WHY IS HOW WE TREAT WOMEN IN LABOUR MORE IMPORTANT THAN WHAT WE TREAT THEM WITH ?

There is one thing that is absolutely undeniably pivotal when it comes to caring for pregnant and birthing women. Whether you are a friend, loved one, doula, midwife, nurse or obstetrician-this one thing is really the the most influential concept you need to keep at the forefront of your mind. This notion that I am talking about is the concept of RESPECT. Sounds easy-right? Let me break it down for you…

According to Webster’s Dictionary, Respect is:

“A feeling of admiring someone or something that is good, valuable, important.”

“A feeling or understanding that someone or something is important, serious, etc., and should be treated in an appropriate way”

I think all of us can agree that pregnant and birthing women deserve our respect. These women deserve the respect of the general public, but most importantly, they deserve respect from their care providers. So why is this often so difficult to find in healthcare these days? Why are women and their families often up in arms about the way they are being treated? Or even worse, why are women suffering in silence? This is because our behaviour as care providers and the general public is often anything but respectful. I’m going to break it down even further to help elucidate my point. RESPECT…

Real

Empathy

Silence

Patience

Encourage Autonomy

Compassion

Talk

“R” stands for REAL. We as birth workers and care providers need to be real. This applies to everyone. It doesn’t matter how much schooling you have or how many births you have attended- you must meet the woman at her level. This means that you need to talk with her and her partner like they are on the same playing field as you are. Sometimes this means sharing a personal story about your own birth, or discussing something completely unrelated at her prenatal appointment because that is where the conversation took you. It’s about showing the woman that she can tell you anything; her fears and her desires. Opening yourself up by being real can make a world of difference for the labouring/birthing woman. In practice, I’ve heard many preceptors/ mentors tell students not to do this because it is unprofessional. In fact, I find that transparency and being authentic builds trust. You want women to feel at ease around you so that their stress levels drop and their oxytocin levels rise (so their uterus contracts and they have the birth they wanted!). So- be genuine and kind!

The first “E” stands for EMPATHY. I’ve mentioned in previous posts why this is so important but I cannot stress this enough. If you cannot empathize with the pregnant/labouring/birthing vulnerable woman then birth work is going to be a tough road for you. You have to sit with that woman and her family, be totally present (I know this can be hard to do some days), and treat her like you would want to be treated. Would you want someone to come in and perform a vaginal examination without asking for permission? Would you want someone to tell you “how this is going to go.” Maybe you would, but I know most women don’t. They may not speak up at the time, but having a care provider who is cold, disconnected and clearly demonstrating a “business as usual” demeanour is not going to express empathy and therefore not be conducive to labour or birth.

“S” stands for SILENCE. Sometimes we need to shut up! Sometimes we need to say nothing and just listen. The care providers that say “hey, how are you really doing?” and stop and let the woman tell her story uninterrupted, not hurried or rushed, can leave the most lasting impressions. I can remember many times the need for silence and active listening. For example, at a birth, when things were happening quickly there was a woman agreeing to have a c-section because she was “stuck at 8 cm for too long.” I remember saying, “Okay stop, we need a minute to discuss this because I am getting a sense that she doesn’t feel this is a good idea, or she is holding something back from us.” Just giving the woman that extra minute to process, breathe and explain what she was thinking and feeling can set the stage for a COMPLETELY different birth. I understand care providers are busy and there isn’t always time for this, but we have to consider whether there is time for this and we just aren’t using it.

“P” is for PATIENCE. Patience and Silence go hand in hand. For anyone who knows me as a midwife or has been in my care, you know that my clinic appointments are almost always behind. Usually on average 20 minutes or so behind. In the world of midwifery that is a long time. That is because I do my very best to sit, listen and to be patient. I need to understand what the client is telling me so that I can help them find a way forward with whatever their concerns are. I need these women to feel heard. Sometimes when the birthing unit has a ton of inductions booked and you are being pressured to intervene (break her waters etc), you need to wait until SHE is ready. This makes a huge difference in how she approaches her birth. If we can do this more on her time (but before she is really exhausted of course) then we have shown her respect. The other aspect of patience  is that if you are so incredibly busy as a care provider and can’t spend sufficient enough time with the patient to listen to her needs, then we need to listen more to her midwife, nurse or doula (whoever is watching over her) because chances are they have been listening when we couldn’t and will know better what she wants and needs.

The final “E” is for ENCOURAGING AUTONOMY. Respect for autonomy is a key component of biomedical ethics. Respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. Some health care providers spend a lot of time educating women and their families so that they can make use of their autonomy and make fully informed decisions. Other care providers gloss over autonomy and find it easier to tell patients what to do. It is true that while some women do want to be told how, when and where to have their babies, I find the majority of women do not. Many women aren’t even aware that they can refuse and decline interventions. This can set them up for a tremendous amount of guilt later on when they say things like “I should have known or I should have spoken up, I didn’t know I could have refused.”

“Showing women RESPECT means that we honour their wishes and understand that coercing them to consent (or bringing the same recommendation up over and over again after they’ve declined or refused treatment) is not helpful. It doesn’t derail birth PLANS, it derails BIRTH- plain and simple.”

So what do we do instead? We honour their decisions, document carefully and support them in their choices.

“C” represents COMPASSION. Compassion is key! Whether it’s drying a tear, holding someone’s hand, asking a student/colleague to leave the room knowing that their presence is making her uncomfortable (unable to birth). Compassion is treating someone like they are human, and not another number. Compassion is dimming the lights and covering their vagina up until it is absolutely necessary to view. Compassion is avoiding a vaginal exam unless it is necessary, and I mean REALLY necessary! Compassion is calling the anesthetist back again and again when the epidural is taking a long time to come. Compassion is telling the woman what you are seeing and feeling as you work, to keep her in touch with what is going on. Compassion is explaining exactly what you are doing during a vaginal exam even though you know she has an epidural and can’t feel it. Compassion is explaining what is going on when the baby is being carried to the infant warmer for a much needed examination. It is reminding the neonatal team that the baby doesn’t need to be bundled in two blankets because he’s going straight onto her chest for skin-to-skin contact. All of these little acts of compassion are what women will remember. These are the things that can make what is remembered positive instead of negative, things that help her enter motherhood without unnecessary guilt.

Finally, “T” is for TALK. This might be one of the most influential of all the characteristics I’ve discussed. We as care providers and the general public need to understand how our words pierce the ears of women. What we say can shape a woman’s pregnancy and birth like nothing else. Let me explain:

Sometimes a care provider says “ Your cervix is ONLY 2–3 cm dilated, we have a loooooooong way to go, you aren’t even in labour yet.” What she hears is “Oh no, these contractions really hurt, and if you are not even in labour yet, how are you going to be able to cope when you are in labour?”

Your care provider says: “You’ve been at this for a really long time and it’s just not working, your baby is probably too big for your pelvis.” What she hears is “This is all taking an abnormally long time, and it’s your fault that your baby got to be so big. You got the epidural and now you can’t birth vaginally.” Sure, we don’t come out and say this to women, but we have to remember that women don’t always know the in’s and out’s of why labour slows down so we as women naturally assume it is something inherently wrong with us.

“Let’s pretend for a second that maybe some babies really are big and don’t fit easily, do we think that telling women this outright will increase the odds of a successful vaginal birth?”

I am supportive of laying it out for women- in terms they can understand. If I don’t think a baby will fit out of her vagina- I will say so but I have to understand that by saying so, I have just changed the entire course of the labour and birth- because I have now put fear and doubt in her mind (So I better be sure!). This changes the equation out of favour of a vaginal birth. If she ultimately doesn’t end up birthing vaginally- well then I was right! ( Or I just made her feel like crap, her stress level sky rocketed and her uterus slowed down). All of these questions or concerns could have been re-framed to instill confidence instead of chip away at what little confidence she has left.

If you tell a woman after 24 hours of labour that she is “still only 3 cm and despite our best efforts, you just haven’t been able to get into labour”, you are going to crush any chance of her ever having confidence at birthing. Even though she hasn’t met the textbook definition of labour does not mean that we should dismiss the back-to-back, oxytocin fueled, grueling contractions that could make any woman fly through the roof. So to say that she hasn’t experienced labour is complete non-sense and needs to be corrected. More importantly, to imply that the labour was “our best effort” is to take away from her contribution to her own birth. We as care providers aren’t doing the hard labour work. At her birth, it is she that is labouring and birthing her baby.

I would say that providing respect to women can even make some of the biggest babies come out of smaller pelvises. The thing is, we know that if we provide women with RESPECT, they will often birth with decency and confidence. If you are a left-brained person, it looks like this:

RESPECT (Increased Oxytocin Levels + Decreased Cortisol (stress) levels)= Increased likelihood of straightforward labour and birth and healthy transitioning newborn!

The equation is simple really. When providing RESPECT, we get a better working uterus, less stress and therefore a better likelihood of a straightforward labour, birth and a healthy newborn. I’m not saying that even if you provide the deepest RESPECT for women, there won’t be complications or traumatic births. I think that we must have a bigger conversation about why so many women and their partners are left feeling traumatized and start taking responsibility for our part in all of this.

I’m asking birth workers to consider humanizing birth and thinking about MORE than just our day-to-day jobs. Birth is so easily manipulated and it’s time that we started reflecting on the way we provide care and examine whether we are truly providing the RESPECT that women deserve.

DO WE HAVE MORE CONTROL OVER OUR BIRTH EXPERIENCES THAN WE THINK?

Scan 4I often sit back and wonder if we have as much control over birth as we think we do? I usually tell women that we don’t have much control over any of it. I think that I secretly want to believe this, but know in my heart that it’s not entirely true. The more I do this work; I realize that things are starting to form a pattern and have for some time. It is becoming more obvious that women carry within themselves a culmination of experiences and emotions that cannot be ignored, especially when undertaking a task such as growing and birthing a child.

Birth is a very magical experience whether you are fully aware of it at the time or not. As an outsider looking in, I see a very pivotal moment in a person’s life that is often shaped and perceived by our past experiences, but more importantly by the way a woman and her partner remember it. I often find that the number one predictor of how satisfied a woman is with her birth experience is how much fear she has going into it. I used to think that it was the way she was treated in labour. This certainly plays a part, however it seems to me that birth outcomes have more to do with how women approach birth.

If a woman comes to me with a very intense fear of childbirth (whether they are aware of it or not), I find that she is already on a path towards a less than ideal birth experience. I know you are probably thinking, “But don’t we all have fear of childbirth, does that mean everyone is going to have an unsatisfactory experience?” No, of course not. I know that often we can’t help the fear that we have. How could we when we have negative visions of birth everywhere? How could we when we have a 30% cesarean section rate and in some countries like Brazil- often 50% in some hospitals. How can we not fear birth when many of us are running around telling each other about our negative birth war stories? Why does surviving a traumatic experience like birth become a rite of passage? Like I said previously, this doesn’t apply to everyone, but it is incredibly common in our culture to talk about birth as if it is something that we may or may not be able to do, or may or may not accomplish. It’s like we approach from a perspective of “how can I get through this experience with the least amount of intervention or the least amount of complications?”

Why is fear of childbirth so important? Why should we be trying to eradicate it?

This is because according to Stoll, Edmonds and Hall 2015, young women reporting high levels of childbirth fear are nearly four times more likely to prefer a cesarean delivery. The conclusions of this study indicate that specific fears, such as worries over how pregnancy and birth will affect our bodies, need to be addressed before pregnancy. They also found that fear of birth and type of delivery (vaginal or cesarean) are similar among pregnant and non-pregnant women which suggests that attitudes towards birth evolve in young adulthood.

The reason WHY we care about the number of UNNECESSARY (I’m not talking about the necessary) cesarean sections is so important is because these types of interventions can have real negative impacts on women and their babies. We not only need to eradicate fear in childbirth because we want women to have better birth experiences, but because we NEED to make birth safer for women and babies on a global level. So if we can help reduce fear, we can reduce unnecessary procedures and surgeries which will ultimately lead to better experiences and less harm overall.

So part of my job is to help women sort through their fears, rationalize them, own them, and then work towards reducing their impact. We all have a baseline level of anxiety around birthing a child and this is completely normal. Most women tend to have more anxiety and fear than confidence and excitement.

So what are some ways to decrease fear in childbirth?

One way is to surround you with positive stories and women who are also confident in birth. That doesn’t mean that you should ward off women with “horror stories”, but it just means that you have to understand that birth stories can help shape our understanding and vision of what birth should be like. If all we have is lying on your back in excruciating pain as your reference point, you can almost imagine how tense your body will become and how difficult it will be to visualize your baby coming out in a peaceful and meaningful way.

How can you be an active participant in the birth of your baby if you only have negative, fearful visions of your baby being born?

How can you go into your birth with confidence if all you think about or visualize is lying on an operating table and crying because this wasn’t exactly what you wanted for the birth of your child? How can you enjoy your planned cesarean section if all you are imagining is complete terror and everything going wrong with your delivery? So find a way to expose yourself to inspiring birth information. This doesn’t mean that you shouldn’t learn about potential complications, but I would recommend that you don’t spend the majority of your time and energy focusing on them. I will post a list of resources very soon that I find very helpful for women to inspire them throughout pregnancy and birth.

Also, try to keep track of how frequently you find yourself thinking about your pregnancy and birth from a place of fear or anxiety. I find that women who keep a journal throughout their pregnancy can often keep track of their thoughts which might give them some insight into which areas they may want to focus their research on. Do you focus more on how birth affects your body? Do you focus more on how birth interventions might affect the baby? Are you spending your time worrying about whether you are going to develop postpartum depression? Or are you worrying about whether your partner is going to step up to the plate once the baby is born and be an active participant? These are all real concerns for women and deserve to be discussed and demystified before you are expected to birth.

Another way to decrease fear in childbirth is to have a care provider that you can develop a relationship of trust

Pick a midwife, family doctor or obstetrician that you can show your authentic self. If you can’t find one of these that you can be your true self with, then consider hiring a doula.

Pick someone that you can be vulnerable with, and say what you think, what you feel and fear. This is so important because this person has so much potential to influence your thought process and your confidence level regarding the birthing process.

You want someone who is going to build you up, instead of watch you fall apart

This is one of the most amazing aspects of midwifery. I love sitting with women and listening to them process all of the information, and shape their experiences in their minds. I love listening to them talk about what could happen, or how they felt about their births afterwards. I especially love watching women come out of their fear and into an excited, open-minded state.

It’s easy to blame society and the medical profession for creating such a morbid approach to birth at times, and it’s easy to blame each other for sharing our war stories but…

The truth is, no one can shape your perspective of childbirth more than you can

We as women have a choice. This seems to be a big secret! We can choose to read about birth, ask questions or stay silent and avoid discussion. We can choose to have a midwife or a physician; we can choose to hire a doula, read scary books, or positive books. We can choose to seek counseling for any life events that might be following us into our world as pregnant women or mothers. We can choose a home birth or a hospital birth. There is so much we can do to help ourselves maximize our abilities to birth, but I think we often don’t know where to look or how important it is to do this work.

We have to take responsibility for our role in birthing our babies

We can’t rely on our midwives or physicians to tell us what to do all the time (although this is easier). This doesn’t mean we don’t need to look to them for support and for them to respect our autonomy. We have to speak up when we are scared, or when we aren’t sure. We need to play an active role in our information sharing and continue to build each other up. I know this sounds very intimidating and easier said than done, but if you find you can’t bring yourself to speak up, then we need to find a way to prevent these recommendations or scary thoughts from gaining power over our visualized birth.

We may do “everything right”, and read all of the right things, and take all of the right classes and still feel like we aren’t enough, or our births were traumatic. Unfortunately this happens and sometimes we are attended by people who are not kind to us, or who don’t have the courage to attend us in the way that we need. This always makes me sad when I hear these stories or if I myself was a participant in these births.

I remember when I was pregnant with my first child. I was so busy working that I didn’t really fully address my own anxieties about birth and raising a child until I went on maternity leave at 35 weeks. I remember sitting around in the dead heat of summer feeling my anxiety rising about pushing this baby out. I remember thinking, “What if I can’t birth this baby? What if I need a cesarean section? What if I need an epidural, or won’t be able to birth at home like I said I would. What if I can’t breastfeed?” I remember thinking, “What kind of midwife would I be if I can’t do these things?” Midwives too aren’t exempt from the human condition and still worry about all of the “what if’s”. I kept trying to tell myself to take my own advice. So I read and re-read Ina May’s guide to childbirth, and watched empowering birth documentaries over and over again. This seemed to help and reminded me that none of these pervasive thoughts are important, that I need to trust myself and I owe it to myself to go into my own birth with a positive attitude and to consider that everything just might work itself out. I also needed to have a respect for the things that I cannot control (like my blood pressure, or which obstetrician might be on-call if I needed them) and let those thoughts go.

As the days grew longer and my due date came and went, I could feel my emotions whirling and my anxiety coming and going by the hour. It took a lot of work for me to control the thoughts in my own head because I knew that if I let them run wild that my body wouldn’t work optimally for birth. I knew that I had to get my stress levels under control; I had to stay calm and focused. So I stopped answering my phone, and stayed close to my husband who always seems to keep me grounded, and visualized what I wanted my birth to look like. I wanted it to be in the daytime (so I didn’t lose sleep!), in the water and at home where I could control who came around and what I could eat and drink. Sure enough, I visualized this so many times that I didn’t worry about it anymore. I already “saw it”.

So the morning that my daughter decided to come, I already had a deep sense of how that day was going to. I’m not saying that you can just order your birth like a meal at a restaurant, but what I am saying is that

The only thing we have control over is our attitude and vision going into childbirth. Everything else is open to interpretation

I see this in practice as a midwife daily, and also in my own experience in birthing my children. Everything else (who is there, where you birth-sometimes, how the baby comes out) is all extra stuff that you can’t really control.

I would argue that your attitude and vision is the most influential factor and the one thing I work tirelessly on as a midwife throughout your whole pregnancy. So instead of just arming yourself with facts and a list of things a mile long that you DON’T want to have happen at your birth.

 I would encourage you to dig deeper into yourself and figure out how you truly feel about birth and being a mother

 I would encourage you to consider what you imagine when you close your eyes and think about all of those things. I want you to pay attention to how your body reacts when you imagine your birth, does it tense up? Do you hold your breath? Do you smile with excitement? These physical reactions are just the beginning and what often sets the stage for a much bigger process. So be willing to work on yourself and your relationship so that you can go into the birth of your child with a clear mind and focus to receive your baby in anyway they come because they will be counting on your strength when they look up at you for the first time.

I mean these words with kindness and in no way want to shame any woman about their birth. In no way do I have this all completely figured out but sure hope to find a way to help reduce the fear women feel. I just want to share my thoughts on what I see as I get the opportunity to be a part of these amazing experiences for women and their families. Even if you close your eyes and visualize the most peaceful calm birth, if there is fear attached to those visions, you will have a hard time watching it come to life. Giving birth is about letting go, and surrendering to the uncertainty. This is also often why it is considered one of the hardest things you’ll ever do.

A FEW THINGS I’VE LEARNED ABOUT BEING A MIDWIFE…

 

IMG_0352The experience of being a midwife lies along a continuum somewhere between the extremes of sleep deprivation and an addicting, adrenalin pumping, thrill ride. Being a midwife is exciting on many levels. It can be challenging at times, rewarding and humbling. There are many articles that already outline the existing ways in which midwives lives manifest themselves but I thought I would share what I have learned over the past five years and what my experience of being a midwife has taught me.

First of all, while studying midwifery for four years, midwifery taught me how to connect with women. It taught me how to sit and really feel what life is like for various different people and their families. It taught me how to be wrong, and to admit it. It taught me how to put others needs before my own and most importantly, it taught me how to come up with 5 or 6 different plans or strategies for whatever you encounter, every single day. Whether that would be an emergency situation, or whether your car broke down and you really needed to be somewhere. As a midwife, you need to be ready to stop what you are doing and leave at any moment. Here’s one of the beautiful things about midwives that often sets us apart from many other healthcare providers- we are incredibly resourceful and amazingly resilient. If you can think of a group of people that have been pounded into the ground over and over again (whether that is by other healthcare providers, each other, or the government) and have managed to pick themselves up time and time again-that would be us.

Midwives literally have multiple different strategies playing out in their head at any given time. If you come in with a pregnancy, birth or post-partum related issue, we often have multiple different solutions and because we know you so well, we can usually pinpoint the strategy that A) you would pick for yourself and B) would be the safest and most ideal for what you are looking for. I bet most people reading this wouldn’t be able to even fathom the incredibly hilarious stories and events that we have sometimes found ourselves in. Whether it would be the birth of a baby in a car on the side of the road (bad winter roads can hold things up), or finding ways to push the boundaries of what is considered acceptable within the constraints of an established hospital setting. An example of this would be when a midwife makes four different phone calls in the operating room to authority figures until they get support in providing skin-to-skin contact in cesarean section- after they are told that they “aren’t allowed to”. I cannot forget to mention that we can literally catch a baby being born in any position that the woman finds herself in, and we know we can do it well.

As much as midwifery training taught me how to be thoughtful and strategic, above all else, it taught me how to have thick skin and be vulnerable. Training under multiple different care providers (midwives, obstetricians, lactation consultants etc) really forces you to see things from everyone’s perspective and (if you are humble and gracious enough) to feel compassion for the types of care each person provides.

Once I was done school and started to practice on my own, a major shift occurred for me. I learned how to be truly present with women, to tap into their worlds and see their visions, fears and dreams through their eyes. I learned how to identify with women and their families. No more teachers looking over my shoulder and micromanaging my every move-for better or for worse. I was able to start shaping the midwife I wanted to be become.

Over the past 5 years of being a midwife, I’ve learned to have thick skin. My job is never completely “comfortable”. It’s always a day full of negotiating and educating, and fighting for women’s choices. It’s often a day full of arguments and conversations with other care providers about the best course of action. It’s about protecting women’s autonomy to make their own decisions for themselves and their babies (this is a lot harder some days than people think it is). It’s often about inventing new ways of turning unfavourable clinical findings into a glimmer of hope that women can hang on to.

Scan 4

Being a midwife has meant going into the hospital to attend a labouring woman on a Sunday night and finally leaving on a Tuesday night. It has meant sleeping in on-call rooms, eating terrible food and having late night amazing conversations with the nurses while my client is sometimes sleeping with an epidural. These conversations often result in me walking away after thinking, “ We really aren’t that different after all, turns out we seem to be fighting the same fight.” It’s meant building relationships of trust with the OB consultants. It’s meant making multiple different phone calls to many different obstetricians until you finally get the consult that you are looking for, or until you find one who is willing to honour your client’s choice. It’s about not always taking no for an answer.

It means calling up a colleague, or another care provider to discuss recommendations that were made that caused fear and anger and were found in meaningless evidence. It’s meant having more compassion for the residents- that need to learn just like we did. It’s meant holding people accountable for their words and actions when they are wrong or disrespectful. It’s meant shutting up when I am wrong or disrespectful.

“Being a midwife means being humble enough to admit when you are wrong. It’s acknowledging that things are never about you, but about the woman and what she thinks and needs. It’s about being truly authentic- and giving women the support to be their true authentic selves in return.”

Being a midwife has taught me that you don’t have to be perfect, and that the work is hard and exhausting, but above all else it’s thrilling and igniting. It can bring so much joy that you feel spun for weeks. Sitting and connecting with women while sharing mutual experiences is one of the most empowering things we can do for each other.

“Being a midwife is about protecting and fostering the connection that pregnant women and new mothers need to grow and raise their babies feeling empowered and informed.”

Being a midwife has meant that I get to share some of people’s most memorable moments, some of the hardest days of women’s lives. It leaves me lying in bed many nights thinking about how happy I am when I leave a long fulfilling clinic day, an intensely amazing birth or a birth that I know was extremely hard both mentally and physically for the woman. My work often leaves me with an immense sense of gratitude. Being a midwife has helped me so much as a mother and being a mother has helped me grow as a midwife.

Both motherhood and midwifery deepen my level for empathy and compassion to a sense that can be overwhelming. Being a midwife means opening yourself up to feel what everyone around you feels- good or bad. This can be exhausting some days but mostly worth the time. This is because you learn much more from the women than you do from the textbooks. You learn much more about birth from sitting back and watching than you do from telling her what to do.

The days and months run into each other and sometimes it feels like the work will never end (we are human too). Most of the time though, when you get that labour call, you jump out of bed, throw your clothes on, grab your keys and run out the door with a smile on your face knowing that you already have 5 or 6 different plans for what is about to come up and you can’t wait to see what will happen next.

Thanks for listening!

Meg xx

My Birth Story is none of your business….

IT’S MY BIRTH STORY- I’LL TELL IT ANY DAMN WAY I WANT TO!”cropped-img_0347.jpg

So here’s the thing- we spend a lot of time thinking about our births. We spend a lot of time wondering what they will be like and reminiscing about what they were like. We also spend a lot of time negotiating just which way to tell our stories. The conversations usually revolve around 3 or 4 questions that need to be answered. These questions are: Did you have a c-section? Because let’s be honest, everyone wants to know if you could pull off a vaginal birth. Did you get the epidural? We want to know just how “tough” you are. Did you need any stitches? And are you breastfeeding?

Allow me to elaborate on how ridiculous these questions are. The answers to these questions are supposed to be what society uses to decide whether someone had a “good” or a “bad” birth.

“The entire conversation is basically a dance between two people trying to avoid making the other feel ashamed.”

Whether someone has a c-section or not is only relevant if you are planning to bring food, help do her laundry, or pick up her other kids from daycare because otherwise, she might be disappointed with her looooooooooong, intervention ridden labour and not want to talk about it anymore, or have to explain WHY she had a c-section. Even worse than that, she may not really even know why. Alternatively, she might have chosen a repeat c-section because the trauma from last time was too hard for her to face again. Either way- asking her is really just forcing her to justify why her baby came out of her stomach, whether it was her choice or not.

Asking a woman if she “got the epidural” is a confusing question, because the response almost always depends on whether the person asking received one as well. If you birth without an epidural, most women downplay that, or feel guilt because of it and then act like they should have, or like they just happened to get “lucky”. I hear women say things like “wow- you didn’t? You are insane, I don’t know how you did it”. Honestly, what does that statement even mean? What good comes from asking this question because A) it’s none of your business and B) Do you even know enough about epidurals to be assessing her answer anyway? Do you know whether epidurals are harmful or beneficial? Or do you just know that they take labour pain away (most of the time)?

“Did you need stitches?” is a hilarious question. Why don’t you just say, “So how exactly did your vagina hold up?”

Why do women want to know the answer to this? If you don’t have kids, do you really want to know “how many stitches” she got? This question is also irrelevant because as healthcare providers we don’t actually count these stitches. There is a lot of muscle to be put back together, so it’s not like you usually get “one” stitch anyway. There is even an inherent judgment in asking how many stitches she got. Why don’t you just come out and say “hey, you got a lot of stitches- that means your vagina is EVEN WORSE than the woman who only got a couple stitches! You might as well also say “Let’s talk about how terrible you probably feel about your body now and how I’m basically focusing attention to the fact that your vagina is likely forever changed.” What good comes from this conversation?

The breastfeeding questions probably annoy me the most because there is SO much judgment in our culture about breastfeeding. There is a lot of judgment against women who don’t, and definitely judgment about women who do.

“The reality is that the answers to these questions are really none of our business and women say they don’t care when people ask them but I find that they absolutely do. They come into my office, close the door and bawl their eyes out. These questions matter…”

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So what should we say?

I find that when women have their babies and the topic comes up, or I’ve just gone to visit a couple of days or weeks later, I say “How are you doing?” followed with “So how did everything go?” These questions are more open-ended and let her take the lead and shape it in the way she feels necessary. You see, we put emphasis on all of the wrong things when we ask these specific questions and I’ll tell you why- because whether you had a vaginal birth, an epidural, stitches or are breastfeeding is not what defines her birth as good or bad. It’s whether she felt respected, valued, informed and in control.

“She will remember her birth positively if she was given all the important information, was treated with dignity, asked permission before she was touched, and was given the sole rights to her baby the second the baby was born.”

She will look back on that derailed, long, intervention-ridden birth with confidence if she knows that SHE made the decision for a c-section, or that she was listened to when she said “I’m not ready for you to break my waters, I want to walk some more instead.” These are the things that matter most. She doesn’t need you to remind her about the specifics- and yes, some women do want to talk about these things, but on their own terms.

“Some women have a vaginal birth, in 4 hours flat, no epidural, no stitches and breastfeed their babies like a champ- and STILL look back on their births negatively. Who are we to judge?”

So I think when we ask women about their births, we need to stop and let them tell their story- because it is THEIR STORY. If they don’t want to elaborate on all those juicy details that we so badly want to hear to validate our own experiences, then we have to respect that. We need to encourage women to tell their stories, and learn from each other, and smile when they say, “Everything went really well.” At the end of the day- she has a whole new job to do and what she needs is support- not to feel ashamed for getting an epidural or not breastfeeding her baby.

Thanks for stopping by to hear my midwife rant…

Meg xx

**Don’t forget to follow my blog if you want to read more exciting/crazy/informed/ pregnancy and birth talk!- oh and some useful stuff too…

THE NECESSARY VULNERABILITY OF BIRTH

 

Although pregnancy and birth is a highly vulnerable time, the part that makes it all feel impossible at times is the sense that we are not enough. We question everything when we are pregnant. We question our ability to grow a baby, to birth a baby, and to raise a baby. Most of us walk around with a shield of armor around us, waiting for something bad to happen. This often consumes our thoughts, and we communicate it in our words. We set intentions that we aren’t even aware of.

We experience our pregnancies through a lens of shame. We are hard on ourselves, and on each other. We keep many of our fears hidden or a secret, to avoid feeling shame when others tell us their opinions about such things as where to give birth to our baby. Or we share our fears out loud in an attempt to seek connection from other women who have experienced those same fears. The problem with the latter is that it just breed’s more fear.

There is a reason why women who refuse to talk about their fears in childbirth, or create very complicated, static birth plans often end up in the very situation they spent months trying to avoid. There is an inherent unwillingness to be vulnerable in our birth culture today. This is a very real and concerning concept, because vulnerability is the very thing we need to embrace when we have created life. When we spend countless hours of time and energy focusing on what we don’t want, we are inadvertently bringing us that much closer to that experience.

So what do we do instead?

We attempt to control everything. We buy all of the essential items (and sometimes more) on our baby registry, we buy cribs and bassinets and we buy breast pumps “in case we can’t breastfeed.” We decorate the nursery because we can’t have a baby without that checked off of our “to-do list.”

“We drown ourselves in all of the things that aren’t important to avoid the things that are.”

We need to feel we have so much control over the outcome of our pregnancy that we forget who we are, and we often become someone else. We become obsessed with how to have the perfect pregnancy, with what foods to eat, and knowing everything we could possibly need to know about pregnancy and birth. We spend our whole pregnancy outside of ourselves, peering in on what it might look like on the other side- once we have “perfected” it. We avoid our feelings, or just simply can’t make sense of them.

We avoid being vulnerable in our obstetrical appointments. We often avoid the hard questions out of fear of sounding stupid, or not feeling worthy of a conversation with someone with such little precious time to give. We choose hospital birth over home birth out of fear that we “won’t be able to do it without pain medications,” or because on a deeper (but more pervasive) level, are we sure we can actually even birth our babies? We avoid telling our loved ones that we are planning a home birth, out of fear of being vulnerable, out of fear of feeling like an idiot when we are transferred in for pain relief. We want to avoid the “I told you so”. We avoid telling each other when we have positive stories, because we feel shame for not being able to identify with other women and their painful experiences.

We consent to interventions that we don’t want because we can’t sum up the courage to ask all of the questions, or say “no” when we really don’t feel like it is the best course of action. We let shame creep in and say, “who do you think you are challenging the doctor, or midwife”? “Who do you think you are pretending like you know birth better than everyone else and choosing to birth your baby at home”? “You better get that epidural, you know you can’t birth this baby without it!” Even worse, we do this to each other. My question to women is always the same- have you ever thought about what it might be like if everything just goes really well? Have you ever considered that you are going to jump off a cliff the day your baby is born, and most certainly will land on two feet? Many women look at you blankly, as if the thought of that is completely irrelevant when preparing for the birth of your baby.


So what SHOULD we do?

The answer to this is easy. It’s called empathy. According to Dr. Brene Brown, empathy is the only way we can beat shame and allow for vulnerability. So this means that when women and their partners share information about birth, you might say, “Oh wow, tell me more about what that would look like, having your baby at home”? Or, “wow, I’m so sorry that you received that bad news about your ultrasound. I don’t even know what to say. My heart is breaking for you, how can I help you through this?” This is in direct comparison to sympathy, which would sound something like “oh really? Well, at least you miscarried before you were really attached to the baby.” Or “Well, at least you transferred into the hospital from home before things got really bad.” Those statements are not helpful, and breed shame. They harm everyone.

We need to say out loud for ourselves to hear, “I’m sorry Doctor, but I don’t understand what you are talking about”, or “to be honest with you, I don’t think that what you are recommending is the best choice for us right now.” Or, “I feel very uneasy being here today for my induction, and I really don’t want anyone else in the room other than my partner and nurse. So could you please make sure that there is no one else other than us?” And we as providers need to respect this decision; we need to empathize with her state of mind and physical discomfort. When we empathize, we breed connection, and therefore trust. Judgment breed’s shame, and where there is shame, there is no vulnerability, and herein lies the problem.

“How can we expect women to grow their babies, birth them, and raise them with an empowered sense of self if they cannot be vulnerable?”

It is our responsibility to ourselves and one another to be vulnerable and in turn express empathy, maybe then we will start to see some real much needed change in our birth culture.

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Instead of focusing on why the cesarean section and induction rates are so high, we should be asking ourselves,

“Why are women so afraid of birth”?

My perception in practice is that they are afraid of vulnerability. Many are afraid of failure, and regret, and losing something they love. So they avoid being vulnerable until the end. They avoid actually considering an unmedicated birth in the event that they may want an epidural, and don’t want to be seen as weak. So if women just plan to get it, it was their choice. Or women may say, “Oh I just had to get an epidural, they made me, I had no choice”. Often times we do have the choice, and if we say yes, then don’t be afraid to admit that. Be empowered by your decisions, and own and accept them because only you can decide what is best in that moment in time.

The second part of this answer pertains to the lack of vulnerability on the part of our healthcare systems. As the care provider, we are taught not to be vulnerable, to be 100% aware and correct at all times. The truth is, we often are not. So care providers need to take a step into vulnerability and be willing to say when they don’t know, or they made a mistake, and we need to be able to meet them with empathy. Maybe if we allowed care providers to be more vulnerable, then we might not be so inclined to do so many cesarean sections in the presence of uncertainty. We may be more inclined to leave women to birth in peace, instead of hovering over them every second.

We need to create more empathy in pregnancy, birth and parenting. We need to be kinder to ourselves, be more open about our vulnerabilities so we can understand that birth is vulnerable. There are no guarantees with any of it. You have to be willing to let go of who you want to become, in order to be who you are.

“You have to stop trying to be the perfect mother, or the perfect patient, in order to be the vulnerable, confused, and scared person you are entitled to be.”

Let’s create a birth world where we minimize shame by having a conversation about it and in turn promote vulnerability. I believe this is essential in our growth as a culture, and it is imperative for us to feel connection with our children and with each other. This is easier said than done, but in my opinion, essential if we want to restore positive birth.

Why Visualize Birth?

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I started this website for many reasons. I also called it “Visualize Birth” for many reasons. I don’t need to tell you all of the reasons, but suffice to say that I called it “Visualize Birth” because that is precisely what I want people to do. I want people to be able to stop by and read about all of the various ways people may visualize their births. Many women nowadays are looking for the “perfect” way to have a baby. Many are buying all of the books, and attending all of the prenatal classes because they perceive that to be the best way to prepare for the birth of their baby. Although this is all helpful, it is really just superficial stuff. Reading books, and attending prenatal classes is really just scratching the surface.

I am a registered midwife (RM) from London, Ontario and have been practicing for 5 years. I’ve had two babies in that time which has arguably taught me more than the 9 years I have spent submersed into this culture we call birth and catching babies. I could have called this website or blog ” My Perfect Pregnancy” in an effort to secure more visitors and create more hype, but I didn’t. I want people to realize how very different each persons “perfect pregnancy and birth” is. I want to demonstrate that all of this is merely a matter of perspective. Let me start in my next post with describing the births of my own children.

I will plan to post information that women should find helpful as well as other thoughts I have as I work towards improving our global maternity care crisis. Feel free to send me an email if there is anything specific you would like me to write about. This is just the beginning for me, and as I learn to navigate this thing called the world wide web, I will be able to more readily transform the constant chatter within my head, to a beautiful piece of text on these pages. Stay tuned!

Meg xx