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!

I Love Housework!!

It's true. Although you probably couldn't guess it looking at the state of my home right now. Cobwebs everywhere. And dog hair. (update: I got a Dyson, and I vacuumed all that shit up)

When I first started doing housework, my mother was working teaching math at the university, and doing art in her spare time, and being a proper wife and mother. I thought she was a slob, so I cleaned up. It was probably an obsessive reaction to being a misfit adolescent, but it did teach me the thrill of cleaning.

"Some people may regard the little details of the physical environment as mundane and unimportant. But very often, the disturbances people feel come from the atmosphere around them." This phrase from Chogyam Trungpa's book "The Sanity We Are Born With" jumped out at me when I first read it, and it affirms what I believe about the simple tidying-up that we can do as housewives, as friends, as mothers, as roommates, as doulas. 

The table I'm working on is a little cluttered. I ran this morning so there's my running detritus. My agenda. A vase of flowers and in the distance you can see some stuff on my kitchen counter. It mirrors my state of mind these days: a little cluttered, some half-finished business here and there, some worrying issues in the sink.

Mother's Day was originally conceived in 1872, and was accompanied by a plea to all mothers to rise up and end war. It took almost 40 more years until Mother's Day was made a formal North American "day", and the one that was accepted into the calendar began as a liturgical tradition in a Methodist Church. 

The original Mothers' Day Proclamation, Julia Ward Howe 1870

“Arise, then… women of this day! Arise, all women who have hearts, whether our baptism be that of water or of tears! Say firmly: We will not have great questions decided by irrelevant agencies. Our husbands shall not come to us, reeking with carnage, for caresses and applause. Our sons shall not be taken from us to unlearn all that we have been able to teach them of charity, mercy and patience. We, women of one country, will be too tender of those of another country to allow our sons to be trained to injure theirs.

From the bosom of the devastated earth a voice goes up with our own. It says: Disarm, Disarm! The sword of murder is not the balance of justice. Blood does not wipe out dishonor, nor violence vindicate possession. As men have often forsaken the plough and the anvil at the summons of war, let women now leave all that may be left of home for a great and earnest day of council.

Let them meet first, as women, to bewail and commemorate the dead. Let them then solemnly take council with each other as to the means whereby the great human family can live in peace, each bearing after his own kind the sacred impress, not of Caesar, but of God.

In the name of womanhood and of humanity, I earnestly ask that a general congress of women, without limit of nationality, may be appointed and held at some place deemed most convenient, and at the earliest period consistent with its objects, to promote the alliance of the different nationalities, the amicable settlement of international questions, the great and general interests of peace.“

~ Julia Ward Howe

Today was Mother's Day. I began my day with a text from one of my daughter-in-loves. Then a son. Then another son called, and I got to have a long discussion with my grandson (who's ten months old, so our discussion was mostly da-da. Da-da-da. Da-da-da-da, and so on). Then another son and his partner invited me for brunch, but I wanted to go for a long run so I declined, then another son called, and another son's girlfriend texted. I went for my run.

So much love!! There's love all around us. And somehow, for me, when I clean it's almost like I'm shining and dusting and uncovering that love, brushing the cobwebs off my worries, shining up my compassion, scraping off my resentments and my hatreds. 

I did three loads of laundry, changed the sheets on the bed, vacuumed and washed dishes, I dusted the wooden furniture and shelves and I replaced the screens in the windows. I watered all the plants. These simple tasks help me stay reasonably sane, in an insane-seeming world.

Every single one of you was born from a mother. Some of you are mothers yourselves. Let's hold hands, in motherhood, in sisterhood, as housewives, as writers, as athletes, as bank managers, as painters, as machine operators, as ourselves. Let's dust off our hearts and spread the love!

The Shaming of Mothers

More and more evidence is coming out about the dangers of cesarean section. Every time I scroll through my birthy friends' Facebook posts, I see another mega-study that confirms what we knew all along: c-sections are dangerous. Of course, this surgery can and does save lives. But it cannot be true that over one quarter of our childbearing population can't deliver vaginally. 

I believe that for a well-fed, healthy population such as ours in the industrialized worlds, the necessary c-section rate should hover around 5%. Do the math: this means that at least one in five women are suffering unnecessary surgery. This surgery sets the tone for a woman's mothering - it isn't always a traumatic event, but it definitely is a physical handicap and a hurdle that many mothers would rather not have to face. 

I don't want to write about the reasons for these unnecessary trips to the operating theatre; the reasons are varied and complicated. I DO want to talk about how we are making women feel when we constantly post about the dangers, risks, and unredeemable damage caused by cesarean section.

Giant study links C-sections with chronic disorders 

Let's shout it out and make women feel really bad about how they birthed their babies. Let's make them feel even worse about an unexpected c-section than they already do. While we're at it, let's talk about how to have a VBAC: all you need is perseverance, inner peace, and you have to be in tune with your body. Right?

Women are having c-sections they don't want. Women are going to the hospital, sometimes with a doula and sometimes (usually) not, and they find at a certain point in their labor that they are not performing well enough, and they are scooted down to the OR. Most women do not want surgery. Most women want a vaginal birth. Many women want to have a vaginal birth even after a c-section. Just one VBAC support group on Facebook has 8,796 members. 

I am asking all of you to spread the word to not spread the word about how damaging c-sections are. Women who have had an unwanted cesarean birth KNOW that they are damaging. Let's try a little tenderness and spread the word instead about loving the mother, home birth, undisturbed birth, midwifery care, all the good things....

Seven Billion!!

I heard today, as many of us did, that the world's population is estimated to have reached 7 billion people!

Let's not speak of low resources, climate change, and gloom and doom, but let's celebrate this 7 billionth baby's birth with a cheer and a toast, to good health, happiness, and longevity for us humans. I'm sure we can find a way to make it all work.

More interesting to me is the likely fact that this baby was probably born at home, with the attendance of a traditionally trained midwife. I do not advocate going back in time to the days when women died in childbirth, but I do believe that home is the best place to conceive and the best place to give birth. I offer a vision of birthing the future from my book:

My vision is one of most women giving birth at home, with full medical back-up available to them if needed. Midwives would provide prenatal care and accompany the laboring women through labor and birth. They would assist with the postpartum period and help the new mother adjust to life with a new baby. If there were problems, the midwives would refer the woman to a doctor, who may in turn refer her to a specialist, an obstetrician. Full emergency support would be in place for the rare occasion that it is needed, so that the midwife would know that she is covered in the case of an emergency. 

The women who chose to give birth in the hospital, in my dream world, would be there because of clear medical or social need. The hospital birthing centers would provide specialized medical care for the few women who need it. Occasionally, there would be a woman who needs the extra emotional support of a doula, but the doula would be well-integrated into the hospital system and would be on call in these situations. Sometimes a woman would want to give birth away from home, and she could go to an independent birthing center which, again, would be fully supported in case of a medical emergency. 

I do not believe that this vision is so far off in the future, or that it is out of our reach. For now, however, our reality is that most women in the developed world are giving birth in hospitals, and many of these hospitals have different philosophies about birth than many of the patients they are there to serve. In Canada, the philosophy of any hospital must be to provide the best care for the greatest number of people. This may translate into an epidural for every woman, especially if there are not enough nurses to support each woman individually. In the USA, hospitals are run as profit-making enterprises, so the word philosophy may not apply. We do know, however, that cesarean section rates are skyrocketing, and that the general consensus is that a national rate of about 15% may be optimum. Personally, I believe that the rate for emergency cesarean sections can be held to 5% without putting the mothers or babies at risk.

The doula is the interface between the birthing community and the medical establishment. This puts us in a difficult position. I have spoken to  women who thought that I would leave them to give birth alone if they decided to take an epidural (this is beyond cruel). I have been yelled at by a physician who thought I had removed an intravenous drip (the nurse hadn’t had time to put it in). I have been looked upon as a knight in shining armor (I don’t even like horseback riding) by women who had not yet understood that the birth work is done by the birthing woman.

     I have also been thanked and cherished by hundreds of women who have been happy to have me by their side as they go through the experience of giving birth. My task, our task as doulas, and in a bigger sense, our task as human beings in the 21^st century, is to “humanize” birth. To me, that means affirming that all of us are different, and that we all have needs, desires, and histories that cannot and should not be judged. My job as a doula is to create a space in which a woman can reclaim her knowledge of birth and give birth according to her own birthright.

La Mamma!

I was lucky when I had four little ones, because I lived in Italy, a country world-renowned for its art and culture. What? You are imagining I took my four rambunctious boys to the museums? No! The museums came to us ...
There was one image that was always around, and that was the image of a mother and child. Everywhere I looked, when I first arrived in Florence with my oldest, who was then a babe-in-arms, was an image of a beautiful woman with a baby on her lap. The religious details didn't mean anything to me - but the beauty of that image moved deep into my soul and colored much of what I believe about mothering.
I was honored back then. It was a generation that wasn't too reproductive, and we made up for it by having four boys each two years apart. Everyone looked at me with admiration, though they thought I was a happy fool. A peasant once drew me aside to ask me if I knew about "the pillola" - the little pill. I was happy in my ignorance and enjoyed the fertility of that life.

I look at my clients here in a city that is under snow much of the time, where children are considered a nuisance, and the best times are when mom and dad get to go out on their own, and I admire those women I meet who devote their immense energies to being with their young ones. I work with women to achieve their optimum birthing experience, but often I find I am giving support after the baby is born and named - when the mother wants assurance that she is doing the right thing by holding her baby when he cries, or she wants her baby to sleep with her, or she keeps her two year old home from daycare. It is hard enough being a mother without having to cope with everyone else's ideas about what you should or shouldn't be doing. If only we could honor mothers just for being mothers! I felt I received that honor, when my boys were small - no one knew who I was or where I was from, but when they saw me with my children, they congratulated me. I was fulfilling the honorable task of raising babies.

To the mothers having and raising babies! To the women who support them!