Doula and UC
Being a doula can be emotionally stressful sometimes. *sigh* I have this client that really REALLY wants a VBAC. She's also struggling with self-confidence when it comes to stating what she wants and how to get it. She actually asked me if she could come to my house while in labor during the day, so that her dh wouldn't know and rush her to the hospital. *headdesk* No no no no no no!!!!
So, we had a talk. I explained to her that as a doula and as her friend, I see it as my job to support her in HER decisions, not make them for her and not support her in deceiving her husband. I told her that I really, really believed this birth could be everything she wants it to be but that doing it that way would be wrong! She agreed and has been doing some preparation.
I also did something I never thought I'd do...I actually encouraged her to get a midwife instead of UC. I have so many reasons for this with regards to this particular woman but I realizing it with her got me thinking about UC and my views on it and how I view midwifery and the "professional" relationships that go along with both.
For starters, anyone who's ever birthed a baby knows that it is usually very hard work (and I say usually because I've known a few moms that have woken up pushing and TADA! had a baby in ten minutes!). It's hard not just on the physical level (which is not to be discounted!) but for me, and for many, many women I know, it's hard work on an emotional and spiritual level. I can only imagine how much more difficult this can be for a woman whose suffered birth trauma, rape, or other emotional or physical abuses in her past. Birth brings out your very soul and because of the nature of the work, it often brings up a bunch of hidden negative things, too.
I have met many women in the UC communities that insist that really, no real preparation is needed for birthing, birthing is natural, anyone can do it. I do see their point, in the end, the baby is coming out, like it or not. We've all heard the uc stories that hit the media: Mother gives birth in car on way to hospital!, Taxi driver delivers baby! How about the woman that gave birth in her attik during Katrina? So we see that there is some truth to "anybody can do it" and that there is't too much preparation needed. However, I think to just slap that across the board is very naive and in some cases, downright foolish.
I'm sorry, birth is work. It's good, hard, grueling work and in our society today, many women are just plain and simply not at all prepared for it. Birth isn't a sacred rite in our society, it isn't something we pass knowledge and wisdom down to our daughters about (unless you count horror stories and "You nearly killed me coming out!"). Many women never learn the first thing about birth until they are pregnant and even then, countless women don't bother to learn anything because "The doctor will take care of it". As a result, so many women go into labor and birthing with no concept, really, of what to expect. They've done no mental preparation, they do not understand what is happening inside of their bodies and as a matter of course, birth becomes something that happens TO them, rather than something they are doing.
This is a great, great shame. It is also a reality of the times we are living in. Therefore, I do not think that UC is wise or safe for every woman.
Let me take a moment to define safety, in the context of this article. Anytime I write about UC or homebirth, I do so with the assumption that the person in question isn't "high risk" (and no, being a VBAC doesn't make you high-risk in any rational person's book). So obviously I am not referring to someone who is so wrapped up in her ideals, she'd attempt a homebirth or uc with known, serious complications. I'm talking about healthy mothers, here, expecting healthy newborns. So lets make that perfectly clear. Secondly, safety in this context is NOT life or death that I'm talking about. There is *always* a risk of death, with any birth, we all know that. Research indicates, however, that HOME and UNHINDERED is the absolute SAFEST way to birth. So I'm not suggesting in any way that VBACers are not safe to birth at home or uc.
So what AM I blathering on about? Safety, in this context, is directly related to mom's emotional state. A woman who is a VBAC that has never birthed vaginally, never experienced transition, long labors or really, unmedicated labor, is in a unique position because of all the damage her perception of birth has already undergone. If she enters into labor unprepared, she may panic. Panic is contagious. Panic can change an otherwise uneventful labor into one that needs to be watched for problems. How so? Well, I think all of my readers have heard me blathering on about "fight or flight" and what happens to a woman's body when she is frightened beyond being able to cope. Futhermore, if MOM is panicking during a uc, how is dad supposed to stay calm and ok, if HE isn't prepared? This sets up a feedback loop of nothing but negative energy. Yes, in some cases, this will not have much negative effect on the birth itself, but it will very much screw up the perceptions of birth, robbing it of any pleasure. In worst case scenario, panic for a first-time VBACer leads to unnecessary transport that ends in yet more interventions, which lead to another cesarian and depending on the individual scenario, may or may not truly be necessary. I've heard tell of many a "Necessary" c-section that was certainly needed when it was done...but would never have been needed if Mom had been left alone in the first place.
As you can see, while the mother may not be at any physical risk at all (or as little risk as any woman giving birth can be at) if she isn't mentally prepared to take charge, to be responsible for her birth, to deal with what comes, she may inadvertently be put at risk by her panic. But lets not overlook the emotional dangers here. It's very difficult to separate the emotional from the physical when it comes to birth (though in my experience, most people really prefer to, which is foolishness, imo). How a woman feels about her birth, even while it's happening, and the results of her birth can have long and far reaching consequences. Check into c-sectioned mothers and the incidence of post-partum depression. Is it mere coincidence that post-partum depression is more common today than it was 30 years ago? Personally, I don't think it is. It's a risk that is run even with expected or completely valid c-sections, how much more so for the woman who is blind-sided by one! The rates of c-sections have gone up over the past 30 years (by leaps and bounds that are really just inexcusable) and while some may wish to wave off PPD as a serious problem, a little thought might shed some light on that one. A woman suffering from PPD is not a happy, healthy mother and her children and her entire family suffer for it. Giving her some pills is not the answer when we could avoid the whole thing int eh first place. So yes, I consider PPD to be a largely avoidable, valid concern when helping a woman plan a birth for herself. As a doula I feel that it's part of my job to council and encourage in a way that helps avoid that situation entirely.
And of course, we've covered just a little bit of the physical drama that can ensue form a panicking mother. Now, in the UC communities I tend to run in, I hear a lot about this panic being directly related to hospital birthing (and this is largely true!) So why on EARTH would I actually discourage someone from a UC? Isn't that the ultimate safety against panic?
For many, many women, the answer to that question would be yes. I have encouraged many women to consider it, to think about it, etc. This is the very first time I've met someone that I feel would be unwise to attempt it. Her husband wouldn't support it and while some relationships and dynamics would invalidate that concern, her relationship would suffer for it. Her birth would, too, my client is extremely sensitive and, God forbid, if something were to go wrong, her dh and possibly herself would blame her entirely for it, even if it had nothing at all to do with the place of the birthing. This always happens, too, and it pisses me off. It could be something that was completely unavoidable and everyone will blame the stupid mother for not being in a hospital (like that would have changed anything). Ok, I'm sidetracked, sorry.
The important thing when planning a UC is faith. Faith in your God, your body, the way he made us, birth process, your baby and each other. I attended a birth last year where Dad had faith in his wife's ability to make a sound choice...not so much in his ability to be "a midwife". He wasn't 100% comfortable with the idea BUT he was 100% confident in his wife. They had an inspiring, beautiful birth and I will cherish it in my heart to the end of my days. That particular experience taught me so much about how I view birth, what I look for in clients I'm assisting, etc. They did things very differently than I would have (duh, they are different people!) but the TRUST was there. It was a beautiful thing to see a dominant, very much HEAD of the family, humbly step back and allow his wife the room she needed to do what God gave her to do. He just stepped out of the way and supported her from below. It truly was amazing to watch (and believe me, I know these people pretty well so I will always chuckle a bit because he is NOT someone you'd expect to ever stand back, lol). The love, support and space she needed were right there. It was totally ok that her dh wasn't entirely comfortable with birth, because he WAS comfortable with HER. This is not the case with my current client. I am just so grateful I've never been in her shoes.
This client isn't ready, plain and simple. I told her, very gently, that I just didn't think she was prepared. I told her that she and her dh really needed to trust each other a bit more before planning something like a UC. Her dh, bless his heart, doesn't believe she can birth vaginally. He's only humoring her desire to try. That is not a supportive, ok environment to try to UC in. ESPECIALLY when you have 2C's behind you and are trying to believe in yourself already! So I suggested she consider the MW she spoke with earlier. That MW was a little uncertain about attending the birth with the unsupportive dh (though the midwife made it very clear she expects my client to have no difficulties birthing, based one her medical history) so I told her that if the mw needed to see that she had some support, I'd be there for her all the way. It's going to take some careful planning as I do NOT have a car, still!!!! The birth center is over an hour away, too, and that's rough but unfortunately, no midwife in the area will attend her at home as a VBA2C (for insurrance reasons) and the one hospital that would allow it in the area won't take her insurrance. There was one other mw that was willing to consider attending her at home but my client didn't click with her and that mw told her flat out that she'd do it, but it would be something she technically wasn't allowed to do so for liability reasons, dh had to be totally onboard. I feel bad for the girl, but well, what can she do? The birth center she is going to be using is a long drive but it's the only alternative option her dh hasn't outright vetod. He said "You are a big girl, you can do that if you want to, but I can't support you in it." *sigh* I think he's afraid so I suggested that my client take him with her to her next appointment. This mw and I probably don't see eye to eye on everything but she is experienced with VBACers and their reluctant, frightened husbands. She has offered to talk to my client's dh and to answer any questions he has. She seems like a candy-wrapped gift to me. Also, this BC is stand-alone and has a fantastic reputation. I suggested it because I felt like it would be a compromise that they could both live with that would be a step towards trusting each other.
I hope I made the right decision. I really do, this was hard. I've never had a client that was seeking MY approval for their choices before. I have had to say with almost every conversation, "What I think is irrelevant! This is about you and what you want/need/feel led to do. NOT about me, my ideals or my thoughts. I am only giving you FACTS."
That's another thing that annoys me about the mainstream views on birth. If a doctor says "VBACs are dangerous" he's just "telling it like it is". If I quote a FACT produced from a study that VBACs are safer than repeat c-sec, I'm "pushing my personal opinion and agenda". *stabbity stab stab*
No, as a doula, I feel it is my responsibility to tell my clients the TRUTH and then stand back and support them in what they decide. If my client changed her mind and went with an elective section, as hard as it would be for me to watch, I'd support her anyway. She has all the facts, now, it's HER CHOICE what she does with them. I just wish Doctors as a general rule could do that. Her Dr. has flat out lied to her on several occasions. She's had 3 ultrasounds and this last visit he whipped out the "low lying placenta" card. My poor client just doesn't have enough information! She called me, freaking out, and I had to explain to her that um, it doesn't MEAN anything! If it's not previa, it's not previa and at this point, it's only going to move farther out of the way, if it moves at all. It's certainly not going to pose her any danger and if it WAS a concern, it would have been caught long ago (she's nearly 30wks, now). That, my friends, is classic set-up for a repeat C because this doc and my client have been politely disagreeing about her need for one from the get-go.
Anyway, I've rambled long enough. My point, through all this jawing, is to state that I have finally pinned down in my head what kind of client I would be unwilling to encourage to UC. I feel like doing so with this one would be feeding her to the wolves. I feel she is just as likely to end up with yet another unnecessary C as she would be if she tried to VBAC in a hospital that "doesn't allow" them.
So, we had a talk. I explained to her that as a doula and as her friend, I see it as my job to support her in HER decisions, not make them for her and not support her in deceiving her husband. I told her that I really, really believed this birth could be everything she wants it to be but that doing it that way would be wrong! She agreed and has been doing some preparation.
I also did something I never thought I'd do...I actually encouraged her to get a midwife instead of UC. I have so many reasons for this with regards to this particular woman but I realizing it with her got me thinking about UC and my views on it and how I view midwifery and the "professional" relationships that go along with both.
For starters, anyone who's ever birthed a baby knows that it is usually very hard work (and I say usually because I've known a few moms that have woken up pushing and TADA! had a baby in ten minutes!). It's hard not just on the physical level (which is not to be discounted!) but for me, and for many, many women I know, it's hard work on an emotional and spiritual level. I can only imagine how much more difficult this can be for a woman whose suffered birth trauma, rape, or other emotional or physical abuses in her past. Birth brings out your very soul and because of the nature of the work, it often brings up a bunch of hidden negative things, too.
I have met many women in the UC communities that insist that really, no real preparation is needed for birthing, birthing is natural, anyone can do it. I do see their point, in the end, the baby is coming out, like it or not. We've all heard the uc stories that hit the media: Mother gives birth in car on way to hospital!, Taxi driver delivers baby! How about the woman that gave birth in her attik during Katrina? So we see that there is some truth to "anybody can do it" and that there is't too much preparation needed. However, I think to just slap that across the board is very naive and in some cases, downright foolish.
I'm sorry, birth is work. It's good, hard, grueling work and in our society today, many women are just plain and simply not at all prepared for it. Birth isn't a sacred rite in our society, it isn't something we pass knowledge and wisdom down to our daughters about (unless you count horror stories and "You nearly killed me coming out!"). Many women never learn the first thing about birth until they are pregnant and even then, countless women don't bother to learn anything because "The doctor will take care of it". As a result, so many women go into labor and birthing with no concept, really, of what to expect. They've done no mental preparation, they do not understand what is happening inside of their bodies and as a matter of course, birth becomes something that happens TO them, rather than something they are doing.
This is a great, great shame. It is also a reality of the times we are living in. Therefore, I do not think that UC is wise or safe for every woman.
Let me take a moment to define safety, in the context of this article. Anytime I write about UC or homebirth, I do so with the assumption that the person in question isn't "high risk" (and no, being a VBAC doesn't make you high-risk in any rational person's book). So obviously I am not referring to someone who is so wrapped up in her ideals, she'd attempt a homebirth or uc with known, serious complications. I'm talking about healthy mothers, here, expecting healthy newborns. So lets make that perfectly clear. Secondly, safety in this context is NOT life or death that I'm talking about. There is *always* a risk of death, with any birth, we all know that. Research indicates, however, that HOME and UNHINDERED is the absolute SAFEST way to birth. So I'm not suggesting in any way that VBACers are not safe to birth at home or uc.
So what AM I blathering on about? Safety, in this context, is directly related to mom's emotional state. A woman who is a VBAC that has never birthed vaginally, never experienced transition, long labors or really, unmedicated labor, is in a unique position because of all the damage her perception of birth has already undergone. If she enters into labor unprepared, she may panic. Panic is contagious. Panic can change an otherwise uneventful labor into one that needs to be watched for problems. How so? Well, I think all of my readers have heard me blathering on about "fight or flight" and what happens to a woman's body when she is frightened beyond being able to cope. Futhermore, if MOM is panicking during a uc, how is dad supposed to stay calm and ok, if HE isn't prepared? This sets up a feedback loop of nothing but negative energy. Yes, in some cases, this will not have much negative effect on the birth itself, but it will very much screw up the perceptions of birth, robbing it of any pleasure. In worst case scenario, panic for a first-time VBACer leads to unnecessary transport that ends in yet more interventions, which lead to another cesarian and depending on the individual scenario, may or may not truly be necessary. I've heard tell of many a "Necessary" c-section that was certainly needed when it was done...but would never have been needed if Mom had been left alone in the first place.
As you can see, while the mother may not be at any physical risk at all (or as little risk as any woman giving birth can be at) if she isn't mentally prepared to take charge, to be responsible for her birth, to deal with what comes, she may inadvertently be put at risk by her panic. But lets not overlook the emotional dangers here. It's very difficult to separate the emotional from the physical when it comes to birth (though in my experience, most people really prefer to, which is foolishness, imo). How a woman feels about her birth, even while it's happening, and the results of her birth can have long and far reaching consequences. Check into c-sectioned mothers and the incidence of post-partum depression. Is it mere coincidence that post-partum depression is more common today than it was 30 years ago? Personally, I don't think it is. It's a risk that is run even with expected or completely valid c-sections, how much more so for the woman who is blind-sided by one! The rates of c-sections have gone up over the past 30 years (by leaps and bounds that are really just inexcusable) and while some may wish to wave off PPD as a serious problem, a little thought might shed some light on that one. A woman suffering from PPD is not a happy, healthy mother and her children and her entire family suffer for it. Giving her some pills is not the answer when we could avoid the whole thing int eh first place. So yes, I consider PPD to be a largely avoidable, valid concern when helping a woman plan a birth for herself. As a doula I feel that it's part of my job to council and encourage in a way that helps avoid that situation entirely.
And of course, we've covered just a little bit of the physical drama that can ensue form a panicking mother. Now, in the UC communities I tend to run in, I hear a lot about this panic being directly related to hospital birthing (and this is largely true!) So why on EARTH would I actually discourage someone from a UC? Isn't that the ultimate safety against panic?
For many, many women, the answer to that question would be yes. I have encouraged many women to consider it, to think about it, etc. This is the very first time I've met someone that I feel would be unwise to attempt it. Her husband wouldn't support it and while some relationships and dynamics would invalidate that concern, her relationship would suffer for it. Her birth would, too, my client is extremely sensitive and, God forbid, if something were to go wrong, her dh and possibly herself would blame her entirely for it, even if it had nothing at all to do with the place of the birthing. This always happens, too, and it pisses me off. It could be something that was completely unavoidable and everyone will blame the stupid mother for not being in a hospital (like that would have changed anything). Ok, I'm sidetracked, sorry.
The important thing when planning a UC is faith. Faith in your God, your body, the way he made us, birth process, your baby and each other. I attended a birth last year where Dad had faith in his wife's ability to make a sound choice...not so much in his ability to be "a midwife". He wasn't 100% comfortable with the idea BUT he was 100% confident in his wife. They had an inspiring, beautiful birth and I will cherish it in my heart to the end of my days. That particular experience taught me so much about how I view birth, what I look for in clients I'm assisting, etc. They did things very differently than I would have (duh, they are different people!) but the TRUST was there. It was a beautiful thing to see a dominant, very much HEAD of the family, humbly step back and allow his wife the room she needed to do what God gave her to do. He just stepped out of the way and supported her from below. It truly was amazing to watch (and believe me, I know these people pretty well so I will always chuckle a bit because he is NOT someone you'd expect to ever stand back, lol). The love, support and space she needed were right there. It was totally ok that her dh wasn't entirely comfortable with birth, because he WAS comfortable with HER. This is not the case with my current client. I am just so grateful I've never been in her shoes.
This client isn't ready, plain and simple. I told her, very gently, that I just didn't think she was prepared. I told her that she and her dh really needed to trust each other a bit more before planning something like a UC. Her dh, bless his heart, doesn't believe she can birth vaginally. He's only humoring her desire to try. That is not a supportive, ok environment to try to UC in. ESPECIALLY when you have 2C's behind you and are trying to believe in yourself already! So I suggested she consider the MW she spoke with earlier. That MW was a little uncertain about attending the birth with the unsupportive dh (though the midwife made it very clear she expects my client to have no difficulties birthing, based one her medical history) so I told her that if the mw needed to see that she had some support, I'd be there for her all the way. It's going to take some careful planning as I do NOT have a car, still!!!! The birth center is over an hour away, too, and that's rough but unfortunately, no midwife in the area will attend her at home as a VBA2C (for insurrance reasons) and the one hospital that would allow it in the area won't take her insurrance. There was one other mw that was willing to consider attending her at home but my client didn't click with her and that mw told her flat out that she'd do it, but it would be something she technically wasn't allowed to do so for liability reasons, dh had to be totally onboard. I feel bad for the girl, but well, what can she do? The birth center she is going to be using is a long drive but it's the only alternative option her dh hasn't outright vetod. He said "You are a big girl, you can do that if you want to, but I can't support you in it." *sigh* I think he's afraid so I suggested that my client take him with her to her next appointment. This mw and I probably don't see eye to eye on everything but she is experienced with VBACers and their reluctant, frightened husbands. She has offered to talk to my client's dh and to answer any questions he has. She seems like a candy-wrapped gift to me. Also, this BC is stand-alone and has a fantastic reputation. I suggested it because I felt like it would be a compromise that they could both live with that would be a step towards trusting each other.
I hope I made the right decision. I really do, this was hard. I've never had a client that was seeking MY approval for their choices before. I have had to say with almost every conversation, "What I think is irrelevant! This is about you and what you want/need/feel led to do. NOT about me, my ideals or my thoughts. I am only giving you FACTS."
That's another thing that annoys me about the mainstream views on birth. If a doctor says "VBACs are dangerous" he's just "telling it like it is". If I quote a FACT produced from a study that VBACs are safer than repeat c-sec, I'm "pushing my personal opinion and agenda". *stabbity stab stab*
No, as a doula, I feel it is my responsibility to tell my clients the TRUTH and then stand back and support them in what they decide. If my client changed her mind and went with an elective section, as hard as it would be for me to watch, I'd support her anyway. She has all the facts, now, it's HER CHOICE what she does with them. I just wish Doctors as a general rule could do that. Her Dr. has flat out lied to her on several occasions. She's had 3 ultrasounds and this last visit he whipped out the "low lying placenta" card. My poor client just doesn't have enough information! She called me, freaking out, and I had to explain to her that um, it doesn't MEAN anything! If it's not previa, it's not previa and at this point, it's only going to move farther out of the way, if it moves at all. It's certainly not going to pose her any danger and if it WAS a concern, it would have been caught long ago (she's nearly 30wks, now). That, my friends, is classic set-up for a repeat C because this doc and my client have been politely disagreeing about her need for one from the get-go.
Anyway, I've rambled long enough. My point, through all this jawing, is to state that I have finally pinned down in my head what kind of client I would be unwilling to encourage to UC. I feel like doing so with this one would be feeding her to the wolves. I feel she is just as likely to end up with yet another unnecessary C as she would be if she tried to VBAC in a hospital that "doesn't allow" them.