What is a Good "Birth Experience," and Why is it SO Important?

I've previously blogged about the fallacious statement that "a healthy baby is all that matters" when it comes to birth. But if you haven't "been there, done that," you might not understand just how strong an effect childbirth can have on you, your significant other, your family, and your relationship with your baby. And a "bad" doctor might not even care about that effect. So if your doctor doesn't care how your birth experience, whatever it is, makes you feel, then how can you trust them? If they don't trust you or your body, how are you supposed to? And if you feel inadequate because you and your doctor can't trust your body, then how does that affect you?

Badly, that's how.

As I've said before, a mother will remember her child's birth for the rest of her life. She may not recall all the tiny details, but she will remember how it made her feel. And if a woman feels disrespected, bullied, talked down to, out of control, without options, and without the authority to make the final decisions about what goes on with her own body, then she's probably going to come out of her birth experience feeling pretty low. She may even suffer from some degree of "baby blues" or PPD (post-partum depression) due to a bad birth experience, and that can seriously affect how she feels towards her baby, herself, and any future pregnancies or births. A positive one, however, will leave a mom feeling strong, empowered, amazed at what her body did (grew and birthed a human being!), and usually pretty serene. You may think that, as a natural birth advocate, I believe only an unmedicated vaginal birth qualifies as a "positive" experience. That is so very far from the truth. What I classify as a positive birth experience is one in which the mother (and her partner) feel that their choices are respected, nothing happens that they don't understand or don't consent to, and they are treated with dignity throughout the entire process, no matter what ends up happening.

Here are some examples of what I would call negative birth experiences:

1.  A first-time mother wants an unmedicated hospital birth, and therefore does not want continuous fetal monitoring, an iv (unless necessary), or to be forced to labor in bed. She wants to be free to move around, change positions, get in the shower or tub (if one is available), and push in whatever position is the most comfortable and effective for her. But, when she arrives at the hospital in early labor and dilated to 2cm, the nurses don't listen and put in an iv without her consent, they strap on fetal monitors, and tell her it's "hospital policy" and there's nothing she can do about it. She gets stuck in bed and unable to move and deal with the pain, so she ends up asking for the epidural she swore she didn't want. Her labor stalls at 5cm because she's lying flat and not moving and so the baby isn't putting pressure on her cervix (which is a major factor in dilation), so the doctor breaks her water to "get things going." It works for awhile, and she gets to 8cm and stalls again. Since she's not dilating at the rate of 1cm per hour that the hospital requires, and her water is broken and enough time has passed that there is a "risk of infection," they tell her she needs an emergency cesarean and wheel her off to the OR, in tears because nothing went the way she wanted, she felt bullied and like the choices were taken out of her hands, and she knows she'll have to fight to have a VBAC if she ever gets pregnant again.
2. A first-time mother is scared of labor pain, but doesn't want to sign up for a c-section because she's also scared of surgery, so she decides that she wants an epidural the second she gets to the hospital so the pain won't be an issue. She goes into labor, and is told by her doctor that first babies take their time, so she should labor at home as long as possible. She reluctantly does, even though her contractions are already 3-5 minutes apart and nearly unbearable, and finally goes in when her water has broken and she can't stand the contractions anymore. She's screaming for pain relief as they wheel her to a room, and when they check her, they tell her she's 9.5cm dilated and it's too late for an epidural. 1 horrendous hour of pushing and a 3rd degree tear later, her baby is born, and she's so traumatized by the intensity and the pain that she was scared of (and couldn't process) that she can't even take joy in the sight of her baby.
3. A seasoned mom of three (all natural, vaginal births) is told at her 37-week appointment that her baby is frank breech, and they'll check again every week, but if baby hasn't turned by her due date, she'll have to schedule a c-section, because the hospital won't deliver breech babies vaginally, and a midwife-attended home birth is illegal where she lives. She does everything to try to turn baby, but at her 40-week appointment, the ultrasound shows it's still breech. She tearfully schedules a c-section for the following morning. But surprise! They don't do an ultrasound before operating, and in the OR they perform the procedure, only to find that baby turned overnight and comes out head-down! The mother is devastated that she had unwanted, ultimately unnecessary surgery, just because they didn't check again before cutting her open.
4. A mom is told at 39 weeks that her baby is getting "too big," and if they don't induce that day, she might not be able to birth it vaginally like she wants. So she agrees, thinking her doctor knows best, not knowing that ultrasound weight estimates can be off by 1-2 pounds in either direction, or that the size of the baby doesn't matter nearly as much as the shape of her pelvis. She requests to be induced overnight by cervidil, because she's read that pitocin makes for harder labors and can have negative effects on mom and baby, and she wants to give her body the chance to labor without it. So they admit her overnight, sweep her membranes for good measure, and insert the cervidil. By morning, she's dilated to 2 and feeling very encouraged, as regular contractions have begun. Her labor is slow, though, and by that evening she is only dilated to 5cm. So, unbeknownst to her, the doctor orders pitocin, which the nurses start in a slow drip. All of a sudden she can't handle the contractions, doesn't know why, and begs for an epidural. She gets a fever, baby's heart rate becomes erratic, and the doctor says they need to hurry and get the baby out, so they turn up the pitocin to speed things up. Lucky for her, she's quickly fully dilated and ready to push, but the doctor breaks her water and then cuts an episiotomy because the baby descends so fast that she doesn't have time to stretch and accommodate birth. She's angry because she would have preferred to risk a natural tear rather than be guaranteed stitches with the cut, she's even angrier when she finds out they gave her pitocin, which may have caused the baby's distress and her fever, and she's most angry about the fact that her baby was only 6 pounds, not the 8-9 pounds her doctor predicted, and has trouble breathing due to being born too early.
5. A second-time mom plans a home water birth with a midwife after having her first naturally in a hospital. She wants the peace and serenity of her home while laboring and pushing, and she trusts her body to do what's right, since her first labor went so smoothly. But her midwife insists on checking her cervix constantly (and against her wishes), coaches her pushing instead of letting her follow her instincts, and tugs on the umbilical cord to "help" in the delivery of the placenta, which causes hemorrhaging and ultimately leads to a hospital transfer for a blood transfusion. Mom is too weak to enjoy her baby's first days of life, and feels very violated.
6. A second-time mom had a super quick, in-the-parking-lot-because-they-didn't-get-to-the-hospital-in-time first vaginal birth when she was 41 weeks 5 days pregnant, she had a 4th degree tear that still causes her pain, and she's decided she doesn't want to go through that again, so early in her pregnancy, she talks to her doctor about the option of scheduling a c-section at 41 weeks instead, or to be taken in immediately for a c-section if she shows any signs of labor before then. She wants to give her baby as much time as it needs, so she doesn't want to schedule any sooner than necessary, and 41 weeks seems to be good choice. Her doctor agrees, but is very judgemental about it, saying that "if she birthed naturally once, she can do it again, how could it get any worse?" The mom feels very put-down, but sticks to her guns. All the nurses and hospital staff present in the OR on the scheduled day are rather rude to her and treat her as if she's a bad mother for choosing a c-section without a trial of labor, and they ignore her request to put the (perfectly healthy) baby skin-to-skin with her while she's being stitched up. She doesn't see her baby until 2 hours after the birth, and she's generally treated disrespectfully for her entire hospital stay, simply because she chose the birth that was better (for her) than her first.

All of those experiences were completely different, yet all could easily have been so much better. Here's how:

1. This mama could have found out the hospital's policies ahead of time, and tried to work with them to meet her requests. Intermittent monitoring could have been a possibility, or she could have opted to wear the monitors while standing and moving about, even if she was limited to the area around her bed. A heparin lock could have been used instead of an iv, so that a vein was open and available in case of emergency, but she wasn't tied to an iv line if it wasn't necessary. If those measures had been taken, she might not have asked for the epidural, not gotten trapped in bed, been able to move through contractions and help her baby move down, and that c-section might not have been necessary.
2. This mama should have trusted her instincts and gone to the hospital when she initially called her doctor, or her doctor should have listened to her wishes, known she wanted an epidural immediately, and told her to come in before active labor hit so she could have the birth she wanted.
3. This one could have been fixed by a simple pre-op ultrasound. Mom would have been spared this unwanted, unneeded surgery.
4. This mom should have asked if there was any reason for induction other than a supposed big baby. There is no way to tell if a baby will be too big to fit through the birth canal before the onset of labor, and for mom's peace of mind, she should have asked to be left alone. It's much easier to accept an episiotomy or c-section after baby gets stuck after the natural onset (and trial) of labor, because at least then, there's a higher likelihood of baby being ready for birth, and there aren't any "what-if's" about it. Mom can feel assured that what happened was truly necessary if any interventions have to be used.
5. Bad. Midwife. Mom should have talked to this midwife about her policies before labor, and made her wishes clear. It's never too late in your pregnancy to find a care provider you trust to do things your way, not theirs.
6. This mom should have found a new care provider after that one judged her. She should have found a doctor and hospital who would listen to her, respect her choices, and treat her with dignity. Birth is birth, even if it isn't the one you'd choose for yourself, and this staff had no right to go against her desires and treat her so poorly, simply because they didn't agree with her.

 Birth changes you, and not just because you now have a baby. The experience can completely tear your confidence down if you are ill-handled, or it can build you up beyond anything you've imagined if you're treated with respect and have your wishes, whatever they may be, honored. This is where doulas are so important. Their presence and support can mean the difference between a negative birth experience and a positive one. They are a set of eyes outside the situation, they are there to stand up for mom and make sure her desires are honored, and if something goes wrong and the plan needs to change, they make sure mom understands what's happening, consents to any necessary procedures, and is assured that she was not bullied in any way.

Doulas can't ensure that all births go "according to plan," but they can help moms educate themselves, make any necessary plan changes smoother, and can help keep the choices from being taken out of mothers' hands. Even an unwanted c-section, induction, or unmedicated birth, doesn't have to be traumatic, if mom feels respected and that she understands and is in charge of everything going on around her. If doctors and midwives don't have womens' interests at heart, and aren't willing to adapt their model of care to each individual mother and child, then someone has to step up and speak for them when they can't, because birth matters. Ask any mom, and that's what they'll tell you, whatever their experience was or what their personal birth philosophies are. It affected them, for better or worse.

You matter, your body has value, your desires are valid, and you deserve respect and choices, because the consequences of ignoring that fact are dire. PPD is no joke, and fear of birth isn't either. It isn't just about "ending up with a healthy mom and baby." Yes, that's the ultimate goal, but it shouldn't be the only goal.

Your Birth. Your Choice. Your Way. Your Experience. It's important.