Saturday, December 12, 2015

Can I Influence My Emotional Response To My Birth?

We are living in a time when there is a lot of conversation happening over social media and individual blogs about birth and how women feel about their experiences in giving it. As a Doula who has been attending births for nearly 2 decades, I would like to try to offer some much needed perspective on the broad range of birth stories we see and help women have more understanding and more empathy for the huge range of stories you will happen upon. When women write about their individual experiences, they can have a profound impact on women walking a few steps behind them, preparing for their own upcoming births. For those of you who are getting ready to give birth, you are probably doing your fair share of research on the web, and may feel confused about the HUGE difference between stories you may see online. Your feelings are well founded. You might find a blog about a woman sharing a glowing account, birthing in a field of flowers and feeling a communing with all women throughout history and then click through to a story about another woman, possibly writing as a tool to help her process a difficult birth only to find yourself trying to figure out what to expect from this unknown we call labor. The differences between the two births may not even be discernible to the reader. How women feel about birth doesn't necessarily depend on the physical attributes of the event. It's also important to remember that for every woman writing about her birth afterglow, and every woman trying to process a difficult birth, there are vast numbers of women in between who have had fundamentally satisfying births. I wish that everyone could have a satisfying birth experience, and for those who don't, I offer compassion. I'd like to offer the next wave of mama's a few bits of my collected experience and hope that it will help you to increase your chances of feeling at least satisfied and hopefully empowered by your birth.

First and foremost I want to say that this is one of the reasons why I feel it is so important to have a Doula. One Doula. Your Doula. The ONE constant. Someone you have spent hours talking to before your birth. (Scroll down for a recent post about How To Choose Your Doula). Someone who understands what you believe you want and will help to educate you about things that may come up that differ from your expectations, beliefs or desires. Someone who can help you process the enormity of what you do experience (both during and following delivery), because even when things go exactly as you hoped and planned, it may still not be exactly what you expected, and when circumstances change and require a re-direct, it can be an even bigger challenge. You deserve a tour guide, a translator, a trained ear, and an ally.

Women are almost always surprised by some aspect of labor. I only say this because I don't want women to feel like that is unusual. There are so many variables, and a birth plan is not a contract with the universe or your doctor/midwife; your plan is a blueprint. There is no way to really know how a woman will feel about the experience of birth, no matter which options she may choose, or what circumstances can arise, until she has been there. There is no wrong answer--hopefully time and open communication can put it all into perspective, but she is entitled to her experience and her feelings. There is no reason to scale it either; no two births are comparable because even if they have similar attributes, they are being experienced by different women.

Any birth can be perceived after the fact in many ways. It depends on a lot of variables. Here are a few of the most common:
  • Understanding of what labor is: My belief is that a comprehensive understanding of birth, honest conversations about the big sensations, as well as what they mean in regards to labor progress can be very helpful. When labor feels hard, even painful at times, if she understands what is happening and can have a KNOWING that even though it’s hard, that she is safe and her baby is safe, it can shift the perception of pain. Pain with purpose and understanding, while it can still overwhelm, is different than just pain. Pain by itself is definitely frightening and fear is a huge component of emotional trauma.
  • Method of preparation/expectations: There are a few models of preparation out there that freely use the word "painless", some even go further and use words that imply considerable pleasure. They are popular, for obvious reasons. If you could sign up for it to be painless, even pleasurable, why wouldn't you do that? Here's the problem--it's just smoke and mirrors. I can rename pain, but a rose by any other name would smell as sweet. Surge, swell, wave, movement. Call it whatever you want. It is a large muscle contraction, it is big, it is powerful, it is awesome. Orgasmic, though? Let's talk about that. Birth is similar to orgasm (for some women) in ONE WAY and ONE WAY ONLY. As the baby descends into the pelvis and begins to move through the birth canal, there is an increasing buildup of pressure in the area surrounding the vagina. When the baby is born, there is a considerable release of pressure. That's about it. The odds of having a "painless" labor followed by an "orgasmic birth" are roughly the same as winning the Powerball, I would guess, unless it's just the vocabulary you choose. I would advise you to prepare for a challenge, like a marathon. If you happen to have a painless labor followed by an orgasm, awesome, but you won't feel mislead, underprepared, like you did something wrong, etc., if labor and birth are more challenging than great sex.
  • Idealization: I think the onslaught of pretty pictures on Facebook have done a disservice to women preparing to give birth. Media is very polarizing on this subject. TV and movies make birth look awful and/or ridiculous, and Facebook labor portraits make birth look serene and gorgeous. The truth is that real labor has elements of both at times, but mostly lies somewhere in between. Don't get me wrong, if I was present at your birth, there is NO DOUBT in my mind that I could (with your permission) capture a breathtakingly gorgeous photograph of you, possibly enveloped in the harbor of your lovers arms. That doesn't tell the whole story though. I don't often see the true grit pictures (which also don't tell the whole story) posted on social media because we haven't been taught to see the profound beauty in the hard work women do to birth. I think that the images of women looking downright primal are AWESOME, but without context, I think the appearance of really hard work can be misinterpreted as pain, especially in still photography. Also, without context, some may misunderstand that even in those primal moments, if there is some pain, it's not like that all the time. There are moments of intensity, moments of beauty, moments of ridiculous, and moments of tranquility.
  • Support: While you are in labor, the people that you choose to surround yourself with can have a big impact on how you perceive the experience. Something as simple as looking up after a tough contraction and seeing your partner’s worried face, as opposed to seeing his/her face filled with pride can easily impact how you feel about it. We rely on the people around us much like a child who has fallen down and looks around to see the reaction, and the reaction (not the pain) determines whether or not he/she bursts into tears. A laboring woman can be vulnerable to suggestion, which is a big responsibility because we can influence not what she's feeling, but how she feels about it, with the words we use and our facial expressions. We can show her that what we are seeing is normal and healthy, and we can offer positive and empowering words to label the sensations, like strong, effective, work, powerful, or we can scare her unnecessarily. She has to be able to trust that the people she surrounds herself with can be trusted with that influence. This should include her medical care providers.

These factors will matter, regardless of what kind of birth you desire. Every birth I can conjure could possibly be looked back on and perceived as beautiful or difficult; it depends on the woman experiencing it, the exact moment in the timeline of her labor, all the above factors, combined with her level of fear, her personal history with pain and other possibly traumatic experiences, and then her personality. It is a combination of so many factors that it can rarely be forecasted and can also never be judged, only met with compassion, and when needed, appropriate help.

There are women who may go in with full understanding (to the degree we are able) of the birth process, and she may have the uncomplicated, unmedicated, family centered birth that she imagined, and she may be thrilled with and empowered by her experience.  She may, though, look back on it with some degree of shock and awe. Women who choose to labor without medication can, at times, be overwhelmed by the challenges of the contractions and the surprising amount of pressure in the pelvis. They can be overwhelmed by the sense of feeling "out of control" within their body because we cannot "turn it off". It is, to be fair, one of the biggest, most important things she will ever do in her lifetime. She may need some support in processing that. She may even regret some of the choices she made, for or against (even minimal) intervention in retrospect.

Being scared about natural labor and then choosing interventions out of fear that you may not be able to handle the sensations of labor is not necessarily the answer either. Women who choose or require pain medication can have a very satisfying birth experience. There are idyllic pain management scenarios in which she doesn't experience "pain" but can still feel the contractions a bit, enough to feel connected to the process and her baby, enough to know when to push and make labor more efficient. Unfortunately, this can not be guaranteed. These women can also feel overwhelmed by the powerlessness. They can feel confined and trapped by the number of tethers, cords, inability to move or feel their bodies, as well as some less than desirable side effects that can occur, like vomiting, itchy skin, and feeling like lead from the waist down. Additionally, losing options to stop the "runaway train" feeling of an increasing need for pelvic exams to assess labor and other (often undisclosed) interventions, which increase the risk of cesarean, and often become necessary, can also cause a sense of being out of control.

Women who choose (which is rarely an option unless there are extenuating circumstances) or require a cesarean, can be empowered by the choice, and have a positive, family centered experience in the operating room (with good planning and support), a healthy recovery and an accommodating baby.  They can also be overwhelmed by being "strapped down", feeling strange sensations of pushing and pulling but being disconnected from her body. They can have issues following the delivery that were unanticipated.  Having to take care of a newborn, a baby requiring around the clock care well after the hospital stay ends, is no small thing by itself, but cesarean births also often are accompanied by at at least a few of the following: deferred pain, itchy skin, constipation, grogginess from follow up pain medication, delayed milk production, wound care, difficulty "getting comfortable" for sleep, breastfeeding, etc.

The thing that all of the lesser desirable scenario's have in common, as well as the numbers of others that I could list, is a sense of feeling out of control, powerlessness. To influence your emotional response to your birth, do your best to maintain a sense of control over the things we do have control over. Hopefully, you will find that there are always elements of your experience that are within your control, and your support people and your staff will guide you to those elements, empower and listen to you. Then, even if the outcome is different than what you wanted, you won't feel powerless. Feeling like you are a part of the decision making process, having your concerns addressed, your questions answered and your feelings understood can greatly impact how you feel about it later. Birth is not just a physical event; there is an enormous emotional component to it.

It is my belief that, while there are no guarantees, the best recipe for a birth that you will look back on with a sense of satisfaction includes the following:
  • A thorough understanding of the process of labor and birth and a plan to feel overwhelmed by your labor at times.  Not all the time, but there will likely be moments that make you question your ability to get through it.  
  • A birth partner who will be available to you during your early labor who is also informed about what to expect, what mama's needs may be, when to communicate with care providers, etc. This will require a birthing class, a comprehensive course. I don't recommend the quickest and least demanding, I also don't recommend a "skills based class" like Hypnobirthing, alone.  If you are unable to attend a comprehensive course for any reason, consider my curriculum, Expecting Kindness (available here:  or on All five star reviews!), as a companion to your tools based class (or independent research) to help you put the skills you learn and the tools into context so you can use them at the appropriate time. Since I know most of the readers here are the ones carrying the baby, I can tell you honestly that even if you have read EVERY BOOK IN THE WORLD about labor and birth, when you are IN labor, when you really need support, you will not be able to be guiding or educating your birth partner on the fly. My book is easy to read, 10 short, informative chapters that will give you and your partner a strong foundation.
  • A privately contracted Doula that will be your ally throughout the process, leading up to the birth with prenatal meetings and phone conversations, being available to you during early labor over the phone or in person as needed to guide you and offer suggestions, to join you at the agreed upon point in labor (usually around the beginning of active labor) and stay with you throughout the entire process, through birth and be available into post-partum.
  • A thoughtful and diligent search for a care provider, in or out of hospital, who you know and trust will answer all your questions respectfully. One who will empower you to be a part of all decisions made with full disclosure (when time allows, of course), offer all potential pro's and con's, side effects as well as other interventions that may become necessary as a result of any prescribed intervention or medication. Also here, if during your prenatal course you find you have departed from trust with your current provider, I ask that you seek someone else, even if you feel a sense of loyalty or obligation. However personal it can feel to you, this is a business relationship, and it is very important that you feel safe.
  • Make your birth plan reasonable and allow for some flexibility.  I still believe in having a blueprint, a framework, because there are many preferences in birth that are very individual. Comfort measures, specific tools and techniques that you find calming, specific words or touches you may or may NOT like. You may have strong feelings about specific interventions. Again, it's not a contract, it's just a plan that helps to inform your staff about you. It's not signed in blood--you have to know that going in. I liken it to having a wedding planner. The plan does not guarantee that the wedding will go off without a hitch, but having some organization makes it so the bride isn't having to make choices on the fly on the wedding day. Same.
  • Know that you alone are inside of your body, and while I know that statistically, many to most women are certainly able to birth vaginally, and many to most of those could likely birth without medication, each individual is not "many" nor is she "most".  There are exceptions. It is not your partner’s body, it is not your doula's body, nor is it your nurse's body, or your midwife’s, or your doctor’s.  You alone must honor, and give voice to, your own physical, emotional and mental well being. If you've done what I suggested above, in choosing your providers and support people well, you should know that they will support you through YOUR birth journey without judgement. Might we challenge you if you ask for something that you were previously opposed to? Sure, if you asked us to, but you are beholden to no one but yourself. You are never a hostage to what you believed you wanted, nor to any person who is attending you. This is true no matter what changes you wish to make, if you believed that (and informed your care provider) you wanted an epidural, but once in labor realize that it seems more manageable than you expected, you are not obligated to have it. Even if the anesthesiologist is in the room and setting up to administer, you can change your mind. Conversely, if you planned to have an unmedicated birth, but due to some circumstance, labor is beyond your level of pain tolerance, SPEAK YOUR TRUTH. I've even had a few couples plan a "safe word", although I've yet to hear one used. If you do this, make sure it isn't something you might utter normally during labor!
  • Be empowered to challenge and question YOUR staff. YOU have hired THEM to safely and respectfully help you to birth your baby. Women have made BIG changes in very ingrained obstetric practices, policies and procedures, slowly over time, but it has happened. From significantly lowering the incidence of episiotomy, to delayed cord clamping, to gaining permission to eat throughout labor, to altering the process of induction, to lowering the obscene rate of unnecessary cesarean sections. All of those have been reported in many women's stories, who claimed to have had traumatic birth experiences. We are powerful, and while you may still walk away with a list of things you might have like to be handled differently, your experience may inform providers, and a woman 2 years or 10 years from now may have a different experience because of your questioning, your challenging, and your honesty about your experience. Again, speak your truth.
  • Be loving toward yourself, even if you feel like you didn't "do it perfectly". Have some compassion for yourself. When having a crisis, I always ask my daughter, "What would you say to your best girlfriend if she were in your situation? You should always treat yourself AT LEAST as well as you would treat her." Talk about it with people you trust. You experienced something huge and important. Might you regret something? Might you feel overwhelmed by your birth? Perhaps. All we ever ask is that you give your best, offer up the best you've got in any situation at any given moment, and know that we are, all of us, flawed and imperfect and just doing our best. We all have to learn from our experiences, whatever we can, love ourselves, and let the rest go.

I sincerely hope that you are able to use some of the tools and ideas provided here to have many of these words connected to your birth story: power, control, respect, connection, conviction, honesty, wisdom, support, vulnerability, trust, hard work, healthy, comforted, beautiful, funny, safe, loving, and kindness. Do everything you can to welcome your baby into an environment that is sacred, whatever that means to you.  
In closing, I should mention that I don't pretend to understand the depths of anyone's emotional response caused by birth, or anything else, as it is a very personal experience and I respect that. If you feel traumatized by your birth experience, all I want to say is that I care about you and your family and I want you to seek appropriate support. Your feelings are real and entirely valid. Of course I hope that in time, with some counseling/therapy/group support, etc., you will be able to draw out more beauty, possibly re-write your story, or learn something valuable from your experience. Your children and grandchildren will probably someday want to reap the wisdom of your experience and I wish you a story of claiming your inner strength, self healing, unconditional love and compassion for yourself, and for the other women who have been, or will be, where you are now. Indeed, a healthy baby is obviously the most important thing, but in order for the baby to continue to be healthy, the physical health and emotional well-being of the mother is a very close second. Take excellent care of yourself so you can take care of your newborn, be well and able to be fully present for all the wonderful, challenging, hilarious, endearing, precious moments that your baby will bring.

If you are local to the Greater Seattle Area, Please contact me regarding Childbirth Education (classes held in Bellevue) and Doula Support. I would love the opportunity to talk to you about how I might serve you in preparation for, and/or, during your upcoming birth. Click on the right to view my resume and a few testimonials!

Kristin Dibeh
Kind Birth Services
Childbirth Education
Birth Doula Services
Placenta Encapsulations

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