Differing Perspectives on the Birth Experience

I have to share this with you. It's a paper written by Sara Anderson for a graduate writing course she is taking. I don't know Sara. She called me after finding me on the internet. She wanted to interview a doula for her "Birth & Death" class. I just read her final paper, and it resonated with me so much that I wanted to share. (She gave permission to share it.) I'll post her poem and a transcript of the interview in the coming days.

Penny Simkin, the founder of DONA (Doulas of North America) famously tells a story of teaching a childbirth education class in a nursing home cafeteria. A resident of the home walked in and attended the class each week, and she spoke up a few weeks into the course. She said she had several children and could tell the group a thing or two about birth. She then proceeded to tell the birth stories for each of her children. It was at that moment that Penny Simkin realized the profound impact of birth on a woman's life. This elderly woman, who likely didn't remember much of her daily life, remembered minute details of the births of her children. The way we feel during birth - the way we are treated - never leaves us.

You'll see that in Sara's paper. Her story is not unfamiliar, unfortunately. Yet, I see some hope in it. Do you?

Oh, and Sara got an A+ on her paper...

Differing Perspectives on the Birth Experience

The birth experience I had with my daughter was not one I’d wish on another woman. Grace was born large and healthy and we were profoundly grateful for that, but many facets of the event left me feeling angry and disempowered. Until this semester I believed I’d put behind me any lingering disappointment about how my labor evolved. Reading Tina Cassidy’s book Birth: The Surprising History of How We Are Born, however, reawakened a grief in me I thought long gone. In hopes of examining (and perhaps healing) some of the emotions the book stirred in me, I used this assignment to interview three people about the birth process. First, I interviewed my best friend and husband of 17 years, Christopher Busse. I wanted to hear his take on our labor and delivery, and what the process had been like for him. Next, I interviewed a dear friend who had chosen a home birth experience because I had heard her say many times how powerful and positive an experience it had been for her. Last, I interviewed a Twin Cities doula, a woman whose name I found by doing an internet search and who graciously allowed me to ask her questions about her work on the front lines of the birthing process.

In each of these interviews, I longed to hear good news. I believed I could predict what my husband might say about his experience, although his answers on many counts surprised me. From the two women with whom I spoke, I hoped to hear stories about “good” births, ones that had left mothers feeling strong and unconquerable. I wanted to affirm that such births can and do occur and I wanted, in hearing these women recount their stories, to celebrate vicariously with those who had actually experienced them.

A Partner’s View on Labor & Delivery

First, I needed to hear more about my own labor and delivery, as seen through the eyes of my husband Chris. It is an odd thing to interview one’s husband about his perceptions on the birth process. The most surprising thing he told me was that the notion of parenthood, of bringing a child into the world, was entirely abstract until the moment he held our daughter in his arms. This caught me off-guard because I’d been able to feel our daughter move inside me since the eighteenth week of my pregnancy. She had felt real to me from the moment we had conceived her, but that was not Chris’ experience.

“I felt affected by your pregnancy but I wasn’t a part of it. Grace’s birth made everything real… I think of all the dads (mine included) who sat in waiting rooms while their children were born and who were then handed a bundle and told, ‘Here’s your child.’ I think they missed something. Sure it becomes real soon enough when you’re holding a newborn or getting up for the first time in the middle of the night or changing a poopy diaper, but they missed the opportunity to be there at the instant when it all clicked into place.”

He also agreed that the care we were given at Fairview Riverside, a teaching hospital for the University of Minnesota medical school, was less than we’d hoped it would be. When I gave birth there in April of 1998, their medical staff did not administer epidurals. Instead, I received
a spinal block that lasted 90 minutes, a drop in the bucket given the long labor I experienced.
We also found the nursing staff, for the most part (although there were one or two notable exceptions), cold and clinical, which was not particularly reassuring to two nervous, first-
time parents.

“Maybe we could have chosen someplace that felt less like a factory and more like a care facility. To describe the care as indifferent is too harsh, but it was damn close. Maybe ‘detached’ is better. It was sort of like waiting in line to
ride a giant roller-coaster for the first time: you’re scared, you’re excited, you don’t really know what to expect or how it all works, but you’re willing to go along. And the guys running the thing are just doing the job. They’re strapping you in and making their announcements and sending you down the track. You kind of want them to be excited with you, to share the experience, to talk about
it and gush about it and squeal about it just like you’re doing. But they’ve seen a million people ride this damn thing and will see a million more and while they truly want to keep you safe, they really just want to get you going and send you on your way.”¹

We went into the hospital on Monday morning when I sprang a small leak. They admitted me later that morning. When labor didn’t progress very quickly, a couple of hours later, they broke my water for me. Even that didn’t do much, however, and at 5 that evening, they put me on a pitocin drip, worried that without amniotic fluid, infection could set in. One doctor told me reassuringly as he left for the day that he was fairly confident I would have a baby by 8 p.m. that evening. As it turned out, Grace wasn’t delivered until after 1 a.m., and she came only after the delivering physician used one half of a pair of forceps to pop her sizable head (at birth she would weigh nine pounds, seven ounces) up and over my pelvic bone, where it had been lodged for a very long time. The physical taxation was nothing we would blame on our caregivers, but the clinical, impersonal care we received—and which I personally believe resulted in a longer, more uncomfortable labor—would rankle for a very long time. I berated myself for opting not to have a doula, a woman to support me through my labor and delivery, and was delighted to see confirmed in an article in the Journal of American Medicine, what women have known intuitively for eons: that having another women present during the birth process can shorten labor.

“The association between acute maternal anxiety and disturbances in the progress of labor is strongly suggested by studies of human and animal mothers. Circulating catecholamines [fight-or-flight hormones] may be the mechanism by which anxiety influences the course of labor…In humans, an increased level of catecholamines as a result of maternal anxiety has been shown to decrease uterine contractility... a supportive companion may reduce catecholamine levels by reducing maternal anxiety and facilitating uterine contractile activity and uterine blood flow. A doula may decrease maternal anxiety by her interactions with the laboring woman—her constant presence, physical touch, reassurance, explanations, and anticipatory guidance. These aspects of doula support may make the laboring woman feel safer and calmer, needing less obstetric intervention for labor to proceed smoothly.”²

Reading this information didn’t surprise me in the least, but I found myself smiling
with satisfaction to see such an intuitive and relatively obvious phenomenon validated
by science.

A Home Birth Experience

Hoping to hear an upbeat birth story, I called my friend Eileen Myers, who gave birth to her eldest daughter Sena at home. A local massage therapist, Eileen gave birth in her former father-in-law’s house, under the care of two mid-wives. She and her ex-husband opted to give birth in a home rather than a hospital setting for two reasons.

“At the time, we had no insurance. We were young and self-employed,” she said. “And a part of us didn’t believe in giving birth in a hospital. I had always felt like I wanted to have a home birth. I thought, ‘I’m not sick. I don’t want to be in a hospital.’ We just felt in our hearts this was how we wanted to have our baby.”

She located a pair of mid-wives who had been delivering babies together for more than 20 years, and went to their home for pre-natal check-ups. There, the mid-wives weighed and measured her and checked her blood pressure. She had no ultrasound during her pregnancy. Eileen’s former father-in-law owned a home with a whirlpool in Osseo, so Eileen and her husband at the time, Paul, opted to give birth there so that Eileen could spend at least a portion of her labor in the pool. She labored without the presence of her mid-wives beginning about 5:30 one morning.

“A lot of the birthing part I did on my own,” she says. “It was pretty intense, but I did it. I didn’t know anything else.” She spent much of the day she was in labor cooking and taking short trips out into the yard. “I’d just go outside and breathe the air. And I tried to rest in between contractions, but that was hard.”

When she was inside for good and the labor had become more intense, Eileen labored in the nude, which she told me was a very natural choice for her. Her mid-wives arrived around 1 a.m. and the process began to ramp up.

“When Jeannine and Jan came, that’s when I felt like things started to happen. My body was waiting for them to be there, and they were great. They talked me through the whole thing. They were very nurturing.”

She labored in the whirlpool for several hours. As labor intensified through the early hours of the morning, the women gave her spoonfuls of honey between contractions to help bring her energy and blood sugar levels up. They also constantly soothed and encouraged her, saying things like, “You’re doing really well, Eileen. The baby’s fine. The heart beat is strong. Ride the waves.
Do your breathing,” she says.

She had rented a birthing stool, but found that by the time she wanted to use it, her contractions were so intense and coming so close together that she couldn’t get into it. “At one point I thought, ‘Is this baby ever going to come out?’ Finally, I somehow managed to get in that chair and did one push and she flew right out.” The mid-wives put her new daughter Sena on her chest and swaddled mother and babe up together immediately, skin to skin.

When all was said and done, Eileen’s labor had lasted approximately 24 hours. She had torn a little bit, and one of the midwives stitched her up. The pair also made and applied cold herbal compresses to her perineum to bring down swelling. Eileen used helichrysum, an essential oil, to numb pain. Ultimately, the mid-wives made two home visits after the birth to check up on her and her new family.

“We were blessed that it all went well. It was all natural. And Sena was born in her grandpa’s home, which is kind of cool,” Eileen says. “It was an incredible experience.”³

A Doula’s Take on Birth

Rebecca Feyder, a doula who works out of St. Paul, got her start in the birth business six
years ago, beginning her training just six weeks after the birth of her daughter. After the birth, she tells me:

“I felt like a superwoman. It was the best experience of my life and I was just crazy in awe of myself those first couple of weeks. I had done something that I didn’t think was possible. I became a doula because I wanted to get back into the birth world. I felt like I needed to find more women like me, women who didn’t know they had it in them. I want women to feel like superheroes, to come away from giving birth feeling strengthened, feeling like they’re the strongest, most amazing people in the world, that they can do anything!”

A doula’s role is to provide information, physical comfort measures, and emotional support before, during and in some cases after the birth. “Doulas,” Rebecca says, “are waist-up, whereas mid-wives are waist-down.”

One primary difference between a doula and a healthcare provider is that a doula generally gets to know the family a bit more than the medical providers do. Doulas can become involved at any time in the pre-birth process, depending on when a family opts to hire one. Most doulas conduct two or three pre-natal visits. The initial visit is one-to-two-hour long consultation appointment where the care-giver and prospective families chat. Based on how well both parties believe that visit has gone, the doula may be hired. Getting to know one another heightens the sense of trust between a doula and a birthing family. After the initial consultation and a decision to hire, a doula and family usually have at least two pre-natal visits, each about two hours long. The mom-to-be, family members and the doula discuss fears, hopes and concerns during these early visits. On the second visit, Feyder discusses comfort measures and optimal fetal positioning. She and her clients practice massage, hip squeezes, and learning how to use a birth ball. They spend a lot of time talking about the pregnancy. Feyder joins a family in labor whenever they want her to come, she says, generally toward the end of early labor or at the start of active labor.

Rebecca doesn’t provide post-partum doula services, although some doulas do. She does visit each of her mothers at least once within a month of their baby’s birth. She takes pictures during the birth, so at that visit they’ll look at pictures and talk about the birth. She also provides what this mother considers one of the most critical services any mother can have: a genuine desire to hear the birth story from the new mother’s perspective. She’ll also talk with families about sleep and sleeping arrangements, breast-feeding, and the possibility of post-partum depression.

She received her certification through DONA (Doulas of North America) International, the largest doula-certifying organization in the country. Her schooling included a two-day, hands-on training seminar in which she learned basic physiology, psychology, comfort measures, massage techniques, and standards of practice. She was required to attend a childbirth education class. In order to fulfill her initial training prerequisites, she was required to attend a minimum of three births, and to be present from a certain dilation point onward. Afterward, family members, doctors, nurses, and midwives present were solicited for feedback and rated her skills. She completed reports on each birth, outlining everything that happened and all interventions used over the course of labor and delivery, to prove that she was educated about the birth process.
Her reports and feedback from other parties was submitted to DONA before she was certified. Since Rebecca was certified six years ago, DONA has added a breast-feeding training requirement, as well. Doulas are required to attend continuing education classes to become recertified every three years.

Feyder says doulas are part of the birthing mainstream in the Twin Cities area, which has the highest number of doula-attended births of any major population center in the country. This is
a trend she’s seen evolve over the past decade.

“We’re not the crunchy fringe group people used to think we were years
ago. The birth community has changed in the Twin Cities. It used to be so medical and stale. A lot of people forgot that birth was a family event. Now,
it’s more progressive and people are realizing just how important this event
is in their lives. It isn’t necessarily about having a natural birth but about being supported and having what you need around you to feel supported.”

Hiring a doula in the Twin Cities today generally runs between $500 and $1,000. When broken out into an hourly wage, this recompense is by no means a livable wage, so many doulas work full-time jobs elsewhere. In an industry where a non-complicated hospital birth starts at approximately $10,000 and climbs rapidly from there, it seems grossly unfair that a doula-accompanied birth, which brings down the c-section rate by half, should pay those who provide this valuable service so little.

Feyder shared several wonderful birth stories with me during the course of our interview. In one instance, she watched the birth of a baby boy whose head had emerged. As everyone in the room awaited the contraction that would expel him into the world, the baby craned his head to one side and looked directly at his father. “It was the most amazing thing,” she says. “He just turned and looked right at his father… Somehow, they know.”

In another situation, she recalls attending a birth that was memorable for its tranquility. Though there were several people present in the room, “no one said a word,” Rebecca says. “It was the most peaceful thing in the world. The doctor didn’t say anything, the mother was quiet, the
other people in the room were quiet, and then out she came and went right onto her mom’s
belly. This baby didn’t even cry. It was the most calm, serene birth I’ve ever seen.”

Rebecca has also witnessed births where women have lost their babies. “We got into this field because we are so passionate about the world of birth,” she says. “I think one of the things we have a hard time with is that birth and death are so close together. We’ve all been present at births that don’t end the way we want or expect them to and that’s really hard. It makes you realize that you can’t be part of birth without being part of the world of death, as well.”⁴

Those instances don’t keep her from remembering why she got into this field in the first place, though. The word that comes up repeatedly in my conversation with Rebecca is “passion.”
I end my phone conversation with her with much to process.

Personal Learnings

I come away from my interviews with these three people and their widely divergent perspectives on the birth experience with a more well-rounded understanding of my own. I have received precious gifts from each of them. From my husband, I have gleaned two things. First, he has validated me by sharing his views on the care we received at the hospital during our daughter’s birth. It was not, unfortunately, top-notch. We delivered there based on insurance coverage and our relative youth. Were we to do it again, we agree we would do it differently. During the course of our interview, he also shared with me his truth about how parent- and fatherhood were abstract concepts until he could actually touch our daughter and count her ten tiny fingers and ten tiny toes. What he had to say on that score both fascinated and unsettled me.

From my friend Eileen, I take away a first-hand account of a woman who was delighted with the way the birth of her daughter evolved. Every aspect of her labor and delivery—the excellent care her mid-wives provided, her labor in the whirlpool, her use a birthing stool to help her body do what it was meant to do, and ultimately having a healthy, safe home birth—renewed my faith in modern obstetric care and in the wisdom of the body. And from doula extraordinaire Rebecca Feyder, I learn that there are woman out there who are not only glad to assist and support laboring mothers, but who do it because it is one of their grand passions, who consider this service one of their very reasons for being. I wish I had met and hired her 13 years ago.

I am grateful to each of these remarkable people for providing me an alternate lens through which I might view my own experience. Looking through them, however briefly, has facilitated the beginnings of my own healing.

Sources

¹ Busse, Chris. Personal INTERVIEW. 6 December 2010.

² Kennell, John, et al. “Continuous Emotional Support During Labor in a US Hospital: A Randomized Controlled Trial.” The Journal of the American Medical Association. 1991: 265.17.2197-2201.

³ Myers, Eileen. Personal INTERVIEW. 8 December 2010.

⁴ Feyder, Rebecca. Personal INTERVIEW. 9 December 2010.