping for an epidural but as a 3rd timer, her birth went unexpectedly fast and she ended up going medication free. And there was still one other Momma who had been hoping for a vaginal birth with little or no interventions, but ended up with an unexpected Cesarean after many hours of pushing.

Despite none of them having their “ideal” birth, as each one told their birth story, they were smiling. Their eyes were shining as they spoke of this most important day of their lives. They weren’t dwelling on what didn’t go right, but instead celebrating what did go right. Their expectations of birth were broad going in, they focused on those things that were under their control and made the best decisions they could in the moment as birth unfolded. As I held each one of their babies in turn and listened to them speak, I followed up with a couple more questions.“Was it what you expected?” And to the woman, they all said, “No. Not at all.” But then I followed up with, “Was it a good experience for you?” And each of them replied, “Oh, yes.” Some of them are already considering baby #2!

Having an idea of what kind of birth you’re wanting to have is very important because it will help you to find the right provider and the right place to give birth. It will help you understand the level of participation that is required of you. It will encourage you to avoid interventions unless they’re medically necessary. But more importantly, it will allow you to engage your provider in open, honest dialogue about the birth of your baby. It’s through this dialogue that you gain the most benefit. Dialoguing with all the members of your birth team, as opposed just handing them a written birth plan, creates connection between you. It’s also an opportunity for them to know what your hopes and fears are around giving birth. It gives them insight into any specific or particular concerns you might have and provides them with ideas of how they can best support you.

Once you have built that mutual trust with your birth support team, you’ll really start to feel like a team. All working together as birth unfolds so that you can make the very best decisions possible for yourself, your baby and your labor.

Birth happens – and then you’ll tell your story. Little or no expectations of having the “perfect birth” will free you up to recognize what’s happening in your birth right now and allow you to adapt better as it unfolds in real time.

You can still have a positive, empowering birth experience even if, sometimes especially if, your birth is not tied to a specific set of expectations. When you realize that birth is too big for an 8 1/2 x 11 piece of paper, you’ll find yourself relying more on your birth team, digging deeper than you thought you could, and embracing the vulnerability that is birth.

Your birth can be so much more than a rigid set of expectations about what is and what isn’t a good birth. Open yourself up to all the possibilities that birth holds for you. 

What if you wrote out your Birth Hopes, Birth Wishes or Birth Desires instead of a Birth Plan? How does switching that word up make a difference? If you’ve given birth before, how did your reality match up with your expectations? How big was the gap?