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Trusting vs Controlling Birth

16 Aug

Trusting birth, controlling birth

Written on July 20, 2010 at 6:03 pm by Birth Sense
http://www.themidwifenextdoor.com/?p=966

MSNBC recently featured a compelling story by Taffy Brodesser-Akner.  She relates a disturbing experience giving birth to her first child in the hospital.  24 hours after the start of an induction, her cervix had not dilated past 3 centimeters.  Her high blood pressure, the reason given for her induction, had resolved, and she wanted to go home and await labor.  Her doctor said he wanted to check her first.  During the vaginal exam, Taffy felt extreme pain, asked the doctor what he was doing to her, and told him to stop.  He did not answer her, but she heard him quietly tell the nurse to hand him a “hook”.  She knew he intended to break her water and yelled, “Get off me!”  The doctor ignored her, broke her water, said “You’re not going anywhere”, and left her room.

Taffy ended out with a c-section–and she now wonders if it was necessary.  After suffering for a year from post-traumatic stress disorder related to her birth experience, she began to question whether her experience could be different the next time.  She asks the question, “Who controls childbirth”?

The readers’ comments regarding this article are interesting, if very polarized.  There are those who chose home birth, unassisted birth, doulas, etc., in an effort to control their birth experience.  Then there are those who retort that you can’t control childbirth, and there’s no point in making any sort of birth plan for something you have no control over.  One reader even mocked women who believe that it’s important to “trust birth”.
What is the truth?  Can we trust birth?  Can anyone control birth?

When I get in my car to drive across town, I realize that I am taking a risk of getting into an accident.  Yet, I trust that I will arrive safely at my destination.  I control what I can:  I can choose to wear my seatbelt, drive the speed limit, not text while I’m driving, pay attention to other drivers around me, and adapt my driving to the road conditions around me.

Childbirth is the same way.  Just as I can’t control the drunk driver who crosses the median at 60 miles per hour and crashes into my car, there are a small number of births in which things go wrong that no one can predict or prevent.

However, just as I may get in my car and forget to fasten my seatbelt, drive above the speed limit, ignore the road conditions, and text while I’m driving, I can also do things that increase the likelihood I will have problems during my birth.

Inductions without clear medical necessity, breaking the bag of water for no reason, continuous fetal monitoring without an indication, and other common medical interventions may increase my risk of being unable to give birth normally.  Is the problem that I could not trust birth, or that my actions made it difficult or impossible for birth to take place normally?

When I speak of trusting birth, I don’t mean that nothing ever goes wrong.  Life happens.  We all know that there are no guarantees.  But I sure know that if I use my car properly, and take proper precautions, I’m much more likely to arrive at my destination safely than if I ignore those precautions.  Likewise, if I take the time to discover what care practices support normal birth, and make the effort to place myself in a birthing environment conducive to those practices, I am much more likely to have an uncomplicated birth.  Trust in birth means I believe that the process works best when there is no interference without clear evidence that an intervention will provide more benefit than no intervention.

As for who controls birth. . .for those doctors who insist that no one can control birth, I would propose that you are attempting to do that very thing by your interventions.  “She’s not dilating fast enough. . .I’ll start some pitocin”. . .”Let’s just break her bag and have the baby”. . .”No urge to push?  Well you’re 10 centimeters, go ahead and try”. . .”Your cervix just isn’t going to dilate.  We need to take the baby by cesarean”.

What is so fearful about relinquishing that control?  Few hospital staff have ever had the opportunity to witness a woman who trusts birth enough to labor without instructions.  I recently helped a young, 17-year old girl give birth for the first time.  English was not her native language, and I was not able to communicate much except through gestures.  Her nurses were amazed to watch her laboring.  She did not like the bed or the monitor, and I told them to allow her to be out of bed as much as she liked, and just check heart tones intermittently.  She paced and rocked, squatted and swayed.  She made soft humming, moaning sounds as the birth drew closer, and then little grunting sounds as she began to feel the urge to push.  Instinctively, she sank down into the contraction, low to the floor, as she began to push her baby out.  I did not instruct her–I was not able to do anything for her except show my support by my presence.

“It’s so amazing that she knows what to do without being told!” one of the nurses remarked.  Another commented, “I’ve never seen birth happen this way. She just seems to be so instinctive about it!”  Other nurses were coming into the room, trying to unobtrusively watch this young woman who knew how to give birth without understanding their directions.  As she began to arch her back with the pushes, one nurse tried to use body language to demonstrate that she was doing it wrong, she needed to curl up into the contraction.  I motioned to her to let the girl push the way she wanted to–after all, the baby was clearly advancing with each push.  Wouldn’t common sense tell you that if the baby is coming down the birth canal, the pushing method is working?

She opened up beautifully, and delivered a healthy baby girl over an intact perineum.  The placenta followed spontaneously soon after, with minimal bleeding.  The girl simply glowed as she held her baby to her breast, and watched her nuzzle the nipple, then latch on.

This is what controlling birth and trusting birth is about.  It’s controlling people and procedures that would interfere in the process without valid reason.  It’s trusting that my body will know what to do.   It’s giving birth the best chance to be normal.

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