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.

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