decisions, decisions

36 weeks and counting...

Yesterday, I finished work and began my parental leave. 

Today, I started bleeding and ended up in hospital, wondering if I was about to go into labour four weeks early.

Now, having been monitored and checked for a couple of hours and given the all-clear, I am back at home.

Today's experience has brought a few things into focus, not least of which is that I should probably wash some baby clothes and pack a bag for the hospital ... just in case.

Mostly, however, it has forced me to think even more about the end-game of this pregnancy: labour and birth. 

This week, I went to visit a specialist to discuss what happened last time and what my options for the delivery would be this time around i.e. would it be OK to labour naturally? What precautions could be taken to try and ensure that what happened last time wouldn’t happen this time? Was a planned caesarean an option and, if so, was it a good option? What were the risks in each of these scenarios? There were a lot more questions too, which the doctor patiently answered. His conclusion? That I am more ‘high risk’ because of what happened last time, and they’d take some extra precautionary measures to actively manage the immediate post-natal period. In his view, however, there was no reason that I couldn’t let nature take it’s course if that’s what I wanted to do. Equally, if I felt that a planned caesarean was the best (‘least worst’?) option then they would be happy to arrange that too. So I have some thinking to do - fairly speedily - about what I would ideally like to happen.  

It’s kind of funny to be contemplating a caesarean this time around, when I was adamant last time that I wanted to avoid one if at all possible. When they offered forceps as a first alternative when the baby wouldn’t come out, my first thought was ‘at least it’s not a caesarean’. In the event, I would’ve had a better recovery first-time around if I had had a caesarean. 

During this pregnancy, up until fairly recently, I’ve been in a bit of denial about the birth. If I thought about it all, I was picturing a straightforward labour and birth without follow-up surgery that would be a much more positive experience than the first one. And, maybe, somewhere at the very back of my mind, it would enable me some time in the future to tell my daughter that birth can be a positive experience. But as that mental image is getting much much closer to becoming - or not becoming - a reality, I’m starting to wonder if that really is the best option after all.

I have yet to make my final decision - although today when I thought I might be going into labour early, I was, let me tell you, much much much less excited at the prospect than last time - but time is getting short now and I need to make up mind.

While in the process of making it up, one thing the doctor said keeps resonating: ‘a straightforward labour and birth after a traumatic one can be an incredibly empowering experience ... but a labour and birth that doesn’t go too well again probably won’t be.‘ It got me thinking, somewhat digressively, about the idea of birth as empowerment, some of the ideas circulating around how best to give birth, and how they may set up women to feel like failures if their experiences don’t match that ideal.

‘Empowerment’ is part of the vocabulary of feminism (and other movements aimed at achieving liberation or greater equality), but I’m not sure it’s entirely being deployed in a feminist way in this case. Certainly, the reclamation of routinely medicalised and highly interventionist births by midwives and expectant mothers is, at least in this country, viewed as one of the gains for women made via second-wave feminism. I’m not knocking that by any means, particularly after the reading I have done about the kinds of births women were subjected to in the post-war period, and still are in some countries. I agree that pregnancy is a state of health and that in the roughly 80% of births that are straightforward (not easy) probably minimal intervention is required. While the ideal of natural, drug-free birth is still contested - some doctors, for example, argue that pain management is also an advance and advantage that women should be entitled to in labour and birth - it is nonetheless mainstream in a way that it wasn’t in the 1950s-1970s. 

There is, however, a sense that a natural birth without drugs is the ideal to be aimed for and that opting for an epidural and/or caesarean or other intervention that is not medically necessary is ‘the easy way out’. It can also be the case that women who have interventions that are medically necessary can feel ‘cheated’ out of the birth experience they wanted, or feel as if they have somehow ‘failed’. It’s interesting that both these terms - cheating and failure - are also used when it comes to tests, exams, sports and other competitive events. When did how a woman ‘performed’ during childbirth become a measure of womanhood and so tied up with her identity as a new mother?

I can’t say for sure, but I think what began as a liberationist approach to highly medicalised births that really disempowered women has been co-opted from its feminist origins to prop up the the ideology of intensive mothering. In this ideology, a woman commits herself totally to motherhood (which, in sociologist Sharon Hays’ terms is ‘child-centered, expert-guided, emotionally absorbing, labour-intensive and financially expensive’). But I think this ideology takes root even before birth, not only in the surveillance of expectant mothers’ habits, but also in whether they ‘achieve’ an ideal birth (giving a whole new meaning to the phrase ‘labour-intensive’). Furthermore, the ideology of intensive mothering is pro-natalist: it defines all women primarily through their reproductive capabilities and, in doing so, props up heterosexual, cisgendered womanhood as the norm by which all women are measured. That doesn’t seem like feminism to me. 

I wonder, then, if the language of childbirth should be less about ideals and ‘achievement’ - and, the flipside, ‘cheating’ and ‘failure‘- and more on genuine empowerment. This means having the structures and resources in place to ensure that women can make fully informed decisions about what might be best in their own particular circumstances so that their birth experience, however that experience plays out, is as positive as possible. 

How might that help me with the decisions I have to make?

If I opt for nature to take its course and have a natural labour and birth, I may well achieve that ideal birth I can see in my mind’s eye, the one that would likely mean the quickest recovery time for me and positive outcomes for my baby. But I may not. Neither me, my midwife, nor the specialist can say for sure whether that ideal birth will become a reality. If I choose to let nature take its course I need to go into it fully aware of the potential risks, and the possibility, admittedly not huge, that what happened last time might happen again. I need to ask myself whether I’m prepared to risk that. And I need to make the best possible choice with my eyes wide open rather than dwelling on ideals and ideologies.

Because, whatever I choose about how I want to give birth this time, I have nothing to prove to anyone about what it takes to be a woman.

natural birth in 0 A. D

‘Away in a manger, no crib for a bed, the little Lord Jesus lay down his sweet head.’

As a new-ish mother, I’ve been pondering the traditional Christmas nativity story in a whole new way this year. Leave aside for one moment the question of whether or not there was a real historical person called Jesus, or whether the familiar nativity story is not supported by what is actually in the Bible.

So the tale goes, Mary, nine months’ pregnant and nearly due, and her husband Joseph travelled to Bethlehem from their home in Nazareth to take part in the census (which, incidentally, makes you appreciate the fact that modern-day census forms can be filled out in the comfort of your own home). Unable to walk because she was the size of the house, Mary rides a donkey the seventy or so miles to Bethlehem. Poor Mary (uncomfortably bumping along on a donkey, with swollen ankles and heartburn for good measure)! Poor Joseph (walking seventy miles in the bleak midwinter)! Poor donkey (stoically carrying a very pregnant passenger)!

When they eventually arrive in Bethlehem - and how long did it take to get there, I'd like to know - there is no space available in any of the local inns for them to stay. So much for the great planning of the Roman Empire. You’d think if they were making people travel to fill in their census, they could’ve made appropriate accommodation arrangements. I hope LOCOG - the London Organising Committee for the Olympic and Paralympic Games 2012 - is doing better. However, one innkeeper, keen to maximise his profits by renting out any old nook and cranny, lets them sleep in the stable out the back.

And here’s where all the Christmas carols start skating over the business end of this business trip. Look at these examples:

Silent night, holy night
All is calm, all is bright
Round yon Virgin Mother and Child
Holy Infant so tender and mild

(Silent Night)

And then they found a little nook in a stable all forlorn,

and in a manger cold and dark, Mary's little boy was born

(Mary’s Boy Child)

Once in royal Davids city,
Stood a lowly cattle shed,
Where a mother laid her Baby,
In a manger for His bed:
Mary was that mother mild,
Jesus Christ, her little Child.

(Once in Royal David’s City)

In Bethlehem, in Israel,
This blessed Babe was born
And laid within a manger
Upon this blessed morn
The which His Mother Mary
Did nothing take in scorn
O tidings of comfort and joy,
Comfort and joy
O tidings of comfort and joy

(God Rest Ye Merry Gentlemen)

Obviously, the focus of the carols is on the miraculous birth and what it means for humanity: the arrival of a saviour who will redeem us from sin. But what might Jesus’ actual arrival on earth have been like?

Mary: What do you mean, we’re out in the stable?

Joseph: He said he doesn’t have a room either, but he’ll give us the stable for cheap.

Mary: You must be kidding! I know I said I wanted a home birth, but this is ridiculous. And how will the midwife know where to find us?

Joseph: Well, there seems to be some gobsmackingly huge star right above us, so she should have no trouble - we’re lit up like Christmas Tree!

Mary: A Christmas tree - what’s that?

Joseph: Never mind. Can I get you anything?

Mary, doubling over in pain, then breathing hard: Oooooh!

Joseph: What was that? Were you having a rush?

Mary: No, I was having a contraction! Stop calling them rushes, this isn’t the story of Moses’ birth, you know!

Joseph: Okay, okay. Here, lie back on this straw. It doesn’t smell too bad.

Mary: I don’t want to lie down, I want to crawl. Oooh!

Joseph: Okay, do that then.

Mary: The cow is looking at me funny.

Joseph: I’m sure you’re imagining it.

Mary: No really. The cow is giving me a weird look. She has to go. Ooooh!

Joseph: Here, have some pine-cones to squeeze.

Mary, giving him a murderous glance: I know what I’d like to squeeze. Ooooh! Ouch, what are you doing?

Joseph: Acupressure. I’m pressing down in the small of your back to relieve the pain.

Mary: Urgh, you’ve got the wrong place, that’s my spinal cord. Move down a little bit. Ooooh! That’s better.

Joseph: Would you like some ice-chips?

Mary: Are you kidding? Ooooh! It’s the middle of winter. If you’ve got a hot water bottle, I won’t say no, though.

A large gush of sweet-smelling water flows all over the straw.

Joseph: Oh, I think your waters have just broken!

Mary: Uh, no kidding. Where is that midwife?

Joseph: Um, I think we lost her somewhere back near Jericho.

Mary: What! And you’re only telling me now?

Joseph: I didn’t want to worry you.

Mary: I’m having a baby in the middle of the night in the middle of winter in a stable with no midwife and a cow who keeps looking at me funny, what on earth do I have to worry about?

Joseph: Hey, I’m doing my best here, this kid isn’t even mine.

Mary: I told you before, he’s the son of God.

Joseph: So you say ...

Mary: Ooooh! Let’s not get into all that again.

Several looooong hours later, Mary is squatting on the ground, holding on to the side of the manger. Her sweaty head down, she focusses deeply on pushing the baby out. With each push, she gives a loud groan and then pants heavily. Finally, the baby crowns.

Joseph: I can see the head! Keep pushing!

Mary: Oooh urgh aah aarh uuurgh ooooof!

Joseph: Oh, oh, here it comes! Jesus Christ!

Jesus: Waaah, waah!

Mary: Bbbl ... mmmm

Joseph: What do we do with the cord thing?

Mary: Wmmmmph? Wanted a lotus birth ... leave it alone.

Joseph: What?

Mary: Need to .... birth Placenta.

Joseph: Oh right.

With considerable effort, Mary births the placenta. Joseph puts it aside for a midnight snack.

Joseph: Where are we going to put the baby? Did you pack the swaddling clothes?

Mary: Mmmm...hmmm. Give him here ... need skin to skin first.

Joseph places Jesus on Mary’s breast and he starts to suckle. Joseph starts throwing things around looking for the swaddling clothes. The cattle are lowing. Some men arrive at the stable door.

Joseph: Oh, hello, who are you?

Shepherds: We’re shepherds.

Joseph: I can see that. What are you doing here? My wife’s just given birth and I’m not sure she wants visitors.

Shepherds: But some angels appeared to us and we were led here by the star. We’ve come to worship the baby.

Joseph: O ..... K. Whatever floats your boat.

He calls back into the stable.

Joseph: Um, Mary, we seem to have visitors. They want to worship the baby.

Mary: Well, he is a little treasure, all right. Just let me pop Jesus in the manger and get myself decent.

Or something like that.

Tidings of comfort and joy, indeed.

As N’Sync might say: ‘Merry Christmas, Happy Holidays!’

'i can honestly say it wasn't painful'

Nearly a year ago, I went to ante-natal classes that focussed on natural birth and how to prepare for it. While there were many positives about this class - not least the wonderful women who I met through it - there were also some moments that I found a little difficult to process. I won’t go into them all here, but one that has stayed with me occurred during the class on the stages of labour.

We were met at the start of that evening’s class by the affirmation ‘every contraction brings my baby closer to me’ written on a large piece of cardboard. ‘O ... K,’ I thought to myself, wondering what on earth we were in for. ‘I guess that’s true ...’ My husband and I took our seats, and listened to a midwife go through the various stages of labour. After this, the course facilitators then spoke about their own birth experiences. It was during these narratives that one of the course facilitators - who, incidentally, ended up having an emergency caesarean - said of her labour ‘I can honestly say it wasn’t painful.’ My first thought was, ‘really?’ and ‘is that even possible?’ We had talked somewhat during the class about productive pain - the kind that brings your baby closer to you - and I was trying to psyche myself into managing this with only some combs, a swissball and a hot water bottle for help. And yet here was one of the facilitators saying that it honestly wasn’t painful. What to believe?

I should add that this facilitator was not making a general claim. She didn’t say labour is not painful, or that she was talking about anything other than her own experience. But, given that was the case, I was left wondering why she said that to us at all. What was to be gained by telling us her labour wasn’t painful? Were we meant to feel envious? Hope that our labours would be similarly blessed? Feel that if we admitted it was pain almost beyond belief that we were letting the side down?

Perhaps there are some lucky women whose labour isn’t painful (and not just the ones with epidurals), but I strongly suspect for most women that natural childbirth is intensely painful. In fact, when I mentioned this exchange to my midwife - a proponent of natural childbirth, but not one to sugar-coat - she said firmly ‘it’s painful.’ Or, in other words, ‘don’t kid yourself, love - you’re in for quite an ordeal'. Her view was that ‘women can do it,’ especially with the assistance of a good, supportive midwife.

I’m aware that some women don’t like to use the language of pain - like ‘contractions’ - when discussing childbirth. Instead, they refer to ‘rushes’ (sidenote: this always confuses me somewhat, as it makes me think of pregnant women getting high on amyl nitrate or something ). I acknowledge that it certainly helps to be in a positive frame of mind when giving birth, and if this is a way that some women get into that frame of mind, well, more power to them. I just question the wisdom of foisting that on to unsuspecting expectant mothers.

It’s about this point that the Kate Figeses and Eleanor Blacks would probably start exhorting the facilitator to ‘tell the truth’ about childbirth. But, again, I’m not sure that truth is the issue. The facilitator may well have been as honest as she claimed about her own experience. I have no way of knowing that. And, as I have discussed before, women’s embodied experiences are not the same and can’t be reduced to one monolithic narrative. Positive experiences that go as mothers planned, home births in specially-bought yurts, and even orgasmic births can and do happen.

But I can’t help but feel that this unthinking comment, made not just by anyone, but by the facilitator of an ante-natal class, was in some ways setting us up for failure. By that I mean that it planted the seed (no pun intended) that labour might not be painful. That if we did experience pain at the limits of our capacity to endure it, we were somehow not doing it right, were not being brave enough, would send other expectant mothers careering into the arms of doctors with big needles. That’s a lot of unconscious baggage to be loading up on when you’re about to enter into one of the most transformative experiences of your life.

On the flipside, there are those who seem to think that the more pain you experience, the more noble your sacrifice. In this view, suffering is an essential part of the process, recalling God’s alleged punishment to Eve once she was expelled from the Garden of Eden that ‘in sorrow, she would bring forth children’ (I say ‘alleged’ because some feminist Bible scholars have argued that this is a mistranslation of the original texts. But I digress.) If we follow this thought to its conclusion, then it’s almost as if you can’t properly belong to the mummy club, or really know what it means to love your child, unless you’ve been ripped to shreds.

Both narratives position women as masochists, and buy into hegemonic notions that women are only defined by their bodies. There is nothing noble about pain and suffering, which will, more than likely, be a defining feature of labour and birth. It doesn’t make you a better mother to have suffered. It doesn’t make you a worse mother to admit that it was painful either.

My own experience was, in the end, comparatively pain-free. Because my labour didn’t progress, and my waters had broken several hours earlier, I was considered to have moved into an ‘abnormal’ labour. After attempting to ride through the artificially-induced contractions, and still remaining at one centimetre dilated after what felt like forever, even my midwife was suggesting I should have an epidural. I did have one, and ended up spending a pleasant day high as a kite, eating sandwiches with my husband and and listening to jazz. Like the course facilitator, I can honestly say that my labour wasn’t painful. As for what came afterwards, however, well that’s another story ...

'and what is your birth philosophy?'

I told the car mechanic story outlined in my last post to my new midwife, who laughed along with me, sharing my outrage, or at least I thought so. When we had finished laughing, she said, ‘if the obstetrician is the mechanic, what is the midwife?’ I was gobsmacked. Hello?! The point of this story is that I was being compared to a car! A car. An inanimate piece of machinery. That doesn’t give birth to little cars. To my face! (Can you tell that I’m still gobsmacked by this?)

A few months later, when she brought a trainee midwife with her on one of her visits, she got me to repeat the story, and the trainee’s response was the same, ‘what is the midwife in this scenario?’ At which point, I replied, half-jokingly, ‘I don’t know, perhaps the tea-lady?’ My midwife sardonically thanked me.

I know the two midwives were only picking up the ball of the metaphor and running with it to figure out what the analogue for their role was, but it still made me feel kind of like an object. I was not a chassis hovering up near the ceiling on a mechanical hoist, I was a pregnant woman. For that moment, it seemed that even the people who were most supportive - in the non-mechanical hoist sense - sometimes lost sight of that in the long-standing doctors versus midwives conflict.

I’m not sure how many stories I heard from my midwife about how great it was that the law had been changed - and no, I’m still not sure what law that was - so that midwives had more autonomy to practice how they wanted. It was like I was supposed to be vicariously thrilled that they’d won their battle. Not that I’m not, I just didn’t want to hear about it all the time. This was the first - and possibly only! - time I was pregnant, and I wanted the focus to be on me, me, me. Oh, and the baby, of course.

Let me be clear. My midwife was excellent. I have few complaints about the care that I received from her. And I was aware that, as childbirth became more medicalised in the nineteenth century, midwives, who had primarily looked after women in childbirth until then, were marginalised in the process. Women’s bodies became subject to the authority of male doctors, who presumably knew better because, well, they were men. If the original car incident with my former GP had taught me nothing else, it was that some male doctors a) still viewed women as objects (a car!) and b) still pathologised what is a natural process.

As I have mentioned before, I have some skepticism concerning the reification of the natural in childbirth and child-rearing. But pregnancy, as that feminist bastion Netball New Zealand confirmed when Adine Wilson played in the losing New Zealand side in the 2007 world championships final three months pregnant, is a state of health. (side-note: there was a storm in the teacup over this pregnancy when it was announced after New Zealand lost 42-38. Would it even have been an issue if they had won?) It is a natural process, but one that is not left solely to nature.

When I was trying to select a midwife, several asked me about my ‘birth philosophy’. ‘My what?’ I thought to myself. Am I supposed to have concluded whether or not my birth would be an affirmation of Platonic Idealism, Cartesian dualism, or even Derridean deconstruction? It turned out that a birth philosophy is more along the lines of whether you’re a ‘give me an epidural with everything’ type or ‘I want to feel every mind-blistering painful moment’ type. The midwife who I had personally gravitated to most told me that she practised natural childbirth i.e. the ‘pain and lots of it’ kind. I really wanted her to be my midwife, as I thought we had got on well when we spoke, but I was unsure if I would be able to cope with an unmedicated birth experience.

I thought about it a lot as I wondered whether to go with her or not. The number one consideration for me was to be with someone that I could trust, and I had felt this way straightaway with the midwife I liked. I also intellectually liked what she said about ‘woman being able to do it’ without help. I liked the idea that the pregnant woman should be in control of her own destiny as much as possible. It sounded like an empowered, even feminist, birth experience. On the other hand, I am a big chicken when it comes to pain - and that goes for big epidural needles too. In choosing a midwife, was it finally time to put my uterus where my mouth was?

In the end, I decided to take the leap of faith and commit to having a natural birth. I felt daunted by it, but hoped that I would be proud of what I had achieved when it was over. Before the labour started, I had even convinced myself that all the pain would be productive and, even though it would hurt, it would be better for the baby and mean a better recovery for me.

But as flies to wanton boys are we to the gods. Far from a natural childbirth, I ended up having an almost completely medicalised experience: induced labour, epidural, antibiotics, forceps, lots of surgery, general anaesthetic, blood transfusions, the works. My midwife stayed with me the whole time, encouraging and supporting me, even though the doctors took over in the end. The baby was fine. I was not, for a long time. It turns out that if we had really let nature take its course, it’s possible one or both of us wouldn’t be here.

I think I have a birth philosophy now, having gone through the experience, and having had eleven sleepless months to think about it, but it isn’t ‘give me lots of drugs’ or ‘I’ll die before I mainline anything’. It’s ....

Nope, sorry.

It's gone.