A beautiful, sunny, winter day stretches before me. I am shutting down my computer, and living in the real world today. I am going to clean my house, walk in the woods with my family and doggie, and make a nice Sunday dinner. Days such as these are precious. May you savour today, and cherish your blessings.
I am just home from a lovely VBAC, which couldn’t have happened to a nicer family. I believe it is going to generate a lot of healing.
I get a perverse thrill when I have lady have a VBAC that defies medical expectation. Her primary care doctor was a family physician who is a huge supporter of VBAC, and was very much on her side. But the Obstetric team needs to be involved with a VBAC as well in this hospital, and while it provides a safety net, it also creates some tension. The team came into the room and laid out the stats and the way they wanted things to progress in order to avoid a repeat section. Now, I know they were just doing their jobs responsibly, and the way in which the information was relayed was kind, positive, and supportive. But there was also a pressure to perform. Birth doesn’t always respond well to performance anxiety. I worry that when something is held with an expectation to fail, the energy can have a tendency to follow that thought, and I have to work hard to buffer that vibe and keep a reasonable amount of faith going.
One thing doctors are very concerned about is obstructed labour. Of COURSE they are, when they are responsible for a woman and baby’s health. It is true that an obstructed labour can increase the risk of uterine rupture during a VBAC attempt. But what this translates as is this: “If you don’t follow the curve in a timely manner, we will diagnose obstructed labour, and you will be sectioned to circumvent disaster.” As we’ve already discussed in past blogs, Friedman’s Curve drives me bonkers for a variety of reasons. Is a VBAC labour which doesn’t go along with the curve TRULY and ALWAYS obstructed?
I ask this because one thing I have witnessed with VBAC, and I have attended MANY VBACs, is that it is actually normal for there to be “stalls” here and there, even more so than in regular labours. Just to throw out a number, but I find it is not uncommon for a woman to hang out at 5cm or so for awhile (though this number is arbitrary..I’ve seen it at 2cm, as well as at 9cm). Sometimes for quite a long time. Instead of this being automatically construed as a pathology, could this not possibly be Nature’s way of helping the uterus gently adjust and adapt to its surgical incision? I’m just thinking out loud.
Obviously I am not making a medical opinion, as I’m not in the position to give one. Obstructed labour is said to lead to uterine rupture in childbirth, but the one rupture I have seen seemed quite directly caused by Synto augmentation to ensure things “hurried” along to “fit” the curve. This one incident obviously doesn’t prove anything at all, and my experience and statistics cannot even scratch the surface of those of a doctor’s. But it does make me go hmmmmm. I guess I am luckier than most doctors to have seen several out of hospital VBACs, and the gentle, trusting way in which they’re held by midwives. We encourage the woman to rest and gather her strength during the ebbs, without trying to stimulate things with aggression. I’m not saying that all VBAC attempts stalled for a long time should just be ignored because it’s always normal…I wouldn’t want anyone to come away with this message. But I would like to take a closer look at the commonality of ebbs in VBAC labour, and reconsider whether or not venturing outside the curve necessarily smacks of potential rupture. Just a thought.
Anyhoo, today’s VBAC was awesome, because it was one of those births the medical establishment was not super comfortable with, but it was a success and it made everyone happy. The mother had been sectioned her first labour after many hours of active pushing (however, according to her, she was made to push for a lot of that when she doesn’t even think she was having contractions), which “reduces” the chance of subsequent vaginal birth. Also, that baby was over nine pounds (doctors don’t love babies being that big…and second ones are potentially bigger, so VBAC attempts with a big baby birther are looked upon with a wary eye). The mother, coming jjuuuuust under the curve by an hour or two was starting to get the hairy eyeball. So we took off into the jacuzzi room to avoid too much outside influence. To make a long story short, the baby came down really fast and was born vaginally at 9 pounds, even though they were expecting a smaller kid. In the end, we were grateful for a little technical help for some fetal distress and sticky shoulders, but a triumph all around.
One of my favourite VBAC stories is of a client of mine who was sectioned with her first birth (at which I was not in attendance) after pushing for many hours, and just not able to move the baby out (she had an epidural). Well, not only did she have a VBAC for her second baby, but she had it unassisted over her toilet after an extremely quick labour. The baby was bigger than the one who was sectioned for being “too big” for her to pass. I am blessed to have lots of stories like this..more stories which shatter this myth that about every second woman has a pelvis too small and too inadequate to pass a baby (oh if I had a dollar every time I heard this statement), than ones of true CPD.
An immature, rebellious little part of me wants to thumb my nose at those who were naysayers and do a happy dance when I see these “miraculous” births… but when I look around at the doctors, they’re usually doing happy dances too, because it makes them feel good to have their patients feel triumphant about their births. When all ends well and the mother is thrilled and grateful, these stories plant seeds for change, and everyone celebrates.
One of the things I have loved most about being an admittedly very experienced doula, is the privilege of being able to share my knowledge and experience with those who are called to the same path of birth attending.
Being a doula trainer has made me a better doula. Being a trainer, I get the opportunity to constantly deepen my knowledge base of non-clinical birth support, re-organize and perfect my own approach, from what to pack in a birth bag to how to manage paperwork, to how to conduct prenatal meetings. I do these things easily and automatically at this point (except the damn paperwork, which is the bein of my existence), but doula trainees need to be guided through these processes, which gives me a chance to step back and see where I can improve my own practice.
My favourite moments are when I get to watch those who apprentice with me witness their first births as doulas. It is such a beautiful thing to see someone’s passion for the process they were called to follow reaffirmed by finally getting to see it happen before their eyes.
What calls people to birth? I mean, when you think about it, it’s often long, it’s sweaty, it’s messy, there’s poo, blood, pain, yelling, amniotic fluid, tears, and involves someone struggling to move a wet and gooey little squalling person out her vagina. I think this is how most people view the birth process….as something vaguely unsavoury. A doctor I’ve worked with a fair bit made me laugh out loud once when she told me, and I quote directly, “If birth weren’t so beautiful, magical, and amazing, it would be pretty f***king disgusting.” But those who actually WANT to be there, and upon going discover how much they LOVE to be there, connect strongly to that incredible magic about birth. It is truly an epic and heroic journey, which is rewarded by a rush of crazy love which heals, changes, transforms, and creates. As far as I’m concerned, who WOULDN’T want to hang out with birth all the time? As hard as it can be, there is usually a beautiful sense of peace in the room a labouring woman is in, no matter how loud things get. The moment a baby begins his earthly life is awesome to behold.
So finding kindred spirits who are actually as excited as I am to be with birth and help to protect a mother’,partner’s, and baby’s experience of it is amazing to me! I love to teach through story, guided imagery exercises, lots of hands on, and celebrate and nurture each student’s strengths. Some are gifted speakers, and strong educators. Some are very strong space holders, and we work on honing and trusting intuition. Some are amazing nurturers, and acutely aware of the needs of those in their presence. Some have magical hands. Everyone has a special strength, and I feel it’s my job to bring it out into the light and help a student develop that strength until it’s her own potent medicine space from which to conduct her work. I also want to know what they fear, and be available to talk about their emotional processing of learning to work with birth energy.
In short, I LOVE teaching. I love my students. I am beginning to trust more and more that those who have come or are coming to train with me are there to help me learn and grow as much as I am there to help them do the same. My students in the past have enriched my life immeasurably. Some have been doulas at my last birth. Some of have become very dear friends. Some are now my esteemed MotherWit colleagues. Some have challenged me to find better ways to communicate and guide. Some have made me dish out tough love, and many have taught me things I didn’t know before. Some have gone on to become midwives and are patient with me calling them to answer my technical questions. In short, it has been quite amazing to be able to provide doula training to some really special women. I hope to continue to do so for many years to come.
One beautiful past student of mine (and it’s so funny to even call her a former student because she is such a dear friend and confidante today) healed me of pregnancy nausea. I am not joking. I was shockingly nauseated during my fourth pregnancy, and still had to do doula work. Friends and family were compassionate about the nausea, but as people do, they said, “well, it’s a good sign..Nature is preparing you to be with discomfort, etc.” All these things are true, and help to put the nausea of pregnancy into perspective. But this woman, with her acute sensitivity, sensed how nausea and I are mortal enemies. I am not nauseated like a normal person. To me, feeling nauseated is like a state of torture, and it does funny things to me emotionally. I prefer pain over nausea, even intense pain, any day. Without words, she knew. We were attending a birth, and I just couldn’t do anything but lie on a couch in the waiting room and pray I wouldn’t barf. This woman took charge. She took me to the cafeteria of the hospital and made me eat mashed potatoes and tuna, the only things I could look at. She anointed me with essential oils for nausea. She wrapped me up in her great big shawl, put my feet up, and when I was in the birthing room doula-ing, she made sure I didn’t get too tired. Nobody has EVER cared for me like that. I can’t even describe it. She was going to do it, no matter what my resistance was, but not in an invasive, over solicitous way. She somehow intuited that my resistance to having someone try to help me with something I thought I should just suck up like a big girl because I had other people to care for was probably at the root of the problem. After the birth of our client’s baby, which was a VBAC (the baby had an angel’s name…Gabriel..and about 5 minutes after his birth on Remembrance Day, a trumpeter played “Amazing Grace” outside the window of the birthing room), I wasn’t nauseated any more…for the rest of my pregnancy. Needless to say, I didn’t birth without her. She is like a guardian angel. She lives out of the country, and is IMPOSSIBLE to reach, but whenever I think of her and miss her, she calls me.
I am unspeakably excited about the summer retreat coming up, and I want to thank all of you who have put so much of yourselves into your applications, and have trusted me with your stories and personal details of your lives. Know that I hold them all to my heart with gratitude, and a focused intention to do the very best job I can to teach you about birth healing. Many of you already know, I believe, and I’m just helping you remember. I also know I will learn a lot from you.
On that note, I am off to prepare for a birth…send blessings for a wonderful VBAC!
I have a few moments before I run off to see the play my daughter’s boyfriend is in. It is fun to have extra “family” members to support.
I have seen a lot of difficulties in birth when women are asked to push before they are good and ready. I have real challenges with the whole pushing circus. The “on your back” thing is a whole other story, fodder for many a rambling blog. I’m talking here about the insane HURRY there seems to be in getting the baby out. There are many reasons this happens. Not to dis doctors as a profession.. I don’t want to give the impression I am against birth in a medical setting..I’m not…just to be clear I’m speaking of individuals, not a collective..but I had a nurse tell me once that a baby most certainly WOULD be born by 7:00 because the woman’s doctor loved hockey and fully intended to make the game he was planning to go to. Luckily, this was not the mothers’ first baby, so she delivered quickly and easily, so all were happy. But had she not, to what lengths would have gone to get the kid out in order to make his game?
I saw a doctor once suggest applying the ventuse to the baby’s head to vaccuum him out, because he was clearly bored (the doctor, not the baby). He was wandering in and out of the room, yawning and looking restless. After the lady had been pushing for an hour, he told us he was very concerned the woman was too exhausted to push, and that the ventuse would be needed. The woman was not exhausted. She claimed she was just fine. He ventured further to say he wanted to spare her from becoming exhausted, and would apply the ventuse so she could have energy for her baby. I wanted to call him on his shit, I most certainly did. But I am a doula, I cannot call “foul play” if I suspect it, because I’m not a clinician, and could be wrong, potentially resulting in a dangerous situation. Also, I have diplomatic relations to keep, and I don’t like to make a mom and dad stressed out by conflict. So I gently and with a smile asked him if it was unsafe for her to continue pushing the baby out. He hemmed and hawed and tried some verbal gymnastics, so I tried again, same tone, same smile, “Is it unsafe for this lady to keep pushing?” Finally, because he could not give any good reason why the baby should be suctioned out of this woman with a fancy toilet plunger (which looks SO painful to the poor baby, and risks intercranial haemorrhage..not something to be used lightly), he sighed and said, “No, it’s not unsafe.” This lady pushed her baby out about 20 minutes later.
I’m thinking maybe the whole second stage pushing dealie should be re-evaluated. When a woman has an epidural, hospitals seem to be smarter about it than when it is a natural birth. They realize that though the woman is 10cm, the baby might need to move down a little more. They have Mom hang out until the baby does so, and her need to push is really urgent and uncontrollable, regardless of the epidural (though it occasionally happens a mom on epidural doesn’t feel this sensation, it’s not the norm…the pushing urge will usually override the medication, and if it doesn’t, the staff will usually turn the medication down so she can feel it, knowing the mother and baby will work better together with sensation). They allow this, because the woman is comfortable on the epidural, and doesn’t make much noise about waiting awhile for the baby to naturally come down.
To me, pushing with an epidural looks like really hard work a lot of the time. When the baby reaches the vaginal opening, the sensation of pain and burning often hits the woman fast and hard (epidural usually doesn’t freeze up to the vaginal opening). Up til then, she’s usually been reasonably relieved of pain, and now, without the benefits of a build up of nice endorphins a woman has when she is birthing with no epidural, the pain seems more brutal, rather than less, as one would think. But everyone is different. Anaesthesia is a funny thing and affects everyone differently. I never personally found “crowning” to be a big deal at all…not compared to dilation. But like I said, everyone is different.
Now for those who are pushing unmedicated, what I don’t like at all is women being told it’s time to start pushing before they feel like it. Just because a woman is 10cm doesn’t mean she’s ready to push. The baby may need more time to come down before hitting all the right areas and triggering the fetal ejection reflex (thank you, Michel Odent, for that wonderful phrase). What’s wrong with not pushing? In home births I’ve seen several women hardly actively or intentionally bear down at all. They just breathe or yell or whatever they need to do, and their body seems to just do it on its own. When a woman is unmedicated, I think the urge of the staff to have her start pushing right away is because those in attendance are uncomfortable with her expressions of these powerful sensations. They tell her, “just push..it will relieve the pain!” This is motivated by compassion, and while I appreciate that, it’s not always the best advice.
The moral of this story is that if Baby’s doing fine, there’s no hurry. I did not feel much of an urge to push with my first baby. While, because she was born star gazing, I felt a lot of pressure in the bum bum, it wasn’t that overwhelming, desperate, uncontrollable need to GET IT OUT, resulting in great bellowings and animal noise making. It took awhile. I think had I not been encouraged to push the whole 3 hours of my second stage, given the urge was not at all strong, I may possibly have not ended up with such a swollen perineum (though with no tear, thank God), or a feeling that my guts would fall out of me for a couple weeks after birth. Who knows?
My advice to women is to follow their bodies, follow their babies. Sometimes that uncontrollable bearing down is present before full dilation, and I echo Gloria Lemay in that I have never seen a woman destroy her cervix when the need to push is bigger than anything else in the room. Though she will, mark my words, be told by nurses that she WILL swell and rip her cervix for being “naughty” and pushing before she’s “fully”, even though when the fetal ejecting begins, she cannot consciously stop it, even if someone were holding a gun to her head. If you have to barf, you may feel nauseated for awhile, and can sort of will yourself not to up to a point. You can breathe through those mounting waves of nausea and think happy thoughts. But for most people, when the body begins heaving because the stomach simply cannot hang onto its contents anymore, it is a relex, not something they can control. How dumb is it to tell someone, “don’t puke” when they’re at the point of no return?
Who says you always have to be 10cm before second stage starts? The cervix usually just slips over the baby’s head in that case as the uterus pushes that baby on down. We’re not lemons because we don’t follow a rule, and most certainly should not be threatened by the destruction of our own bodies for “daring” to veer outside the norm. And conversely, just because you’re at the magical 10cm, doesn’t mean you automatically need to start directed pushing. In fact, unless you like to and it feels right for you, as some people really find it helpful, why take much direction about pushing at all? After all, if you were out in the woods and you went into labour, and given everything was normal, you would get that baby out. Imagine that, without one yell of “PUSH” or counting to ten 3 times per contraction, or having your eyes bug out of your purple face from the effort of straining and holding your breath for so unnaturally long. Now that’s a whole ‘nother topic.
You know what phrase drives me around the bend 2 times? It’s “Why not take the epidural? You don’t HAVE to be a hero!” Women are already pretty awesome by sheer virtue of the fact they can produce babies out of small places, never mind all the other magic involved. But this whole thing of discouraging heroism is whack. For one, it’s demeaning. In a way, there’s the element of, “Why on earth do you think you have something to prove by ‘going natural’? Do you think you’re better than other women or something?…don’t want you to put on airs, after all.”
When a woman works long and hard to achieve an unmedicated birth because that’s what she wants to do, there’s sometimes an attitude that she’s engaging in an act of extreme feminism, equivalent to being “macho”. There’s no talk of how healthy it is for her and her baby in most cases to go through a natural, drug/artificial hormone free birthing process, or encouragement for making this wholesome choice for herself and her baby’s optimal physical, emotional, psychological, and spiritual wellbeing. No, instead she’s criticized and judged as “crazy”, “foolish”, and perhaps even “dangerous”, as if these healthy choices are doing potential harm. Who makes these judgements? Not most midwives, doulas, and natural birth advocates, obviously, but friends, doctors, nurses, partners, and parents who simply don’t understand that the pain is not some risky, unpleasant by-product of labour.
“You don’t have to be a hero” also belittles those women who most certainly ARE heroes…those ladies who really wanted to have an intervention-minimal birth, worked for days to achieve it, pulling out all stops and digging into all resources, only to end up with birth outcomes that were completely opposite of what they had hoped and dreamed for themselves and their babies. Do they not GET to be heroes because they had pain medication or surgery not because of personal preference but because of necessity? Do NOT tell me these are not heroic women, and don’t tell me (or them, please) that their grief over their birth experience is unwarranted because they have a healthy, live baby.
So if you ever have the urge to utter this little phrase “you don’t have to be a hero” to a woman in your presence who is powerfully expressing her labour pain, bite your tongue. Right off, if you have to. “Hero” does not mean “martyr”, which is actually what I think people are inferring when they tell her not to be one. A “hero(ine)” is a being of prowess and beneficence, This is fitting for a labouring woman. A “martyr” is a person who is willing to suffer death rather than renounce her cause. So far, I’ve never seen a woman take her desire for natural birth to that extreme, and doubt I ever will.
And what, by the way, is WRONG with being a hero? If you had the opportunity to be one for your child, wouldn’t you? If being a hero means trying to do the very best for me and my baby by refusing unnecessary medications and procedures and yelling the house down if I must in order to cope, then slap a cape on me and call me Wonder Woman.