Wednesday, January 6, 2016

Birth Processing and Creating Change

I recently received this incredibly thoughtful piece, written by a beloved client (and shared with permission) detailing her vastly different birth experiences and how the type of care she received  mattered to her in the days, weeks, and months following the births of her two children.  Even in the 3 years since her first was born, I have witnessed significant changes in regards to the reverence of birth in hospital, though there is still a LONG way to go for them to be in the same ballpark as most of the OOH (Out Of Hospital) Midwives I've had the pleasure to work with. I share this because changes are made in obstetric care when we share our truths, and it's never too late.  I hope that this finds it's way to in-hospital birth workers.  If your birth center has made changes that improve the experience and well-being of the women you serve, then I thank you, and please feel free to share this with your team to validate the changes that have been made.  If it hasn't, feel free to share this with your management to initiate more focus on allowing birth to be the sacred, magical, beautiful event that it should be. Birth is a fantastic physical event, and the physical safety of mother and baby are always the top priority, or course, but birthing is also emotional, and spiritual. When we care for the whole mother, and acknowledge that the baby who is joining the world also deeply deserves our respect and reverence, women simply feel differently about their experience. I don't attend births every day, or even every week necessarily, but when I do, when a baby is born, I always feel like time should stop...for just a few minutes.  I feel sad for people in cars driving by outside that are going to work, like nothing has happened, they don't even know that LIFE JUST BEGAN...RIGHT HERE and RIGHT NOW.  It's precious.  Perhaps we shouldn't stop traffic about it, but at least in that room, for that family, during that labor, and that birth, our focus should be on making them safe, yes, but also make them feel as if the world stopped spinning for a moment when their child was born.

In retrospect, after reading'll get it...I do wish I had been able to herd all the spectators out of her room.  Damn regret.  It's something I would normally try to do, and probably did, but teaching hospitals can be tricky that way...just an FYI.

Thank you C, for sharing this so that other women may be empowered to write their own stories, speak their own truths, and affect change in a very stubborn system.  Mothers coming after you will have better experiences because of your honesty and courage to speak.

When referring to birth experience, I've heard countless women use the line, "All that really matters is having a healthy baby in the end."  I birthed two healthy babies, and thankfully, I will never know the stress and heartache of an unhealthy newborn.  That being said, I would like to speak to the importance of a woman's birth experience.  I had two vastly different birth experiences.  My son is just two weeks old, and he was born in the water at Eastside Birth Center, a freestanding birth center, under the care of midwives.   My daughter is a little over two years old, and while we had hoped for an intervention free delivery at Eastside Birth Center, she was born at UW after needing necessary medical intervention.  Our doula, Kristen Dibeh, mentioned that often times a woman who has a hospital transfer with her first doesn't attempt an out of hospital birth for subsequent children.   My doula suggested I write about my experiences to offer encouragement to women who are contemplating where to give birth after a hospital transfer.
With my first pregnancy, ignorance was bliss.  I had no idea what labor and delivery felt like, and all I felt was excitement for the big event.  I knew there was about a ten percent transfer rate, but my pregnancy had gone so smoothly that I never really thought I would fall into that ten percent.  We got to the birth center after laboring at home for twenty four hours.  We were ecstatic that I was about eight centimeters when we got there.  Shortly thereafter, it was discovered that baby was descending in a way that put uneven pressure on my cervix, resulting in a badly swollen cervical lip.  None of the usual tricks worked.  We tried a rotation of different positions, Arnica, and time, but we ended up transferring to UW Medical Center.  The urge to push had kicked in while at the birth center, and I needed an epidural to stop pushing against the swollen cervix (it was making it worse), or I would never dilate to ten.  The epidural was a welcomed and necessary relief, but it started the cascade of interventions.  Next, I needed Pitocin to make contractions stronger because I was essentially stuck at nine centimeters for seventeen hours.  With the support of our doula, she coached us in how to safely push back against their recommendations for a C-section, which they continued to mention throughout my labor.  I was okay and the baby was okay, so we waited and waited because there were no signs of distress.  Eventually, my body and baby were ready, and she was born vaginally after forty two hours.  Her delivery felt very stressed.  There were at least a dozen students and medical professionals in the room or in the doorway when she was born.  I remember feeling like I was somehow on display because there were so many strangers in the room.  While they truly respected our birth plans as much as possible, the whole experience was not what I had imagined.  For me, this was really hard.  Yes, I was thankful for a safe, vaginal delivery, but I still couldn't shake that feeling of mourning the experienced that I had hoped for.   Plus, the recovery was very difficult after such an ordeal.  I replayed the events in my mind over and over, feeling distraught about her birth experience for nearly a year.  I knew I had to accept the way she joined our family, but I definitely struggled.  I knew that with my next child I wanted to try for an out of hospital birth again.

When I found out I was pregnant with our son, we had long conversations about where to go for our care.  Now that we actually had to move forward down the path, I was afraid.  I was afraid that something might go wrong again, and we'd have to transfer to a hospital.  I was afraid of the birthing process, having experienced it with my daughter.  It hurt with drugs, how on Earth would it feel without drugs?!  I even suggested to my husband that we go through a hospital in order to avoid the potential disappointment of a change in birth locations and providers in the event of a hospital transfer.  It wouldn’t be ideal, but at least there wouldn’t be the possibility of a transfer.  Fortunately, my awesome husband didn't even consider that option.  He knew how important this was to the both of us and to the health of our baby.  I knew I had to surrender to the process, find that same trust in my body, and go with my head and my heart.  We went back to the birth center for what I called a "do over."  We were lucky enough to have the same midwife, Chris Thain, and we hired Kristin Dibeh again to be our doula. 

My beautiful son was born just two weeks ago in a natural water birth at Eastside Birth Center.  Now that I've experienced two vastly different birth experiences, I can say with deep conviction that a woman's birth experience matters.  Here’s what I noticed in comparing the two experiences:

  • The physical discomfort of recovery with my second was days rather than weeks.  No epidural, Pitocin, catheter, or stitches, plus a shorter labor meant a MUCH easier recovery.  It was definitely easier to focus on caring for my baby (and toddler) without so much pain.   I had never had a catheter before, and that caused a lot of other problems that I hadn’t anticipated.  It felt like it took days for the drugs to work their way out of my system.  The bloat from water retention wasn’t fun either.  Knowing what I know now, I’d opt for a more intense drug free delivery any day over a long, drawn out, uncomfortable recovery.  
  • I really appreciated that my husband and I got to call the shots with the decisions we were qualified to make at the Birth Center.  Once we knew baby was healthy and I was okay, we could take our time.  I got to decide when to get out of the tub and hand my baby over.  We had zero pressure to cut the cord too soon.  I got to decide when to eat, when to feed the baby, what to wear, when to leave for home, etc.  It truly felt like our experience on our terms. With our first, we were stuck for nearly six hours trying to get “permission” to go home with our baby.  It was infuriating. 
  • The newborn exam was more like a celebration and detailed overview of my baby that I completely missed with my first.  At the Birth Center, this was done right on the bed next to me, so I could enjoy every part of it.  With my first, I was being treated by doctors, while my husband watched this exam.   
  • One of the biggest differences between the experiences was with the people present.  At UW, I had at least a dozen people in the room that I didn’t know during my daughter’s delivery.  Between pushes, I glanced up and could see a room full of people staring at me, watching my bare naked self at my most vulnerable.  It was an insanely intense experience, and I still remember being aware of that feeling.  I was so grateful to have avoided a C-section, and the birth was awe inspiring, but it didn’t feel as if the event was treated with the reverence that birth deserves.  In contrast, with my second at the Birth Center, I knew every person in the room quite well.  No one was coming in and out.  No one was using lines like, “I hope your prove us wrong,” in response to pushing back against their early C-section recommendations.  
  • Overall, I felt more valued and respected giving birth at a Birth Center with midwives.  I always felt like safety was the top priority, but I always felt that my emotional well-being was equally as important.   

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