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Monday
Aug312009

Birth Guilt

A long discussion on Facebook unwittingly delved into why women feel they failed after their births. It began with reading this letter from a woman who felt forced into a repeat cesarean.

She exposes her heart by saying, “Under your care, I failed in the most basic way a woman can fail – I failed to birth my children.” 

This sad and angry woman doesn’t outline the many things she probably did to prepare for her birth, but she does mention her birth plan that was totally ignored. It really is important for women to know that just because they spend the time researching and writing out a birth plan doesn’t mean anyone is going to read it, and if they do read it, they might not care a whit what is in there. Body memories shuffle nurses along from placing external fetal monitors to injecting narcotics to preparing the woman (physically) for a cesarean. Attending to a patient’s individuality is a jarring experience that requires thinking and, perish the thought, caring for the woman as an individual. Many nurses do care about their patient’s worries and concerns, but I have rarely found a nurse who cares about her experience. “The experience” is tossed aside for all the nuts and bolts of birth – the tangible – because, to them, that is the only requirement, a live baby and mother. Mothers, of course, want that same thing, but also meekly ask for some civility and tenderness along the way. Efficient care is rarely kind. 

Objections often include, “I don’t have time to be touchy feely with patients; I have another patient next door.” Even those nurses that would like to be more intimately involved with their patients are pulled in a dozen directions, certainly needing to push the urge to help aside in the name of quick resolutions and compliant patients. I have heard more than one nurse say they breathe a sigh of relief when the patient accepts an epidural; suddenly, they are wonderful, quiet patients who sit still. Those pesky wandering, out-of-bed mothers are too hard to keep track of. I mean, they have to watch the time to make sure the patients get their 20 minutes on the monitor out of every hour, sometimes having to hold it on because the woman just doesn’t want to get back in bed. Sitting there, the nurse must be tallying the tasks she should be doing and fretting about how far she’s going to be behind now. *tap tap tap* Hurry up already. (And, of course, this is with a NICE nurse! The mean nurse wouldn’t hold a monitor on for anything. “Get in bed,” she’d bark, “The baby needs to be monitored now.” This is the nurse who never watches the time and the woman finds herself in bed for hours at a time when she didn’t want that at all.) 

It is in this attitude surrounding birth that women try to get a different experience, a “homebirth in the hospital.” When I wrote “When You Buy the Hospital Ticket… (You Go for the Hospital Ride)” three years ago, I didn’t expect the amazing response and the continual referral to the piece. I wrote, “Why… why oh why… if you want a ‘home-like birth inside the hospital’ aren’t you considering a home or birth center birth? If you want control, why go where egotistical birth is the norm? If you want autonomy, why go where lawsuits and defensive medicine are the rule? Ohhhhhh, because it’s safer? Is that what you think? Oh! I see. Well if you believe hospital birth is safer and that’s why you want to be there, then BE THERE – with all it has to offer… in all its guises… in all its paranoid glory.” I didn’t address women who have no choice about where they birth. Honestly, I still don’t have solid answers about what to do when you have to have your baby in the hospital beyond saying, “That sucks.” I mean, you could certainly do your best to find a supportive doctor or midwife, you could try to work with them regarding a birth plan (make it very, very short!), but the likelihood of “success” is, according to history, not that great. 

So, in this climate of Laboring-Woman-Has-Very-Little-Control-Over-the-Outcome, it’s almost astonishing the number of women who feel guilty after their birth plan falls apart. These women/You women are the norm! As the author of the letter to her OB says, “I hired you for an intervention-free VBAC.  Instead I had EVERY intervention I told you I did not want.” 

A birthing woman myself, I am well aware of the coulda-shoulda-woulda’s of postpartum reflection. I had a UC that could have been disastrous (I had a shoulder dystocia), but miraculously ended in a live baby. I replayed that birth a million times, eventually realizing if I’d have had a midwife, things might not have been so dramatic. I also knew if I birthed in the hospital, she would have been a cesarean. While I was healing, another couple in our Bradley class had had their baby, so I went to hear their story (I’d just become a birth junkie). I listened wistfully as the mom re-told her birth story, of how peaceful her labor was, how she pushed her baby out slowly on a bear-skin rug in front of the fireplace. I remember having tears in my eyes, so wishing that had been me. Then I heard it… the first time of hundreds of subsequent times… this woman who’d had such a glorious birth said, “I just wish....” I don’t even remember what she wished for… a sip of water? Different music on the stereo? For her other child to be in the room? The impact was deep and lasting; even women with fantastic births have regrets. I suspect we all carry pieces (or chunks) of guilt around, too. Until Meghann was tapped as gifted, I worried continually that my UC choked her oxygen supply and damaged her brain. Even now, 25 years later, I can feel the sting of guilt at my choices with all three births. 

A doula and childbirth educator, Heather, who writes Oatmeal Intellect said, way back in 2007, “'Birth guilt' is an unnecessary and heavy burden to pull around. To carry it is (to) assume that you had the power to change the birth experience, when in reality, there is so much you cannot control in childbirth. It is a force of nature that you can only set the stage for, and then stand back and let it unfold as it sees fit. To think you can change how it unfolds is like trying to hold back the sea as it starts to roll in. When you are able to let go of the things you really never had control over in the first place, and to allow yourself to just ride the experience nature has provided you, it can be a liberating experience. Instead of trying to make things be 'right', you end up empowering yourself to experience what is pure and simply, yours.”   

Sounds so easy, doesn’t it? Why aren’t we able to say, “I did my best” and leave it at that? How come we aren’t permitted to set the stage as much as we have control over and then sit back and watch, detached and observant? What is it inside us that makes us pick over each detail, playing, re-playing it over and over until we’ve played out the zillion ways the moment could have gone –had we only done this or that. 

As if our inner guilt isn’t enough, it doesn’t just come from inside. Sometimes, it’s others that stab guilt into the cracks and crevices we developed during our births. While we study each nuance with a magnifying glass, others also point out our "deficiencies". 

Playing the “If Only” game is a favorite pastime of those of us in the birth community. As a midwife, I am often asked to play, whether as a participant in someone else’s game or by the woman herself as she explores the birth she felt went so wrong. It’s easy for us who sit on the sidelines, to see exactly where the birth started to go “wrong.” “Ahhhh, she should have asked for more time instead of letting them break her water. That’s why the baby’s head was cock-eyed and she had the cesarean.” “Her husband didn’t tell that nurse to get lost or to shut up about the epidural. If someone had been there to remind her she didn’t want the epidural, she wouldn’t have caved.” “There you have it. If she hadn’t eaten so many carbs her baby wouldn’t be so big and she wouldn’t have had the ultrasound. And if she’d have told them ‘no’ to the ultrasound, well, she wouldn’t have been induced.” (And of course, we can all detail the cascade of each of these women’s experiences, can’t we?) 

How does playing the If Only game affect the postpartum woman? Even if you whisper these thoughts amongst friends, doesn’t the energy travel to her? Your judgmental attitude touching her tender heart? Sadly, though, the If Only game isn’t just relegated to Sunday brunches and trips to Starbuck’s. Some people are so crude as to drag the new mom into her If Only game, not seeing her fear and the piles of guilt sitting on her lap. “Why did you…?” “How come you…?” “Did you try…?” as if the mother hasn’t asked herself these questions a thousand times already. As one birth traumatized mother said to me, “I also have had to hear for four years the questioning of my choices, the searching for blame that other women do. And then the ‘Well, there you go, bingo! That is the one thing you didn’t do that I did and that is why your birth sucked and mine was awesome. It’s not even subtle. I say something like, ‘Well I wanted a natural birth, but it didn’t go so well…” and they say, ‘Oh, well, did you have a doula?’ ‘Yes, I had a doula.’ ‘Did you have a midwife?’ ‘Yes, I had a midwife.’ ‘Well, did you do Bradley?’ ‘Um, no, that wasn’t really my philosophy.’ ‘Oh, yeah, well, you see, we did Bradley and it went just great. I highly recommend it.’ I truly think women want to believe that what they did had an effect, and I mean, it does have an effect, but there is also just luck, too.” 

I think the dialogue this mom experiences is echoed so many times each day with multitudes of postpartum women. The crunchier the community, the deeper the scrutiny. 

Perhaps it is time for us to put the brakes on all this judgment and find compassion for birth traumatized women. Maybe we have been unwittingly piling more guilt on an already birth-guilty mother. If we can open our eyes to her pain and choose our words more wisely, perhaps she would be able to heal more quickly.

“It must be hard for you. I’m sure you’ve looked at your birth 1000 ways from sideways and wonder what you could have done differently. I am here if you ever want to talk things out.” 

“I hope people aren’t telling you how you could have avoided a cesarean. I know you were really educated, but it does suck that sometimes crappy things do happen in birth. I’m sorry you had to experience some of those.” 

“I know it’s early, but whenever you’re ready to talk about what you would have changed and what you might change for the next time, I am here to listen.” 

“Do you need to talk? I’m here, without judgment, to listen.” 

“How are you doing?” 

“I can’t imagine what you must be feeling, but I am here to listen if you need me.” 

“I totally understand. My own birth had so many unexpected things happen, I was so angry for a long time. It helped me to talk about it, so if you ever want to talk, I am here for you.” 

There are many ways we can support a mom who had an experience they didn’t want. The mom above said it’s the (birth) “educated” women who have the hardest time because they know what they missed and, usually, why. Women who haven’t spent their entire pregnancy trying to make everything perfect don’t know any better. (They may still have birth trauma, but not know where it came from or where to direct it. They, too, deserve our compassion as they explore their own births.) 

I wrote about (what I feel is) a woman’s process of healing from birth trauma in The Gray, Grey Messenger: Recovery, seeing the pattern weave this path: 

- Adoration (of the care provider)
- Disbelief  (in what happened)
- Sadness for Naiveté (playing the If Only game)
- Anger & Blame (at the provider, but the anger sometimes oozes throughout the woman’s life, to her partner, the baby, all care providers, childbirth educators and, of course, herself)
- Sadness for Experience
- Re-framing (Taking new information and looking at the birth from different viewpoints, including the medical personnel’s.)
- Acceptance (of one’s experience and who she was as a person then and who she is now)
- Assimilation & Preparation (Pulling the whole process into one New Self as she prepares for another birth or for her life with the children she has.) 

As with Elisabeth Kubler-Ross’ stages of grieving, women can go from one stage to another and even experience two or more of the stages at the same time. Some women will be in the Adoration phase for a few minutes and others for a year. You see the Anger & Blame stage? That is the place where Birth Guilt resides; a part of the healing process. It needs to remain a part and not become the overwhelming part of the woman’s inability to find peace with her birth.

I believe it is with our compassion and kindness that women can work through their difficulties. It is important for those of us who are near the devastated women to remember this is their walk and we are merely there for them to lean on.

References (2)

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Reader Comments (23)

This is really what I needed to read just about now. In many ways I feel I'm "better" or as past it as I'll be for a long while, and then I found myself fretting last night, looking at the calendar, my due date, comparing to how long my mom is staying, the old familiar "but what if it happens again" cropping up and here we are, right back on the ride.

It took, for me, a harsh reminder from a friend to pull me out of what I feel was the most destructive phase of it for me, the analzying and picking apart of every birth I read. I mean, I still do it to some degree as a birth junkie, but not in the same negative manner. I realized every story I heard, I was holding up to my personal measuring stick. "Oh she said it was a rough birth, but I went through X Y Z" and "Well she knew what I went through with my birth, and she STILL chose X and now she's telling me it was rough!?" and even if I wasn't saying it (most notably the latter, to my SIL last december) that energy most certainly found its way to her, even though I'd been trying vocally to be supportive and lend an ear. We were having a goofy "argument" about who had the cuter baby, and out of nowhere it escalated into her telling me that at least she had been able to push her baby out. It kind of stunned us both, but there it was. All my negativity and pushing of my own frame of reference on the births of others and how it had gone from an interest and a passion into this nasty thing that crept into my every birth conversation with them.

Not nice. But it was a big turnaround for me, and I found that scarcely a month later I was sitting with my cousin after her first birth, as she told me about her fast, painful labor, inability to get drugs because things went so fast, a quick vaginal birth...and I wasn't jealous. I wasn't angry. I was happy for her, and sad with her for some of the things not going quite as she'd liked. I was proud of her.

I still agree that we need to feel all the various stages of grief but there can certainly come a point when the birth guilt becomes poisonous and it may be time to "move on" to another stage, or push harder to find a way through it before we let it spill onto other mothers. I think a big key to being able to listen without judgement is having been listened to without judgement, and sadly that can be a VERY difficult thing to find.

August 31, 2009 | Unregistered CommenterStassja

I'm honored to be quoted! This is a great post Barb, thanks for writing it. I am going to link it to the Solace for Mothers board (www.solaceformothers.org).

August 31, 2009 | Unregistered CommenterJennifer Z.

Oh, and just posted it on Mothering too. We'll see how long that lasts ;-)

August 31, 2009 | Unregistered CommenterJennifer Z.

Interesting you tie the birth stages of recovery to the stages of grief in death. I believe there has to be a reason these are similar. Excellent points here. Since it's been almost 2 years since my last birth, and I am pregnant again, I'm going through this all again. I am doing my best to insure this time is better, but there is a part of me afraid to have ANY expectations whatsoever. I again finding myself wanting to be the good little mommy and not make waves. Yet, I also find myself being up front with my new provider, and wanting some assurances...checking out how she responds to my questions. I've already heard the word pitocin (like as in, well, if we need pitocin of course I have to monitor you...but yes, it's okay to use intermittent monitoring on a normal day) and I think "why would she mention pit when I'm 14 weeks along? Anyway, you make some true observations. We have to do the best with what we have and we have to ride the birth rollercoaster for whatever happens and learn to deal. There are ways to prepare, but it's a lot like preparing for having swine flu. Some people don't get it though exposed and others don't really feel it and are fine in the long run, others die (okay, birth is NOT a disease...but the unknown is the same). Babies turn, bodies do different things, nurses behave in certain ways, midwives and doctors have life happen and cannot come in when expected, care providers hide what they will really be like, partners support or flake out, things just happen. I wish we didn't feel like we had as much control as we think we do...and yet I wish we would be allowed to control what we can without a fight. What I want first on my birthplan is NO FIGHTS ALLOWED, just tell me what you want to do and why and give me time to consider it unless my baby is dying or I am dying....

August 31, 2009 | Unregistered CommenterDawn

Great post Barbara!! I relate to your process of healing with my own experience, it took about 3-4 years for me to move through the stages.

August 31, 2009 | Unregistered CommenterHeidi

Birth guilt and grief is a hugely complex subject that will always be important to midwives. Thanks for your exploration of it, Barb.
The assumption that a written birth plan will be relevant at any decision point; the assumption that being well through the nine months of the pregnancy means that the labour will be uncomplicated; the assumption that we can learn to give birth by some popular method of childbirth education ... not necessarily.

We know that the birth plan is actually a woman's plan, and may not be the plan of the obstetrician or others. A woman needs to own her plan and intentionally keep to it as labour progresses. I agree with you Dawn. The initial statement (Plan A) in any plan for spontaneous physiological birth is "I plan to give birth myself" - in any setting. If the mother agrees that she needs to hand over to someone else, it's no longer normal birth.
This was in my mind as I wrote in my blog a couple of days ago http://villagemidwife.blogspot.com/2009/08/baby-born.html .

August 31, 2009 | Unregistered CommenterJoy Johnston

I had a wonderful, unmedicated birth, and feel only satisfaction with my daughter's birth, so I am not speaking from experience.

But it always makes me a bit sad when I hear/read women who have had c-sections say that they haven't given birth. I understand the grief, regret, and disappointment, but to me, whether medicated/unmedicated or vaginal/surgical, it's all giving birth.

August 31, 2009 | Unregistered CommenterJen

Great post. Made me realize I force other women into the game, and I have been trying to stop without realizing what I have been doing all along. This gives me more reason to just stop it all ready! I didn't really play the "if only" game with my first birth. I played the "in spite of" game. I had a great birth "in spite of" having unsupportive support people, that stupid epidural, being so numb that I couldn't push for an hour, etc. etc. My "if only" guilt comes from having a very difficult, overwhelming breastfeeding experience. I never produced enough milk, 10 oz a day by test weights, and was guilt ridden about it. I still am. If only I hadn't let them take the baby and pass her around to my whole family before I nursed, If only I hadn't had that epidural, if only I spent more time at home when my milk came in and let her nurse constantly, if only I hadn't introduced the pacifier and the bottle so soon, etc etc. I came to a place where I was okay with it, and now I am rehashing all those feelings because I am pregnant again. Now that "if only" guilt is back full force. I am doing everything in my power to prevent insufficient supply (hiring a doula, asking to hold off on all the tests and visits with the family until after I nurse, promising myself that I will not leave the house until after my milk comes in, having those medical issues addressed that weren't addressed before, etc.) but I don't know what I will do if I have the same issue. I can feel the depression setting in already. I can't make my breasts work like they should, and that kills me.

August 31, 2009 | Unregistered CommenterJennifer B

I was lucky not to feel this particular guilt, because I knew that what blame there was did not lie with me; it is not a sin to trust your care providers! It was THEIR sin to be untruthful--had they given me some notice as to what I was up against, I would have felt I had an ally, and been able to fight for, at least, a better c/section. Instead I found myself on a battlefield with my own side shooting at me (so to speak). Which caused me tremendous anger and depression, but not guilt. I refused and continue to refuse to accept any guilt whatsoever.

Grief I had, in spades, and that was/is the hard bit. But I think I knew inside that the only way to survive for me was to refuse to believe that I had caused what happened by failing in some way. Joining ICAN was a big part of this; it's hard to believe it's all on you when you know 50 women with similar stories from all walks of life. That's when you really know you're up against a much bigger force than just your own inability to do research or ask the right questions.

The hospital and OB culture has far too much power to coerce and far too little interest in good practice, and that's the ultimate source of the problem, not women's inability to tailor their birth plans to every contigency. We shouldn't have to fight so hard just to be cared for decently.

August 31, 2009 | Unregistered Commenteremjaybee

I definitely went through the stages of grief when my 2nd daughter was born, her clavicle broken. I think I'm currently at the Sadness/Reframing stage right now.

I'm personally not comfortable with a homebirth (at least this time around) and hubby definitely is not comfortable. So, we are giving birth at the same hospital we had our other two girls, with a different practice of doctors. We are going to labor at home as long as possible, however, which is a change from my previous two births where I RUSHED to the hospital (only to have contractions slow down the moment they make you lay down to monitor contractions).

August 31, 2009 | Unregistered CommenterJoy

It's funny. I thought I really had dealt with my feelings around my son's birth, but reading this post almost made me cry. I'm one of those women who didn't buy the hospital ticket but still got the hospital ride.

My birth wasn't "bad" by any stretch of the imagination. I had planned a birth center birth, ended up being induced in the hospital 10 days after my due date for low amniotic fluid. I still was attended by my midwife. I had a little trouble with the overnight OB nurse, but not awful. I did end up on the monitor full-time because of unreassuring and erratic traces, but I had a vaginal birth of a healthy baby - no C-section, no vacuum, no NICU. And I managed to labor without pain medication, which was very important to me, managed to be mobile throughout my birth. As far as these things go, it really was not that bad.

Immediately after the birth, I felt great about it. But very soon afterward, I started to second-guess everything. Should I have used evening primrose in the weeks before? Should I have tried a castor oil induction? Should I have refused the induction? I know that when I tell my story to natural birth types, they think I ought to have. They know that all inductions are bullshit. I think my induction probably was the right thing to do. Two days before my induction, I went two straight days with practically no fetal movement. He had a lot of classic signs of being post-date. Given that my body did not respond to either 12 hours of cervadil or breaking my water, I don't think I was that close to going into labor on my own. But even that train of thought led me to guilt. Without medical intervention, would my body have killed my baby? And of course, I feel guilty for feeling guilty. What do I even have to feel bad about, compared to what some women go through?

It makes me really sad that we judge ourselves so harshly. I feel like I've come a long way in dealing with this (and pretty much stopped projecting my own hopes and regrets on to other women and their births, something I know I did to my sister-in-law, but see how I still feel the need to justify being in the hospital at all). Like you, hearing from women with "perfect" births who still had regrets or things go wrong helped me ease up on myself. But I worry about how I'll feel if I need intervention for the birth of a future child. A lot of women who had bad births will talk about how healing it was for them to have a subsequent birth go better or differently. Even though the main lesson I draw from my birth is that things don't always go according to plan and that we need a certain amount of zen to just roll with it, I know the whole time I'll be hoping it goes differently and I'll be really disappointed if it goes the same or if I need more help. I wish I could let go of that.

August 31, 2009 | Unregistered Commenterchingona

So many great thoughts in this post!

Something that I feel comes with non-judgmental listening is not presuming that a woman's experience was traumatic for her. This is sometimes twisted around as evidence that the mother-friendly standard of care is an unrealistic and unattainable birth ideal. I've always just seen it as people being people and processing things differently. The flipside to "you should be grateful you have a healthy baby (and quit whining)" is "Ohhh, that must have been so hard for you."

As usual, emjaybee rocked my world... " it is not a sin to trust your care providers! It was THEIR sin to be untruthful"

I have long since stopped wondering aloud and internally about why women trust their care providers. Some refer to it as blind trust. I think trusting other people is a beautiful thing and I'd even call it a need of a laboring woman. What sucks is that personal interests are put before patient interests in sneaky ways sometimes and that trust is abused for a variety of reasons.

There's a fine line for me between feeling guilty and weighing my role and responsibility in past events (in life in general) and learning from it. It's when I worry that I might have harmed someone else that I feel guilty. Don't you think that looking back at birth is just one of the many, many things a woman might explore while dealing with the huge responsibility and life change of becoming a parent? I look back at other significant life events in the same way I looked back at my birth experiences until I no longer need to look back. For me, it's all wrapped up in the process of coming to terms with a major life change.

September 1, 2009 | Unregistered CommenterJill--Unnecesarean

Barb,
Just when I had speculated that you had closed your computer and returned to the tasks of everyday living
( I’m so impatient), you post this thought filled piece on your blog. Your uncanny timing was amazing. I was hurtling the wall of guilt that even midwives must when their clients birth plan runs astray. This post gave me the extra boost I needed to clear that wall.
I will pass this piece on to my client with the hope that she too can read these insightful words and begin her process to recovery and acceptance.

Sandra

September 1, 2009 | Unregistered CommenterSandra

So many wonderful comments! I *love* what you said emjaybee and Jill... both of you said very profound things. Thank you. I want to add so much, but will have to do so when I have more reflective time.

I need to say, though, that your comments fuel me. I had gotten to a place where I honestly thought I just didn't have anything else to say regarding women and midwifery. I didn't have that uncontrollable urge to write anything for so long; I have to be driven, I don't drive. I rarely edit anything but typos as I write. I recheck the piece once before publishing and then check again once it's published. It's very odd, I know, to be able to have coherent streams of consciousness.

But this topic was really good, I just couldn't resist. I was talking to a client and felt that, "I know I can help more than just one woman with what I know" feeling. I *do* have things to say.

Sometimes it just takes time. Thank you all for being patient.

September 1, 2009 | Registered CommenterNavelgazing Midwife

I really like Jill's point that you don't feel guilty unless you feel you've harmed someone else, and how weighing our role and responsibility is not guilt. I never quite thought of it that way.

I think the stage of grief called "sadness for naiveté" is maybe more appropriate a term then guilt. I did feel guilt over what the experience did to my son, and our relationship, and I wished I had known better then to expose him to that. But, I realized even then that I just didn't know, and there was no way for me to have known. They didn't teach personal defense in childbirth classes. They told me I would have choices and options, and when I got there I was coerced and forced. There is no education that can prepare a woman for the realities of dis-empowerment, and the shock of it after being told she can empower herself by making choices and options for her birth. When I played the "if only" game, it fueled my anger at my provider, it didn't really cause me more guilt. Sadness at not knowing? yes. But guilt? I think it is a similar feeling, but not quite the same. I felt guilt about not holding my son after he was born, because it was probably my fault for not asking (though I have accepted that I did not have the capacity to advocate for myself in that moment after what I had just been through). As for the rest of it though, I think I was simply angry with my provider, and sad that I didn't know better, but not really feeling guilty over the things that could have been handled differently. Those decisions and choices were not mine, I was forced to comply with them. And the choices I made that were mine, I can understand why I made them in the moment, even though they have had a negative overall effect on the experience. I guess there may be a tinge of guilt there, but it is mostly sadness and wishing things had been different.

However, when people question me about it, the implication is that I personally did something wrong. Well, not so much the implication, but the blatant suggestion. And I think that does induce guilt. When you have someone in front of you, or online, telling you how great their birth was because they did something different then you (that they assume made the difference) it is hard not to fall into that line of thinking. That idea that there was some choice or some thing that should have been done that I didn't do. And I'm not saying there are never things that could have been decided differently that may have lead to a different outcome. But, birth is not a math problem. There are so many things at play that you can't boil it down to an equation. The emotions a woman has, the triggers she may be experiencing, the trust she has in her provider, her natural instincts to attach to a provider while going through a challenging experience, her individual pain levels or ability to gain support, all these things and much more go into every decision she makes. We can't possibly understand or judge her decisions as outsiders of her unique experience.

September 1, 2009 | Unregistered CommenterJennifer Z.

Hello~I'm pregnant with my first baby and I have decided to go with a midwife and home birth. I've been looking for articles that talk about loneliness and regret. I'm afraid I won't do everything I need to to prepare myself for this birth. After reading your post I realize that I'm doing everything I can now and need to take heart in that.
My birth classes start in a couple of weeks. My midwife and her team will be teaching the classes and I'm really looking forward to them. I'm going to become a regular reader of your blog. Please keep writing. You must know that its really just helped me out today when I needed it the most.
Take care~

September 1, 2009 | Unregistered CommenterAby

A really thought-provoking post! When you wrote, "The crunchier the community, the deeper the scrutiny," I could really see myself there; I have been both the person who was too-critical and not thoughtful enough and the woman on the receiving end of that criticism, but until I read this blog post tonight, I didn't understand fully how harmful and ignorant that attitude could be. Thanks for sharing your thoughts on this topic.

September 1, 2009 | Unregistered CommenterJackie

I think that birth guilt can affect all of the participants at a birth. My daughter was born two and 1/2 years ago, but just a week or two ago my husband told me I wish I'd insisted that you deliver at the Level 1 trauma center instead of at the small local hospital or that I'd insisted that the doctor perform a c-section instead of pushing for a vaginal delivery. When I told my best friend that I'd requested a more complete copy of my medical records a few months ago she told me, I wish I'd sided with the anesthesiologist and convinced you not to get the epidural. Two and one half years have gone by, but they both believe that they failed me.

For me, well 2 1/2 years of counseling has brought me to a place where I understand why I made the decisions I made, and how they weren't bad decisions. It was simply a comedy of errors, Murphy's Law, an episode of ER, and a fluke. I don't regret the choice to induce, to get the failed epidural, to continue trying for a vaginal delivery, or even the vacuum assisted birth. Those were all my choices.

Would I make changes if I lost my mind and did it again? Yes, but those choices really only involve choosing a care provider who communicates better in emergency situations and choosing a facility that's equipped to handle those same obstetrical emergencies. No matter how I replay it, I cannot eliminate the reality of my birth not being "normal". Complications, no matter how rare, can occur, and we all have to be prepared to discard our plans to accomodate those changing needs.

September 3, 2009 | Unregistered CommenterDonna

Beautiful post, Barb...so very true. I've passed this on to all my fellow doulas. Thank you for posting this!

September 4, 2009 | Unregistered CommenterSonia

Wow, your post had me in tears. And that's a good thing!! Of course I am approaching the anniversary of my daughter's surgical arrival, and once again in the comments, there is someone telling me how to feel about my daughter's arrival. Ummm..

At the time Pain and grief were everywhere in my life. For years. I am 21 years always grateful to the nurse who kept saying "I'm sorry" as she shaved me, as i lay there sobbing, and I can still find the anger directed to the midwives who turned me over to the slaughter, because "my water had been broken for too long, based on their back-up OB's protocol". A healthy mother, a healthy baby...unnecessary surgery. My guilt....to this day....Is that "I knew what was going to happen, I knew I didn't need or want it, and I knew I could leave. And I didn't. I didn't listen to my own instincts." And that's how I became a mother. Suppressing my own instincts. And I know I'm not alone. Cesareans disrupt our instincts. They are intellectual decisions. I lived with that guilt for a long time. I was finally able to forgive myself....because at that time....I didn't have ALL the information I needed to make another choice. I had my instincts, but no plan. I forgave me. Thankfully.
I 'd like to say I have replaced MOST of the grief in my heart with love and have had two glorious home births after that cesarean. (one that busted the CPD definition by 3 lbs). But I am constantly reminded that the scar is permanent. And your post just did that...and I'm glad. Just the little jostle...of how many times I had to hear..."what matters how the baby is born? All that matters is a healthy baby?" And those tears that trickled down my face as I read this blog post and comments are still real, my feelings can still be triggered, and I am torn between writing a response out of my feelings...or from what I know. . The tears are in part, a response to the loss of love, and the loss of niavete that I experienced as I planned a birth to avoid an unnecessary cesarean, and got one instead. I lost that dream of a healthy mother and a healthy baby born into a midwife's hands. Part of me really did die on that day...and that loss...is worthy of grief. IT IS WORTHY OF GRIEF. I am worthy of grief. My daughter did nothing to deserve the birth she got...and I do believe with all my heart, that she deserved better. It was not the best birth I could have given her. It was only the best birth I could give her, given the choice I MADE AT THAT MOMENT. It is worthy of grieving, for no other reason...except that it was worthy of love. While I think I've done a pretty good job of emptying that grief box....I now understand...that my ability to continue to grieve over the loss of that birth plan is powerful and as significant as other losses in my life. Would you tell me not to remember my great grandmother with fondness, and not to be unable to cry on the memory of her passing, or sigh with longing and sadness that I wish she could see me now? That's grief. That's love. She's been gone 40 years. Is there a time frame for which I will no longer grieve the loss of my father? Who wants to create one for me? Do either of these griefs debilitate my life like my cesarean did. NOPE. NEVER. So why, if my hopes for participating in my own biological destiny in a loving and caring way, was distorted, and aborted by abuse in a system OR fates of nature, am I not allowed to grieve and why is that grief not honored? Would you tell me to love less? So why tell me to grieve less? Grief is the love, the same love we feel for something that comes into our lives...it just comes when we lose something very precious in our lives.
I like and have been living with Kubler Ross' definitions of grieving as they relate to loss for decades now. They aren't just applicable to death. They are applicable to LOSS. I was introduced to them in dealing with parents who are raising special needs children. Loss of any kind. They apply everyone. Birth, death, the loss of a dream of a healthy child. I think my sensitivity to grief and how it relates to birth came through my study and certification with BirthWorks. I liked your tweaking of the categories to fit birth better, and I think it may speak to more women that way. And that is a really good thing.
I'm not sure I agree with your thoughts about :"What ifs"? I think "what ifs" can be a good thing. "What if's" are our vehicles for processing. "What if's" are our vehicles for change. "What if's become our vehicle for understanding. "What ifs" become our vehicles for acceptance. They are a necessary part of the process. They keep "change" and "hope" as a player on the table. Why question your medically orchestrated birth, if you can't ask "how do you think this would have been different if a midwife had been at the helm? Or what if you had chosen a midwife instead?" What ifs" help us realize what we chose, and what was out of our realm of choices and why. They help us realize boundaries between what we are capable of doing, and where and why things happen that are out of our control . And even if I can't change my outcome, or my future outcomes, I still have the capability to bring positive change on this earth in this world. That ability, to understand one woman's power, comes as a result of "what if's. And her power is profound. Let us not snuff out the "What ifs". Let's just be better listeners before we start asking the "What ifs".
Imagine for a moment we're having a discussion about how you met the love of your life? What happens if you "What if ?" that?. What happens if you play the game.."what if you hadn't gone to the party?" Or what if you had slept late and not gotten on THAT bus in the morning". Where do those "what if's" take you? Usually no where...but to some acceptance of the universe, and fate.and gratitude for the love that came as a result of that choice..etc... Possibilities are endless...we make our choices and sometimes the fates put us together and we find love.. However sometimes when we play what if.. we get pulled from love and we grieve. The what if doesn't become a bad thing because it causes us to touch our pain, our grief or our disappointment. Grief and love occupy the same cup of life.
The same can be true if we "What if" birth....except that when we What if birth, we often find grief, and regrets. If what we find is guilt...its because it is lying on the floor with grief and anger, sometimes unrecognized. And we, as a culture...don't welcome it. We aren't so comfortable with people's anger. Where is the CNM who is going to look me in the eyes and say "I'm so sorry that your CNM turned you over to a back up OB who sliced you, unnecessarily, put you and your entire birthing future and family at increased risk unnecessarily, brought you back into the OR for a second abdominal surgery 11 weeks later, caused you problems with lactation, etc...when I could have turned you over to an experienced CPM in the community and instead of a birthing center birth, you could probably have had a homebirth. I do that all the time." Anyone stepping forward? Anyone want to support me, when I close my eyes and live out this dream. This dream that was one phone call away from a reality. Just imagine....The What if.
The woman who is turning the What if's into guilt...has a LOT more grieivng to do...she just may not be aware of it. If her response to a WHAT IF is guilt...she is responding with anger. Anger is grief.. Grief is that good old response to loss. Do we not want her to feel loss? What ARE WE CONTROLLING HERE? Guilt is a very interesting piece of the experience. And truthfully, I don't think it operates alone. Trying to compartmentalize it, and focus on it...in the absence of looking at the whole picture is not productive for the woman or our birthing culture. Guilt is part of the angry response, and its damage occurs because it is self-anger. It is anger that is inflicted towards the self. Pretty unproductive UNLESS we are going to grow from it. Usually it does not happen in isolation of other angry responses. But the other responses get stifled. Anger is very powerful. But Guilt is the piece that continues to hurt the MOTHER of that beautiful baby in ways that no one else can hurt her. Why? BECAUSE THERE IS NO WHERE TO GO WITH THE FEELINGS. Our society doesn't value grieving. The most popular thing you can do with anger, is hire a lawyer. Guilt is anger that is self-directed and we don't need lawyers to deal with it. We do it to ourselves. Guilt is ANGER masturbation. We do it to ourselves. We're good at it. We direct it towards ourselves because where else do we go with our anger? We listen to our own anger..because no one else will listen. And when people do listen to it..they judge us and it. When women write angry letters to care providers do you think they get replies? Do doctors respond, or turn the letters over to their lawyers?
WE need to talk about birth. Women need to do this. We don't need to JUDGE other's choices. But we need to be able to talk about them. We need to have the ""WHAT ifs. And if women feel guilty because they didn't DO something...that becomes a tool for their own personal growth and change. Girls are not being raised to understanding that they are POWERFUL and have CHOICES in childbirth, AND that Choices have consequences are all part of privilege and responsibiity that goes with making the choices.. The rise of the use of midwives in the past decade is not because of great PR on the part of the midwifery associations. Its because women are talking about their experiences. YEAH!!! Women are grieving their losses. YEAH. We are teaching our daughter, if only by our poor choices. We are sharing our dreams with the hopes of making them realities. . Women talked themselves (with the help of the medical profession) out of midwifery and out of birthing babies at home. They quit talking about birth on the porches of their houses.

If someone asks them a WHAT IF, and their response is guilt or self hate...it is quite possible being received by a woman who already doesn't trust her body or birth. A woman who has been hurt or victimized is a fertile bed for more hurt, anger, and loss. One out of 4 (some say 1 out of 3) women who come to birth using their vagina are victims of sexual abuse. What do we do with that information? We don't know how fertile the emotional bed is, that this woman brings to birth...or what will grow and thrive there.

Women need to be encouraged to talk about their grief responses to their birth, even if they don't perceive them as traumatic.....Birth is an unbelievably emotional time for a woman. She is capable of great, powerful emotions, that will be with her for the rest of her life. If we don't honor them, (good or bad feelings) we are not honoring her in her journey as a mother. And if we don't honor her, then she is living in dishonor...and as a culture...we all pay for that. We need to let women know...that it is okay...if they wish they had done things differently. As long as we honor her in her thoughts, even her angry thoughts....she can find peace and grow.
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Most women don't grieve over bullshit. They grieve because something is really important. We need to listen to it. Guilt is anger. Its just mis-applied anger. It means that a woman is angry. That anger may be very justified. Anger is part of a LOSS response. A grief response. We don't get angry, unless we perceive something to be lost to us. So guilt just means we're grieving...and it needs to be heard as ANGER...and approached with love.
I applaud you for wanting women to feel less guilty about her decisions in childbirth. But I caution you. Her feelings are not right or wrong..they just are. And you're wanting to fix them can be perceived as a judgment of her feelings. It isn't "NOT asking the What ifs", (because maybe what she needs is the questions), to open up her process. More importantly its in the listening to her...and not talking to her. It's asking her...what she wishes she had done differently...and what kept her from doing that...and really listening to her answers. Its about giving her permission to be angry...understanding that what she experienced was a loss, and will likely be perceived as a loss for the rest of her life...at some very deep level...and honoring that. And it isn't a light switch...of not asking the "What ifs" that is going to fix this. It's active listening, without judgment. Its in the understanding, that what stands in front of most of our decisions is love. Even the choices we wish he had done differently are usually made out of love. And grief is in the same cup as love. We don't grieve something, we dont' get angry about something, unless we sense that there has been some loss...be it loss of a dream, or loss of control of something that we value. Grief is love. And where there is grief...there is potential for healing.

September 6, 2009 | Unregistered CommenterBonnie

I see us saying many of the same things, but you are writing from a very emotional place... your words were like a torrential waterfall. I laid out the grief process I see women going through after a traumatic birth and I am SURE no one would ever say they felt I was judging them regarding their feelings. Empathy is something I ooze. I am not trying to FIX anything. I am offering another viewpoint so women don't beat themselves into the ground over their choices.

Healing is wonderful, however it comes.

September 6, 2009 | Registered CommenterNavelgazing Midwife

Joy I'm sure you are a wonderful compassionate woman on your journey of life. I just wanted you to know that when you wrote "I understand the grief, regret, and disappointment, but to me, whether medicated/unmedicated or vaginal/surgical, it's all giving birth." it begged the issue of the blog, at least in my mind.
I learned long ago, that the "but" in the middle of your sentence, negates the first part. This is a perfect example of it. You demonstrated to me, that your understanding is very different than mine.

Please don't tell the rape victim that its just "rough sex" or "she should be lucky she didn't get killed". And please don't tell the cesarean victim, that what she experienced was "giving birth". Instead...let her tell you how it feels to her...and maybe. it did feel like giving birth...and maybe, just as legitimately, it didn't. Feelings are neither right or wrong, they just are.

Because don't we all know rape is sex?....it just doesn't feel the same.

.In my experience, cesareans feel NOTHING like giving birth, any more than one would suggest adoptions are giving birth. Cesareans are surgery the day your baby arrives. Adoption is another way to welcome a baby into your life. And to suggest that to me, diminishes the amazing birth experiences I had, compared to the trauma I experienced on the day of my child's arrival..

Over time....with enough listening, perhaps you will understand this in a different way than you do now. Anything less is just a judgment of legitimate feeling based on a woman's trauma. in peace.

September 6, 2009 | Unregistered CommenterBonnie

This is a wonderful post. I was recently dumped by my midwife (for a non-medical reason) and have not been able to find another homebirth midwife. I am in the midst of the grieving process while still an otherwise healthy/happy pregnant person so on top of it all I really feel guilty for being so upset and depressed while I should still be celebrating the life growing inside of me.

September 16, 2009 | Unregistered CommenterRM

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