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.