Sunday, October 25, 2009

Thinking, no conclusions yet

I like reading things that make me think, hard. That make me examine my assumptions and evaluate what I'm doing and why. Things like one day in a life by Sweet & Salty Kate. I have a lot of complex responses to her post.

I fall somewhere inbetween the "you can't plan or control anything; birth is just one day and mothering the baby afterwards is the most important thing" camp and the "your birth is the most important event in shaping your life as a mother" camp. I think it's because birth itself is so complex and multi-faceted. There's the unpredictable, wild, ferocious nature of birth--sometimes generous, sometimes harsh and unforgiving--that we can never adequately plan or prepare for. That's where Kate, and many of her fabulous commenters, are coming from.

But there's also the reality that certain choices generally--not always, but often--lead to certain consequences. If you choose an elective induction at 38 weeks with a closed cervix...chances are you'll end up with a highly interventive labor and a c-section because of the failed induction. If you seek care with a midwife or physician who has a low cesarean and intervention rate...chances are you'll have a smooth, uncomplicated, spontaneous labor and birth. If you seek care with a busy OB practice with an assembly-line approach to pregnancy and birth...chances are you'll be sent down that assembly line too.

But in all of those cases, there will always be exceptions and surprises. And there's where it can be so hard to make any kind of generalization about birth. Because there are women who have elective inductions at 38 weeks with a closed cervix and their baby pops out after a quick labor. Because some women will have highly complex, complicated births even when they're planning for it to be as natural as possible. Because some women are extremely satisfied with their assembly-line care and rave about how fantastic their OB was. So whenever you try to say anything definitive about birth, someone will always pop up with an exception.

In Jan Tritten's case, the sentence that prompted Sweet & Salty Kate's post was poorly worded. I understand, though, why she might have said something like this. After all, her life's work surrounds birth. She's a midwife and editor of Midwifery Today. In her world, birth is highly significant, often the pivotal event in a woman's life.

I was wondering: how would I say that my children's birth ranks in importance in my life? It's hard to quantify. My own journey wasn't just about "the birth," but the entire process of thinking and researching and planning--not just for the tangible, physical birth itself, but also for the spiritual process of becoming a mother. I deeply treasure the memories of my children's births. I love that my labors were experiences predominantly of love, peace, and calm. I love that I was able to meet and overcome the challenges of labor and birth and find strength in other areas of my life, knowing that if I could give birth to a baby I could certainly do ___ (run a half marathon, finish my dissertation, etc).

Making a woman's birth as positive and empowering and enriching as possible is important. Why not strive to make every birth as good as it can be? Why make anything unnecessarily difficult or painful or traumatic? But of course giving birth isn't the one definitive moment for all women, even though for some women it is. If you speak to the women at Solace for Mothers, you'll learn how a traumatic birth experience can haunt someone for years. If you were at the International Breech Conference, you heard women still deeply affected by their birth experiences, years after the fact.

So how do we reconcile the complex natures of birth--the parts that you can't plan for, and the parts that you can?


  1. Interesting.

    I had my UC more than a year ago. During my pregnancy, it was my "BIG GOAL" and my DREAM, my total focus of my pregnancy. Then it happened, and it was THE BEST DAY in my life. I had never felt so real, close to God, a true woman, etc...

    And now, more than a year later, it's almost like I couldn't care less. It seems so long ago. Our life has moved on and I don't get excited about birth anymore (I rearely read this blog now). I don't care to brag to anybody that I delivered my own baby. It just doesn't matter anymore.

    So did it matter at the time? Heck yeah! Did it motivate me to take better care of myself during pregnancy? Yup (even on a psychological level--a whole lotta growth happened during that pregnancy!) And do I still believe my daughter is far more balanced and secure as a person, compared to my older son, because of it? (because of the UC perhaps indirectly--because of my state of psychological health) YES.

  2. Very interesting. I might have to blog on this myself, it's stirring up lots of poignant thoughts. For me, both of my children's births were very important, indeed pivotal, points/experiences in my life. I would not say it is an important part of their childhood or even my motherhood, but my LIFE. I guess that's because I don't often seperate my pre-parenting days and my parenting days. It's just another piece in a long chain of connected parts of my life.

    I often hear that birth becomes less important as the years follow it. I guess that's what happens with any major life event, though. If you win a prestigious award, naturally you'd be talking about it for a while...but if you're still talking about it all the time five years later, that'd be a little odd. It doesn't mean that winning the award wasn't an important part of your life, though.

  3. I suppose the question is, what if you'd had an abruption with Dio that required hospitalization and perhaps other medical interventions to save your and/or Dio's life? Would you be any less of a mother to Dio than Zari?

  4. Rixa, I'm where you are. I've been mulling it over since Molly posted it on Talk Birth.

    I keep writing stuff in this comment box and deleting it. To be continued...

  5. I am having such mixed feelings when reading this blog lately. A week ago, I had a crash section for a footling breech baby - he was lying oblique, he wasn't engaged, but when I checked myself, I could feel him cheerily trying to shove his feet down when I was little more than 4 cm dilated. My local hospital are very supportive of vaginal births of rump breeches - and I'd have happily gone that route - but they told me honestly that nobody there was willing to hazard delivering a footling breech. As it turned out, there was no time to get him turned - they diagnosed his position at thirty-six weeks and change, and I went into labour at thirty-seven weeks on the dot.

    I spent my pregnancy keeping myself fit and well, drinking my raspberry leaf tea, sitting on my exercise ball, doing my pilates, and taking hypnobirthing classes. I chose a doula I liked and trusted (who was actually brilliant through the whole thing, and let me have a good weep all over her afterwards), and chose a hospital known for its 'quirky' midwifery-centred approach. In the end, though, the birth I got was not at all the one I'd hoped and planned for, and it's hard for me to point to anything I did or did not do as leading directly to this birth - I feel as if the one decisive call I got to make was dialling for the ambulance once I felt that cheery little foot pushing down through the membrane.

    I've got to say, I really hope this birth WON'T be a pivotal or shaping experience for either of us...

  6. I don't know how to reconcile the complex nature of birth. But I do believe in its importance in a woman's life. Women are divinely created to be mothers. I believe that a mother should feel fulfilled in all aspects of her calling. It's hard to say that, though, because mothering IS so complex. you've made me think -hard.

  7. Tamsyn: my pregnancy and birth experience were similar to yours. Planned homebirth, turned hospital transfer, turned c-section due to my baby having her foot positioned by her head and knee bent backwards.

    I was disappointed I didn't have a home birth, and I was very angry about the c-section pain. But, I have been able to accept the c-section as necessary due to my baby's positon.

    What I found interesting was how much more open minded I am about hospitabl birth now. I still will plan a home birth for my second child, but the hospital wasn't as bad as I thought it would be. This particular hospital is very mother and baby friendly, and because I was well informed and had my midwife with me acting as a doula it was a relatively good experience.

    So, I guess for me, the experience is important, but the key to having a good experience is being well informed so I don't have unecessary interventions. Necessary interventions, however, are welcome and don't negatively impact my view on the birth and mothering.

  8. Labor and Birth is a definitive moment in every woman's life. It is not necessarily the hinge on which all self-realization swings, but it is a catalyst for so much in our lives. I can tell you that I was so so proud of myself, and learned so much from myself, with each of my births... but now, years from my first, my first birth ITSELF is not that monumentally pride-inducing. It is more the lessons that I learned through it that I have brought with me and applied in life.

    I see the process of labor and birth (or even delivery - a cesarean has much to teach us about ourselves as well) as a journey to helping us realize our strengths, weaknesses, and potential strengths and weaknesses. We can realize these things through any large life-changing event, labor and birth just happens to be one such that most women experience, and thus, can take advantage of.

    When I work with a woman who has to deviate from her hopes and dreams for her labor and birth, or when things happen outside of her control, it is about helping her to still be the choice-maker, the one making the turns through her journey to holding her baby - when she can own those choices, no matter what they are, she is more apt to experience a REWARDING (even if not necessarily "great") birth experience. An example is the birthstory of a momma I worked with( who wanted, more than anything, a VBAC, and was not able to achieve it. She was said she was disappointed in not getting her VBAC, but so happy with herself.

    What she learned from that birth helped her heal from her last birth experience (though the delivery route was the same) and gave her a glimpse of herself and what she can do even when faced with the unknown and adversity.

    Every Birth teaches us, and the more I witness these women work through difficult choices I realize that it is less about the birth and more about the choices and the lessons that the act creates...

    So.. I understand the MW - and I understand the Mother... and I honestly think they are speaking the same truth.

    I used to be adamantly NCB - now I am adamantly WOMAN. (I hope you understand that it doesn't change my POV on NCB and birth options - but... I digress). Have I rambled enough?

  9. I would like to leave giant ditto marks here ____ under Nicole's comment.

  10. I was thrown headfirst into the world of natural vs. intervention-heavy childbirth when I found out 8 months ago that I was unexpectedly pregnant with my first child. Since then I've been dealing with the contradiction of what I keep hearing from NCB advocates and what I can actually get from the doctors I've been seeing -- yes doctors, because there were no midwives in the first town I lived in during my pregnancy, and then when I moved across country at 34 weeks, no midwife would take me that late in the game. I've come to the conclusion that childbirth is no different from the rest of our lives -- you have to decide what is important to you, what is worth fighting for and when it is just time to let go. I am much too tired at this point to fight for all the things I've been told I'm supposed to fight for, because once this is done, I have to be a mother, too, and a wife, and a daughter- and sister-in-law as we live with my husband's family while his mother battles cancer. So yes, I believe that my baby's birth will be *a* defining moment in my journey as a mother, but like the rest of my life, there are only so many aspects I can control, and I refuse to give myself any more anxiety attacks over a less-than-ideal birth experience. Not quite an "all that matters is a healthy baby" perspective, I suppose, but more of a "Life is unpredictable and while I can make certain choices to get what I want, I can't control everything and my highest priorities are my baby's health and mine, both physically and emotionally" philosophy. And if my emotional health depends on being able to accept a birth outcome I didn't want, then so be it.

  11. Something I didn't think to say in my own post about this a couple of days ago (maybe I should go back and add it), is that it isn't necessary to have a "good birth" to have it be a pivotal or life-shaping moment--we learn more from triumphing over difficulty sometimes. In a lot of the posts I read on the subject and in my own post, an assumption was and that only if the birth was empowering and wonderful did it qualify for "most important event" status.

    In my own experience, my "shaping" event was struggling through postpartum with my new baby--I think because it was so difficult for me, that is why it stands out as THE event, opposed to my children's births (which were empowering and triumphant, etc.)

    Hmm. Maybe I won't add this to my own post after all, because I don't know if I'm getting across what I'm trying to say!


  12. I read the links and was surprised by sweet and salty's reaction to the little blurb because I didn't take it that way. Reading the rest of the paragraph I think the sentence (in context) is saying how important it is that a woman is nurtured during her birthing year.

    I found it to be more of a slam on care providers than on mothers.

    It reminds me of one book I read on NCB (I can't remember which one) that said that a labor and delivery nurse, a midwife, an OB cannot allow themselves to have a bad day. Everything they do and say on this pivotal day will have consequences. If a care provider actually believes whole-heartedly that their words and actions will echo for years they will treat every pregnant woman very gingerly.

    My mother told me that the nurses were so condescending and irritated with her when she went to the hospital in labor with her first baby in 1976. It did affect her confidence in mothering.

    I can't remember where I read this but another woman said that she was so happy with the birth and her new baby until a nurse came to her room and scolded her for giving the baby too much formula because the baby spit up. Suddenly she lost all confidence and shut off her mother-instinct because she thought it was flawed.

    On the flip side, we can heal from the most heinous injustices done to us. But just because we are strong and we do become stronger when we face adversity, that does not mean that it's a good idea to sign up with a care provider who is "just doing his job."

    I was not nurtured during my first pregnancy and it ended in a c-section. It wasn't the c-section that was the problem, it was everything before. I wish I could say that I rose above it all...and successful breastfeeding was a huge confidence booster and help to trust myself as a mother, but I've made so many mistakes with my first-born. I'm still not sure if that was due to not being nurtured or just being a first-time parent who was way too uptight. I wish I had let her exert her independence more and much earlier.

    My second pregnancy I found an awesome group of people to support me and tried to fix all of the mistakes that led to the first c-section...and ended up with another c-section that actually sucked more than the first one. However, the baby will be 15 months in a about a week and I'm still blissfully in the middle of my babymoon. (happy sigh)

  13. I love this post, Rixa. Thanks for your thoughts. And I've enjoyed some of the other posts around the web on this topic, including Molly's at Talk Birth.

    My own point of view, and one that I see as a theme in most of the comments here, is that it's less about *the birth* and more about how women are cared for and supported in the birth that affects women and babies so profoundly. Safe, humane care and excellent support are so critical in preventing both physical and emotional trauma.

    I wrote a post a while back on similar themes (after the Denis Walsh hub-bub when he was quoted as saying women should forego epidurals). I wrote about the research that shows that doula support in labor and keeping moms and babies together after birth have long-term benefits for maternal-infant attachment *irrespective of* whether the woman had an epidural and/or a cesarean.

    This is one of the reasons I am so supportive of Lamaze's Healthy Birth Practices because they can be adapted to so many less-than-optimal circumstances while simultaneously increasing the chance of an optimal outcome (safe vaginal birth with no or minimal intervention).

  14. This made me pause and really think.
    Here is my response.

  15. I never thought I'd say this, but I have to agree with the commenter who said that the actual birth and the feelings that went with it fade as time goes by. The reason I never thought I'd say that is because for 8 years I was very wrapped up in birth and pregnancy and newborns and all of that. I revelled in the homebirths, and accepted the hospital births. I laughed at and got worked up about the funny moments, and tried valiantly to forget the painful ones.

    Now that I'm finished birthing babies, birth is no longer an issue to me. I'm always happy when I hear that women are thrilled with their births and sad when I find out they're not, but my own birth experiences don't seem to have as strong an influence on me as they used to do. Perhaps that is because I am now completely immersed in the day-to-day parenting of four kids, and trying to figure out how to help them in their futures.

    I'm intrigued by the differences with which each of my children came into the world, but I'm even more intrigued with the differences in their personalities and the ways they take life on. Parenting is an amazing, exciting, terrifying, thrilling, frustrating, fabulous ride. Kind of like birth, but now we're dealing with the rest of their lives instead of one single day.

    It was quite a post.

  16. Glad to prompt thinking. That's always a good thing.

    Your post is lovely and reasoned and sensible, and I agree with all your points - it certainly applies to normal birth. (I don't mean to be patronizing there - bear with me.) It applies in cases where there is a choice. In cases where the child or the mother's life is not in imminent danger. Then, of course, we would all opt for an experience that felt empowering, and on our own terms, whatever those terms may be.

    My issue is how rhetoric like Jan's creates a dangerous flip-side for women deprived of choice by necessity. On her blog Jan has said "homebirth is the gold standard", which is so overly simplified and exclusionary it's no better than a doctor claiming the same of hospital birth. And in the post I referenced, she insisted that birth is THE moment that defines our motherhood. She describes hospital births as "horrible" and homebirths as "miraculous". It goes on and on. I appreciate what she's trying to achieve, but the language she uses is false, irresponsible and divisive.

    I agree with you. Women need to be supported in adapting to all potential directions of birth. But not in an atmosphere such as this, which generates only one of two acceptable post-labour mindsets: the victorious homebirther, or the traumatized victim.

    For some women, birth *should* pale in comparison to what comes after. It must. It has to be shaken off. All that meaning heaped upon it, all the condemnation, the feeling of robbery. It can't - and shouldn't - matter that much when things go 'wrong' with the method. Perhaps an unwanted c-section. Or in my case, much more gone wrong - twins born three months early, and one of them suffering brain surgery and heart surgery before a death at six weeks old.

    My twins' birth was a crash c-section that had doctors sprinting me on a gurney to an OR, knocked out completely in order to save the life (by seconds) of the one twin who survives today. It was a nightmare. I'll be fine. On that day, I was inconsequential. It was required of me as their mother.

    Despite having witnessed the suffering and death of my child, I've had doulas and midwives scold me for being "too outcomes-focused". Which pretty much leaves me flabbergasted, feeling like this gulf between misfortune and fortune is not navigable.

    Thank you for not doing that. This was a thoughtful and lovely post, and I appreciate that you shared it.

  17. I have so many thoughts about this all!
    Wrote a blog post because the comment would have been too long LOL and this is just a first impression. I still need to read it all thoroughly.

  18. sweetsaltykate--one of the things that jumps out at me about your story is "On that day, I was inconsequential. It was required of me as their mother." It reminds me of something I found deeply meaningful from the book Transformation Through Birth (I'm paraphrasing): "a cesarean is a tremendous act of personal courage." I think this is true--not a cop-out or non-miraculous, but an act of personal courage. This is also related to what I meant about birth (sometimes) being a pivotal life event whether it is a "good" birth or a "traumatic" birth.

    Best wishes,


  19. Here is the issue; birth transforms us.

    Right? Is that in dispute? Physically and mentally, it's a big deal for us. Whatever comes after.

    But then, so is parenthood. And the first death we suffer. And our first kiss. And hard-won accomplishments outside of birth.

    What weight we give to each of these things is up to us.

    In Kate's situation, which I will freely say I could not possibly comprehend from outside, where that weight falls is going to be considerably different from a woman who does not suffer a catastrophic birth and loss of a child. It seems logical that all your goalposts would be in completely different places.

    What the tension seems to be here, is the one side that many of us are on that pushes, saying "We must fight for this to be better. Bad things are happening because they are not better, like higher mother and infant mortality. And birth is important to how a woman sees herself, as well. This matters. Women's needs in birth, their thoughts and feelings, matter."

    And on the other side, the women like Kate who have gone through a wholly different fire, saying "We have had different choices to make, that were more important. Don't presume that your definitions regarding birth apply to our experience."

    What I think the two sides have in common is that we are touching on deep deep veins of feeling about our own wholeness, our identities, and how we find that wholeness. And that maybe is why we sometimes seem to talk past each other.

  20. I actually really liked her post. I think it's easy to get carried away with "the cause" and to forget that birth, while imminently pivotal, IS a doorway. It's the beginning of something just as much as it is the end of something. The moment in and of itself, as powerful and defining as it may be, is the transitional moment to something that will define you, moment by moment, for the rest of your life. The birth itself is important, yes, but it's not THE ALL. Her perspective was a good reminder that we can wound very deeply even while we are trying to fix something that has been broken.

  21. When I was a small girl my Mom had a poem on her bedroom table. It said "God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference." Your post reminded me of that poem. It is something I still think of daily.

    Birth matters. I hear women tell me their birth stories all the time. Even women in their 80's remember certain parts of their birth that they want to share with me. It is a very interesting journey.

  22. Pinky, this reminds me of something someone told about Penny Simpkin. She was doing a doula workshop I think, and maybe it was in a nursing home or somewhere where there were elderly people, or someone's mom was there, I don't remember, but she said that this elderly woman had been listening to her talk and finally got up and very lucidly related the birth of one of her children. She was 80 yo. She remembered every single detail.
    I think the account is on the DONA doula video. Pretty impressive.

  23. I found this post and all the comments very interesting. I'm a mother and a midwife and I feel passionate that the actual birth experience does matter. I have spent the past 9 years researching women's experiences for my PhD with Professor Kathleen Fahy (at Newcastle Uni in Australia). My focus has been on how women's embodied self changes during childbearing. The 14 stories I collected for the research give a very detailed picture of women's experience before during and after birth. I've recently published them (called 'Feelings of change: Stories of having a baby' available from ). I don't give any commentary with the stories because they are pretty long the way they are, but I plan another book that shows my findings.

    Briefly, here are some of the findings from my PhD (cited below). My findings indicate that any woman can experience an improved sense of embodied self as a result of childbearing generally and childbirth more specifically. Embodied self change that is most empowering occurs when a woman uses her own power during labour and birth. This process of change is facilitated by a sense of self-trust and by being inwardly centred. A woman’s improved embodied self is then manifested by an increased awareness of and capacity to use her inner strength. This has the consequence that a woman who experiences a sense of improved embodied self feels more confident in dealing with other challenging life circumstances. I therefore conclude that when a woman uses her own power during labour and birth she is most likely to feel an improved sense of embodied self during childbearing.

    Parratt, J. (2009) Feeling like a genius: enhancing women’s changing embodied self during first childbearing. PhD Thesis. School of Nursing and Midwifery. The University of Newcastle, NSW, Australia
    Parratt, J. (2009). Feelings of Change: Stories of having a baby. Raleigh: (available from )


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