Birth (and life) after Cesarean

I love to listen to birth stories. Many of the stories that I hear are a testimony to the pregnant woman's great ability to "animal out" on her attendant. My favorite is the story of a young woman who had her first daughter by cesarean section She became pregnant again the same month and it turned out she was carrying twins. Her doctor was very alarmed and booked her for a cesarean at 38 weeks, She went into labor at 36 weeks and delivered two lovely girls, vaginally.

Of course, women who are trying for vaginal birth after cesarean don't always have such fine stories to tell. Two remarks have stayed with me over the years, and these were both delivered by obstetricians to a laboring woman. The first was: “Childbirth is like war, and I am on the front line.” The second: “This is Monday morning in a busy hospital. There are road accidents, emergencies …” This was said to a woman who wanted to labor a little more before the decision was made to go to surgery, implying that the birth of a child had to be scheduled in somehow between a messy car accident and some other horrific case. Why did this man want to become an obstetrician? How did he feel about his "patients"? How had he been born? What was it about birth that suggested to him images of war?
What is it about childbirth that makes these people think in terms of war, car accidents, death? Is it just fear? And if it is, what exactly are they afraid of? And , more importantly, where does the midwife fit into this mosaic of fear, or does she fit in it all?

Doctors and midwives who are afraid of childbirth are partly afraid because of their training. Allopathic medicine teaches about pathology rather than the whole healthy being, and pregnancy is often seen as a pathologic condition. But there is another more profound reason for this fear, and it has to do with the fact that Western medical training teaches health workers to rely only upon their own knowledge. How does this lead to fear?
Let me explain. During childbirth there is something present that is outside of us as individuals, out­ side our knowledge, even outside our experience or our skill. That "something" has to do with faith. It is only with a leap of faith that you can appreciate or even accept that a new human being comes out of a woman's vagina. Without that leap of faith, what happens? Two things: more obviously, you have to interfere, pull it out, cut it out another way. But another thing happens as well. Strangely, your faith (most of us have faith in something) gets turned inwards. As an obstetrician, you have faith only in your own skill. And that is what is frightening-- that an event which cries out for the presence of God gets reduced to the simply human.

I'm sure that there are obstetricians who works differently, but I think that it is easier for a mid­wife to accept that there is something else, something larger than herself, working through a birthing woman. It is quite noticeable how many mid­wives are religious, how many live in sight of that something which many people call God. But what happens to the sympathetic midwife working within the medical system? What happens to her sensitivity to that Other which touches us when we give birth?
I have met many diverse people over the years of working with birth.I have encountered some women who probably disliked their work, who were overtired, overworked, who had little faith in any­thing. I have also encountered mid­wives who have accepted modern medicine's vision of birth. And I have met many brave and gentle souls doctors, nurses, midwives, and doulas, who are working within the medical sys­tem and trying to maintain their faith at the same time.

What do we see in a hospi­tal? We see, first of all, an exagger­ated reliance upon technology. We know that the use of technology has a snowballing effect, creating the need for more and more complicated interventions. Secondly, we see a rigid hierar­chical structure in which usually one person is calling the shots. Finally, we see the "spiritual" infrastructure upon which this hierarchy is based, to be inward looking and grounded only in human knowledge.
What happens in the hospi­tal when things start to "go wrong," when things don't follow the pre­scribed path? When I went into the hospital in labor with my first child, the nurse, who was actually a mid­wife trained in Scotland, touched by belly and said cheerfully, "This baby will be born by noon." As time went on, she touched me less and less. By the next morning at the start of her shift, she didn't even greet me. As they let me eat and drink less and less, my cervix grew smaller, I was touched less and I began to feel more and more isolated. I was touched only when necessary. The baby's heart­ beat was checked less often. I began to feel abandoned.

Can I offer some advice to birth attendants working with women who are hoping to give birth vaginally after a cesarean section? Remember that the previous cesarean(s) have left scars not so much on the uterus as on the woman's sense that she is capable of giving birth. Accept that having a cesarean can hurt. Please don't de­scribe to her how a ruptured uterus may feel. Watch for danger signs yourself. Keep your concerns to your­self as much as possible. Remember "failure to progress" can be linked to fear and stress.
Keep things easy even when they get hard. Remember that a woman work­ing for a VBAC needs the comfort and security of her own home. Remem­ber that she may need to work on building confidence, on throwing away fear, on finding her "animal" self. Re­member as well, if it turns out to be another cesarean, don't abandon her. Give her the support through the birth and afterwards that you give any birthing woman. If a lady has another cesarean, she may feel very low; it may help her to talk to another mother who has been through the same thing. Avoid the mistake of "You're lucky the baby's okay.That's the important thing." Yes it is, obviously, but ... she may still need to grieve.

I am lucky - I have been blessed to have attended many successful VBACs during my years as a birth attendant. Thank you, again, to all the women who have shown me how fearless and strong birthing women are - not least, the woman who have said "Yes, I am ready for surgery, of course, if my baby's life is in danger."
Here's to a happy marriage of modern medicine and safe midwifery, with lower cesarean section rates and happier and healthy mothers and babies. L'Chaim! To Life!

Meconium Happens

The more I live this life, the more I am convinced that the deal is, it is not what happens to you that matters so much, it's how you accept it (or not). I have been to births that have been really challenging and tough, where the woman accepts the labor and is thrilled with the whole experience. I have seen other women fight against labor and birth, one contraction at a time.

Today is December 6, 2020. A day like any other. Except not: it's the anniversary of the day when 14 women were killed by an armed killer.

It's a day when my friend had to go back into hospital. It's a day when thousands of people died from Covid-19.

It's a day when we have to, as always, take the joy from every moment and cherish it. And even when we are full of joy, and all comfy in our enlightenment and entitlement, shit will happen. Meconium does happen. A baby can suffer some small slight and poop. Or a baby can get their cord squeezed so much they poop a lot. Things break down, things break. People break. 

But where there's rupture, there's repair. A body's urge is to health, just as a plant moves towards the light. In the same way, the knowledge of women has always been towards healing. 

We can't do anything to bring those women back to life. But we can speak out against violence every single day. And, unfortunately, in my field (haha no, not in my cafe...in my real field which is maternity care), violence against women is rampant, ugly, and expected. 

What can be done? Well, one thing that's happening is that pregnant women are rising up and saying "No more violence! No more treating me like I'm a child, that I don't have feelings, that I don't know my own body. No more speaking about me as though I'm not present. No more making decisions about my body without my consent. No more doing things to my body without my consent. No more lying to me!" And how are these women doing that? By withdrawing from the hospital system. They are giving birth on their own or with Traditional Birth Companions. 

Another thing that is happening is that doulas are continuing to support women who choose to give birth in the hospital. Or, more importantly, those women who don't actually have the choice and have to give birth in the hospital. Especially these days, it's hard to be a doula. Many hospitals have taken away the birthing woman's right to support by insisting that she choose between her partner and her doula. So doulas are providing companionship and support virtually. 

Medical staff in hospitals in today's world are stressed. They're overworked, tired, and they have all the same concerns on their minds as you or I. Suicide rates are higher for physicians than for the general population, and higher for female doctors than males. The medical system isn't working for anyone.

What can a doula do to relieve everyone's symptoms? Let me be clear: when a doula works to facilitate a mother feeling empowered in a situation where her power can be taken away from her at any minute, we are not talking about getting at the root of the problem. If a birth is an undisturbed birth in a place where the birthing woman is comfortable, safe, and respected, then the doula can do the work of being a doula: easing labour, providing encouragement, seeing to the birthing woman and her family's needs. But if a birth is taking place in an environment where the go-to routine is medication, management and directives then the doula can only provide bandaid measures within a strict and abusive system.

And these bandaid measures can work! Any number of women leave the hospital with their babies feeling joyful, even ecstatic, and satisfied with their care. But a huge number of women leave the hospital hurting.

Is it time to finally step away from an abusive system? What happens to a woman when she has a vision of a natural, normal birth and she arrives at the hospital and things start to go haywire? Is it possible to convince women to stay at home, at least until they are in active labor? What about the woman who feels every contraction, from the very beginning, like torture; the woman who can't separate her labor contractions from an abuse she experienced years ago? What is the role of the doula through this seismic change? What about midwives? Why are midwives still using the words "should" and "allow" when they speak about birth? 

Is it time to Rise Up?

Lovers

We went out last night to talk. There's always someone around at our house, and everyone always wants to hear what we are talking about and why. Sometimes its nice to get away, in the event that we can't find Maxwell Smart's Dome of Silence.




Our favourite quiet lounge was being renovated (?why? It was perfectly nice before...) so we drove and walked around for a while - this may sounds pleasant but I find it hard to have a conversation when you're walking together in anything below 0 degrees C. We finally found a nice little bistro, and we sat and had a drink and I made lists of our whacky pipe dreams from 2003 ahead, and we tried to decide what to do with the next five years.

We've always been dreamers and planners. From the moment we met, we were arguing about how exactly to make the world a better place. Over the past few years, we've had all sorts of ideas - from going back and living on the mountain,

to opening a bookstore/cafe in Florence, Italy, to starting up a catering business in Barbados. 

Right now, the plan is to build up the place up on the mountain and let birthing women come there to have their babies....Sounds great, no? If you're reading this and you're interested in joining us in this project, let me know.

I digress. Lastnight as we were drinking, arguing - we rowed a little close to the shore a couple of times ("I can't stand the way you always do that..."), and writing lists, I noticed a lovely young couple sitting by the window.

She was pretty. Dark hair, tied up in an abrupt pony tail. Skinny body and face. She was dressed up in tight black pants, and a little sweater and waistcoat. Not much makeup. Her hair was falling in spirals next to her face where it had rebelled against the elastic. He was handsome in a typical boy-next-door-who-hasn't-shaved-in-two-days way. Sexy. He was wearing a button down shirt, with v-neck pullover on top, jeans. You could tell they had both picked out their clothes carefully.

They were in love. She held his hand. He would her hair around his other hand. They smiled at each other and laughed.

I'm putting this message in a bottle and throwing it into cybersea:

Keep your love alive. Never forget that feeling of awe that you had when you were sitting in that Bistro. Time will try to rob you, but don't let it. When you decide to have a baby, be careful. Don't let anyone tell you what to do. Go with your heart. Only you know what you can and want to do - having a baby is like making love, it's between the two of you and no one else.

Plan to sit together, in thirty years, and make a list of crazy dreams from your past, present and future...

Blessings

I went to bed happy last night, because every Sunday I get to play jazz clarinet with a small group of amateur musicians (and one professional to glue everything together).

I read for a bit, Adam and Eve, by Sena Jeter Naslund - an interesting read. I put my head down and within five minutes my phone rings and a lady's water has just broken, very exciting, water everywhere. "Just like in the movies," she said.

All is good, I suggest she try to sleep a little. We spoke a few times during the night, as she was having some contractions, but I continued to suggest she sleep as much as possible.

In the morning, she call to tell me that she and her husband have decided to go to the hospital, where the news is that her cervix is not dilated, and they are going to try Cervidil to "jumpstart" labor.

Just asking all you folks out there, whether you're "in the know" or not, to throw a blessing her way. Just throw it out, and if it doesn't land on her, it'll land on another birthing woman...