Hypnobabies Moms: Use your Bubble of Peace if you choose to read this.
This morning I was driving home from visiting a client and I was listening to an excellent Evidence Based Birth® podcast episode called "The Wide-Reaching Effects of Birth Trauma." It got me thinking about my own experiences of birth trauma (that I've witnessed as a doula) and my goals for all the students and clients I work with.
In the podcast they talked about obviously trauma like serious complications during birth, a loss, or direct assault by a care provider, all of which, sadly, do happen. But they also talked about other ways people may experience birth trauma. The mom who wasn't listened to or shown respect during her birth, the young couple who were railroaded into choices they didn't understand, and other ways families can leave their birth experience feeling terrible about how they were treated and just generally traumatized by the whole experience.
This trauma is far reaching. It can impact how the parent and baby bond. It can affect breastfeeding success. It can cause postpartum mood disorders like anxiety and depression. It can even cause people to alter their plans for their family when they can't imagine giving birth again even though they wanted more children.
The two best ways I know how to help families avoid trauma is to help them carefully select a care provider who "does" the type of birth they want every day, and to arm them with so much information, knowledge and empowerment that they truly know that THEY are in charge of their birth. This is one key focus of Hypnobabies and one reason I love the course so much.
Unfortunately, not all care providers (doctors, nurses, and midwives) are the same. As a doula who has attended births all over the Twin Cities at nearly all local hospitals, all birth centers and many home births, I see the dramatic difference that provider and location choice make. In many cases it is literally the only thing that causes a birth to be traumatic or not.
There was the mom was having the most beautiful, natural birth at a hospital not known for being natural-birth friendly. She was slow dancing with her husband and I was in awe of her strength. Then the doctor came in when baby was very nearly born. He basically said "Get in the bed on your back. I've been doing this 30 years. You don't know what you are doing." She had wanted to push in a position that used gravity and protected her perineum but was now being forced to get on her back in the bed. I looked at the dad in panic and tried my best to say something in the moment to help the mom remember she could do whatever she wanted. But when a baby is about to come out of you, you are quite vulnerable and she did what the doctor said. I can only do so much as a doula. What was almost such a beautiful, empowering birth turned into a traumatic one in only a few minutes time.
There was the mom having her third baby (and third un-medicated birth) and seeing an OB known to be very intervention-happy. We rolled in to the hospital and mom was about to push out her baby. In an 8 minute period, the doctor directly ignored three clear directions that came right out of the mom's mouth. The first was for the doctor to take her finger out of her vagina after a cervical check. The second was to delay cord clamping. The third was to let the placenta come out on it's own instead of pulling it out. I knew this doctor only by reputation but I quickly understood why some doulas won't attend births with that practice. What I saw was assault and completely unnecessary. Luckily that mom didn't seem traumatized. But I sure was.
There was the mom who had been pushing for three hours with a first baby and an epidural on board. This is all very normal. Her baby was close to being born and mom and baby were doing great. The doctor came in, told the mom she looked tired and probably didn't have enough energy left to get baby out. She said she'd probably have to do a vacuum extraction or c-section if she didn't get baby out soon. This motivated the mom to get the job done. Then the OB told mom she was going to tear and might as well let the OB cut an episiotomy. The mom consented, sort of. The episiotomy extended into a 3rd degree tear but the mom was told by the doctor it was only a second degree. She had to get the real information from the nurses later. This was traumatic for a mom who had trusted that her OB group had her best interest at heart and wouldn't do anything medical that wasn't necessary.
There was the client who had the nurse try to hold in her baby in because she hadn't called the doctor in on time, even though the doctor was literally outside ready and waiting. This, if you ask me, is assault on that baby and mom's body. And all so the doctor can bill for a delivery? At least in this situation I was able to lean down and whisper in her ear "push your baby out" and she did just that. The nurse had to catch.
There was the mom who received an extra cervical check while completely anesthesized (under general anesthesia) simply because the nurse didn't believe the mom was completely dilated even the OB had checked a few minutes prior. This is sexual assault.
There was the mom who kept having her pitocin increased without consent even though her waves (contractions) were two minutes apart and one minute long. I brought it up but the nurse just blew if off. Mom attained her epidural-free birth but it was a huge challenge and immediately afterward she said "no more babies!"
Luckily, for my mental health, I have stories of amazing, beautiful, empowering, family-centered births to counter each of these stories of traumatic birth.
So what can expectant parents do? First of all, if your doula or childbirth educator says "Have you considered midwives/a different hospital/a different provider?" realize that she is saying this because she knows something you don't know. If you are low risk you can absolutely see midwives both in the hospital setting or out of hospital. You can always consult with a midwife and see if you qualify as low risk. It's a much broader group of folks than you might expect. Midwives can often attend VBACs, moms with diet-controlled diabetes, pre-eclampsia, a premature baby, parents who used IVF to get pregnant, "older" moms, moms with a higher BMI, and so much more, Or find those rare OBs who follow the midwifery model of care and practice true informed consent and informed refusal. They do exist but since most doctors and hospital midwives work in a group practice and you get whoever is on call, it is always a crap shoot to give birth with a larger practice of providers.
If you really truly want a low-intervention birth, choose to birth at a birth center or at home with a skilled midwife in attendance. Provider choice is the most important thing you can do, followed closely by having a supportive team (doula, partner, family, etc.) and fully educating yourself about birth, your choices, and how to create an environment where you have truly informed consent at every step along the way.
Click here to start researching the safety of birth centers.
Click here to learn all about home birth and start exploring if it might be an option for you!
Want to learn more about having a midwife attended hospital birth? Check out this article I wrote about Five Surprising Reasons to Hire a Midwife.