Google+ Authentic Parenting: Chance or Choice (rerun)

Wednesday, April 3, 2013

Chance or Choice (rerun)

Written by Cindy Crosby and originally posted on Birth Smart

Many people believe that birth is very uncontrollable and the kind of labor you have is “luck of the draw”. And while that is true in a sense, I also KNOW that there are specific practices that can reduce a woman’s risk of various complications happening (like good nutrition, exercise, or not hiring the Dr. with the 70% c-section rate . . .). Birth is an experience of a lifetime and has emotional and physical challenges no matter how the birth story unfolds, but in my work, I am constantly reminded that women have more power than they realize to create the birth experience they desire. Three women I have recently helped to support illustrate this concept well.

I.

Marian . . . a very average-sized woman . . . recently woke up during the night with a contraction and less than 2 hours later calmly pushed out a 9 lb 4 oz baby. Things went very smoothly and, frankly, she made it look easy. Most importantly, she was ecstatic to finally hold her healthy new baby in her arms and provide him a safe and peaceful entrance into the world.

Her birth had uncanny similarities to one of my own (and Kristin and Beth who I recently worked with) and I can just imagine that she will soon hear the same common phrases: “Wow, you were so lucky to have that fast/easy labor” or “I might have gone natural too if I had a labor like that”.

There’s a lot more to Marian’s story, though, than a 2 hour labor. First, I know that she was committed to avoiding medical interventions unless they were truly necessary, including induction. I also know that she carefully chose a doctor who would support this view. Her labor actually started with contractions on and off for weeks, a lot of late pregnancy discomforts, daily exercise, and several instances of “almost active labor”. The afternoon prior, she had five hours of consistent contractions that she suspected was her labor. When they stayed steady, but did not progress, and then eventually stopped, she knew it was not yet ‘the real thing’. Though this was her 4th baby, it was her longest pregnancy and every day that she went past her expectations (about a week longer than any of her others) was a trial of her faith in the belief that her body would birth her baby when he was ready to be born. Knowing that one of her previous babies had been 10 lbs nagged on her faith a bit as well, as I’m sure you can imagine.

So it certainly wasn’t easy . . . physically or emotionally. But it was the price she chose to pay for her “easy birth”.



II.

Tamra recently gave birth to her second baby. Her first birth was about three years ago, and while it was a positive experience overall, she had a few bumps in the road that she did not want repeated (namely: an allergic reaction to epidural and assisted delivery). So this time, she approached her birth with the intention to avoid interventions, if possible, and set herself up for success by choosing a birth location and midwife that seemed supportive of her goals.

She was very successful. In fact, she gave birth to baby number 2 without any problems whatsoever . . . and guess what? This baby was A FULL POUND HEAVIER (almost 9 lbs) than her first baby who required a forceps assist to be born.

Before you start thinking her birth was easy, let me tell you about the days leading up to it. As a working mother, Tamra had a lot of pressure on her and was exhausted with the end of pregnancy discomforts. She knew the risks of induction and wanted to avoid it unless it became medically necessary. Unfortunately, this was easier said than done when the OB backup for her midwife started to pressure her to induce. There was some question about her due date and though she knew she had barely passed her true due date, the doctors put her at 41+ weeks. She was monitored closely and all signs indicated that the baby was doing very well, but their standard of practice was to induce at 41 weeks (despite ACOG defining term through 42 weeks). They threatened to pull her midwife off the case if she did not consent to induction. She reluctantly scheduled the induction, but did not feel good about it (and the fact she was bullied into it). She called back and made her case for letting labor begin spontaneously. After consulting with the midwife and backup OB, they finally agreed to her request to postpone the induction and retain the midwife for her care.

Interestingly enough, she ended up going into labor the day of the scheduled induction. She was thrilled, relieved, and proud that her body initiated labor on it’s own. She was able to labor in water and give birth on a birthing stool with support from her husband, midwife, and doula. She was surprised when she realized how big her baby was, but she had been telling herself all along that her baby would be the perfect size for her.

She was right.



III.

Vanessa, a first time mom prepared well for her birth by choosing a supportive provider and committed to avoid induction without a medical reason (are you seeing a pattern here . . . ?) She had her own emotional and physical challenges during pregnancy and as time went on, there were some concerns about her baby. Her midwife kept a close eye on the baby and eventually determined with Vanessa that a medical induction was warranted. Vanessa was frustrated because she knew that induction brought increased risks to her and her baby (higher chance of fetal distress, c-section, etc.), but as she carefully weighed the benefits and risks of continuing the pregnancy vs. inducing, she felt that induction was the best for her baby. Though it wasn’t what she had planned and hoped for, she could feel confident that she wouldn’t have regrets . . . knowing that she made an informed decision.

When she arrived the next day for her induction appointment, the midwife checked in on how the baby was doing and she showed some very positive signs of improvement. At that point, they reevaluated the situation together and decided to cancel/postpone the induction. I know Vanessa and her family counted this as a miracle. And it was. But I also see the miracle that occurred months earlier as Vanessa chose a provider who supported her choices and shared her values.

In all my experience, I don’t think a provider cancelling a scheduled induction is a very common practice. In general, our maternity care system sees very little risk (if any) to induction.

About five days after the would-be induction, Vanessa gave birth to a tiny, perfect little girl who came on her own time. Her mama was well prepared for the long but unmedicated labor that brought her into the world and so grateful to hold that loved baby in her arms for the first time.



So . . . chance or choice?

I am confident that these three women made choices along the way that made huge positive impacts on their birth experiences. Though we can’t know what would have happened if different choices had been made, I firmly believe that the outcomes could have all been very different.

I constantly hear women say that “their bodies just didn’t work”, “they couldn’t dialate”, or “their doctor MADE them get induced/have a c-section”. But what if they really did have a choice? What if they could have given their bodies more time to prove that they really did work? Or what if they communicated more effectively with their provider about their preferences? Or what if they changed providers when they discovered incompatibility? Or what if women who chose to be induced owned that choice by saying, “I chose to follow the recommendation to be induced”. Even that simple shift in language, shifts the power in our experience. If we don’t believe that we have choices, our births DO just happen to us and it is “luck of the draw”

. . . But if we want a birth experience that isn’t based on chance, we can learn about and start to recognize the many choices available to us.

Cindy Crosby was an ESL teacher whose life changed forever when she picked up her first pregnancy book almost 9 years ago. Ever since, she has studied and experienced all things birth and along the way become a certified doula and childbirth educator. She is an expert at supporting and communicating with women right where they are. She blogs and provides online childbirth education resources at www.birth-smart.com. She has enjoyed many wonderful opportunities and life experiences, including living abroad twice, and currently lives with her husband and three children in Derby, Kansas, USA.


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6 comments:

  1. I totally agree with you! It is our decision and choices that affect the outcome of our birthing process!
    I wish I had more actively pursued my own wishes! But, alas, I had two "emergency" C-sections! (Which I don't think was necessary!)

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  2. beautifully written - this is a great point to make. thank you for this.

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  3. This really struck a chord with me--I also had an "easy" labor and I do often think about how "lucky" I was, etc.--but maybe this has more to do with the messages I get from our society as well as friends and family. I chose to birth at home with a wonderful midwife who I trusted completely. So others see my "luck" that all went smoothly, comfortably, and that the baby was safe, but I suspect this has more to do with our choice to birth in an environment where I felt safe and comfortable and supported (and left alone). When I get the "my baby would have died" stories, and then the mom tells more of the birth story (with "just and epidural", or an induction) it makes me wonder if the baby would have had respiratory issues or whatever if the birth had been free of interventions. Nice examples of how lucky has not so much to do with a smooth birth process!
    Annie

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  4. I had planned a home birth but developed pre-eclampsia at 39 weeks and could not do anything other than hospitalisation and induction with associated ventouse delivery, awful episiotomy and breastfeeding problems. I so wish things could have been otherwise but do not believe it was possible. I find reading posts like yours very upsetting - please make reference to those situations where it is not something you can influence (or please, please tell me what else I could have done to stay natural - I'd love to know if there is something I don't know about).

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  5. Dear Anonymous - So sorry to hear that your birth experience was not what you hoped for. While it's not possible to address every issue in each article, of course we are all thankful for necessary intervention. It's just that unnecessary intervention is so rampant and most women do not realize that there are ways to minimize (unfortunately not ELIMINATE) complications. I wish you hope, healing and peace to know that you did your best and have nothing to regret. You may enjoy a favorite recent post from birth unplugged - http://birthunplugged.blogspot.com/2011/04/trap-of-idealizing-intervention-free.html

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  6. When I was pregnant with my second I looked all over for stories about women giving birth to big babies without damaging themselves, needing extensive stitches, etc. I didn't find a lot, but this is my story:

    I was 110lbs, 5'6", size 0 when I got pregnant with my second baby. My daughter was 7lbs 10oz and a 3 hour, lovely waterbirth without tearing. I knew my son was bigger - I was huge! We arrived at the birth center around 5 am and he was born at 7:27, 10lbs 4oz, no tearing! It was a wonderful birth.

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