“Baggage Check” An Essay on Releasing Expectations

October 27th, 2010
Sometimes you read something and you just have to share it. So it is with this guest blog post called, Baggage Check, By Angela Quinn. This post  just made me think of all the Mamas on Bedrest when I read it. How many of you, (and I have to include myself in this category) have spent even a smidgen of time ruminating over what you could have done differently to have avoided your pregnancy complications and/or bed rest? Do you wonder, “Was it the exercise classes I was taking?” “Those late hours at the office?” ” Some sort of environmental exposure?” For a few, there may be an actual cause. But for the vast majority of us, our pregnancy complications are just that-regular old complications that occur during pregnancy in a certain percentage of women. While it sucks to be a statistic, the bottom line is, life happens and sometimes we just have to accept that we were caught up in the flow. Angela comes to this realization and I hope that by reading her post, some of you will be able to “Let it be”.

Baggage Check By Angela Quinn

This article originally appeared on The Unnecesarean (one of my favorite blogs. I highly recommend it!)

Wanna know a little secret?  Not all homebirthers are free-spirit, hippie-types who run barefoot and bra-less through life without a care in the world.  Some are (and I’m totally jealous) but a good many of us are really type-A, compulsive, control freaks.  I wanted to have a homebirth for a number of reasons: lack of confidence in the non-evidence-based medical model of labor and delivery, lack of desire to fight policy and procedure during contractions, and mostly because I wanted to be in control of my own birth process.  But I also wanted to be able let go at any time without feeling like someone was right there hovering over my shoulder waiting to take that control from me.

So there it was in a nutshell – why I chose homebirth.  On July 29th, 2010, I had a “successful” HBAC and brought my beautiful little girl into the world to join our family.  However, I’ve struggled for the past couple months with why I have felt cheated, dissatisfied and disappointed.  After all, healthy mom, healthy baby – that’s all that matters, right?

Recently I realized that I am suffering from the loss of my expectations.  I thought that I could control the whole process of birth. If asked, before the birth, I would have smiled serenely and said things like, “I don’t know what to expect, we’ll just wait and see,” or, “I’m just going to let things play out and see how they go,” or, “I’ll just go with the flow.”

But inside, I just knew.  This birth, maybe my last baby, was going to be the most awe-inspiring-amazing-empowering-healing-example-setting-I-am-woman-hear-me-roar example of childbirth EVER.  Here’s how it would go, I imagined.  I would realize I was in labor, I mean, having surges, and I would immediately put on my Hypnobabies CD and go into hypnosis.  I would recognize the surges for what they were, functional and opening my cervix like a flower.  I would light some candles, send my husband out for Rita’s Italian Ice, read a book, and get into my nice warm birth tub where I would labor in stoic silence, a pillar of strength, telling my midwife and doula that they could rest and I’d let them know when the baby was born.  I would push for a few minutes, because (this time) my baby would be in an optimal position since I’d done everything right during this pregnancy (I exercised, ate well, saw a chiropractor, sat on my birth ball for work, watched my posture, did pelvic tilts, visualized).  I would have a waterbirth. The Hallelujah chorus would play as I reached down to feel the baby crowning and usher her into this world into calm, loving, peaceful surroundings.  I would immediately place her on my chest.  She would crawl up to my breast, just like the videos, and latch on by herself.  And, cut!  Fade to black with mother and baby happily bonding and music from a Summer’s Eve commercial playing in the background.

My mom says I’ve always been like that, expecting things to go the way I plan them. When I was 9 or 10 years old, I’d write these skits that my younger siblings and I would put on for my parents.  Somehow I expected Broadway, and was always surprised and disappointed by the reality of 5 little kids who forgot their lines and had safety-pinned towels and paper hats for costumes.  In preparing for this birth, I thought I was just visualizing and being positive, but what I had really done was written my birth story ahead of time.  Well, guess what?  It didn’t follow the script.

In reality, I went into labor in the morning and worked through the first 6 hours or so finishing up stuff for my boss and sending emails.  Then I went to a scheduled appointment at my midwife’s office (an hour away), dropped off the kids at my mom’s, run some errands, and threw up in the car.  The Hypnobabies stuff worked in the beginning, but once it got harder, damn, that woman’s voice got annoying.  Surges, my ass!  How about hot knives being shoved into my lower back.  I had excruciating back labor (again!) because, despite my best efforts, I had another occiput posterior baby.  I didn’t like the birth tub after a couple hours and got out.  I whined and moaned…a lot.  I considered transfer to a hospital since I really thought she wasn’t coming out at one point, but the only reason I didn’t transfer is because I was so wimpy that I knew I wouldn’t be able to handle my contractions (or the back pain in between) in the car.  I never felt the urge to push since she was face up, but I pushed for over 2 hours, painfully, and she finally came out once my tailbone broke (again!).  She didn’t crawl to my breast by herself, because she wasn’t breathing and didn’t breathe until after about 5 minutes of resuscitation attempts. It was the scariest few minutes of my life, and I’ll never be able to think about her birth without remembering that heart-stopping, throat-constricting fear.  Fear that we would become a statistic, that this whole thing had gone horribly wrong.  After this birth, I knew I didn’t want to have any more children.

This wasn’t how it was supposed to go.  This birth was supposed to be healing.  I was supposed to overcome the physical and mental obstacles of the birth process through sheer determination and feel so powerful afterwards.  My education and knowledge was supposed to carry me through any tough times.  I was supposed to have a wonderful, idyllic story to tell to those considering homebirth.  I was going to be an example to others of how the female body is made to birth naturally and effortlessly.  My birth was to be a statement about what’s broken in maternity care today.  I don’t know about you, but I’m thinking that’s a pretty freakin’ huge burden to put on one vagina.  That’s a hell of a lot of baggage to hang on the shoulders of one tiny little baby.

That’s not to say that I’m not allowed to be disappointed.  Or grieve the loss of the perfect birth story that lived in my imagination.  Or to feel betrayed by my body once again.  I’m allowed to be sad about it sometimes.  But I think I would have been less so if I had not decided ahead of time that my birth story would be defined by what it could DO for me.  Assigning a value to the birth process based on a pre-determined “yes or no” outcome is exactly what frustrates us so much sometimes about the “quit whining you have a healthy baby” attitude of society.  So why do we do that to ourselves with the other outcomes of a birth?

I wrote down my actual my birth story a couple days afterwards, and it had a lot of grief and anger and sadness in it.  I could barely see to type it up because I was crying so much while I wrote it.  It was only later, when I started looking through my camera to add pictures to the story, that I began to see the details that I had been missing because I had so many pre-conceived ideas that were clouding my perspective.

As I saw the pictures taken around my house, I remembered that there were times of peace during the process and that I was comfortable in my surroundings, allowing me to focus on what I needed to do.  I can say without a doubt that had I not been at home I would have had another cesarean.  The picture of my doula putting a wet washcloth on my forehead and pouring warm water on my back made me realize that I did need to rely on others around me and that it is OK to ask for help.  Seeing how often my husband’s hands were in the pictures as I leaned on him for support made me realize how much he was there for me.  Our relationship has been on the rocks for the past few years, and I even said to him that it didn’t matter to me if he was present for the birth.  I didn’t need him or anyone else.  I prided myself on my independence.  But I did need him, surprising both of us just how much.  He felt needed and I felt taken care of.  It’s quite possibly the first time in 11 years of being together that I have ever relied on him to that extent, and it changed something subtle in the dynamic of our marriage, for the better.  When I saw the picture of my husband cutting the cord and the one of her lying on my chest afterwards, I was grateful for the decisions I made leading up to and immediately after her birth.  I remembered that I was smart enough to choose a competent, knowledgeable midwife who understood the benefits of natural birthing, delayed cord clamping, skin-to-skin contact and the power of the human body.  My faith in my instincts as a mother returned as I looked at the picture of her nursing for the first time, strong, alert, and healthy.  And when I looked at the pictures of myself laboring in different positions, my muscles straining, my face a mask of determination, I realized that I was not a wimp.  I am strong.  Not with the kind of strength that wills away the presence of obstacles altogether, but with the strength that allowed me to overcome and to persevere despite the unexpected difficulties and challenges I faced.

We can do our research; we can prepare our minds and bodies; we can make sure that we are healthy and ready.  But we can’t define our birth story ahead of time. We can’t go into it assuming it will be healing or empowering or a message or a political statement.  When we do that, we risk that we will not see our birth for what it is – a beautiful, amazing process that helps define us as women and mothers in ways we may not expect.  It may not be pretty.  It may not live up to our standards of perfection.  Sometimes birth just….is.

And now, cheesy as it may seem, I have to close this post with this quote.  Ask not what your birth can do for you…nah, just kidding.  Worse, a Beatles song.  It’s been going through my head since I started writing, so I guess it has to make it in here somewhere: “Let it be, let it be, let it be-ee, let it be.  Whisper words of wisdom, let it be.”  There, now it’s in your head too.

Thanks so much for that reminder, Angela!

NIH Post VBAC Conference Consensus Statement

March 12th, 2010

Following the 3 days of meetings and discussions between the National Institutes of Health’s Consensus Development Program, various obstetrical experts and birth advocates on the viability of vaginal birth after cesarean section (VBAC), the NIH has released a consensus statement highlighting the key points from the discussion,  where they believe subsequent research needs to focus and their recommendations to obstetricians about how to approach the subject of VBAC with their patients.

Here is a summary of the consensus statement.

  • The panel affirmed that a trial of labor (TOL) is a reasonable option for many women with a prior cesarean delivery.
  • Rigorous research shows that a trial of labor is successful in nearly 75 percent of cases, and maternal mortality is actually lower for women who have a trial of labor, regardless of whether they end up delivering vaginally or by cesarean, though those women who have an unsuccessful trial of labor and undergo a repeat cesarean delivery experience higher morbidity than those who have a successful VBAC.
  • Concerns have arisen because although VBAC does reduce morbidity in mothers, there is a slightly increased risk of morbidity and mortality to the fetus. The Panel is asking for more research to see if these disparities can be resolved and definitive risks determined for both mother and baby.
  • The panel is advocating for additional research to develop clear, evidence-based risk assessment tools to assist mothers and providers in the decision-making process from early pregnancy through delivery, accounting for individual risk factors, values, and preferences to see who is an appropriate candidate for TOL and VBAC and who is not.
  • The Panel strongly recommended that policymakers and providers collaborate in the development and implementation of appropriate strategies to address malpractice concerns that may keep providers from recommending VBAC, such as increases in malpractice premiums and threat of litigation in the event of untoward events.  These factors and others seem to be (along with other factors) exacerbating barriers to TOL  for women with a previous cesarean delivery.
  • The Pannel recommends that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess the requirements to have an obstetrician and anesthesiologist “immediately available” while any woman who is having a TOL is laboring.  This recommendation has created a significant barrier to TOL and VBAC for many hospitals who cite the cost of having an obstetrician and anesthesiologist constantly on call is prohibitive. They ask the societies to compare VBAC risk relative to other obstetrical complications of comparable risk, risk stratification, to see if it is truly necessary in light of limited physician and nursing resources.
  • The Panel recommends that Healthcare organizations, physicians, and other clinicians should consider making public their TOL policy and VBAC rates, as well as their plans for responding to obstetric emergencies. This will help the providers and patients better assess if a TOL really is a viable option for their situation.
  • They  recommend that hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate to develop integrated services that would reduce or even eliminate barriers to a trial of labor and subsequent VBAC.

The full NIH Consensus Statement is available Here.

Policy makers need to hear from us if we want to have choices in how we give birth to our children. I am in contact with many advocacy groups and will share your concerns. Please add your comments to the panel discussion in the comments section.  ~DTL