Wednesday, February 03, 2010

Necessary/Unnecessary: A round of birth stories

The fourth Lamaze Healthy Birth Carnival about "avoiding unnecessary or routine interventions" is about to begin and I hope I'm not too late! I have several birth stories to share, all featuring long, exhausting, non-progressive labors.

Paxye, a mother of four, recently wrote about her first two births. Both began in birth centers in Quebec, and both were very long, posterior labors. She transferred to a hospital after a day and a half of laboring and very nearly had a cesarean with her first baby--the only reason she didn't was her persistent refusal and her son's birth one minute before the absolute deadline her doctors gave her for a vaginal birth. Her second labor followed much the same pattern, but she insisted on staying at the birth center and, with a very supportive midwife, gave birth on her own power. Her third birth was a planned unassisted birth, one that went very smoothly and quickly compared to her first two. A year after that birth, she wrote about why she chose unassisted birth. She just gave birth to her fourth child and first daughter Wilhelmina. It was a long, stop-and-start, posterior labor like her first two births. She commented:
As I grew in my knowledge and my confidence the stories show a progression. The first ended up being a hospital transfer and a whole array of interventions short of a C-Section, but only because I would not consent. The second, with me refusing the transfer and staying at the birth centre but still with more intervention than I would have liked and then finally my second unassisted birth [Wilhelmina], which resembled the first two labours, yet I had all of the control.
Jenne's first birth, a planned unmedicated hospital with CNMs, turned into a traumatic ordeal when she had a long period of "failure to progress" early in labor at 3 cms. She wrote about this birth for the Lamaze Healthy Birth Carnival #4. In her words:
I was bullied, harassed, threatened and manipulated into accepting pitocin augmentation and AROM. I knew it was not necessary and I felt no need--physical or emotional--to speed up my labor. I was coping well and was trusting the natural process that birth is.

Eventually as I was so adamantly refusing to consent, I was summarily kicked out of the hospital. I say it that way because there was no gentleness or supportiveness in the attitude of the attendants. They used it as a threat to get me to cooperate. When I didn't, they rudely told me to leave and left it at that.
You can read the full birth story here. This birth was so traumatic that she developed PTSD. Jenne has also channeled those negative experiences into positive action; she helped found the support group Solace for Mothers. Jenne gave birth unassisted to her second baby about a month after Dio was born. She recently revisited what birth means to her, if you're interested in reading that.

Amy Romano's sister Katherine just had a homebirth-turned hospital transfer-turned c-section. She wrote about the labor and birth in the post my lovely c-section. She labored at home for a long, long time and finally decided to transfer after no cervical progression. She tried an epidural, pitocin, and sleep to see if that would help her labor pick up. Eventually she chose to move to a cesarean section and, although it was the last thing she had planned for, she felt very positively about her decision.

And, if you've been reading my blog, you heard about my sister-in-law's birth in Failure to progress or reason to be patient? She wanted an unmedicated birth, but after a marathon labor and several hours of no progress past 8 cms, she chose a few interventions. After 8 hours of no progress, she tried AROM and an IV for hydration. She gave it another 2 hours and, when she was still 8 cms dilated and starting to fall asleep standing up, she chose an epidural (to help her sleep) and Pitocin (to augment the contractions). That did the trick, and she gave birth vaginally just a few hours later.

So I've been mulling over the question "what makes an intervention necessary or unnecessary?" The prominent theme in these four sets of birth stories is that the women who felt the interventions were necessary and welcome (Katherine and my SIL), rather than unnecessary and traumatizing (Paxye and Jenne), freely chose the interventions on their own--on their own request, on their own timetable, and on their own initiative. They knew it was time for assistance. They were the primary actors in their births, rather than recipients of others' agendas. They held the locus of control, even when that meant asking others to do things for or to them at some point (IV, epidural, Pitocin, or c-section).


  1. I love this view of birth -- emphasis not on whether someone "succeeded" or "failed" at having the perfect "unassisted" or "unmedicated" or "natural" or "safe" birth, but that it is most rewarding and satisfying when the woman in question is in charge, not the doctors, not the "unassisted-or-bust ideology" (if that exists), but the woman herself.

    In wanting a more natural birth this next time, my overarching goal is to just be more in tune, more in control, more responsible and prepared and aware -- however it turns out.

  2. I experienced necessary (in my opinion) interventions with both my births.

    My first birth I was hoping for an unmedicated vaginal delivery. Instead, SROM at 1 cm to thick, thick meconium, and baby's heart rate in the 50s lead to an emergency c-section. She had aspirated meconium, both her lungs were collapsed, and she spent the first few days of her life on oxygen to heal her lungs. There's no doubt in my mind she would never have made it through labor and a natural delivery alive.

    My next birth I was again hoping for an unmedicated vaginal delivery. This time, almost 40 hours in labor with only 3 cm progress, SROM, labored another 4 hours with 1 cm progress, finally got an epidural so I could sleep. A very low dose of pitocin, progressed 6 cm in the next 4 hours and after 30 minutes of pushing my son was born vaginally. I couldn't have made it through labor without the epidural. I was falling asleep sitting up while they tried to place an IV because I was SO tired.

    Having experienced both, I would never choose a c-section, but that birth did open me up a little to the fact that sometimes, like it or not, interventions are necessary. We'll see how things go next time:)

  3. freely chose the interventions on their own--on their own request, on their own timetable, and on their own initiative.

    This sums it up for me. Obviously I wanted a very low intervention birth because I chose homebirth, but I was not unhappy when I had a c-section (well, not much). I remember when I spoke to my mom right after my daughter was born, she asked, "Why did they make you wait so long (for the c-section)?" I told her, "No, it wasn't them, it was me. I chose to wait."

    My baby's position (foot by head, knee bent backward) pretty much necessitated a c-section. But, not knowing that, I had to do exhaust all other options before I felt okay with consenting to surgery.

    Looking back, I'm even more comfortable with my decisions because I know I can have a vaginal birth next time. I made it thru crazy painful back labor for several hours, dialated fully and learned how to push. So, as long as the next one isn't practicing yoga in the womb, I can do it.

  4. I absolutely agree with this point of view of the woman being the primary authority over her own birth. It only makes sense (to me, anyway) that women are taught to see everything surrounding birth (even interventions) as tools at their disposal.

    My desire is to equip women to understand the use of the tools, and when/how they may need to use them OR refuse them.

    Thank you for a great post!

  5. Yes, yes! Though I longed to have an unmedicated water birth in a birth center, and felt afterwards that there were things we could have done to help that become a reality, the truth was that in the moment (stalling at 7 cm with an anterior lip, double peaked contractions, and an urge to push), I believe that the epidural and a bit of pitocin were necessary interventions that saved me from a c-section. Immediately after the birth I felt *empowered* and radiant, because nobody had pushed or bullied me into anything. I had been my own advocate, and I felt like we had tried everything we could considering the circumstances. I will try again for an unmedicated birth - and I have to say this time I have even more confidence in my body & excitement about labor, even though I wasn't "successful" the first time.

  6. Great post. I haven't yet read the birth stories, but I'm about to.

    I had a question for you, Rixa. I'm not sure if you'll have an answer, as this question is just sort of a result of my time as a Doula and an avid birth story reader. Do you know if there are any studies on the correlation between uneccessary interventions and birth partners? In other words, for women who want natural births, but have partners, parents, siblings, friends, etc., present with them that don't necessarily fully support this choice, do you find that there seem to be more interventions?

    I ask because although I do believe that in hospitals particularly, there is a lot of bullying that takes place by hospital staff, in addition to pressure, threats, etc., to receive certain interventions, I find that oftentimes, the most pressure comes from those who are present that are scared, nervous, or simply don't believe in birth as a non-emergency.

    I feel pretty strongly about this, although I've not really read any research to back it up. For my upcoming birth, I am not having one particular person (who is very close to me) present, simply because of her worry, panic, and fear that my choice to birth at home is a bad idea.


  7. Rachel, I don't know of any research on this but I wouldn't be surprised if it did exist. I do agree that you shouldn't invite people to the birth who will not be supportive.

  8. "...freely chose the interventions on their own--on their own request, on their own timetable, and on their own initiative. They knew it was time for assistance. They were the primary actors in their births, rather than recipients of others' agendas."

    So eloquently put, Rixa!! This sums up why I, after having an elective c-section for a persistent breech baby, was able to emotionally heal and not be devastated by having had a c-section. I called all the shots. I tried every technique in the book to try and turn our baby. I sought out having a vaginal breech, but couldn't find anyone locally with experience. I had a very specific "Mom/Baby-friendly c-section plan" and I made certain my OB was 100% supportive of it. He honored nearly every request I had and fully supported my decision to await spontaneous labor. He even fully honored my request to delay our baby's cord-cutting! Amazing. (I love looking at the photos from my birth where you see the entire surgical team patiently waiting for my baby to continue to receive her own cord blood before cutting!) And my request to have the surgical drape placed low enough for me to hold our baby during surgery was also honored. Your quote is exactly how I felt. I called the shots with this birth, and even though it was a c-section, nobody coerced me, nobody bullied me or manipulated me. I felt nothing but respect and love.

    I am firm that should I ever have a persistent breech baby again, I will make certain to find a practitioner with vaginal breech experience. However, I have few regrets about my most recent c-section birth. You're so right: I was "the primary actor in my own birth." :)


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