Continuing Education

A couple weeks ago, I put a book on hold at my local public library. My husband and I went to pick up some books to read before the library would be closed over the Christmas weekend. I felt the need to warn him that the book I had on hold was a book about childbirth. “Don’t freak out,” I told him (because he’s obviously not in the same place that I am on the subject yet), “it’s required reading.”

But guys, I’m so glad that I chose this book from among all the others on the list. Childbirth has always interested me, and I’m fascinated by the variety of ways and places in which women give birth, whether by their own choice or someone else’s.

The book I’m almost through reading is Ina May’s Guide to Childbirth, and let me tell you I really wish I had read this book before M was born. Because I was looking for the most positive birth stories I could find when planning for a positive and peaceful natural birth experience. And the whole first third of this book is exactly that. Positive and empowering and moving stories about mothers giving birth to their babies, letting go of fear and participating in one of the most significant experiences a woman will ever have.

While reading through the rest of the book, I can’t help but reflect on my own experience of labor and birth and wonder about how a few seemingly minor things might have led my son’s first few days and weeks and months of life might have played out differently. I also can’t help wanting to share some of the information I’ve learned with those in my life who are eagerly preparing to welcome their own little bundles of joy earthside. Because even with all my extensive research into various interventions and potential outcomes, when it was my turn, I never even really knew just how much I was doing for my child by my steadfast faith that nature knows best. And I hope that whichever way my loved ones’ labors go, they have beautiful experiences with ideal outcomes–healthy, happy babies and healthy, happy mommies.

Reasons I chose to avoid induction without medical indication:

  • Artificial rupture of membranes (breaking the waters) increases risk of infection and starts the “labor clock” in hospitals. In some cases, it can cause “the umbilical cord to fall out of the cervix below the baby’s head, causing a life-threatening emergency for the baby.” (Gaskin 210)
  • Pitocin induction causes harder, more painful contractions which are more stressful on the baby. It is likely to lead to forceps, vacuum or cesarean delivery due to fetal distress from the stronger contractions, which limit oxygen-rich blood flow between the mother and baby. It is associated with increased risk of postpartum hemorrhage, uterine rupture and is not even always successful at starting up labor. (Gaskin 210-11)
  • Prostaglandin (gels or medications applied directly to the cervix) induction increases risk of uterine rupture, may cause nausea, vomiting and diarrhea. Cytotec, which may or may not still be popular due to the controversy over a number of maternal deaths resulting from its use, has not even gone through FDA approval for use as a labor inducing drug and even contraindicated in pregnant women. (Gaskin 211, 213)
  • A due date is not an expiration date. Many women have irregular periods and most cannot pinpoint the exact date of conception. Midwives and OBs are not psychics, and only the baby knows when it’s ready to be born. Normal pregnancies vary in length, and unless there are clear signs of distress, a forty-two or forty-three week pregnancy shouldn’t be a problem. I was prepared to wait, though I had an OB in the practice I saw who would most definitely brought up induction at my 40-week appointment. Fortunately, my son didn’t want to talk about it either and he was born a few days before that would have happened.

Reasons I “Just Said No” to drugs during labor:

  • I wasn’t afraid of experiencing the many facets of labor, even if it included pain. And I honestly didn’t know if it would be painful, I was more curious about how it would feel than afraid of the hurting. I wanted to be fully aware of myself during the entire process. I don’t drink much or take even much over-the-counter medication, so I didn’t see why I would need it during something that my body was meant to do. I also don’t like feeling out of control (as with excessive drinking or recreational drug use)
  • “Tranquilizers, sedatives, and sleeping pills all have negative effects on babies, and they do not reduce pain.” (Gaskin 233) I wanted my baby awake and alert after birth so we could initiate breastfeeding right away, and I knew that certain drugs could have a negative effect on that process.
  • Epidural doesn’t always work. Two of my coworkers have lasting back pain years after their children’s births. They can cause fever, which doctors will treat as a sign of infection with the administration of antibiotics, which also carry risks. Epidurals can cause a drop in blood pressure, putting both mother and baby at risk. The numbing effect can be unpleasant, can slow down labor, make it difficult to push, which can all lead to more of a chance of forceps, vacuum-extractor or cesarean delivery. Sometimes the babies have breathing trouble or difficulties with breastfeeding. The puncture site can become infected, the drug can cause full-body itching, and can rarely result in maternal death or permanent paralysis. (Gaskin 235-6) Also, I wanted to be able to move both during and after my labor and birth, and the epidural pretty much cancels out that option.

Reasons I chose to avoid a C-section at all costs:

  • It is a major abdominal surgery, which I didn’t want to be recovering from while getting to know and having to take care of a newborn infant.
  • It can interfere with bonding and breastfeeding and increases the likelihood of experiencing postpartum depression.
  • It is risky to both mother and baby if there is no true medical need that outweighs those risks.

C-section involves the following risks to the mother:

  • increase in hemorrhage requiring transfusion
  • hysterectomy for uncontrollable hemorrhage
  • accidental cutting of the bowel, leading to peritonitis, possible colostomy, or death
  • accidental cutting of the uterine artery
  • surgical trauma to bladder and ureters
  • increased postpartum infection, scar breakdown
  • scar pain, numbness
  • long-term severe back pain following epidural block
  • increased pulmonary embolism
  • anesthesia mishaps, including paralysis and death
  • decreased fertility
  • abdominal adhesions leading to bowel obstruction
  • increased tubal pregnancy (in future pregnancies)
  • increased placenta previa (in future pregnancies)
  • increased placenta accreta (in future pregnancies)
  • increased placental abruptio (in future pregnancies)
  • increased uterine rupture (in future pregnancies)
    (Gaskin 289-90)

And the following risks to baby:

  • accidental fetal laceration
  • respiratory distress
  • accidental prematurity because the cesarean was performed too early
    (Gaskin 289)

Something I just learned that I didn’t know before is that there are two ways to sew up a uterus after a cesarean surgery. If you find yourself needing a C-section for whatever reason, make sure they sew you back together in two layers. A single-layer suture significantly increases the risks in subsequent pregnancies, especially placenta accreta (where the placental tissue attaches too deeply in the uterine wall to separate normally during birth).

Really, all pregnant women or women who ever plan to become pregnant someday need to be informed about all the choices they will have to make for their pregnancy and delivery. Each pregnancy is different, and each woman and caregiver are different. I’m sharing my choices in the light of the new information I’ve recently come across because it scares me that a lot of us don’t know more about our bodies and how different things can affect us and our babies. We shouldn’t fear birth, as our bodies were made to experience it, and if any of the things that I’ve listed above are scary to you, they probably should be. Learn how to avoid them, or at least communicate your fears and thoughts with the caregiver that you trust.

I was lucky to experience the kind of birth that I did in a hospital setting. It was beautiful and mostly the way I wanted it to be. I didn’t have to fight, but I also don’t quite feel like I had the most perfect and empowering birth and postpartum experience that I could have had. There are a number of little details I would go back and change if I could. I just hope that sharing some of my new knowledge can help someone else have a beautiful birth like I did. Like we are all capable of having when we are informed and supported throughout our pregnancies and labors.

Read Gaskin’s book if you have the opportunity. I know, as this and many natural birth advocates and midwives know, that these are life-saving technologies without which we would lose many of the moms and babies who truly need the interventions. But the problem our birth culture seems to have is that the emergency has become the new normal. And it’s not. It doesn’t have to be, anyway, especially when the treatment of a normal pregnancy as an emergency tends to make it so.

“In no way can we improve a normal pregnancy and labour in a healthy woman; we can only change it, but not for the better.” –G.J. Kloosterman, obstetrician and professor

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One thought on “Continuing Education

  1. Kelly says:

    Great post! I read Ina May before I gave birth – and the birth stories were really great! Reading positive stories made me feel more confident in my ability for natural childbirth as well. One of the best I read was in Dr. Bradley’s book “Husband Coached Childbirth.” We took a Bradley birthing class, and the book was recommended by our teacher. The first birth story in that book paints this great picture of a couple experiencing the birth of their child together and going through contractions together and enjoying the non-contraction time together – it was exactly what I wanted my labor to be like and ours really wasn’t too far off from that! I also liked “The Birth Partner” but mostly for the explicit information about each stage of labor. Being prepared and knowing what was coming was also a big part of building my confidence. The movie “The Business of Being Born” is also a great reference. I think a lot of people don’t even consider natural childbirth because they just think it is impossible for them or unnecessary. Just learning a little about it can make you think twice. It is definitely possible and so good for you and your baby.

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