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?