I want to preface this post with this: I know women who have had great experiences with my former OB’s practice, and the hospital I delivered my daughter at. This not a general statement about either of them, but rather, my own personal experience. If you had a great experience with them, then I’m truly happy for you.
My pregnancy with my daughter was unexpected; I hadn’t done any research, and was sort of thrown into the whole thing the second I saw that plus sign staring back at me. When it came to making my first appointment, I went with the easiest option: the OB I had already been seeing for my annual exam for the last 5 years. I knew a few people who had delivered with his practice, so I figured it was a good choice.
My prenatal appointments were nothing like I expected. I thought we’d spend a lot of time talking about pregnancy, about what to do and what not to do, etc. But for the most part, I was sent home with a bag of handouts after my first visit, and we discussed the pregnancy very little. Most of each appointment was spent doing an ultrasound, talking about what he saw, and then what we’d do at the next appointment. Reflecting back, I realize that my OB was what I’d call “ultrasound-happy.” I had ultrasounds at 9, 12, 16, 20, 28, and 37 weeks. At the time, I didn’t know that these were mostly unnecessary ultrasounds – of course I wanted to see my baby. But these were 3D ultrasounds, and that much exposure is really not recommended unless there’s a reason for them; ultrasounds do heat tissue slightly. They haven’t been proven to be harmful, but unless medically necessary, there’s no reason to do something that has unknown long-term risks. But they were never presented as optional, or as an option with any potential risks. It was just something they did, and I didn’t know any different at the time.
I always wondered if the next appointment would finally be the one where we’d start talking about my birth plan; he hadn’t asked me about it yet. It made me nervous that he hadn’t brought it up – I felt deep down that it was probably a bad sign. By the time my 24 week appointment rolled around, I finally asked if we could discuss it. I told him I wanted to plan for an un-medicated, low-intervention birth. His response? Um, okay. Most women don’t tell me they’re doing an un-medicated birth until they show up and it’s too late for an epidural anyways. Just be prepared for the chance that it might not turn out the way you want.
Not the response I was expecting or hoped for. Where was the support? Where was the encouragement? Instead, he chose to immediately cast doubt on my plan? I had no illusions, I knew that birth doesn’t necessarily always go to plan; but that didn’t mean that I didn’t have the right to express my preferences.
As I was leaving that appointment, he felt the need to tell me a birth story about a woman who wanted a natural birth, refused induction, and had grand ideas about the baby just falling out of her. But then she of course had to have a really high intervention birth that resulted in a c-section. “She had wanted to be like an animal in the wild, like some sort of cow,” he smirked. Is he really making fun of another patient right now to me?
I left the appointment uneasy. Uneasy about how this doctor had reacted to my plan, uneasy about how he had laughed about another patient’s “ideas”, and uneasy about what I was going to do next. I knew one thing for certain: I couldn’t stay with this doctor. He had shown me his true colors.
However, for some reason, I was scared to switch practices. Call it inertia, or fear of the unknown. So I took the easiest step I could: started seeing the other doctor in the practice. I was relieved to find out that he was supportive of my birth plan. He was open to doing delayed cord clamping, and said I could labor however I wanted to. The rest of the pregnancy went smoothly, and I felt like I was in good hands.
However, what I didn’t realize was that there is a difference between being supportive and knowledgeable about natural birth. When it came right down to it, my husband and I were on our own to make this happen. (In hindsight, a doula would have been extremely helpful, but we were naïve in thinking we wanted this experience to be about just us. Little did we know that a hospital birth involves very little privacy anyways).
And your doctor is only one part of the equation; the other part is the hospital they deliver at. He happened to deliver at what is locally known as the “baby factory.” At the time, this felt like a comforting idea – man, they deliver so many babies, they must know what they’re doing. Reflecting back, the idea of a factory is exactly what it sounds like – high efficiency, high intervention. I had no idea that I was walking into a situation where the nurses rarely see physiologic birth. When I tell people now that I had an un-medicated birth there, they look at me like I’m a unicorn with 2 heads. Here’s an abbreviated version of the story:
I labored peacefully at home for 9 hours before going to the hospital, as I knew that was my best chance for sticking to my birth plan – I was already dilated 6 cm by the time I arrived, and was in active labor. When being admitted, I asked the charge nurse if I could be paired with a nurse who was experienced with natural birth. Oh all our nurses are supportive of natural birth, she chirped. Not so. My labor & delivery nurse was the opposite of natural birth friendly. She immediately offered me an epidural, even though I had explicitly told her I wasn’t interested. I was wary of how my time with her was going to go based on this very first interaction.
After some time on the monitor and getting admitted, she finally left. I began alternating between 3 positions: sitting on the edge of the bed, sitting on my yoga ball, and on my hands and knees on the bed. This is when my husband became a HUGE help to me, and really stepped up. As the contractions became closer and closer together, my needs were changing by the minute. He provided my back with much needed counter-pressure, fetched me water and juice, got me a cold washcloth with my lavender oil, and helped me through each and every contraction. I truly couldn’t have done it without him.
And then the nurse came back. She doubted me when I said I was progressing quickly – oh you’re a first time mom, you have at least a few more hours before we need to call your doctor again. I insisted again that things were moving quickly. She reluctantly checked me, and she did so roughly; she was clearly used to women on epidurals who couldn’t feel it. She was shocked to find that I was right, that I knew what my body was doing, and she sprang into action, getting the room ready for delivery and called my doctor again. She pushed the epidural idea at me one more time, as it’d be my last chance – I told you lady, it’s not on the menu for me. Leave. Me. Alone.
I was about to go through transition – what most people call the hardest part of labor. Thankfully, the nurse left the room again, so I got to do this in peace. Slow-paced breathing and focal points were no longer enough to manage the pain, so I changed my breathing pattern a few times, using the He-Blow breath and the fast-patterned breathing techniques we had learned. I never thought that vocalization would be a useful technique for me – I always thought it was cheesy when I saw it in the birthing videos, but it turned out to be extremely helpful. Repeating phrases like “I can do it” and “I trust my body” were essential in distracting me. When I could no longer say these phrases myself, I asked my husband to talk to me throughout each contraction, repeating the phrase “You’re doing it.”
My doctor arrived to check in on my progress. My water still hadn’t broken yet, so he provided me with two options: Either he could break it for me, or he could go do a c-section he needed to do, be back in 1 hour, and see if it had broken on its own and if I was ready to push when he got back. I knew I’d have my doctor’s undivided attention if I waited the hour, so that’s what I opted to do.
The next hour was pretty hard – and this is what helped me understand why many women choose to get an epidural. If I hadn’t been prepared with all of the breathing, visualization, vocalization, and comfort techniques, it would have been scary. But the preparation allowed me to remain confident, and take everything 1 contraction at a time, with my husband’s help. I don’t think I’ve ever been so focused in my life – and I don’t think I’ve ever felt so powerful. I remember thinking of the word “power” in my head, convincing myself that my body had the power to do this. I did everything I could to relax my body and my muscles in between every contraction. Near the end of this hour, the contractions were practically on top of each other – sometimes I only got a 15 second break in between them.
When my doctor showed back up, he said I was at 10 cm, and he broke my water. Now there were 3 nurses in the room, and I was supposed to start pushing. All of a sudden my quiet, peaceful labor bubble was filled with people telling me what to do.
The 2 new nurses were supportive, as was my doctor. But like I said, supportive is not the same as knowledgeable. They weren’t used to women eating and drinking during labor – so they didn’t to remind me to empty my bladder before pushing, resulting in some pretty ineffective pushing for a while. They also fell into the norm of directed pushing, where they’d yell out when to push, and count to 10 loudly 2-3 times per contraction, until I was pushing so hard that veins were popping out of my head. All of these things are unnecessary and counterproductive when having an un-medicated birth – they weren’t allowing me to listen to my body. And they’re actually damaging to your body and pelvic floor. I knew that holding my breath during pushing wasn’t good (a relaxed jaw means a relaxed body and cervix), but they kept telling me to do it that way. I didn’t think my body was ready to push – all I wanted was to take a little break before starting again. But they were yelling at me to push during every contraction. And when everyone in the room is telling you what to do, it’s extremely hard to stop the show and get off the stage. I know I didn’t feel comfortable with what was happening, but I was too swept up in the moment to know how to make it stop or ask for anything else. Their direction had taken my power away.
Going back to my first negative nurse: apparently the position I was pushing in wasn’t “convenient” for her, because the monitor kept slipping off of my belly. She repeatedly told me it’d be easier for her if I was on my back. I refused, I wasn’t comfortable in that position. She asked if she could use internal fetal monitoring, since I was moving around so much. I’m sorry, you want to screw an unnecessary electrode into my perfectly healthy baby’s head because I’m moving around while in labor and you have better things to do than to hold the monitor still on my belly? Never mind the fact that continuous fetal monitoring isn’t evidence-based? Her negativity was just too much for me, it was shutting my body down. I don’t consider it a coincidence at all that my daughter was born 15 minutes after this nurse’s shift ended and she had left the room.
Even though I tried pushing in different positions, they eventually pressured me onto my back (which is the most convenient position for them to see what’s going on, but unfortunately happens to be the position that your pelvis is the smallest in.) Gravity was no longer helping me, and my daughter was stuck for a while behind my pubic bone. By the time my daughter was crowning, an hour and 45 minutes into pushing (which, by the way, is a perfectly normal amount of time to push as a first time mom), they should have told me to slow down to protect my perineum; instead, their impatience made them tell me to push harder, making my 10 lb. 1 oz. daughter come barreling out of me.
Yes, at the end of the day, I accomplished my goal of having an un-medicated birth. But it didn’t mean that it was the birth experience I desired. It doesn’t mean that I was respected during it. I had to fight for it. I had to refuse unnecessary IV fluids, I had to demand wireless monitoring, I had to turn down continuous pressure to get an epidural; I had to simultaneously stand up for myself while trying to relax and focus on the hard work of labor.
Yet when I became pregnant again, I still debated whether it was worth switching practices & hospitals just to potentially have a better experience. Once again, I was scared of the unknown. Was it better to go with the devil I knew? Could I be better prepared this time? I think you create a strange emotional connection to the person who assisted in delivering your baby, even if it wasn’t the perfect experience. They were there with you in your most intimate and vulnerable of moments. You were high on birth hormones. And after all, he did save me from bleeding to death of a postpartum hemorrhage. All of these things gave me pause.
But I was making excuses. At the end of the day, we all deserve to be treated with respect in childbirth. Regardless of the type of birth: homebirth, hospital birth, epidural, induction, c-section, VBAC – whatever. We all deserve care providers who practice evidence-based medicine. We deserve informed consent. I know too many women who had unnecessary c-sections because of a cascade of interventions that were done without their consent. You ever want a reality check about the current state of maternity care, go read some birth stories on ImprovingBirth.org’s Facebook page. Birth trauma is real – up to a third of mothers describe their birth as traumatic. These stories have literally made me sob myself to sleep because they are so distressing. Too many providers are ignoring the role the mother has in her own birth. This is so hard to explain to a first time mom – you assume that your providers practice evidence-based care, you assume that everything they do is the best thing for you. But maternity care has become so screwed up – so few providers even know what a normal birth looks like. You have to be your own advocate. My birth wasn’t traumatic; but it wasn’t respectful care.
So I made the leap. I’m now with a midwifery practice that delivers at a hospital with the lowest c-section rate in the state (less than half the rate of my first hospital). It’s the opposite of a baby factory – there are only 6 labor and delivery rooms, and they offer water birth. I’ve also chosen to use a doula for this birth. And I finally feel supported.
After our first midwife appointment, and then again after our hospital tour, my husband looked at me bewildered. You mean everything you had to fight for before is just standard of care here? Limited ultrasounds. Food & drink during labor. Low lighting, showers, and tubs in labor & delivery rooms. Non-directed pushing. Delayed cord clamping. All of it standard and supported.
And more than just support – knowledge. I asked the first midwife I saw about non-directed pushing. She immediately started giving me examples of how women naturally push, and even started making low guttural sounds to demonstrate how it helps open you up. (Basically the opposite of holding your breath and pushing until you’re purple in the face.) Every appointment involves talking about birth, answering every question I have, and coming up with a plan. They understand and trust physiologic birth, and the default is no intervention.
And more than just knowledge – respect. I’ve heard the same message over and over again from this practice: you’re in charge of your own healthcare. You have the right to refuse anything. I’ve been given options with everything that has come up. There’s this test you can do, here are the pros and cons, it’s your choice if you want to do it or not. No thanks, I don’t need a test with a high false positive rate, I already have enough anxiety about this pregnancy. You can choose 1 of 3 options for gestational diabetes testing. Awesome, I choose jelly beans over that gross glucose drink any day. Your baby is measuring big, so you’re eligible for another ultrasound at 37 weeks if you’d prefer. But you can also decline it. Sweet, I’ll decline it, because I’m not scared of a big baby, my body’s done it before, and I won’t do anything different (e.g. get induced early) even if he is big.
At my most recent appointment, I was chatting with my midwife about the hospital policies for postpartum care. Even though this new-to-me hospital purports to be more baby-friendly, you never know which nurse you’re going to run into. She said something that no healthcare provider has ever said to me: No is a complete sentence.
If they want to take the baby off your chest to do footprints and measurements? No is a complete sentence. They can do those things while he’s still on your belly.
If they want to take your baby to the nursery to do the admissions process? No is a complete sentence. They can do that process in the room.
If they say that they have to do an exam in the nursery because they don’t have the staff to do it in the room? The staffing isn’t your problem. No is a complete sentence.
I was amazed. Here my midwife was, handing me back my power. Telling me to stand up for my choices. And telling me that she would support me.
I don’t know how my birth will go – but I feel confident that I’ve chosen a provider who will give me the respect that I deserve, and involve me in decisions. And if I wasn’t confident of that, then I wouldn’t be afraid to switch providers again, even late into my pregnancy. It took me a while to get to this place. I know a midwife isn’t right for everyone’s situation – I know you can find respectful care with an OB too if that’s what you need. But it means you have to raise your expectations. If you’re not receiving the care you deserve – find someone else. It’s never too late.
No is a complete sentence.