Childbirth education is extremely valuable. It allows us to feel prepared for and understand the stages of labor, anticipate the strange and unexpected procedures that we may undergo, and know what our alternatives are, in terms of comfort measures, interventions, pain relief options, etc. Feeling better prepared helps allow us to relax and feel more confident about giving birth. Childbirth education also helps our partner or coach to anticipate the your needs during childbirth, and to have some sense of what is “normal.” But to be really accurate, no class truly prepares you for birth. From all the birth stories I have read and heard, it appears that no degree of education truly prepares you for your own, unique birth experience.
I strongly recommend taking a good childbirth class, but I also recommend that you consider that to some degree you are not meant to be fully prepared for childbirth. Giving birth is truly a singular experience. No one has yet experienced the birth that you will have, and the ability to be flexible and let go of expectations is of enormous value.
I asked some of the moms at The Nurture Center to provide their birth stories, to illustrate the range of normal labor experiences.
Lara Honos-Webb, who is an Assistant Professor of Psychology at Santa Clara University, gave me an "autoethnography" she wrote regarding her own birth experience, entitled "Being Pulled Apart: The Antagonism between the Medical and the Natural Models of Birthing." She makes the point that birthing women are figuratively "pulled apart" by the divergent messages they receive from the medical profession and natural birth advocates. Lara attended a Bradley Method class, a hospital-based childbirth class, and a HypnoBirthing class, hoping to be well-prepared for the birth of her first child.
She also hired a doula, intending to "...have a drug-free, minimal intervention birthing experience in a hospital setting." Instead, what she felt she received was confusing and conflicting information that did not prepare her for her own birth experience.
Lara's labor began with a full week of prodromal (prolonged, early stage) labor. After a week, her water broke, and she began to labor more intensely, and also developed a fever of 102 degrees. She received high doses of Pitocin to accelerate labor, and received an epidural after 11 hours of hard labor. After dilating to 10 centimeters, she pushed for 3 and a half hours, and delivered with the help of vacuum extraction.
In her words:
"Immediately following the birth, my son was taken from us and put in the intensive care nursery for possible exposure to infection due to my high fevers throughout labor. I sustained third degree lacerations, could not walk at all for two days following my son's birth, fell 3 times in the hospital and frequently for four weeks following the birth. I was diagnosed with a condition called 'Lumbarsacralplexypathy' which meant that I experienced nerve damage during the delivery. This diagnosis came with a prognosis of 6 months to 2 years for a full recovery. I had numbness and weakness in my knees as of 4 months postpartum. I experienced postpartum depression for two months following my son's birth, was prescribed antidepressants which I declined because I was breastfeeding."
What was most striking to Lara were the contradictions between the recommendations of the " medical model" of birth and the "natural model."In both cases, they seemed to argue that birth is a controllable event, and that you only need to follow certain protocols or recommendations to have a good outcome.
In all her classes, Lara was given the sense that if she did the "right thing," and made the "right choices," her birth experience would be positive. Obviously, this is not the case. There is no way to control whether you will experience prodromal labor, premature rupture of membranes, or whether you will develop an infection during labor. Many women labor for hours after their water breaks with no ill effects, and other women will develop an infection after a short time. There are certainly factors that can minimize these risks, but the bottom line is you cannot control your birth experience entirely.
"The contradiction between the two approaches hit me head on: Should I stay or should I go (to the hospital)? The contradiction increased my sense of tension, increased my sense of self-blame and recrimination, increased my level of fear as I was left with the realization that whatever I chose, I would be making a terrible mistake from one of the perspectives. Staying at home was a mistake from the medical perspective. Going to the hospital was a mistake from the natural perspective. I felt like I was being torn apart - literally, in that labor pains were intense and figuratively, in that I was caught between two systems of thought antagonistic to each other."
While Lara had intended to avoid an epidural based on her natural birthing education, she found that in her own experience, the epidural had a positive effect on her labor.
"In my own experience, after 11 hours of natural birthing, and high levels of Pitocin, the pain became unbearable and I requested an Epidural. In addition to immediately relieving the pain, I began to dilate quickly until I reached 10 centimeters in a short amount of time. After 11 hours of natural labor I progressed from 3 centimeters to 6 centimeters. After administration of the Epidural, I progressed to 10 centimeters in 2 hours. I chose an epidural, not because of a thoughtful consideration of the pros and cons, but simply because I could not bear the pain anymore. But it is ironic that in retrospect, it seems that the epidural was the only thing that allowed my labor to progress. This went counter to everything in the natural childbirth classes and every natural childbirth book I read. Ironically, in my experience, the natural birth model failed me by inducing me to endure 11 hours of needless pain that did little to progress my dilation."
A flexible attitude allows one to consider that, as much as one may want to avoid pain medication, in some cases it may be of value. It is not the first time that a woman has told me that her labor began to progress more quickly after receiving pain relief. Whether this is due to the mother's greater ability to relax when pain is relieved, or whether at the time the pain is greatest (when she asks for an epidural), labor is about to progress quickly in any case, no one can know for sure. But no mother attempting an intervention-free birth should feel that her choice to receive pain relief during labor is anything other than a reasonable choice given the circumstances of her own unique experience.
In contrast, Margo Schembre, who sent me her birth story, described an "idyllic" home birth, but even in her case, there were elements of the unexpected. Margo began early labor in the middle of the night, but had heard that first labors were usually long, and she wasn't sure it was the "real thing," so she sent her husband off to work anyway, and spent the day relaxing.
"I did go ahead and call my midwife, Nancy, after breakfast just to let her know what was happening. We chatted briefly, I was very positive and not concerned, and she agreed that it sounded like super-early labor and the main event wouldn't probably happen until Tuesday (which would have been my due date.)"
During the day, her labor progressed, but she still didn't think it was the "real thing," and spent time reading, answering emails, and taking a hot tub.
"I called Nancy again and let her know I'd lost my mucous plug. She agreed that it didn't mean labor was coming fast and it could still be awhile. I agreed to keep her informed. She said she would " probably stop by this evening, around 7pm" after rush hour just to check me."
Margo didn't bother timing contractions. But as the afternoon went on, the contractions continued to intensify.
"By now (around 2pm), the contractions were strong enough that I felt the need to sink down into a squat and rock a little bit."
She spent some time in the hot tub that afternoon, and her labor continued to progress:
"... (T)he contractions were coming awfully frequently. I still had never timed them, but looking back I think I got about a minute and a half rest between them. I was focused on relaxing between contractions and not anticipating them, which worked well. Too well!! About the time I noticed that the contractions were awfully frequent, I noticed that they were also getting stronger. About every other contraction, I needed to vocalize (low moans,) to get through them and the relaxation started to erode."
"Another contraction. Eyes wide open now. I thought about getting out of the tub, because it's difficult to get in and out of even when I wasn't having contractions and they were coming so frequently now. I checked the time. It was almost 5:00. ...I grabbed the phone and called Mike. I said 'I think I'd like you to come home now.' He agreed. ...About a minute after we hung up the phone, I felt a pop and knew that my water had broken."
"I had another contraction right after the 'pop' happened and it was MUCH more intense and it woke me up COMPLETELY. I was no longer able to purposefully do the hypnobirthing techniques, but I was always able throughout the labor to relax completely between contractions and keep my body loose during them."
" I immediately grabbed the phone and called Nancy. I told her my water broke. ...I had to hang up quickly when a contraction started. In fact, I think all my phone calls after this point ended with a breathless " I have to go now, 'bye' and then either a quick hang-up or just the clatter of the phone on the floor with no waiting for a reply as a contraction started."
"I have never been more relieved to hear the front door open and Mike come home. I couldn't shout for him because I wanted NO exertion between contractions and could do nothing but lay like broccoli. Mike came around the corner and I reached out my arms for him as a contraction started and said something like 'on your knees. In front of me.' And he knelt down in front of the toilet so that I could wrap arms around his neck and lean into him for the next contraction. We did this for about 15-20 minutes with Mike trying to disentangle himself and dash out quickly between contractions and take off his coat, and do whatever he had to do. My memory of this period is pretty fuzzy. I know he was trying to time contractions and says they were about a minute long and 3 minutes apart. At some point he spoke to Nancy again and she advised him that if she didn't get there in time, to just 'catch the baby.'"
"...I remember noticing that the contractions weren't always the same length or the same intensity. They really were less "contractions" and truly did feel like 'surges.' I'd laughed at the hypnobirthing book/tapes for using that term, but that's exactly what they felt like. Sometimes I would need to moan through them, and they were very intense and others were only moderately so and were managed rather easily. Interesting."
"At about this time, Nancy arrived. SUCH a relief to hear her voice! She asked how I was and I said something like 'the baby's crowning!' This is where my memory starts to break down. I know that she checked me and said that the baby was about an inch inside - and I thought 'yeah, right - when I'm between contractions it is. But when I'm contracting that head bulges outside!'"
"The baby's head was now partially emerging and then sinking all the way back between contractions. At one point I was sure that the baby's head was coming and during the resting phase, it slo-o-o-o-wly slid& back& in. I almost laughed! I said 'no no - you're going the wrong way!!' Nancy said that the baby was being kind to my perineum and was trying to stretch it rather than bursting through. I did feel the 'ring of fire' as everything stretched tight. It was painful, but I knew that the next thing after that was the baby being born and the excitement of knowing that overwhelmed the pain. The next contraction and the head got securely wedged and did not slip back. It did not continue out, though - just sat there half in and half out of my body during the next 'rest period.' ...The next contraction finally came and the head finished delivering. Then the shoulders and the baby was completely out. 7:06pm. Roughly 2 hours after my water broke."
"They waited for the cord to stop pulsing and then Mike cut the cord. ...Brutus [the dog] had been on the floor right by my head the whole birth and had been rock-still. I only vaguely remember his presence, he was good as gold. When the midwives took the baby to measure and weigh and do the Apgar thing, he got up and went over to them and got a little agitated. I think he was afraid they were taking the new puppy away and wanted to make sure that his pack got their puppy back."
"I did end up with a small tear - it never bothered me. Felt like a big paper cut and just stung a little sometimes. No big deal. Nancy looked at it and said it was extremely shallow and not worth trying to repair. I didn't feel it when it happened."
" I've told this story to several people and have heard over and over that I was 'lucky' to have an easy birth. I firmly believe that, although genetics and 'luck' may have played their part, the biggest factors in my having such a wonderful experience were that I was relaxed and comfortable with no " performance pressure" and that I was at home and felt safe, in control of my environment and supported by my attendants. I think I'm 'lucky I gave birth at home and thus had a peaceful, beautiful labor and birth.'
In another birth story I received, Merry Burns' story of the birth of her second child was not what she expected at all. She was attempting a VBAC. Her first labor never progressed at all.
On Thursday night, she began having fairly regular contractions, but then they stalled out. She was pretty sure she would have the baby the following night. On Friday, the contractions came back, and were more regular and stronger. She went to get checked on Saturday at 3am.
" ...I couldn't sleep at all and was very uncomfortable. We got to triage and found out I was MAYBE dilated to 1 and not effaced at all. How embarrassing for me and was I bummed because I thought I had a high threshold for pain!!! We asked them when we would know it was time to come in and they said the timing would be like it was now but that I wouldn't really be talking between contractions, I wouldn't feel normal. I never went through this with Hailey because we were induced after 12 days and then had to have the c-section."
Labor continued into Sunday, and things were very consistent and getting more painful.
"Even Sunday night I thought 'holey moley I have got to be close' but we didn't go in because we had an appointment with the doctor on Monday at 2. I couldn't sleep at all, so Bill took Monday off to go to the doctor's with me. We went to the appointment and she told us we were not in labor, were only 1 centimeter dilated but were 70% effaced. She talked to us about our next appointment on the 19th and possible induction on the 22nd. I was VERY bummed and feeling like a wimp! But, the good news was that at least I was almost effaced, which didn't happen at all with Hailey. We got home and I got back on the treadmill, bounced on the yoga ball and tried to distract myself from some pretty strong contractions. My mom left and Bill went to get some sleep since we were sure he was going back to work on Tuesday."
"[On Monday night] ...(t)he contractions got harder and harder and faster and faster but I still felt like myself in-between. The biggest thing was that I could not get any relief for my back, no matter what. Around 2:30ish I woke Bill and told him to call and that we were coming. I told him if I wasn't dilated past 2 I was getting a c-section because it was too painful! ...We left the house at 3ish and I could barely walk through the contractions but at least they weren't coming one on top of the other, they were spaced out a bit. I even thought '...oh, we better not go because I am just stalling out again!' But we leave and then I have a couple monster ones and Bill realizes we have to get there now and starts driving 95 m.p.h. to Walnut Creek. I thought I wouldn't make it through a couple of those contractions - it was unbelievable. We get to the garage and I tell Bill to stop the car and I get out. He has to park the car because he is in the doctors space so I start walking to the entrance. A huge contraction hits me and I lean on a garbage can and then start to walk again. Then Bill comes up to me when another one hits and I lean on him and start walking away from the hospital (I had no clue what I was doing). At this point I am in tears and moaning and I didn't think I could make it and am still thinking I am not in labor but am a wimp!!! This guy sees us and asks if we need help and Bill tells him yes we need a wheelchair. Then Bill pushes me like the Indy 500 into the hospital and to Labor and Delivery."
"We have to go to triage first and the nurse is not there. So I am standing, dying and not knowing what to do my mind is so disengaged and Bill is like 'Where the h*** are they?' It is kind of funny now! The nurse comes in all cheery thinking here they are -- saw the doctor less than 12 hours ago and not in labor and acting like they are going to have a baby. I really was going to kill her!!! She was joking around and I was NOT in the mood to joke. She wanted a urine sample (sorry guys it gets really messy now) and I told her I didn't think I could but I would try. I was barely walking, holding onto every surface and Bill was trying to help me. Well, there was only blood and I told Bill I feel very strongly that I have to push -- tell the nurse. Bill told the nurse and she said have her come back into the room so we can check her."
"Somehow I get into the room and she wants me to lie down so she can hook up the monitor and I told her no chance, lying down was the most painful position for me. I asked her for drugs and she said she couldn't give me anything until they checked where I was. She told me to tell her when the contraction stopped so she could check me. I told her they weren't stopping so go ahead. Bill is helping me because my memory is not so good about all this now. I laid on the bed, she checked me and said I was 8-9 or more centimeters - she couldn't tell because I was so far already and then another bad contraction hit and my water broke. The nurse now knew I was serious and called and said the baby was coming we were on the way. They yanked up the bed rails, kicked open the door and Bill drove again, like the Indy 500, to the birth room. I remember her telling Bill to be careful like he was going to drive us into the wall. I was contracting like crazy and pushing. We got to the delivery room and there were a few nurses in the room prepping it."
"The midwife came in and said no need to check her, look at her, the first nurse said she is more than 8-9, she is ready. They wanted me to get into the labor bed off the gurney but I couldn't do it -- it took a minute for me to focus through the pain to switch beds. I was asking for any medicine to help me, anything and Bill was so sweet telling me they would help me soon and holding my hand."
" [There was] ...one nurse trying to get a monitor on me, two nurses trying to switch beds, one nurse trying to check mer, one nurse looking for an IV and the midwife trying to get me to scoot down for the birth. At this point I am past reasoning, pushing and they are telling me to wait so they could get all the tools out, gloves on, etc. I didn't know if I could wait or not and they gave me some oxygen because I was freaking out. Bill is telling me to breathe and they are saying, 'no don't breathe, push' and I am like - 'get this out!!!!' The activity in the room was incredible, people flying in and out. The second push and Ashley's head was out and they told me one more big push and I would be done. HEAVEN to my ears. I pushed again and they said open your eyes and there was Ashley on my tummy! I was still in shock that this had even happened. Bill cut the cord and saw the whole thing - again, not what he expected this time either. We both thought I would get an epidural and have a six hour nap before real labor began."
" They let Ashley stay on my chest for a good 15 to 20 minutes while I delivered the placenta and got stitched - 2nd degree (tear) cause it all happened way too fast. Oh yeah, the other thing was that they wanted her out fast too because they couldn't get a monitor on her."
" So, she is gorgeous and we are home and still trying to get over what we just went through. All the nurses and the midwife were laughing at us saying that was the fastest VBAC they had ever seen and for the next one we should plan on arriving early. They also could not believe that I did not dilate at all with Hailey considering how fast I went from 1 to 10 in less than 12 hours. I was thinking what an idiot I was to be laboring at home thinking I was only 2 or 3 centimeters when I could have been at the hospital with drugs!!!!"
In another story, Lara Friedenfels shared with me a letter she had written her childbirth educator after the birth of her baby.
"I should tell you, I was really glad I attended your class, and learned about birth alternatives that I might otherwise not have carefully researched. I ended up being induced, and between the pitocin and having to lay down because my blood pressure went up, I was having weird convulsions and not handling my contractions well at all. My midwife and I agreed that an epidural was the sensible course, and I had a very comfortable labor. She turned off the pitocin for the pushing, and coached me really well. I felt like we both actually had more control, not less, because I was not in terrible pain, and she said she was able to spend extra time working him out carefully because I was not in much pain. Because I had a tight hymen (of all things!), she said she might have done an episiotomy to get him out 20 minutes quicker if I hadn't had the epidural; as it was, I had just a small tear, and we got him out in an hour's worth of efficient, but carefully coached, pushing."
"I feel like I have an entirely new perspective on the birth process now. Things are just not as obvious as the birthing books make it sound. Rather than feeling out of touch and out of control with the epidural, I felt calm and able to participate in a really conscious, aware way in the pushing. Interesting. (Especially to me, as a historian of women's health)."
Each of these stories show that, while there are benefits to being prepared, one of the greatest strengths in the birthing mother is a flexible attitude.
Lara, whose story I told first, described how the feeling of being unprepared added to her experience of her birth as traumatic. In her very astute words:
"A sense of helplessness and being out of control are central in the etiology of trauma. Whether a woman births in a hospital or at home, she will certainly be profoundly out of control during the process of childbirth. ...(T)o the extent that expectations about the birth experience are unrealistic, the more likely trauma reactions will be. ...Given the reality that birthing entails a profound loss of control, a protective factor from trauma would be to enter the experience with an increased sense of flexibility. ...Birth and its attendant trauma can be an experience of immense personal growth for women. It may be that the lesson that we are not in control, and the important learning of being more open and flexible are important lessons preparing women for the ultimate purpose of birthing - parenting."
I am sharing these stories with you mainly to suggest that in addition to being as "prepared"as you can for your birth, spending some time contemplating how you feel about the fact that you cannot know what your birth experience will be like, that the course of your labor with be outside of your control, and allowing yourself to be flexible in your expectations.
It certainly helps if you have faith in your birth practitioner and/or doula, your body, a higher power, or whatever gives you strength. There are many ways to birth a child, and in the end, the vast majority of births have a positive outcome. How you get there is another story, however. Be prepared that you will not be prepared.
Meri Hanson Levy is a Coach-Parenting™ Certified Coach and Certified Lactation Educator, the Executive Director of The Nurture Center from 2000-2009, and the mother of three children: Emma, Elijah and Benjamin, who each came into the world in their own surprising ways. Visit her website at www.BondingCoach.com.
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