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On Choices and Judgements

from MotherWit Doula Care

I have edited this article by Lesley Everest of MotherWit Doula Care. Thank you Lesley for your honest, wise thoughts!

We should honour whatever approach people take for their births. We all have different personalities, and everyone has a different relationship to strong sensation. For me, while labour pain can be extreme, I can handle it. Unless there were a really good reason to do so, my choice is to not take epidurals or other forms of pain relief. It hurts, but for me, the endorphin and oxytocin reward at the end was worth it. But the sensation of nausea? Youch. The sensation of nausea is so odious to me that given the choice between a 36 hour posterior labour and a 12 hour stomach flu, I would absolutely choose the 36 hour labour. Because of my intensely difficult relationship with the sensation of nausea, I have compassion for women who have a feeling the sensation of labour might be something they absolutely abhor. Some people can handle achy pain but not sharp pain, or some breeze through a terrible bout of food poisoning cramps, while a migraine may traumatize them. It is such a subjective thing that it is important not to pile all women into one group, give them the same goal or one method to prepare for labour, then send them off promising if they do it correctly they'll be fine

The challenge: you're not aware of how intense it's going to feel, how you're going to cope, whether the sensation is one of those types that's "safe" for you or challenging on a deeper level. This is an opportunity to explore where you are coming from. It is perfectly appropriate to be anxious when teetering upon the precipice of the complete unknown. Using that energy can aid women in gathering what they need as an individual: resources like support, primary care, knowledge of ways to cope, emotional exploration, cultivating an ability to relax and breathe with challenging sensations or emotions.

Many women believe that a combination of good obstetric care and the nurturing support of a doula creates the best of both worlds for them to "go natural." Then there are those who are not that interested, perhaps want a doula there to help assuage their fears and hold their hands through the epidural and just be a friendly face to hang out with and make everyone more comfortable. Fair enough; my mandate is for them to feel like rock stars no matter what their approach. But I do have a few guidelines I feel are important for all to consider.

1) Prepare for anything and know you're great no matter what. Just about the only thing I can guarantee about birth is that it is unpredictable. The vast majority of healthy women with good attitudes, if well surrounded but undisturbed in a private, cozy environment, feeling safe and supported, can have their babies with little to no intervention. But birth, especially hospital birth, takes some preparation and knowledge. The whole, "Do nothing, have no fear, and you'll just open like a flower" approach is not useful or realistic in an environment that tends to make sphincters shrink rather than blossom. Neither is the "I'm going to have an epidural the second I have pain, and my doctor will 'get the baby out' and then it will be done" approach. Both extremes have the potential to leave one feeling disappointed at best, to traumatized at worst.

What if you plan to have an epidural as soon as you feel pain and it doesn't work out that way? For instance, what if you have one of those types of labours in which you're having a huge amount of pain at 1cm? Some women just have a lot of pain in early labour. This doesn't mean they're wimpy. But what if you're having close contractions that you consider an 8 on the pain scale, you're planning an epidural, and lo and behold, nobody wants to give you one because doctors don't really like to give epidurals to people at 1cm (for good reasons)?

What if you plan an epidural, you get to the hospital, and lo and behold, there are 3 Cesareans in a row for the anesthesiologist? I have seen women have to wait hours for an epidural. Sometimes they give birth before it comes. It is not the norm, certainly, but it can happen. Or, what if you have the epidural, and you are one of those ladies it doesn't work for, or it's all weird and makes you feel numb everywhere except for a two inch patch of excruciating pain in one little area on one side of your belly? What if you plan an epidural and give birth too fast to get one? You can begin to see where having skipped the chapters on pain coping techniques or ignoring that part of your childbirth education class might not have been the best idea.

If you are going to plan an epidural, that's fine. But always prepare for natural birth too, because you never know. The last thing you want is to be faced with pain you never expected or prepared for because you decided to give all the jurisdiction over your sensations to an external source. Give over all your power, and the potential for birth trauma is everpresent. Do yourself a favour and get some tools to help you cope.

Conversely, what if you're planning a natural birth, you've done all the preparing and totally believe in yourself, that you can do it and everything will be great...but it doesn't end up this way? I believe very much in the power of positive thinking and trusting that the bodies that make babies can birth them. Childbirth preparation truly comes more from the work we do on the inside than reading a bunch of information. However, having an understanding of what might happen IF something comes up and you find yourself in a position needing to make some hard choices about things like pain relief or you end up having that Cesarean you NEVER expected would happen to you, is important.

Making good choices in advance goes a long way to creating a wonderful experience, but again, there are no guarantees. Having a basic understanding of what it might be like to switch plans is a resource, not a hex, and will lend well to the situation if it ever comes up.

2) Manage your expectations. Preparing for natural birth is all about stretching your body, stretching your mind, stretching your heart, and stretching your limitations. Expect it to be a challenge. Don't be cocky. Everything about you will open wide. When women talk about whether or not they're interested in birthing naturally, the frequent answer from well read, well informed women who are choosing to birth in a hospital is, "I would like to do it naturally...but if it gets to be TOO much, then I'm open to taking an epidural." What this says to me is, "I wish to have a natural birth but I give myself permission to call time out to spare myself from entering into what I fear could be my worst nightmare." The qualifier also comes from a fear of judgement. "What if I share my dream of natural birth to the world, then I don't have it and everyone (including myself) will say, 'ha ha, told you so! poor little woman, it was really cute for you to think you could do it.." A woman who's birth reality ends up not matching her expectations doesn't need judgements, she needs SUPPORT.

I like to ask women what "too much" means to them because quite honestly, there WILL be points where it is "too much." People rarely have natural births when they have a well-padded escape plan based on whether or not it will be too hard. If I said, "oh, sweetie, the pain isn't much. Just breath into point A while chanting phrase B, you'll be just fine" I would be a liar and deceiver of the worst kind. Women may say, "why are you telling me it's going to be so hard? Won't that make me nervous and make it hurt more?" I'm not personally so powerful that my words prenatally can make you hurt or not. If I tell you it's going to be hard, two things can happen..it ends up being hard and you are prepared with resources to cope with it, or you've expected it to be so long and hard that it sneaks up on you and we arrive at the hospital to find you're in way more advanced labour than you thought..great! Don't ever think that if I DON'T tell you about the challenge it won't exist. Better to know.

When I ask ladies what "too much" means, they often don't know. Some say, "I'm afraid the pain is going to make me really mean to my husband or the staff, and they'll get mad at me." Media paints the picture of women turning into these monsters during labour, scratching their husbands' eyes out. My experience is that in normal birth, oxytocin tends to make women quite loving, trusting, and snuggly. Yeah, they're fierce too, but the ferocity is directed towards managing the energy of their sensations, not emotionally castrating their partners. There can be some irritation, but I rarely see a woman go rabid. This is reassuring news for those who define themselves by their polite and good behaviour.

Others say, "I'm afraid I will lose control of myself." What they usually mean is that they will be in such a state that they will lose all semblance of who they are. I tell them that they will change, yes, but they will still be themselves within that pain/endorphin haze, able to take in, process, and communicate what is needed in the moment. Yes, they may lose their modesty in front of strangers (who are quite used to it), find themselves nude with blood, fluid and mucus running down their legs, nauseous, or making uncontrollable noises they never thought they'd make. To some, this animalistic image is deeply disconcerting. But really, if you're willing even a little bit to go there, what you will find is freedom and even possibly a level of intimacy you never knew could exist with your partner and those in attendance. There is nothing more liberating than being in that space of pain and mess, looking up in your misery and finding eyes that meet yours in total acceptance of your experience, eyes that mirror back absolute approval and praise for what you are doing. You are safe, everything is okay, and this is what labour is. You have "hit bottom" in terms of what our culture deems ladylike behaviour. You have found ultimate surrender in pushing away all cultural expectations of your femininity which believes having it all together is the sign of an accomplished woman; now you learn that where you find your truest power is not in keeping your shit together, but in letting it all go. What you have been afraid of all this time is becoming the birthing animal you actually are and have been programmed to be since your DNA decided to light up as "girl". You will come back...I promise. But you will come back having witnessed and activated a deep part of your Self that we are meant to bring to motherhood.

It’s possible to make a commitment to natural birth without a disclaimer. You will not have to go around wearing some scarlet letter if you don't reach your goal. Be willing to get down and dirty; if you can't figure out how to "do" a hard contraction, yell your head off if you can't breathe through it. It's okay. Choose not to waste your time in between contractions negotiating with yourself how much longer you're going to do it, or how much more you can take. Sink down into what you will find is a deep, beautiful, profound space, without thinking. You will say "I CANNOT do it anymore" only to find three hours later you still are. Be willing to exist in the sensation even when it hurts, be willing to have those huge waves crash down over you, trusting that strong contractions bring you closer to meeting your baby.

I will never candy coat labour pain to a woman. That is not love. That is disempowerment. 

3) Own your choices.  When it comes to normal labour, I think it's really important for women to own their choices. "I had the epidural because I just couldn't do it anymore" (at 4cm five hours in) is not the truest of statements. This is not to be mean, but I have a hard time with that. We're not victims of our normal labours. What does that mean, "I couldn't do it?" Well, yah, technically, you probably couldda. If you had been walking around in the middle of nowhere and labour came upon you and there was nowhere else to go, you'd just do it. There would be no opportunity to say "I can't do it", you would have to. If this same labour comes upon you in modern civilization, "I can't do it" is what many women say when the crunch is on. Actually, when given the choice and available epidural, and admittedly the much more challenging birthing environment to labour in, the truer statement is "I don't want to do it." And you know what? That's perfectly okay. You are in no way, shape, or form expected to have a natural birth you don't want just because you think you should. If you ultimately didn't want a natural birth when you got to active labour, it's important for the sake of your friends and daughters and women everywhere not to blame your labour for your personal choice. I'm not talking about situations like inductions, or you're at 9cm for years, or a hideous back labour, or a PTSD reaction, or the staff simply drives you to distraction so you lose your mojo, or it's really long and you're truly exhausted, or there's some kind of problem...these scenarios are more about survival than personal choice. I'm just talking about regular labour you decided wasn't your thing.

I feel so sad that many women think they need to apologize for their choices for pain relief or cover up unneccessary shame by trying to convince themselves and others that their bodies were lemons for not birthing "properly" when in fact there was no problem. Maybe it means they felt they failed themselves and didn't feel as strong as their friends who had natural births. It's not a competition.

An elective cesarean of those "too posh to push" often is made without correct information on benefits vs. risks and is not one I'll ever feel good about as a doula. But claiming to be too posh to push is at least really honest, and the choice is totally owned with emphasis on the woman's desire for her Cesarean rather than blame on the probable birthing excellence of her body. There are very sad and misguided aspects to this choice and it does create collective harm, but at least there is no blaming or creating victimization to justify a choice.

You know, there are other ways women can experience surrender and raw power. It doesn't HAVE to be in the realm of childbirth. It's not "for" everyone. I have seen a few incredibly beautiful births, which were intensely empowering, with women whose mandate it was, for personal reasons, to feel NO pain in labour. I learned a lot from these births, and came to an honest place of honour for these women. While I may not personally agree with some choices, meaning I wouldn't choose them myself, I can totally appreciate an informed choice and ownership for that choice. Personally, if my labours felt like intense nausea instead of the way they did, I'd probably be strutting around saying, "Yeah, I had them knock me out the minute I felt sick. I was simply not interested in going there. There are no benefits to my feeling that way in any circumstance in or for anybody in my life. Wanna make something of it?" Or, I might do my very best to heal my issues surrounding nausea and deal with it because I believe so strongly in the benefits of natural birth. But if I did in the end make the choice to end the discomfort, I wouldn't make any apologies for myself. It is what it is.

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