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Archive for November 6th, 2011

As a doula, I often hear exchanges between pregnant women and doctors that sound something like this: “I’d really like to try for a natural birth if at all possible.” “Oh, yes, natural is definitely best if it’s possible. But the important thing is having a healthy baby.” Does it have to be Either/Or? And if we think of these aspects of birth as separate and unequal, how does that influence birth?

Biomedical science pooh-poohs the idea that emotions and mental states are integral to health (or illness). Yet when we are not sitting in a doctor’s office, most of us know that our emotions are directly connected to our physical experiences. Ina Mae Gaskin offers the simple example of blushing. We feel embarrassed; we blush. What about crying? We feel sad (or sometimes mad) and we produce tears.

Having a “safe birth” means far more than monitoring our physical symptoms. In many hospital births, no one is trained to pay attention to more than the biochemical level of birth. If something looks sort of “off” at the physical level, no one is ready to reassure the mother, “You’re safe. You might feel scared. Breathe. Keep working. You’re doing awesome and your baby is coming. It can feel scary, but you are OK.”

One of the most important physical indications of whether birth is proceeding “safely” for the baby is the baby’s heart rate. But our heart rates and our babies’ heart rates are not the same as, say, the gas meter in our car. In our car, the gas meter indicates a simple, mechanical truth about the car: how much gas is in our tank. If we monitor the gas meter, we will have knowledge about what we should do (pull over immediately to the nearest gas station or not).

But the indicators, like a fetal heart rate, that we can “measure” during labor are different. Birth is not a purely biochemical process; it is a biochemical process AND it is also a mechanical, emotional, relational, and often spiritual process. What a woman feels about her labor actually impacts how the birth proceeds. Gas meters don’t feel anything and their emotional state does not affect the production of any automobile hormones. Humans are different. If we feel scared, we produce more hormones like adrenaline, which shut down labor hormones, and we produce fewer labor hormones (like oxytocin). Adrenaline and other such hormones can have a profound effect on our physical symptoms and, many believe, on our baby’s heart rate.

[Ironically, sometimes even the physical mechanical level of birth is ignored because all the focus is on biochemistry. Sometimes a change of the laboring mother’s position can shift the baby’s weight off the umbilical cord and change a non-reassuring heart rate to a perfectly normal heart rate. I attended a birth recently where all of us forgot this fundamental idea for two hours. When I finally remembered to suggest a position change (for a mother on an epidural), the baby’s heart rate changed back to normal and stayed that way.]

How we feel ABOUT giving birth is AS IMPORTANT as having a healthy baby. There is no either/or dichotomy. If a woman is truly empowered in labor, she will feel fundamentally at peace with the decisions she is making, including any decisions SHE might make about using interventions. I have attended  a fully natural birth with minimal medical intervention at which a woman felt traumatized by her experience and I have attended C-Sections at which women felt peaceful and empowered. How we feel depends on whether we are treated holistically as intelligent, emotional, spiritual, physical beings, not just a mass of biochemicals that need to be measured constantly.

I know that doctors have seen babies die. They have seen babies born with serious problems. Some babies spend weeks or months trying to survive in the NICU with tubes all over their bodies. There are real tragedies that doctors, nurses, and families have to deal with. I know that when a hospital staff member treats a laboring mother as something less than human and when they laugh derisively at the idea that her “experience” was not positive because she ended up with a healthy baby, so what is she complaining about, they are thinking of those tragic outcomes. Ironically, the feelings that sometimes determine the course of labor decision-making are not the mother’s feelings, but the feelings of hospital staff disguised in the form of “doing something.” But because we do not put much emphasis in medical school or residency on identifying or coping with difficult feeling states, this remains virtually an invisible and unnamable problem.

I am grateful for the medical skills of hospital birth professionals. We definitely need them! Yet how much more effective would these skills be if they were always, everywhere accompanied by emotional skills, such as an ability to express empathy for how a laboring woman might feel in any given situation? Because I run mom-baby groups for moms of newborns and toddlers, I know that how a woman is treated in labor affects her FOREVER. The end does not justify the means in this case. Treating women with deep respect, empathy, and reverence is MORE important during what appears to be a medical emergency. This is when women need such support the most!

I have been in labor rooms where medical personnel were able to communicate this sort of respect and empathy and reverence, even in the middle of emergencies, and I have been in labor rooms where not one hospital staff member was able to muster such a positive vibe at any pont.

“Having a good experience” and “being safe” are not separate categories. They are inextricably intertwined. When we expect moms to be happy about their birth experiences because they have a healthy baby, we are sticking our heads in the sand. Labor and birth are profound rites of passage that women remember, in a dream-like, deep way, for the rest of their lives. Research tells us that how a woman feels about her labor dramatically impacts her post-partum ability to mother (to breastfeed, to feel competent, to avoid depression). We all need to pay attention to the multiple levels of labor simultaneously. Instead of a dichotomy, we need to reimagine birth experience and birth outcome as the SAME THING.

If you are a doula or a woman who has given birth and you know a doctor, nurse, or midwife who is able to do this, please let them know that you noticed and appreciated this skill. We need more of this! Please share your stories about this either/or thinking and times when this has been transcended in the comment section!

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