We’re all biased: our desires are not universal
Note: With the Make Birth Better blog we try to create an open space for all people to share their opinions and perspectives on trauma. As an organisation we strive for individuals to be seen and heard. We believe that personal choices and individualised care matter.
This is a story of a positive second birth after earlier trauma. The thing is, I hesitate to use the word ‘positive’ because of the associations I have with it which I found to be quite damaging in my mental preparation for my second birth. In this post I try to explain why.
My first birth was traumatic. Mostly due to the refusal of pain relief. I had never intended to go ‘drug free’. Actually, I had kept an open mind: I was aware there can be side effects to medical pain relief, but I also felt I couldn’t know how I would cope with labour until I got there. I decided to give birth in a midwife-led unit (MLU). I was not explicitly informed about the lack of epidurals. If I had been fully aware of this, I would probably never have set foot in one. Instead, I was told by midwives at antenatal appointments that I wanted ‘a lovely natural labour.’ My reward for being ‘low risk.’ No one asked me if I wanted that reward. Actually ‘natural’ was never a big concern for me: safe and with adequate pain relief ranked high above that. Unfortunately for me, I wasn’t fully aware of the lack of pain relief until I was on the MLU, and was prevented from having an epidural because of it, despite being only a corridor away from an obstetric unit with anaesthetists. So I took the only thing on offer, a pool. I have to add, a subsequent birth reflections midwife could not fathom why, in active labour, an epidural was refused, and why no pethidine or even gas and air was offered.
“I was told that I wanted ‘a lovely natural labour’: no one asked me.”
Finally some acknowledgement
I was assured then – and later when I complained – that ‘women love the pool’. I didn’t love it. Even less so, when the midwife in an attempt to ‘let me get on with things’ left me largely unmonitored in there, dismissing my husband’s growing concerns and my screams, as sepsis began to take hold. Five hours in, I was eventually released to the obstetric unit, and felt blessed relief to have my pain, and now fever, acknowledged. Eventually my large, malpositioned baby was delivered by forceps, after careful counselling and allowing time for ‘natural delivery’. I will always be grateful for the midwives and consultant in the latter half of labour and delivery, for their compassion, and the fact they listened to what I was saying, which I’m sure prevented deeper trauma.
Thorough research
So, I researched carefully before baby 2. The possibility of a further instrumental delivery was low, and it seemed, anecdotally at least, second labours were ‘easier and quicker’. I was set on a hospital birth, not wanting to risk further denial of pain relief, or any delay in treatment given the sepsis in labour one. C-section was definitely an option, but the prospect of recovering from major surgery with a newborn and toddler was unappealing. I came across some research about induction at 39 weeks. In my mind, with no professional knowledge, I couldn’t see why this was not an option. If babies can be delivered by C-section at 39 weeks by maternal choice, why not induce a vaginal delivery? It turns out, there is some research showing reduced C-section rates at 39 weeks, rather than ‘overdue’ inductions, and an avoidance of the slowly rising risk of stillbirth post-term.
Frowned upon
It seemed ideal. I could have a better idea of dates (although this was more a narrowing of a window, rather than choosing a time), I would be in hospital from the get-go, and I could look people squarely in the eyes before contractions kicked in, and make sure there would be no repeat of the words ‘women love the pool.’ I read the NICE guidance. Maternal request inductions are not supported, except in ‘exceptional circumstances’: the example given of such circumstances is the unavailability of the husband. I found no one in the birth choice community is bothered by this paternalistic phrase. Apparently induction is something foisted on unwilling women, and sticking your head above the parapet to say ‘actually, I think it’s the choice for me’ is certainly frowned upon.
“Sticking your head above the parapet to say ‘this is my choice’ seems frowned upon.”
The ‘wrong’ choice
It seems to me you are admonished about the effect your choice has on other women, your inability to properly understand research, your foolishness for siding with obstetricians and for not buying certain books which tell you how to appropriately exercise your choices (appropriate choices = natural or elective section). ‘Women don’t want medicalised vaginal births’. Apparently there is no conflict in advocating choice and saying that spontaneous vaginal labour must be preserved. Once again I found my wishes contradicting with those of ‘women’. How dare I choose the wrong choice? Thankfully my midwife referred me to a consultant, who ran through risks and benefits, and satisfied this was my choice, booked me for induction. I did face a few further queries in the administrative booking process, presumably due to my ‘unwomanly’ choice.
A true panacea?
Hypnobirthing then. The ‘panacea’ for birth trauma. Helps everyone doesn’t it? It did, to an extent, once someone said ‘it’s really just breathing.’ Because the breathing was, to me at least, very, very helpful. What was not helpful, was the rest of the course which I feel implied all previous difficult labours were down to stress/anxiety, lack of positivity, and the ‘wrong’ birth environment. I see. If only I had been a bit happier about the pool, my baby would have untwisted itself from the chosen odd position for descent and I wouldn’t have contracted sepsis! I felt silenced about my previous experience with this attitude. And the talk of positivity stopped at induction and hospitals: ‘No, no, no, that’s terrible.’ Guaranteed a bad experience there. Don’t start making your own decisions on data. Instead a lecture on how being post-date is not a good reason for induction, and a vague reference to the placenta not working as well. You’re not allowed to mention stillbirth risk. That’s what doctors say to threaten women. Having the raw data, and making a decision for yourself isn’t right, it’ll scare you into a negative experience. The reality is that the rise is small, too small for some to want to risk the potential negatives of induction, but enough for someone like me to decide it’s a reasonable choice.
“The implication that difficult labours are down to anxiety or lack of positivity did not help me.”
Because it’s ‘better’
The course stated pain relief was perfectly compatible with hypnobirthing, but then reframed any talk of pain or contractions. The implication being ‘it’s not really painful, it’s all in your mind’; except, I had given birth before, and it was really painful. Really, really painful. It wasn’t in my mind, it was in my uterus methodically squeezing my giant baby. It hurt. Again though ‘women don’t want to hear negative stories.’ I really am bad at being a woman. This attitude I found repeated at yoga, ‘you’ll be fine if you just breathe, you won’t need anything.’ ‘Why not have a home birth? Women really want to give birth at home.’ Well, I really don’t. One writer about home birth suggested no one really wants to give birth in hospital, if you say you do you’re just quashing your true desires. You see, I don’t even know my own mind! At antenatal groups people talked of their desire for a pool birth. I kept my mouth firmly clamped shut. Then, afterwards, everyone apologised for any pain relief or other intervention, explaining why they had chosen it, even if natural is really best. One rolled her eyes at her former self. ‘I can’t believe I swallowed it.’ I saw a blogger cry that she had ‘given into’ pethidine in her first labour, and she was really going to practice her hypnobirthing and try to do without any pain relief for the second because it is ‘better’. Is it?
“The pain wasn’t in my mind, but in my uterus squeezing my giant baby.”
Swayed
A sample birth plan in the hypnobirthing pack showed you how to refuse sweeps and vaginal examinations. I thought back to my first pregnancy, using my best debate skills to get my midwife to sweep me early (she refused) and my joy when it got to examination time in labour to know exactly what was going on down there. My second birth plan even asked for hands on perineal support to reduce the risk of trauma. The hypnobirthing course admonished anyone concerned about tearing. ‘It’s not a big deal! It’s natural!’ Obviously, I am not zen enough to embrace the idea of perineal trauma. I must just have a knack for making the wrong choices. And yes, the plan was suggested as simply one person’s choice, namely the instructor, but let’s not pretend you are not going to be swayed by the choices of the person who is instructing you on how labour will be.
Above all else
My issue is that whilst in my opinion such movements always state that they are about choice, inevitably I think they celebrate the ‘natural’ above all else. I feel it is difficult to find a hypnobirthing course that doesn’t talk rapturously about birthing in a pool, breathing through contractions, never needing to push and the womanly glory of refusing all pain relief. I heard one hypnobirthing teacher even said that it was ‘sad’ that some women just want to get through labour. They must, in her opinion, embrace it and have ‘an experience.’ I can’t describe how angry it makes me to hear someone who believes they are doing good work actually thinks it is right to prescribe how others must feel.
Ironically natural unnatural
To my labour then. It was an induction with a sweep, artificial rupture of membranes, the Syntocinon drip. All the ‘horrors’. Except it wasn’t horrific. Far from it. And perhaps due to it being a second labour, nowhere as painful as the spontaneous first. I breathed through the initial contractions, moved onto gas and air, and by the time pain approached that of labour one, an anaesthetist had her needle poised for epidural. However, at that stage, I had to reluctantly admit that I strongly suspected I was sitting on the baby’s head. The anaesthetist withdrew and I flopped onto my back (to the end making the wrong choice, women don’t want to give birth on their backs!), two pushes and baby crowned, three and it was born. We were both healthy; no fevers, no delirium, no tears. We were home for sunrise. An ironically natural, unnatural birth.
“My labour had all the textbook ‘horrors’, except it wasn’t horrific.”
Your bias
I am not writing this to say everyone must have inductions. Or that there aren’t woman who are bullied into them, or who have horrible experiences with them. My aim is to say: everyone has a bias. Recognise yours. Yes. Your home birth may have been lovely, but your desires are not universal. ‘Natural’ is not morally superior, even if you call it ‘physiological’ instead. It’s all very well being ‘positive’ but to be so to the extent that you cannot mention risk is infantilising of pregnant people. Treat us like adults. And certainly don’t pretend that a push for ‘natural and positive’ can’t actually do harm.