Friday, June 28, 2013

Natural birth...and why I chose it

So, I didn't actually intend to write that last post. I intended to write this one. But then my introduction stretched into a whole post, and after writing and proof-reading that one, my first thought, from the perspective of someone else reading it, is why the heck do you even choose natural birth if the pain occupies your mind that much?

I do ask myself that question. And the fact that I've chosen it so readily, both times around, baffles me, because I really dislike pain.

I really, really dislike pain.

(Confession: at one of Peregrine's vaccine appointments, the nurse mentioned I should get my DTAP booster. She said she could just do it after Peregrine's shots. Peregrine got his shots, and she forgot. I didn't remind her. Because I didn't want the shot! I'm kind of mortified about this, and I will be getting my DTAP within the next few weeks, as I'm in my third trimester and all that.)

But natural birth, for me, isn't really about the pain, or lack thereof. There's a lot more that goes into it than just pain, or not. It's about--well, about the whole perspective on how birth is done.

Let me explain that a bit, because I don't want to come across as judgmental, or even as having some sort of cause surrounding natural birth. I don't. I just love it for myself. And I like talking about it.


I kind of hate the label natural birth. Firstly, because it's vague (there are whole internet feuds devoted to its actual meaning), and also, because it implies that anything else (whatever its actual meaning is) is somehow unnatural. And that's somehow bad.

There are a lot of choices that go into a birth. There isn't just natural (whatever your definition is) or not. There are a lot of unknowns and uncontrollables that go into a birth, too. And I'm willing to bet that most women today, at least in the Western world, have at least something "unnatural" about their birth experiences. Even getting into a car to go somewhere to have a baby (or having a midwife get in a car and come to you!) is breaking company with nature, if only a little.

So, without further splitting of hairs over the meaning of "natural," here's what my general giving-birth plan was (and is): out of a hospital setting (unless medical complications arise), attended by a midwife, with as few interventions (induction, pain medication, etc) as possible/safe. And when I say "natural birth," for the duration of this post, that's what I mean.

Tangent over.)

So why did I choose natural birth, and why am I choosing it again? First off, these were NOT my reasons:

I am not in any way opposed to hospital/medicated birth, nor do I think home/natural birth is an inherently better decision. I have plenty of friends who have chosen, for a vast variety of reasons, to give birth in the hospital, to use pain medications, or even to have elective C-sections. I fully support and celebrate their birth choices. I love hearing their birth stories and I truly, truly do not think my birth choices superior. (Most) doctors are incredibly gifted, capable, and caring people who I would fully trust to deliver my babies. (Most) hospitals are extremely safe places held to incredibly high standards of excellence. (Most) birth interventions are proven safe and effective, with millions of happy, healthy women to prove it. (I say most, because there are some horror stories. But then, there are plenty of horror home/natural birth stories, too.) If for any reason my first-choice birth plans became impractical or dangerous, I would quickly trust my life, my baby's life, and our mutual birth experience to my local OBs and hospital. Gladly, because I am so incredibly grateful they exist. I am so grateful that dying is not among my main concerns when thinking about childbirth.

I am not opposed to the use of interventions. When medically necessary, I am all for interventions. Though some of the side effects sketch me out, the vast majority of them are perfectly safe, and are used well millions of times a day across the country. If I needed interventions (even if I felt I needed them), I would ask for them. And I might choose an epidural and five hours of sleep over an additional ten hours of labor. Even if I could have maybe done the ten hours. I fully support anyone's (informed, and doctor-supported), decision to use them.

I do not think hospital/medicated birth is necessary violent or violating, or that babies born in less "natural" situations are necessarily traumatized or wounded. I have spent a lot of hours reading up about natural birth, and, whether subtle or not, this implication frequently comes up. I have read all sorts of things about "gentle" birth being the gateway to "gentle" parenting (another loaded word, gentle), and that a woman must stay mindful and engaged and fully alert (i.e. not on any medications) in order to bond with her baby as it is working its way out of her womb. I do believe strongly in the birth experience being one in which the mother feels honored and cared for and in which the baby can begin normal life as a baby (i.e. snuggling, nursing, being warm, etc) as soon and as, well,  gently as possible. But I really, really don't believe that a few birth choices reflect on your love for, or your closeness to, your baby. There are days, and years, and months, in which to love a baby well, in which to bond with him or her, in which to be the gentlest, and the fiercest, parent you could possibly imagine. There is no reason to put guilt on a laboring woman for any decision she makes during labor. Birth is a vastly diverse experience (and hey, if you want to get technical about it, I'm willing to bet my friend's labor, in which she chose an epidural early on and spent the hours of her labor talking with her baby and praying for her future, was a lot more "gentle" than my fast-and-furious labor, in which I mostly focused on getting through it, not bonding with Peregrine). And? Sometimes trauma in birth happens, and has to happen. Sometimes a C-section, or forceps, or a terrifying rush to the NICU or OR, are necessary to save a mother or baby's life. Sometimes mother and baby can't bond right away. Sometimes birth is anything but peaceful and blissful; it's horrifying and frightening and very traumatizing. That's very much not ideal for either mother or baby. But ideal doesn't always happen. And there is again no reason to make any woman feel guilty about it.

I do not have a desire to prove my own tolerance for pain. Actually, I don't think anyone chooses natural birth for this reason. But people seem to think they do. Or like the measure of your gutsiness is somehow dependent on when/if you asked for an epidural. For the record, it isn't.

So why did I choose it? And why on earth am I choosing it again?

My mom had home births with my youngest two sisters. I was there, and witnessed parts of both of them. I'm certainly not just doing it because my mom did. But I do think, because I saw birth done this way at such a young age (and because that's the only type of birth I saw, outside of a few TV births here and there), it just was the default norm for me. And I think I was de-sensitized to some of the fears and concerns about home birth that some people have. I saw them, they were normal and undramatic, it's never really occurred to me to worry about a (low-risk, uncomplicated) home birth being safe.

I have a lot of trust in the Midwives Association of Washington State. Honestly, I can't say I'd choose out-of-hospital birth any and everywhere. I want my births to be safe far more than I want them to be natural. I want to know that if my midwives ever feel unsure about their ability to provide excellent care for me, they would quickly transfer me into the care of someone they trusted. I would hope they would trust the OBs in town, and refer me to them, without hesitation, if necessary. And, in Washington, I know they would. Washington holds midwives to an incredibly high medical standard, both for their specialty (low-risk, normal pregnancies and births), and their limitations (high-risk, abnormal pregnancies and births).

I am kind of a hippie. It's not my only reason (and I'd be worried if it was!), but it's there.

I am wary of unnecessary interventions. I tend to be fairly hands-off and natural when it comes to my health (and most of my life in general). Not natural as in herbal, natural as in--well, nothing, unless necessary. I don't tend to go to the doctor, or take medications, unless I really think I need them. I just like to let things run their natural course and wait them out unless they don't seem to be resolving themselves naturally. And, as midwives are pretty good at letting things resolve themselves naturally, we make a good match as care provider and client. It's not that I'm morally opposed to interventions. I just don't tend to choose them. And it's easier not to choose them when your care provider's default is not using them. It's easier not to choose them when you're in a calm environment where the rules are flexible and you're generally allowed to do things your way.

Which brings me to--

My absolute, number one reason for choosing natural/out-of-hospital birth:

When I have something difficult to do, I absolutely hate doing it in an environment that is remotely stressful. And I hate being told how to do it. In order to succeed, I have to do things in my own way, in my own time, and in a very calm and peaceful environment. Really, this is what it boils down to for me. And when I ask myself, why did I really choose natural birth, this is what I always come back to. Birth is immensely difficult, and really, the only person who can give birth to my babies is me. Assuming I have a normal labor, where I'm conscious and healthy and so is the baby, the work is all mine. And nothing would stress me out quicker than being constantly monitored, being told what to do and how to do it. There's a lot of monitoring in hospitals, because it's the way the system works. Some people love it, and some people don't mind it. I would hate it. I would hate the lights being on, and nurses coming in and out, and people asking me how I'm feeling and how much pain I'm in. I would hate being told when and how to push. And yes, I'd do it all in a heartbeat if it was necessary for my or my baby's life or health. But, if it isn't, I'd rather be alone, or at least with a select few people I knew and trusted. I'd rather be in the dark, and sit (or stand, or lie, or walk) wherever I want. I'd rather have everyone quiet. I'd rather be the one in charge and let my body take over. I'd rather say I'm not ready for this, or I don't want that, or actually, scratch my whole plan, I feel like doing it this way. And I'd rather be in the care of someone whose basic birth philosophy is that a laboring woman should do just that. I'd use the hospital system if I needed it. But as long as I don't need it, I'd rather not feel like I had to fight it. I don't want to fight anything while giving birth. I want to just be. And I want to be able to tell a whole room to turn off the lights, or go away, or not use remotely loud voices, or take the pillow away because it smells bad, and have them rush to do just that. Because then I can concentrate on getting the baby out.

I know there are a lot of hospital horror stories circulating around the natural birth community, and I know they don't represent every hospital, doctor, or nurse. I do trust that most doctors and nurses are kind and caring and want the best possible birth experience for their patients (one of my dear friends, in fact, spent years as a labor and delivery nurse; I can't imagine a better birth attendant). And if I went in to a hospital needing to deliver there, I wouldn't go in assuming everyone was out to get me and ruin my autonomy over my birth. But I know hospitals are systems, and need to be systems. When you have lots of women laboring in a place--a big place--things are necessarily run a certain way. Out-of-hospital birth is just a lot more flexible. Midwives, on the whole, believe in the laboring women being basically in charge, and generally going with her desires for the whole birthing environment. And midwives, on the whole, believe in a basic atmosphere of very calm.

Which is how I do things. Not just birth, but anything. Driving. Math. Rock climbing. Learning new skills. I hate pressure. I hate unnecessary noise. I want to be trusted to do things my way, my time, unless I'm clearly floundering or there are real dangers present.

Birth is an intensely personal choice and an intensely personal experience. And so, by necessity, different things will have different weight with each of us. And the things that matter to me happen to align with the midwife model of care and out-of-hospital birth. That's pretty much the long and short of it, in the end.

Thursday, June 27, 2013's coming up soon

I'm 32 weeks tomorrow and less than two months away from Sylvia's due date. Which means, in two months or so (hopefully not much sooner!) I'll be giving birth again.

In the months leading up to Peregrine's birth, I think I felt every possible emotion on the fear-to-excitement spectrum. Some days I couldn't wait to give birth. Some days I was terrified, absolutely terrified. And most days, I fell somewhere in between.

I remember telling Andrew that anticipating giving birth felt like anticipating death. You know you have to do it, and there's no avoiding it. You know in the end, it will be okay, and beautiful, and good. But you don't know what it feels like to go through it. It's just this dark thing in the middle of your path that you have to cross through, and people have told you the other side is worth it. Pain is a hard thing to envision. When people tell you it's the worst pain you've ever experienced, what exactly does that mean? How do you prepare for something you can't really put your finger on?

I think Andrew thought I was being melodramatic when I told him that. But even now, it's the best metaphor I've found.

I think it's easier, this re-anticipation. I've already been through it, there's not that vast unknown. I know it's the worst pain I've ever experienced. And that's sometimes why I think it's a bit harder, the second time around. I have something real to fear.

I know, I'm part hippie, I'm immersed in the natural birth community, you don't have to remind me that fear creates panic, panic creates pain, birth is just powerful and intense, not scary. I know relaxing is important.

But birth is scary. It hurts like nothing else. And what's almost scarier is that I really can't remember just how much it hurt. I just remember what I thought at the time, which was, why does anyone in their right mind ever have a second child? As Peregrine's head came tearing and burning through me, I thought, consciously and clearly, that despite my lifelong dreams of having a houseful of kids, this pain was enough to make me reconsider it and possibly completely back down. That's a pretty intense thought, for me. How bad was that pain that I allowed myself to think that?

Sometimes I feel like the magic has been taken away from birth, having been through it. That the whole birth-is-awesome-and-mystical-and-powerful mentality I thrust myself into when I was pregnant with Peregrine was dashed by the actual thing. I never really felt awesome and mystical and powerful. It was sweaty and intense and painful. I felt--I don't know--earthy--and not in the beautiful-hippie-mama sense. Just, raw. Dirty and concentrated and primal and body. Nothing metaphysical. No time or space, for that matter, for anything metaphysical.

Until afterward. And I don't mean the moment I held my baby, because honestly, when Peregrine finally emerged, I was just in shock from all the pain and tiredness. But days later. Quiet moments, when I remembered the darkness, and the sweat and blood and tears, and the fact that my body, my incredible amazing female body, had given birth to a child. Then it was awesome. Then it was powerful and sacred and wonderful. Then the mystery, the holy-freaking-awesomeness of it, was so very much more intensified than I had ever envisioned before I had been through it.

And that's probably how it will be again. I'll spend the next 8 weeks (give or take, and please not too much give or take--on either end), waffling between remembering Peregrine's birth for the excruciating painful bloody mess it was, and the awesome powerful incredible miracle it was too. Then birth will come, and it will just be there--concentration and sweat and the very most non-metaphysical sort of humanity. And then, I'll have another story to tell. Another story of beauty and power and wonder. Another life that my incredible body gave birth to.

And quite honestly, it isn't labor that scares me so much. Labor hurt, but I never felt like it completely overpowered me. It was hard, so very, very hard, but I did it, and I'm pretty confident I can do it again.

It's the head that scares me. That's the moment that completely took me over. That's the moment that was bigger than me, and not in a good way. I seriously dread crowning like nothing else.

Sorry, natural peaceful birthing community. That's probably why it hurt in the first place, according to half of what I read. I'll try to relax and think positive, I really will. But mostly, I'm hoping Peregrine stretched me out enough that Gigantic Head #2 won't hurt quite as terribly.

Sunday, June 23, 2013

Concerning Crying

During my first few months of parenting, one of the odder compliments I received from various doctors and friends was how well I was able to tolerate hearing my baby cry. I've never quite been sure how to take that. I think calmness in general is one of my strengths as a parent, but I don't really want to be seen as someone who is callous or tough. And I feel like there's a lot of guilt circling around the world of parenting when it comes to baby crying. I think it's often assumed that a really good mom, with really good mom instincts, is so very in touch with her child, and so very connected, that she cannot tolerate any of her little one's distress. It's subtle, I think, but I see it everywhere.

Empathy is terribly important, of course. And any mother hates to see her baby in pain. But while complete apathy toward a baby's cries is certainly a problem, I think it's equally unhealthy to feel extreme panic or anxiety when a baby cries, and feel like you must respond immediately right now lest you lose your baby's trust or hesitate in meeting an important need. The truth is, babies cry, and they cry a lot, and they cry for a lot of different reasons. A lot of parents say they are more relaxed about baby cries the second time around. Not because they care less, but because they've learned how to gauge each cry's importance.

There is a lot of parenting-book space (including on the internet!) devoted to crying babies, and plenty of people promise that if you use their technique, your baby will cry less. I've read everything from African babies never cry because they're carried and nursed all the time to strictly scheduled babies never cry because their needs are met before they have to cry for them. And sure, no one wants a constantly-crying baby, and any technique you can use to help your baby be calmer and more content is probably worth it, for everyone's peace of mind. But I think it's easy to tie crying (or lack thereof) to parenting ability (or lack thereof), and that's simply not true. Some babies cry more than others, for any number of reasons. But all babies cry. Including the babies of very, very good parents.

There are a couple of things that are very helpful for me to keep in mind when dealing with a crying baby. (And it's important to note that I am talking here about pre-verbal infants; toddler crying is a whole 'nother ballgame that I may or may not take on sometime). And in questioning why (other than experience as an older sister and as a teacher) I tend to tolerate baby crying without (too much) panicking, I think these two things play a huge part in my ability to keep things in perspective.

The first is that crying indicates communication, but not necessarily distress. If you think about it, crying is the only vocabulary babies have. They have plenty of non-verbal signals, but when they want to say something to you, they cry. And sure, you should respond, because they're talking to you, and you should listen when your children talk. But it doesn't necessarily mean they're terribly upset. If your preschooler told you she was hungry, you would feed her (or assure her dinner was coming up soon). You wouldn't panic, or feel terrible that you hadn't fed her yet. You'd just listen to what she was saying and respond. A baby who cries from hunger might be very hungry, sure. But he's not necessarily so hungry he had to cry, in the older-child sense. He's just so hungry that he had to tell you.

A lot of resources will tell you that every cry (especially in a younger baby) indicates a need. And while this is certainly true, I think it's easy to take this and assume that every cry indicates an urgent need that must be met right away. And that isn't true. Sometimes babies cry from raw, primal need (hunger, clean diaper, tiredness, etc). But sometimes crying simply expresses a feeling (fear, for instance, or boredom). And sometimes it's a reaction to a new experience (wind, or cold, or a big dog). There is a need there, of course, a need for your presence and reassurance. But it's not necessarily an emergency of distress. Sometimes it's just a touch-base to make sure you're there.

And I think it's okay to say no, or later, or wait, even to a very young baby. Obviously, primal needs should be met, and the younger a baby is, the more immediately they should be met. But it's okay to finish feeding an older child before starting to feed a younger. Sometimes, it's okay to assure a bored, frustrated baby that you will help him out as soon as you get off the toilet or off the phone.

My beautiful grandmother is one of the gentlest people I know when it comes to handling babies. Nothing, absolutely nothing, ruffles her, and I have never seen a baby who doesn't love her immediately. And nothing makes her hurry. She never rushes to anything, she never panics, and when a baby fusses, she will call across the room, quietly and calmly, in her Southern accent, "I hear ya, I hear ya." Then she will carefully finish hanging her dishrag, or whatever she was doing, and when she is done, she will attend to the fussing baby. This isn't breaking a baby's trust, and it isn't ignoring his needs. Sometimes, it's important just to let your baby know you hear him, and will be available soon.

And sometimes, you will fail at meeting your baby's needs, simply because his cries didn't make sense and you mis-read them. That's okay. In any relationship, miscommunication occurs. Sometimes you'll guess and guess and guess, and you'll be wrong, and your baby will keep on crying, and you just won't know what's wrong. This doesn't mean you're not in tune with your baby. It doesn't mean your baby will stop trusting you. It simply means you and your baby are trying to work out a relationship, and you don't speak the same language. It's tough, sometimes. Spouses miscommunicate. Friends miscommunicate. Co-workers miscommunicate. Parents and children miscommunicate, too.

This is not to say that real distress doesn't occur. It does. And almost every baby has a cry that means I need you right away!!! You'll hear that cry, and you'll know it. And when your baby is in pain, or terrified, you probably will panic a bit, or be a bit heartbroken. That's okay. No one wants to see their tiny one suffer.

But it's also important to remember that it is not your job as a parent to keep your child's life free of discomfort and pain; it's only your job to help them through the discomfort and pain they will experience.

It's a terrible part of living in the world we live in. Your child will suffer. There will be pain, and sadness, and frustration, and disappointment. There will be sickness, and fever, and colic, and teething. There will be shots and exams and medicine. There will be toys that don't work and baby latches on all the fun cabinets. There will be older siblings who need attention, too. There will be times you, as a parent, make a decision the baby protests: seat belts, medicine, sleep training. And there will be tears, lots of them even, because of the pain and frustration these things cause.

But it's not your job to keep these things from happening, or even to make them go away. Often you couldn't, even if you tried. Often you shouldn't, because sometimes, hurt has to happen in order for something better to happen, too.

There's a lot of material out there exhorting parents to avoid giving their baby trauma. It's a scary word, trauma. It conjures up images of irreversible injury, brain patterns being created by bad things happening. But trauma is a spectrum, and no matter how carefully you try to avoid it, your child will experience it, to some degree. And it's easy to get wrapped up in guilt for the trauma we could have maybe prevented. The maybe-necessary medical test. The slightly-too-long car ride. The sleep training that may not have been the only option.

Friends, it's not our job to prevent bad things from happening. It's not our job to stress about the bad things we might have been able to prevent. Because bad things will happen. Our children will have to experience them. It's not an excuse for selfishness, to be sure. But it is a fact of life. And isn't it better to show our children that we love them through the bad things and help them learn how to weather them, than that we try too hard to keep the bad things away?

And finally, it is worth noting that sometimes crying does indicate a bigger problem. Sometimes babies cry too much. And in cases like that, there are pediatricians and specialists and older, experienced mothers and grandmas who can help us figure out what the problem is, or if there is a problem at all. Sometimes it's worth getting some perspective. Not from Doctor Google, or from strangers on the internet, but from someone who's seen a lot of babies.

But the crying days usually don't last too long. And then you get a toddler, and, as mentioned before, toddler crying is a whole 'nother ballgame.