Lately, I have been thinking about how fascinating our individual perceptions of birth are.
Some women feel so comforted by the hospital environment. They feel secure with the constant electronic fetal monitoring, the IV placed just in case of postpartum hemorrhage, the induction so they can plan and prepare for the day their baby will come, the epidural so they don’t have to ever feel out of control, the operating room down the hall in case an emergency happens.
Other women are comforted birthing in their own home with a midwife. They want to let baby play a part in the timing of birth and receive all of the cord blood, they only want medications and IVs if they are truly needed, they want the freedom to follow their body and move without the constriction of constant monitoring or an IV pole, to be surrounded by people they know and trust, to give birth upright or on their hands and knees, they want their birth to feel sacred.
Of course, there are so many other reasons women choose hospital or home birth, these are just a few. There are women who would gladly sign up for an elective cesarean section. Then there are women who want nothing more than to have a vaginal birth; if they end up with a surgical birth – even if it is evident the cesarean was necessary – they have a long and painful struggle fighting their way back from the emotional and physical hole they find themselves in. Over the years, I have also witnessed women have births that other women would pay to experience – very straightforward, textbook births, they meet all of their goals and desires – but afterward they feel traumatized.
When I first witnessed this, I was very perplexed.
I attended a woman who gave birth in the hospital to her first baby. The labor progressed beautifully, she felt the urge to push and the nurse ushered her to the hospital bed per protocol. She pushed for a reasonable amount of time, her husband and I each supporting a leg. The baby had “tight” shoulders – when the shoulders take a little effort to deliver, which can cause a slight delay between the birth of the head and the body, but which isn’t a true shoulder dystocia. Baby came out and all was well. It was a very normal, textbook hospital delivery. Later, she felt trauma. As I recall, the trauma was related to feeling stuck and helpless in that position.
I attended her next birth as well; it was a home birth with a midwife. This baby was significantly larger, and pushing took about an hour (which is unusual for a second baby). The head slowly emerged in water. It became clear to the midwife as baby was born slowly to the forehead, then a little more to the eyes, then to the nose… that there would be a shoulder dystocia. The midwife had the mother get out of the water, and after a few position changes and maneuvers the baby emerged with a cry. Everyone was thankful.
At one point while managing the shoulder dystocia, the midwife used “the mom voice” – the voice that lets you know you need to listen and do what needs to be done. I really thought that the mom would feel some level of trauma after this experience. Nope, not at all. She felt so cared for and confident in her body and her midwife. She really appreciated the ability to move and be in the comfort of her own environment. At the time, I chalked it up to a hospital versus home birth and the perceptions surrounding the two.
Years later, I was working at a busy birth center. A first-time mom arrived – she practically ran down the hall and straight to the tub. I checked her and she was 8 cm dilated. She had only been in labor for about 4 hours so this was amazing progress for her first baby! She was surrounded by her loving husband, her mom and her sister. Everyone was giving very attentive support. I could tell she felt out of control; we talked her through each contraction. She moved into different positions in the tub, and pushed her baby out within a few hours of arriving. It was a beautiful water birth, the baby transitioned from womb to world well and the placenta came with no problems. Many women would sign up for this birth in a heartbeat.
The next day I went to her home for the 24-hour visit. She told me she couldn’t sleep, she kept having flashbacks of the birth and she felt very traumatized. She felt it was too fast and she wasn’t able to process what was happening in the moment. How interesting. For her next baby she planned a hospital birth with an epidural. Huh – I had to reframe my thinking about women’s perceptions of their births once again.
The thing about perception is that it’s the lens with which we view all things; and all of our life experiences, our culture, the knowledge we have gained up to this point, our feelings, and even epigenetics (our ancestors’ experiences) influence our perception. Even more, our perception – even if it is based on illusion or things that aren’t real – it feels like truth and it influences what matters to us in the moment.
Another layer I have been slowly uncovering over the years is the perception of the people providing care for mothers. Recently, I attended a mother giving birth to her second child. We anticipated baby was likely to need help breathing right after the birth. The birth was difficult and baby did indeed need us to help her transition to air. Mother had delivered on her hands and knees, on a thick mat on the tile floor. As we worked quickly to help baby breathe, we kept baby close to mom and left the cord attached to provide oxygenation and precious blood to the newborn; the entire resuscitation happened on the mat and warmed blankets, between mom’s legs. After stimulation, postural drainage, and a few minutes of ventilation we called EMS in case baby didn’t take over breathing on her own soon. EMS arrived within a minute of the call – by the time they arrived, baby was breathing and crying. My attention was on the baby and the mother. The room filled with many people and lots of equipment. Mom delivered the placenta and we laid mom on her back with baby, skin to skin. Once we knew respirations were absolutely normal, I did my best to help EMS get all the information they needed, mom signed a waiver, and we let them know they could leave.
Later, I debriefed with the lead paramedic. The lights were dimmed in the birth center, and he thought we had resuscitated the baby on a cold tile floor. He felt he couldn’t gain control of the scene. As I processed, I tried to see it from his perspective. Sometimes I forget how vastly different a community birth is from a hospital birth. I forget how different a resuscitation scene is as well. Midwives take pride in supporting women to birth on their own terms – in any position and in any location. We move and accommodate the birthing mother – we don’t ask the mother to accommodate us by laying in a bed that we can adjust to our height. While it would be easier to cut the cord and move the baby to a location set up for a resuscitation, we instead bring a tray with a warmer and all of the supplies to resuscitate baby next to mom – because we know leaving the cord intact is best for baby, and it is best for mom to be right next to baby. When all is well, we know it is best for mom and baby to be skin to skin. I can see how it looks chaotic, but we are able to control the situation on these terms – and convenience has no value to us. What made my heart sing, made the lead paramedic cringe with discomfort.
I could share a hundred similar examples of different perspectives between community birth midwives and obstetricians / nurses. Sometimes through communication we can come to a shared understanding – and even if we can’t agree to share the same perspective, often we can see how another reasonable person would have a differing view. Sometimes we just can’t get there. But we can still honor that individual and all that went into creating a perspective that is so different from our own. There are many gems of wisdom that come from this diversity of thought. As we learn to truly respect one another, the world of healthcare – and humanity – could restore some of the love and beauty we have lost along the way.