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The Ripping Apart of Natural Birth

I keep seeing critiques (more like lashing out) of natural birth, homebirth and the women who make crunchier choices. Gillian Telling’s article “Girl Talk: Don’t Judge Me Because I Had a C-Section” in The Frisky highlights one aspect of the not-natural birth movement: 

“Unfortunately, the first thing people ask you about when you have a new baby is how your labor went. When I mentioned the ‘C’ word, unless the mother had also gone through it and we could commiserate, there was always this little face, like she had smelled something rotten. It was usually followed by a look of pity, an ‘ohhhh…’ and maybe something like ‘I’m sorry,’ ‘That’s too bad,’ or, ‘You can always have a VBAC [Vaginal Birth After Cesarean] on your next one.’ Some would ask if it was an ‘elective C,’ and I got the feeling that had I said yes, they would have felt even more awkward around me, like I’d said I think puppies make for a tasty snack. It got to the point where I lied a few times and just said he was breech, instead of going into the long story and feeling kind of inadequate.” 

It’s startling to me she lied about why she had a cesarean. That really is a sad commentary on the state of affairs in post-birth communication. 

Or really, is it? I’ve listened for years to women who were birth-traumatized (not just by cesareans, but they are certainly part of many women’s picture) say how they lied about their births, putting on plastic smiles and saying, “Everything was fine,” or “It was great!” when, in fact, it was very far from either of those things.  

Women healing from birth trauma often find the telling and re-telling of their stories an integral part on their paths to normalcy (not the old normal, but the new normal). But those around them seem to hit a saturation point and it is a rare woman who has not heard, “Can’t you just get on with your life already?”  

There are other topics that make people uncomfortable… death and illness are two of the most common… but I find anger, pain and disappointment about a woman’s own birth experience all but taboo. When people are in mourning, we’ve been encouraged to listen quietly, not try to fix things, but when a woman says she hated having her baby, rabid judgment and an immediate, “Don’t say that!” meets her feelings. I wish I had a penny for each time I’ve heard, “All that matters is you and the baby are fine.” It isn’t all that matters; ask around. 

And then I came across this article, “Looks Like Nobody Ever Had a Baby Beforeby Daphne Caruana Galizia, written in The Malta Independent Online. Granted, I don’t spend an inordinate amount of time trolling the Internet looking for negative stories. In fact, that’s part of why I’m writing this; they are falling into me unbidden and to me, that means they must be growing in numbers. 

Ms. Galizia spits her words venomously. She states her premise: 

“I get the feeling that life on the maternity ward would be so much easier if childbirth classes were to include one whole session of drumming it into expectant mothers that they are not the first person to have a baby, nor will they be the last.” 

And then to pound the point: 

“Imagine just how much less angst there would be if the breathing trainer, or whatever they’re called, were to say repeatedly: “Remember that trillions of women have had babies throughout history, and that you’re doing nothing special. Even if it feels like you’re the only woman in the world to give birth, you’re not.”

Then they could put it on a banner and hang the banner up at the front of the childbirth class for good measure.”

I know I travel in different circles, but I rarely come in contact with such angry women… angry about childbirth and the way some women choose to traverse the experience. 

Ms. Galizia has had two babies, with CNMs in the hospital, so it isn’t like she is clueless about the kind of care one can get with a midwife, but didn’t she feel special? Did she not feel special having her baby? Unique? How does that not happen? How can a woman who’s, in a sense, birthing "God", not feel amazingly gifted/special/unique? 

But, I stand back and listen to her and try hard to hear her point; it’s just not something I can fathom. Probably the same as she can’t fathom mine/ours. 

Apparently, she has written before about natural childbirth and breastfeeding… and not in a good way. She considers many of us to be involved in “The Cult of Childbirth and its breakaway Cult of Breastfeeding, so (she says) we won’t go into any of that because I really have no time for a sack-load of letters and e-mails from the Queens of Suckling.” 

It’s almost amusing that someone… probably many someones since she’s written about it before… takes this angle on what a pretty vocal group of us feel is equally important, but the polar opposite. 

But, if I think about it longer, maybe she doesn’t feel that birth-breastfeeding is that important after all. Isn’t that the implication (if not all-out snortylaugh)? That we’re navelgazingly obsessed with our biological performances? 

On the heels of reminding us we aren’t so special just because we can make a human being out of two cells, Ms. Galizia launches into the (to me) tiresome argument that hospitals are oh-so-much safer than having a baby at home. 

At the risk of quoting half the article, I’ll just yank out snippets: 

- “The one thing these Cult of Childbirth gurus won’t tell their ‘everything must be perfect’ audience of expectant mothers is just how many women and babies died during or immediately after birth back in those halcyon days when the neighbours milled about downstairs with teapots and towels while the lady of the house screamed, hollered, bawled and strained upstairs.”  

- “It is thanks to hospitals and advanced medical care that we have been divorced from the biological fact that childbirth kills. Yes, it kills.” 

I’ll counter with it isn’t just medical care that has removed maternal deaths from an every day experience, but improved care overall. We know much more about the healthy pregnant and postpartum woman. We (in the west, anyway), for the most part, find information and education a valuable tool in keeping ourselves healthy during the childbearing year (and beyond). It is absolutely true that prenatal care is what happens between appointments, but we also know there are experts who can help us if we wander out of the range of normal. While women who’ve been insulted/assaulted by The Medical System may choose to birth outside of that Establishment, it would be a rare woman indeed who would stay home allowing herself and/or her baby to die if they needed the help a hospital can offer.

I couldn’t resist adding this quote from Ms. Galizia: “Hospitals and advanced medical care are artificial, yes, if you want to put it that way. But this is precisely why they are so wonderful. Nature, red in tooth and claw, is often hideous and cruel, and childbirth is one of the most obvious examples. Even when all goes according to plan, even when there is no ripping, cutting or slicing, it is gruesome. In their beautiful artificiality, doctors and hospitals have conquered nature, which seems determined to kill off a sizeable percentage of women and babies.” 

Sometimes, no response speaks volumes. 

The latest assault on natural birth came this week from The Guardian; “Torn Apart by Childbirth.” How’s that for a title?

“Vikki Dutton, who lives in Essex and has three children aged eight, five and one, had a fourth- degree tear when she gave birth to her first child. ‘For a few hours after the birth, I had one hole instead of two. I spent two hours in surgery, and left hospital with more than 100 stitches. It was incredibly, unbelievably painful – like getting a paper cut in the most intimate part of your body, only 1,000 times worse.’

And there are more stories like these – lots more. Two years ago a poster called Cyee started a thread on ‘birth injuries’ on Mumsnet while she was lying in bed after surgical repair for a fistula. More than 1,395 posts have since been added. Under the veil of anonymity that web-chat allows, women pour out the pain, and tragedies, that they have hitherto suffered in silence: some tell how they can't bear to be touched, let alone have sex, a year and more on from the birth. Yet more tell of how they wouldn't – couldn't – contemplate a second child, so terrible was the physical fallout from the first.”

The piece spells out the gory details of urinary and rectal incontinence and the isolation that comes with smelling like poop all day long. The women are unable to tell even their spouses of the physical damage that occurred because they are so ashamed. It can take years for women to learn there are ways to be repaired; probably too many women never know they can be.

“Her (Michelle Thornton, consultant colorectal surgeon for NHS Lanarkshire) bugbear… is that women aren't being told there are risks to vaginal delivery just as there are risks to caesarean delivery. ‘We know that certain circumstances make birth injury more likely,’ she says. ‘Big babies are a definite risk factor; a rapid second stage of labour is a risk factor. Having torn in a previous delivery is a major risk factor; augmentation is a risk factor, and so too is a forceps delivery.’

Uh, what about a woman’s position during second stage? Valsalva pushing? (Which is shown to increase pelvic floor dysfunction/damage.) The ghastly “help” doctors and some nurses do… the “perineal massage”? (It isn’t perineal massage, it’s perineal pulling and vaginal pressing. I’ve seen horrid outcomes of that sort of un-help; torn vaginal floors, swollen nearly shut vulvas and ripped perineums, all from another person’s fingers.) What about the effect of multi-hour’d immobility on a woman’s vulva, vagina and rectum? The effect of a catheter going in and out throughout labor? How might pitocin alter the expulsive process? What happens to the perineum when an epidural’d woman is being coached to push? How might the vagina respond to repeated vaginal exams? What if those exams are aggressive? What if, in addition to fingers, the vagina has had an IUPC inserted? An internal monitor screwed onto the baby’s head that’s deep inside the body? None of these issues are taken into account in such an inflammatory article. 

internal fetal scalp electrode 

But, you and I both know that whole slews of pregnant women reading the article are going to beg their doctors for cesareans so they can avoid the horrors they read about. If we wrote a thousand articles about the ways women’s genitals can be damaged during birth and how to avoid them, they couldn’t come close to the emotional impact this one article will have had. We need to try anyway. 

Those of us that write need to get louder, more aggressive in our countering articles such as those mentioned above. I challenge natural birth-oriented bloggers (myself, included!) to attack these overt slams against our birthing choices word for word. I’m certainly not wanting to give them more air-time, but if someone Googles “4th degree tear childbirth,” I want them to be able to find many other articles/blog posts countering the original piece. 

I can’t do it alone.

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Reader Comments (47)

I liked these:

"You’d think that this level of fixation would result in a deeper desire to give birth in a hospital, as that is by the far the safest place to do so, but no."

Mmm... cite your source please.

"It is because of doctors and hospitals that women in developed societies no longer die in childbirth"

Errr.. what? They don't?

Very sloppy journalism.

I've read through her comments on this article and on another about childbirth.. she seems to be very ignorant, ill-informed, and generally hateful - but also seems to have a fan club who will rush to her defense if anyone dares to disagree with the unresearched, biased drivel that she spouts. Gross.

December 13, 2010 | Unregistered CommenterEmma

I try not to be extreme. When I began my career, "natural childbirth" was about avoiding the neonatal effects of respiratory depressive medication given IV to laboring women for pain relief in labor. Nothing beyond that, and it was good. It has evolved into an ideology which gives priority to the birth over the infant, and that's bad. Some of the blogs I read make me want to shout "It's the baby, stupid!" when a woman moans about the "tragedy" of her emergency C/S, or when a homebirth results in a dead baby and "it was the child's karma" to die, but the birth "was beautiful".

During my 40 years in maternity work, I have seen [I think] just about everything. And if I've learned one thing it is that "one size does NOT fit all". I don't think women who have had Caesareans should behave as if it was the biggest tragedy of their lives, nor should women who have given birth vaginally should think they are somehow "victorious". I'm not as angry as Ms. Galitzia, but I do understand her. The method of birth, or feeding, or parenting, is really secondary to giving a child a loving home with parents who use their common sense, for all things.

December 13, 2010 | Unregistered CommenterAntigonos

Now, I don't really get why some people are so anti-homebirthing or etc., as I feel like people can just choose whatever they want, but I honestly don't feel the same way you and many others do about the specialness of childbirth. When you say you can't fathom why that one writer sees birth as such an ordinary event, and you put it on the scale of birthing "God", you can understand that there are wildly differing perspectives there. And I'm much more on the birth-is-not-that-extraordinary side, I guess given my anthropological background or just because to me it IS the result that is more important--the baby. I think BABIES are a big deal, but birth? Eh. The reverence you and many others have for childbirth, and the interest you have in it, is not at all universal. I find birth stories mostly boring, for example, and I have no interest in ever witnessing a birth, but I require photographs of newborns ASAP. I was disappointed for my baby's sake that she needed to be born by c-section but not all that much so for my own. Some people really just aren't that interested in birth! I know it would be hard for a midwife to understand that, though.

December 13, 2010 | Unregistered CommenterAntropologa

An Ah-HA! moment!

I absolutely acknowledge the near-obsession with birth some of us have... the birth junky-ness of us. But, don't *most* people have *something* that drives them? That is a place in their lives that creates a great deal of pleasure, whether doing or listening?

For some, it's collecting trains... others, talking about airplanes... and still others, it's religion that's the obsession. Might we not acknowledge that for some people (people like me!) that obsessive/constant/overwhelming passion has been and is birth? That if we *have* that drive within us, it isn't *wrong*, but just different?

My head is swirling. I might be saying the same thing a hundred others have pointed out before, but this is a new realization for me. Suddenly, it all makes sense!

(When people/teens/young adults tell me they don't know what they want to do with their lives, I've asked them what books they gravitate towards when they go to bookstores [I'll have to revise that to compensate for technology!] and when they tell me knitting/art/religion/photography/history/travel... I tell them that gives a *lot* of information into their strengths. Dashing to the birth books has been my life-long drive. Surely, you have yours, too, right?)

I'll have to ponder this more.

I know you didn't mean to, but your point about birth being eh makes perfect sense now! Isn't it funny how myopic some of us (ME!) can be? *laughing*


December 13, 2010 | Registered CommenterNavelgazing Midwife

Ironically, one of my birth "preparation" mantras was basically telling myself that I was not unique or special because I was on embarking on a natural birth. I was one of millions and millions of women who have had a natural birth because that is exactly what my body was designed to do. Now, of course, I knew my child and my birth were unique and special to me, but I looked to the generations of women before me as having natural births as an absolute strength.

I mostly told myself this (repeatedly) because so many people told me how "un-natural" my desires were to have a natural birth. Kinda funny! Fortunately, I lived in San Francisco and had a doula and delivered with a practice of hospital-based midwives...but was surrounded by other natural birthing mommas in a prenatal yoga community.

And what I still cannot fathom why more people doesn't appreciate how natural childbirth, while more "messy" in the process, is so much easier post-birth. Even though I had 10 stitches (which I was very afraid of, but ended up being no-biggie at all), but I could not believe how physically amazing I felt after. I don't think enough people know about this huge benefit of natural birth.

December 13, 2010 | Unregistered CommenterLesley

I want more studies on damage done with bad pushing practices and more. I didn't have trouble with my bowels until after baby #6 was born. The OP baby was not the problem, the nurse who had me push for an hour an 1/2 and had her fingers stretching me (I'd had 5 births before lady!), this likely helped cause my problem. The count...push thing...too. Makes me angry that I have to help myself complete a bowel movement because I was not allowed to move in the bed, and because they were in a hurry and yelled at me to push while counting and I followed! Now I'm trying to figure out if kegals or sphincter squeezes will help heal me after #6 who I DID have to push hard for because she was having a long decel at the end and was OP. For a true problem I will take the pelvic floor damage, but for impatient people and controlling women in labor (so having them in bed etc) I get angry!

December 13, 2010 | Unregistered CommenterDAwn

I just don't get it. Most people don't have natural childbirths, we are a small minority. Who are these women speaking to? Why do they find this small group of people so threatening that it angers them? Who are they trying to convince? They are wasting their time and energy because most women already agree with them. And why do they even care to convince the small fraction that don't? And who are these people coming into contact with that they are actually asked about their births? They actually find people who want to hear the story? I've had a traumatic birth and a great birth, and both times all I wanted to do was talk about it afterwards. Nobody asks. I only got to tell my story a handful of times, and most of those times I shared more info than the person asking wanted to hear. Nobody cares about the birth. Everyone cares about the baby. That's the realty we live in, and these women must feel awfully threatened for some reason to even care enough to write something about this when they have very little work to do to convince people to have medicated or surgical births.

December 13, 2010 | Unregistered CommenterJennifer Z.

Hi, I saw your post through another blog and wanted to share my perspective. Our three sons were born via cesarean. Our first was in serious distress and I CHOSE repeats the following two times. I had no interest in vaginally birthing our children. I suppose, there may have been some passing curiosity but only because I personally witnessed several mothers become rabid over "natural" or, what I call, ordinary childbirth. I actually had to take a home-birther-gone-mad into the court system and request a PPO because she would not stop harassing my family. She sent a crazy and destructive e-mail to our home, after law enforcement had to tell her NOT to contact us and she was further sanctioned in circuit court for crazy and frivolous mad attacks on our family. In her e-mail, she said "anyone who cuts their kids out of their stomach for drugs and fun is no friend of mine." The woman literally went mad and spiraled. She also claims to be a "healer" and "doctor." In our state, anyone can call themselves a "doctor." This is the NCB community's main issue. They can be really obnoxious and evangelical and, really, at the end of the day, many moms are simply too busy actually MOTHERING their babies and children to be engaging in the birth olympics. Usually this competition masquerades under the guise of "helping," or "caring," or "informing." But, seriously, not many are truly ASKING for their input. Instead, they're proselytizing and some, to such a great degree, that we wonder, who is raising their children? Is there something that we're missing? Are these women who preach birth ultimately so utterly low in self-worth and self-esteem that they feel they need to prize themselves on their births? I look at our beautiful strapping sons and marvel at how my body grew them, but certainly not how they came out of me. I was simply grateful that we came through the process happy and healthy! Yes, that is all that counts. NCB'ers are no more "special" or superior as mothers than those who accept pain relief, have hospital births or cesarean birth. Once and for all. It's not a contest:)

December 13, 2010 | Unregistered CommenterNicole

I just think it is incredibly unsensitive of you to condanm woman for wanting to talk about their birth injuries, YES it happens, even at home... wanting to make woman believe that birth is ALWAYS uncomplicated and orgasmic and magical...ect is just setting them up for failure! what if theirs isn't perfect???then it s their fault right?? or the mean eveil doctor.... but what do you tell woman who have dissapointing HB???

December 13, 2010 | Unregistered CommenterFlorence

Florence: I am baffled that you think I'm bashing women who talk about their birth injuries; you are totally reading it wrong. I've heard some pretty horrible stories of birth damage that *did* come from homebirth midwives. The rest of your questions are rhetorical, so I'll just leave them floating around the cyberworld.

Nicole: We are a product of our experiences. You have had *quite* the experience with a nut job who just *happened* to pick cesareans as her "enemy." Sucks and REALLY sucky you've had to protect yourself and your family from her. I'm pretty sure she wouldn't be any friend of mine either. (I have to deal with my share of NBA bullies, too, because *I'M* not crunchy enough, either!)

But, I don't know where this belief that NBAs are having contests with each other -or with those who choose not to have natural birth- where it came from... that we're vying for medals or ribbons or trophies or whatever... but, it's hilarious! It's so bizarre a thought, I haven't figured out a cogent response to counter it! I can't think of a more abstract thought about natural birth.

Those of us who choose natural birth aren't even in a contest with ourselves! We have goals.

Okay, never mind. Gonna try to write a post about this. *laughing* Forgive the stuttering of a concept; trying to figure it out. It's a process, right? ;)

December 13, 2010 | Registered CommenterNavelgazing Midwife

I find this post condescending and insulting.
First, you fail to recognize a central idea of midwifery: respect for women's ideas, experiences, and opinions. This includes women who had positive cesarean experiences, those who are tired of the Cult of Childbirth, and those who had negative experiences with "Natural Childbirth" (and the absence of interventions).
Second, you suggest that all birth trauma must be the result of mismanagement of labour and delivery by doctors and nurses.
I would suggest getting over a "one-size-fits-all" approach to delivery and respecting other women, rather than criticizing and condemning.
A disappointing blog.

December 13, 2010 | Unregistered CommenterHolly

A disappointing blog? Or blog post. Whatever. You didn't like the piece. Got that.

Well, reacting to ONE piece is far from knowing me in context. Your blanket judgement of what (you say) I believe is so far off the mark as to be stupifying.

Not sure where the linkage went to, but not my typical demographics.

December 13, 2010 | Registered CommenterNavelgazing Midwife

For what it's worth, I hope that many women pick up your call to arms...er, words, and write about birth choices. All of them. There needs to be more discussion of birth as a parenting decision, and all parents need to be given the information necessary to make the right decisions for their families. Same thing with breastfeeding. Too often, parents just follow assumptions on what birthing will be like, and whether parents decide to go for cesareans or epidurals or natural births, they need to be educated to make those decisions.

A woman in one of the pregnancy and birth communities that I belong to wrote in that her in-laws were scoffing at her efforts to put together a birth plan because "births never go as planned" and she just needed to do whatever the doctors tell her to do. Attitudes like that are rampant and unfortunate. Every patient should be a partner of their care, whether that's birth or cancer treatment. The patient needs to be educated, and we can only encourage that by encouraging more discussion around the numerous ways to go about this whole business of life, and bringing it into the world.

Thanks for this very energetic post!

December 13, 2010 | Unregistered Commenterceleste

It's hard to take your comment seriously, Holly, when in the same breath you both chastise the author for not embracing and respecting diverse birth choices, and use the phrase "Cult of Childbirth".

I suspect you wouldn't be very happy if someone implied that you were a member of the Cult of Caesarians or the Cult of Medically Managed Birth - so why would you casually disrespect someone whose birth choices differ from yours, by labelling them as a cult member, implying they are a fanatic? Particularly considering that is the very point that you are arguing - that we shouldn't criticise and condemn women for having different opinions and wishes (or lack of wishes) for birth.

December 13, 2010 | Unregistered CommenterEmma

I also don't understand where all the vehemence is coming from. Well...maybe I do. People who write about natural or low-intervention birth tend to do so with a certain amount of reverence and passion. As Barb said above, birth is their calling. And they study it, analyze it and expound on it from many different angles.

But what I've always taken away from most (not all) child birth blogs I read is CHOICE. It's about choice, it's about respect, and it's about allowing as many different types of birthing styles and preferences as there are women to give birth. It's about allowing women to tell their stories and about listening to those stories without judgment. It's especially about respecting individual experiences. There's room for different perspectives and room for people to have different goals and focus in what birth means for them.

Of course there are zealots, there are bullys, there are those who speak without thinking first. Show me an online community where those people do not exist. But they do not represent the core and whole of what birth advocacy is about.

December 14, 2010 | Unregistered CommenterLinnette

Wow, what an interesting group of responses! I admit to being a little mystified to what is so offensive about the post in response to an article which was quite angry and offensive, in my opinion.

We all need to be balanced, and I feel that NGM is usually pretty balanced in her posts and opinions. Childbirth should be BOTH normal AND special. Yes, it's happened billions of times, but for each women it only happens X amount of times. Some women might dwell on their experiences, and some don't. Often it comes down to experience and personality. Trauma is that that- traumatic. If trauma happens for any reason during childbirth, the woman may want to work through it by talking about it to others, or she may cope by putting it behind her. Both ways should be supported by those around her.

Women who are driven to try and inform others about "normal" childbirth are often coming from traumatic experiences themselves, and others (like myself) really just want to HELP women. I don't push anything on other woman, but if I know someone is pregnant or looking to get pregnant, I try to inform her of things that she may not get from her friends, Dr. Oz, or her doctor. I do that because many current practices are DAMAGING to women and babies. How can I just sit back and not try to do ANYTHING to help? What they do with the information is up to them, but my conscience will not allow me to sit by idle and not try to be a positive influence.

I don't understand the "birthing God" reference, though..?

December 14, 2010 | Unregistered Commentersara

NGM - i'm an avid lurker, first pregnancy (due in May), and want to thank you for this blog - i can't tell you how much i've learned from you! slightly off-topic, but you mention above something about perineal massage - sounds like you don't like it much. i'd love to see a post just on that, or links - i haven't seen anything else negative about it online. thanks!

December 14, 2010 | Unregistered Commenteraudrey

It is odd to me that people feel so judged by a community that makes up less than 10 percent of all birthing women (if that). To me, it's like women who wear makeup complaining about all the mean old hippies judging them. Or alternately, it would be like reacting to someone who is proud of running a marathon with a rant about how my joint problems don't make me a lesser person.

I actually feel like I shouldn't even mention, when birth comes up, that I used midwives or didn't have an epidural because people will think that just by mentioning what I did, that somehow I'm judging them.

And for all that, I have my points of contention with natural birth rhetoric. "Our bodies were made to do this" can become a bitter phrase for those of us who end up needing help to have our babies.

And I understand and realize that for many women, the births of their babies are just the way they get the baby out of their bodies and into their arms. I don't think there's anything inherently wrong with that.

There is quite a lot of talking past each other, isn't there?

December 14, 2010 | Unregistered Commenterchingona

Re: Birthing God: Over the years, I've tried to figure out metaphors for women to understand the extreme importance of taking care of herself, of eating properly and the like. The two I've used most often are "growing a brain" and, depending on a woman's spiritual orientation, "growing God." These seems to have brought the reverence and understanding I was aiming for. The growing baby can be quite abstract, especially to first-time moms, so reminding them of what *is* happening inside can be the mental jolt they need to attend to the pregnancy in a healthier way. (Trying hard to not use the word "compliant" - can you tell?)

Also (exposing a woo woo part of myself), to me, a baby is the epitome of perfection... that when a baby is born, *anything* is possible! All goodness, all perfection and all knowledge is present. (Sound familiar, Christians?) Of course, I *know* that Nature has a giant hand in shaping the outcome of that child's life, but it is a rare parent who doesn't look upon their own child, especially right after birth, as if they are the most holy being every born. That's what I mean.

chigona: I was thinking of other examples, too... cat vs. dog lovers; fur vs. fashion; Christian vs. Muslim; (over the course of time) Catholic vs. Protestant; (do I dare mention it?) circ vs. not circ; vax vs. no vax (ahhh, now we're getting into the factions of NBA, aren't we?)... surely we could go on and on. So, what *is* it that makes it so appealing to pick apart others' choices? NO MATTER WHICH "SIDE" WE'RE ON?!?! Gads, wish I knew a... who would know... anthropologist? sociologist? psychologist? Wish I knew who would know.

Good thoughts, all. Even the ones that critique. I *love* hearing what's in others' brains! You know, we're all God in a little way, right? ;) (No offense to the a-theists... like myself.)

December 14, 2010 | Registered CommenterNavelgazing Midwife

What exactly is your position on pelvic floor/genital damage? Do you believe that it never occurs in the absence of bad labor management? Are you upset that women who've suffered this damage are upset about it and want to start a discussion? What exactly is this call to arms about?

These things happen. I think it is pretty clear that attributing them to labor practices is just wishful thinking. They cause a great deal of suffering and are very rarely talked about. The repair operations you mention are not as simple and straightforward as you might like to believe. Women should be informed about these things and allowed to make their own decisions-- even if that means they choose c-sections.

December 14, 2010 | Unregistered Commenterjane

Good question, Jane... and no, I do *not* think only mismanagement has a hand in pelvic floor/vaginal/clitoral/urethral/rectal damage. I have seen every single one in completely hands-off births. So, while education is *totally* important... and don't think I've ever said it shouldn't be... I do think it needs to be said that perhaps a great *deal* of the damage, IN OUR CULTURE, might (probably) come from mismanagement and a too-aggressive attempt to "help" women where no help is needed.

So, if women choose a cesarean after knowing that mismanagement is probably the cause of the majority of these surgeries needed and they don't want to go to the bother of avoiding the *cause* of mismanagement (sheesh, could there BE any better reason to overhaul hospital birth?), then so be it. But, education IS the key... you are correct. But, let's not just give the "you might tear your bottom to shreds in birth" without putting it in context. It is the context my "call to arms" is all about.

December 14, 2010 | Registered CommenterNavelgazing Midwife

I tore with my first, because of the position they had me push in, and the fact that I didn't know any better and let them "stretch the exit". My second came so fast that they didn't have time to "break down the bed" and only one person was at the foot of the bed and she couldn't hold my legs back and catch at the same time, so I got to push in (sort of) the position that felt best. Since they had me flat on my back on a non-elevated bed, I sort of ended up arching my back to point my butt down while doubled over to support my own perenium. Thank goodness for a 6 foot wingspan. :p 8lbs 3oz of big-headed baby boy born in a "Gonna get him out quick" fashion since no one saw fit to answer my questions about "if his heartrate looks bad, shouldn't he COME OUT FAST?" :p No tears. Peeing didn't even hurt afterwards.

Childbirth looks gory because of the blood involved. It's scary because we associate pain with damage instead of feeling it's the "pain" of exercise and exertion. Nothing stretches that isn't meant to stretch. Nothing opens that isn't meant to open.

When we trust our bodies and use the 'pain' to drive our positions, we're less likely to be injured. Not fully unlikely, as yes- our bodies can be imperfect sometimes and our babies can be all cock-screwey. But less likely. When we ignore our bodies to listen to the doctors that are going in blind with no idea what our babies or our bodies are doing.. IMO injury is more likely.

With both of my births, I was a puppet to the birth. I moved in different ways. When I tried to consciously try different positions, they were WRONG. When my body put me into positions that seemed odd or counterintuitive, I almost felt like I couldn't change out of that position without breaking something. Until my body put me into a different position.

"Sorry, my body won't let me do that" is a phrase commonly heard at my births, apparently! :P

December 14, 2010 | Unregistered CommenterSara

So you're saying that it can and does happen even in perfectly hands-off births, but you think it's mostly caused by mismanagement?

What makes you think that physics alone isn't the cause? Why does there have to be some evil obstetrical component?

December 14, 2010 | Unregistered Commenterjane

Jane: The word "evil" is yours.

I know physics alone isn't the cause because I have watched... OVER AND OVER AND OVER... as docs and nurses (and even homebirth midwives) have stretched a woman to tearing, long before the baby was even near the perineum. I have heard docs do that "oh, shit" grunt as their fingers plunged through the pelvic floor.

The most recent was a nurse thinking she was oh-so-helpful doing "perineal massage" BEFORE THE BABY WAS EVEN IN THE VAGINA. By the time the mom was pushing, the entire vagina had swollen so shut, the mother felt the barrier as she pushed; she had a cesarean. (And the nurse let me [god, how I hate the word "let"] check the mom before the cesarean so the mom would believe she hadn't made progress from the last exam.)

So, while it certainly *can* happen with an upright, hands-off birth, the reality is it happens so often in the hospital, perhaps someone ought to look at the "physics" of it.

I'm guessing we're at an impasse.

December 14, 2010 | Registered CommenterNavelgazing Midwife

I don't understand the idea that women who birth with the goal of little intervention are trying to get a medal. I just want to do what is best for my baby, and the least intervention thing has so far been best. Also, I am one who tries to deal with things myself first. If I have a headache, I first try to figure out if it's sinus, and then blow my nose, or is it stress...and nap. I try to avoid medicine unless I cannot do it otherwise. This is not some martyr stance, I'm not a better human, it's just a choice I make. I also want to get through birth as unaltered as possible. If my baby is healthy and I can do something to protect my bottom and vagina, I will. The least damage to me and to baby both, and baby's health does come first, and mine is next.

December 14, 2010 | Unregistered CommenterDawn

I agree with you about the perineal massage thing-- I hear a lot of people suggesting that it's a good way to avoid tearing, but it just doesn't seem likely to me, and I haven't seen any real evidence that it helps at all.

It also seems like a lot of the time people will decide after the fact that a tear was caused by something that happened during the labor, but I don't know how they can really determine that. It just seems like that sort of damage is an unavoidable complication of vaginal birth sometimes, and I wish women were really informed about it.

You've witnessed doctors and nurses actually tearing a woman's body? That's just horrible to think about. I hope you reported them.

December 14, 2010 | Unregistered Commenterjane

HAHAHAHAHAHAHAHAHA (and not in the funny way) about reporting a doctor or nurse. I reported a doctor for SUTURING NO TEAR WITH NO LIDOCAINE OR EPIDURAL and nothing happened to him. There IS no one to tell anymore... only blogs. Whistleblowing isn't heard unless someone has ears.

December 14, 2010 | Registered CommenterNavelgazing Midwife

Oh, forgot to mention *I* am banned from that hospital. Wouldn't want me seeing anything amiss, now would we.

December 14, 2010 | Registered CommenterNavelgazing Midwife

I was a member of that mumsnet thread for a while, and honestly, having had a drug-free delivery with my first which left me with sufficient damage that I required a Fenton's repair seven months later, and then a caesarean with my second, I found that I got an awful lot more sympathy after the caesarean. After a caesarean, everybody expects you to be having problems with stitches, possible infection, and to still be feeling as if you've been run over by a truck six weeks later. After a vaginal delivery which has gone horribly wrong, there's just - silence. Nobody wants to hear about how it still hurts to move certain ways months later, or how your continence has been destroyed, or how a year later you still haven't managed intercourse because of the pain. I watch movies like 'Juno' and want to laugh hysterically because she's riding a BICYCLE only a few months after birth. That would not have been possible for me.

Anyway, the amazing thing to me about that thread was that I wasn't alone - that loads of women had gone in to labour with their Hypnobirthing CDs clutched in their hands and said no to the epidural and moved around during labour (the UK isn't the States - pitocin is not routinely used, epidural isn't that common, and they don't put a drip in you as soon as you show up) and still just been ripped up by the sheer biological mechanics of birth. (I know, I know, loads of women pop out babies without damage - but then there are the rest of us, with the stubborn OP babies or the stargazing babies or the babies who like to salute the world on their way out or the tissues that just don't want to GIVE that much...)

I was lucky in that I got a sympathetic consultant to look at me after the first birth and actually listen to what I was saying, rather than telling me jovially that this sort of thing was just to be expected, eh what? He said that he only performed about seven of those repairs a year, but he suspected that there were a lot more women out there, suffering in silence. God bless the internet. At least when I read blogs like Her Bad Mother (precipitous delivery, torn explosively) and Esme of Whoopee (prolapse after natural delivery of a very large baby), I can ruefully reflect that at least I'm not alone.

December 14, 2010 | Unregistered CommenterT

T: Thank you for sharing your story. I cannot imagine the (physical and emotional) pain you must have gone (and/or are still going) through. I promise you, when a mom tells me a story like yours, I do not just re-play her birth story with a different ending, I listen. I have though, you are right, *been* that judgemental NBA in the past, but I have tried to change as life has presented itself to hardly ever be what I, at first, thought it was.

I'm really glad there's a place for women who've been damaged by birth to talk and be open. In birth, I've found unlimited factions that need a supportive place to speak/vent/share. This topic, I'm sure, was a really hard one to find. (Another "outcast" one is the Tokophobics... they, for a long time, had nowhere to go. Blessedly, there are groups for them, too.)

So, you've reached out. If you were going to teach a midwife how to tell women of the potential pelvic floor damage in birth, how would you do so? There are lots of us listening who are receptive to your knowledge and experience.

December 14, 2010 | Registered CommenterNavelgazing Midwife

I think that this is in a UK context matters. My understanding is that it's very difficult to get an elective c-section there. Saying that women should be aware of and informed of the risks of vaginal birth in that context is different than it would be in a U.S. context.

Also ... hard to know how to put this ... but it's easy to assume that most women know what we know. A friend of a friend had a baby a few years back and labored for 20 hours without pain medication not because she wanted to and not because she was coping just fine but because she didn't realize she could ask for pain medication. She thought they would tell her if she needed/could have pain medication. And here we make our birth plans about how we're going resist the relentless onslaught of epidural-pushing nurses.

Or more germaine to the topic at hand, I was talking about my second birth earlier this year with two friends who have not yet had kids, and I said something like "When they were stitching me up," and they got these really confused looks on their faces. "But wait, you didn't have a cesarean," they said. "No, I didn't." "So what were they stitching up?" And then it kind of dawned on them, and they went a little pale.

Now, presumably they would read more if they were actually pregnant. And of course no one thinks it will happen to them. But how much more betrayed and confused would you feel if you didn't even know? It's one thing to make a calculation that it won't happen to you and just get really bad luck. It's another to have no idea that it could even happen.

And T, if you're reading this far in this rambling comment, I'm very sorry for what happened to you and very sorry that you were met with silence.

I'm thinking back now to my conversations with a friend after she tore badly (though not as badly as you) with her first. She had a cousin who developed serious continence issues after a bad tear, and she was really scared of that. She thought a lot, early on, about having a cesarean for her future births. I remember being shocked to hear her say that. To my mind, she'd had a great birth. I think on some level I thought her tear was like my tear, just larger. I don't think I really got the way there is a sort of exponential effect to the damage done by a large tear. My friend ended up healing very well with time, but I wince a bit to realize I was rather cavalier about it.

December 14, 2010 | Unregistered Commenterchingona

I think there might perhaps be a comparison between this and the sometime antagonism between women who work outside the home and women who stay home with their children. This would seem to be an entirely personal choice. But it is also one that has been manipulated by governments, deliberately, and by news and entertainment media for reasons I can't quite understand. During WWII we had "Rosie the Riveter," as a song and as a poster. But after WWII, when the servicemen came home, there was a song in which a woman sings, "I want to do HOME work." Magazines now showed pictures of women at home, in heels and a dress with their hair done, but wearing an apron and smiling as they dried a dish in an immaculate kitchen, or beaming down on a baby, or surrounded by -three or four-well dressed adoring children.

In how to give birth, as well as in whether to stay home or work outside the home, there are an almost infinite variety of factors which influence an individual woman's choice. But there are also people and entities with an interest in those choices, sometimes a financial interest.

Right now there are doctors saying that all women should have their babies by C section, and many others who see no compelling reason to try for a vaginal birth if there are any adverse factors, including factors such as the doctor's other plans! C sections are so much more amenable to management, to control! They make doctors feel much more secure. Administrators of hospitals find the economics of C sections appealing, especially the way in which this would enable them to plan for constantly full but not overfull obstetric OR's and maternity units. So much easier for scheduling staff. So much more economical not to have staff there with little to do if no one goes into labor, not to have to pay them anything for on call time, not to have empty rooms which aren't generating income.

Of course women who have had birth injuries need a place to talk to other women with this experience. Of course one understands why a woman to whom this has happened will choose a C section with her next baby, and will wish she had had one with her first. But if suddenly there are many articles about such injuries, I can't help suspecting that SOMEONE wants to make women afraid of normal birth.

Of course I feel terrible for the woman who couldn't ride a bicycle even months after her birth. But should someone like my 16 year old daughter who went outside the day after her baby was born and rode her skateboard (I was enjoying time with my granddaughter) be pushed to have major surgery to have her baby because this happens to some women?

Wouldn't it be better to try to figure out how midwives, doctors, and nurses can best guide birthing women to avoid these injuries? NGM has pointed out that perineal massage, once a favorite in natural birth circles, can actually be harmful. What else is harmful? Too much pitocin, pushing labor along too fast. Purple pushing. Giving birth on one's back with one's legs up in stirrups. If we avoided these things, such injuries could at least be reduced.
Then there is a question of whether such injuries could be predicted in certain women. NGM thought not. But perhaps there are ways we don't know about yet. Perhaps there are genetics of cartilage and skin pliancy, or of prenancy hormones which influence cartilage changes, which could be investigated. I do fear any sort of tests like that for fear that they would be over-interpreted as a way to push yet another set of women into C sections, yet there is no doubt that for those who have these injuries a C section would have spared them much anguish, so I think it is a subject worth investigation.

If it is a matter of physics then it is a matter of forces (affected by anything which makes labor or the expulsion of the baby too fast, since force =mass x velocity) and materials ie the maternal tissues, and those are the places one would look to change these outcomes.

There is also the truth that human emotions affect the physical being.
A woman who feels safe and supported is -usually-going to have tissues which are more relaxed and pliant. So a more comfortable environment for birth and better treatment for women giving birth would probably reduce these injuries.

Please don't think that those of us who did enjoy our births and feel empowered by them, don't care about the plight of those whose births crippled their lives. We just don't want birth itself to be made the culprit, to be hunted down and wiped out!

Susan Peterson

December 15, 2010 | Unregistered CommenterSusan Peterson

Every woman should be able to be treated for birth-related injury, no matter how it happened, without being shushed. However, stories like the one referenced (torn apart by childbirth) could be a little more balanced. Yes, it's true that women are damaged by vaginal childbirth, but how many MORE women are damaged by c-sections? How many "maternal request" c-sections would have to be performed to avoid one terrible maternal tear during vaginal birth? Most women will give birth vaginally with only minor damage, and will be healthier and have healthier babies because of it. That's just statistically true.

Personally I had a very easy pregnancy and birth, but I don't just tell that side of the story when I talk to women. I usually tell them my story in short to be encouraging, but I also admit that it is unlikely that their labor will be as quick as mine was. Only by telling both sides of the stories can women really be informed.

December 15, 2010 | Unregistered Commentersara

I have to say this is yet another example of what I feel feminism has accomplished-that is women denying their innate feminine attributes-like birth, mothering, and nursing. These women are not the first and they will not be the last to attack some part of motherhood-that will continue until women see themselves as different than men but just as valuable for their FEMININE contributions.

I've written a post about this if you're interested in learning my thoughts on the matter.

December 15, 2010 | Unregistered CommenterKimberly

Hi, all!

I have 5 children, and have birthed them in just about every way you can! I have also suffered some *damage* with each birth-- and pregnancy!-- and have felt alone and weird and ashamed and silenced to differing degrees through all of it. Blogging can help, spiritually, because sometime a broken hurt Mama cant barely get a shower let alone go to physical therapy or a psychologist-- let alone find that kind of provider and afford it! Heres a bit of my stories, in the spirit of sharing our truths, (Which I believe to be the ONLY real helpful thing we can aLL do as women and mothers, tell and listen and be kind and open hearted)

Baby #1: Induction in the hospital. AROM for no reason other than "to get things goin'", Epidural at my screaming request about 2 ctx after the AROM. Purple-pushing semi reclined "Pull those knees back, Mom", possible hands in my vagina, random episiotomy for "big baby"?, 8lbs 12 oz baby girl, 39 weeks.
Damage? Extreme pereneal pain for over 2 months. Afraid to have bowel movement. Couldnt stand up for too long without aching feeling, feeling like my "butt" was falling out, hemmorhoids from the pushing. Afraid to go to my 6 week check up, didnt go until 10 weeks, at which point I asked why my vagina was "sewn shut"...was told hey, maybe you'll need us to repair that a little bit, why dont you come back at 6 months...no sex...too afraid...then at 6 months had an outpatient "pereneoplasty, with new stitches, which healed very well and went on to have a normal sex life.

Baby#2...another induction for suspected large baby, this time I couldnt push at all from the multiple epidural attempts that lead to Nubain/Stadol/Puking/Confusion...CSection...really bad recovery, no help with my toddler or newborn, infected incision, pain tightness burning depression dissapointment sadness at what I felt my "worth" was to family and friends (Someting to the tune of me being very hurt and very disabled and finding out that nobody comes over or seems to care, at age 25, knowing NOTHING about any Natural Birthing Community or the ilk)

Baby#3, Homebirth with a Direct Entry Midwife. 11 pound 41-weeker. I was surprised by my levels of exhaustion and pereneal pain after deeply entrenching myself in the mystique of the magical homebirth, I was happy to not have been through surgery, but still felt very alone in my ability to explain to "people" that no, I cant come to the beach, I am still flooding in bloody pads, no I dont wanna go on a bike ride, my coochie is mangled and my pubic bone kills, no I cant do your postpartum exercise class, my entire pelvis is unstable and I have a need for rest, not jumping or dancing, and who can I talk to about my depression when I had this big "Victorious HBAC"? lonliness and a sore bum, again...seeming to last a bit longer than the nice magazine/blog/book promised me.

Baby #4 I get the big idea to do a UC and about 1/2 way through labor feel something is terribly wrong, go to the hospital, have a very positive experience as far as support of the staff to help me VBAC, but truly cannot push out my 12 pound, chin defelxed, asynclitic son and have another csection. COMPLETE abandonment after the birth from the staff, husband stuck at home with 3 little kids and can barely come visit me, I faint in the shower alone and have to crawl to my hospital bed, massive hemmorhoids the size of dominoes, utter disregard for my health or safety at the hospital, total nightmare time. Husband back to work the DAY after I come home...deep depression and loss of self. Body seems RUNIED, this csection gave me the dreaded apron/belly flap-bulge, no stomach or core muscles force me to walk in a tight funny way, complete exhaustion and PTSD, nightmares, avoidance of family and friends, family problems due to my depression, trouble having a bowel movement, feeling for 6 months that something was iside my vagina, exacerbated by any standing for more than a few minutes, sneezing, coughing.

Baby #5, reconnected with old midwife and a doctor who was said to be "VBAC friendly", but ultimately decided on an elective c-section (me!?) with the idea that if we planned for help after the birth, and planned for 2 weeks off for my husband, then this time it might go okay. FAIL. EVERY one of our friends and family who volunteered to help us out bailed on us for varying reasons, the "cool" staff who was there for the actual surgery turned into a whole new crew of very very mean and hurtful postpartum nurses, and my PTSD came back fast, I was hysterical raving crying delerious abandoned mess of a woman, alone again for 6 days in hospital to care for myself, be told I was nursing too much, be told I should be up and walking by now, be told theres no reason to cry, be told hush up, be told I cant have anymore ___actual painkillers, you name it. Came home to care for 5 kids and settle in to my new life as the saddest most depressed owman on Earth. But this time with my rectum protruding into my vagina (after an elective section! yes sometimes "just" pregnancy can do damage), I seperated stomach and pubic bone, and a loss of identity on natural birth sites, as well as my own long standing blog. Still have mush instead of core muscles, still have deeply indented and tight/burning/ripping incision area, still have alot of work to do as far as PTSD and abadonment issues.

And yet, the baby is 2 1/2 years old, all the kids are darling and healthy and I am really going to be okay. But if anyone had been able to tell me about this ride, whooooo I dont know if I could have even comprehended it. I have been a naive Obstetrical patient, a starry eyed Homebirther, a UC-er/UP-er with the accompanying coo-coo fest over on MDC nearly brainwashing me, an informed OB patient, and probably everywhere you can be on the nutty SPECTRUM that modern birthing can be. I now choose to live my life as a humble listener to women and an advocate for the truth, whatever that may be to each Mama, each family. Silence is DANGEROUS stuff, but so are blinders. I think if anyone chosses to delve into the world of internet mothers then they need to read as wide a smattering as humanly possible, with large breaks for neutralizing/introspection as well!

Love you Barb, great blog POST! ;)

December 15, 2010 | Unregistered CommenterHousefairy

Ms. Galizia spits her words venomously. She states her premise:

“I get the feeling that life on the maternity ward would be so much easier if childbirth classes were to include one whole session of drumming it into expectant mothers that they are not the first person to have a baby, nor will they be the last.”

– I have to say that I don't disagree with the concept that childbirth is nothing special or unique. Perhaps it is a miracle, but an everyday, ordinary miracle. Like a previous commentator, the knowledge that many women the world over give birth every day and that birth is a completely normal part of life helped me prepare for my births. In fact, that very fact contributed to my decision to have an unassisted birth.

This should not, however, "make life on the maternity ward easier". Easier - for whom? That reminds me of OBs in my country of residence, Serbia, shouting at laboring women, "What are you so hysterical about!? My gran worked the field, gave birth, and continued working the field! You're nothing special, spoiled bitch! Shut up!" (unfortunately, this is a direct quote from someone's birth story).

Birth can be easy, relatively painless, stress free and absolutely normal and every day. I'm thankful that I had such a "nothing special at all, every day event" kind of birth!


December 15, 2010 | Unregistered CommenterWrite About Birth

"HAHAHAHAHAHAHAHAHA (and not in the funny way) about reporting a doctor or nurse. I reported a doctor for SUTURING NO TEAR WITH NO LIDOCAINE OR EPIDURAL and nothing happened to him. There IS no one to tell anymore... only blogs. Whistleblowing isn't heard unless someone has ears."

Yes. This. The nurse in the hospital to which I transferred after my son's birth literally grabbed into my perineum and jerked until it tore- nearly 4 hours after the birth. To whom does one report the head nurse, when the only people in the room (and therefore the only witnesses) were a student nurse/assistant, her (the authority figure) and the mother (me)? I wrote to the hospital administration, but nothing- not even an acknowledgment of receipt.

This kind of pelvic floor injury has nothing to do with the physics, and everything to do with unnecessary intervention (to put it nicely).

December 15, 2010 | Unregistered CommenterSarah

As I read these comments I keep thinking that both sides are fighting each other for the same thing: informed consent. Natural birthers want women to be informed about the risks of obstetrical interventions, while the women who have been hurt by not having any interventions want women to be informed of the risks of natural birth. We all want the same thing! It doesn't really matter to me what women choose as long as they are making an informed choice. When we only give them one side of the picture, no matter which picture you are showing them, their choice is not informed. I am not a natural childbirth advocate, I'm an Informed Consent and Refusal advocate. I push for women to be given information that will assist her in making the choices that are right for her. I trust that women have the ability to make good choices for themselves when they have good information available to them.

That being said, now I will add my anecdotal experience as well: I think homebirth midwives are the best providers to see if you want accurate information about vaginal tearing. Most of them really care about a woman not tearing and are committed to helping a woman keep her perineum intact. You don't see them doing things that making tearing a given, like valsalva pushing, insisting women stay on their backs during pushing, making women push at 10 centemeters instead of when they feel an urge, and giving women episiotomies when they think they are going to tear (to what, help them to tear???). These are all things that are done routinely in hospitals. Having any of these things done to a woman is not "natural" so I would argue that natural birth is not the cause of the tearing, unnatural interventions are (natural birth is more than just not taking drugs!). My first baby was born in the hospital where I was in active labor for less than 3 hours. I had an episiotomy and a 3rd degree tear. My second baby was born at home in a birth tub. My entire labor was 2 hours and 15 minutes. I had no tearing. I had a great deal of swelling though, and something my midwives called a scrape along the episotomy line. It took a few weeks to feel healed, but that was better than the first time which took a few months to feel healed. So, I have a hard time believing that it is purely physics. My second baby came shooting out of me posterior over scar tissue and I didn't tear. Nobody touched me, examined me, told me to push, or cut me. I delivered in the position of my choosing moving around freely as she was being born and pushing only when I felt an urge (and I felt very strong urges and pushed very hard for the record). I credit those things with not tearing.

December 16, 2010 | Unregistered CommenterJennifer Z.

It's great to hear that many women give birth with little or no damage. I think that message is already out there, loud and clear. When I was pregnant all I heard and read was that birth was natural and healthy and safe-- in fact, natural birth was the best thing I could do for my baby and myself.

What I didn't hear was that I might be damaged in a way that would affect me physically and emotionally the rest of my life. What I have since found out is that these injuries are quite common, but no one likes to talk about them, and no one thinks it's appropriate to tell pregnant women about them because god forbid they might choose c-sections. I wish someone had been honest with me, because if I had known what was going to happen to me, I would certainly have demanded one.

For the record, my baby was not particularly large, and it was a natural delivery with midwives at a birth center. You can't blame it on interventions because there were none. Nor were there any factors that might have helped predict it. I'm not overweight, don't have a family history of such things (though how would I know?), don't smoke or regularly lift heavy objects, etc. I even did all the recommended kegels.

December 17, 2010 | Unregistered Commenterjane

So, I'll ask again.

Pretend YOU are the midwife/practitioner. How would YOU give a pregnant woman the information re: potential pelvic floor issues?

December 17, 2010 | Registered CommenterNavelgazing Midwife

I honestly don't know how this information should be presented in a way that it won't terrify women in advance. I just know that part of the awfulness of what happened was the way that none, none of my (natural oriented) pregnancy and childbirth books even hinted that these things could happen. The childbirth classes certainly didn't. Without the internet, I'd have felt entirely alone, and thought that I was the only woman in the world that this had happened to - and even the internet was a mixed blessing, as there's a distinct idea amongst the natural birth movement that if you get badly torn up by childbirth or suffer a prolapse or a broken tailbone, it must be Somebody's Fault, Probably Yours. You can see it in this thread.

I had a great midwife during my second stage - all four hours of it. I was upright, in a dim room, in a birthing pool, moving about. Things just - went wrong. I was too tired after vomiting with pain for more than twelve hours. My contractions softened, dwindled, went away altogether with my baby trapped down low, and then, inevitably, my baby went into distress, necessitating ventouse over very bruised and swollen tissues. So who do you blame for the ensuing damage? My soft-spoken midwife? Me? My apparently inept body? My stubborn OP baby? Goodness knows, blaming the mechanics of childbirth isn't an option nowadays.

I still planned a vaginal childbirth for my second child, as I was willing to risk the repair site tearing open rather than choose the risks inherent in a caesarean. His footling breech presentation when I went into labour scotched those plans. I was told by the operating theatre midwife 'You know, most women who have had repairs opt for an elective section.' It wasn't my choice, but I can't really blame them for making it.

I don't really want to go back to the days that the grannies cheerily talk about - all 'Eeh! She were that torn up by her fifth one, he was a grand lad and all her innards came out!' - when macabre horror stories about birth seemed to be the order of the day, but the current cheery of-course-you'll-stretch-this-is-NATURAL isn't that helpful either. If it's not fair to let a woman choose a caesarean without explaining all the risks to her person, it's not fair to let her go into a vaginal birth without understanding the possible risks too. Even a gentle 'Sometimes there CAN be damage sustained to the perineal area and women can have continence issues or problems with intercourse - but if you think this has happened to you after the birth, insist on seeing a specialist as it can usually be helped' would be better than nothing.

December 17, 2010 | Unregistered CommenterT

I guess one would have to find out just how common these injuries are.

Then one would have a handout which said "X % of women have some kind of permanent damage to the pelvic floor after a vaginal birth, X % had painful intercourse for longer than 6 months, X% had incontinence of urine, .X % had incontinence of stool... These injuries can be much reduced by an upright birth position, not urging the woman to push when she doesn't feel an urge or to push harder than she feels the need to (unless the baby is at risk)...and _______whatever else you think goes here______, but such injuries are still possible in any birth.

If there are any stats comparing home births to hospital births in this regard, or making distinctions by birth position, type of pushing etc those would be good but I suspect there aren't any.

You might also mention your personal stats if you have kept them, as in "I have been the primary midwife for X number of women and out of those
X have had ___, X have had ____ , X had minor tears which healed well and X had an intact perineum, and no members of the last two groups have reported any permanent impairment. (Or whatever is the case.)

I think that is as honest as you can get about this.
And it doesn't solve the problem of how to keep some women from going through this kind of misery, while not completely giving up on birth itself.

Susan Peterson

December 17, 2010 | Unregistered CommenterSusan Peterson

What about the damage done by cesareans? In addition to a cut on my abdomen and another on my womb, I lack sensation on one side of my crotch, an inch each way from the incision and down to my labia, which I understand happens often when nerves are cut along with the skin. This is something I do not see spoken about a lot, even though numbness/tingling/strange sensations are very common among women who have had cesareans.

I've had some damage to my vulva before (not from childbirth) and it healed without any trouble, as mucuous membranes are wont to do. Not so with the cesarean scar, which I feel has left a gaping hole in my perception of myself. My sensuality? My bodily awareness? Something like that. I'm numb now, and my sex life is pretty nonexistent because of this.

Mine is a case of typical cesarean damage, so common it's hardly worth mentioning. Had I been in a position to choose (really, had my damn asynclitic baby been in a position to make this possible, hah) I would have much rather taken the typical vaginal birth damage.

December 23, 2010 | Unregistered Commenternumb

I can say natural child birth has more benefits than cesarean. if you plan to have a natural child birth, you do in advance. because pregnant women need assistance to manage the methods that she need those for childbirth. it is safer for both child and mother.

February 16, 2011 | Unregistered Commentercalm birth

When are we going to understand a hospital birth
can not be compared to a home birth…they are apples and lemons.

Our Medical Model of Industrialized birth sets women up for a c-section....just entering the swinging doors into an environment of strange behaviours, masks, stainless steel, bright lights and labour (guarded by our amygdala) ceases. It is a survival mechanism built into our DNA. Then we we hear "failure to progress" it demonizes the new mother at her most vulnerable time of life and it starts to slide downhill...that is only time we use gravity....in the process of a hospital birth.

It is sad that most women say: "I had to have a c-section" and they truly believe it...the Gods in green said it...and likely said also "wow lucky you were in a hospital....the doc saved you and your baby's life!"....'Meadow Muffins' to that bull...the stress of both baby and mother would never elevate to set off all the damned monitors that create the stress.
What do the Netherlands and all other sentient countries know that we don't...DUH...birth is natural and easy when you have basic understanding and a good well trained midwife....hospitals are just show rooms for all the surgical supply industries and the source of a perpetual pension plan for physicians and professionals who get to DEAL with all the fallout of hospital birth:
Iatrogenic problems, nosocomial infections and damage, plus all the numerous disease, dysfunction and damage we call 'congential' implying it is genetic...Meadow Muffins!....my son was born with a 'birthmark' or 'iatrogenic artifact' really: a healed scar above his eye…thank God it wasn't his eye...all the damn diagnostics that do nothing but scare hell out of women and partners...he had been stabbed by a poorly trained ultrasound tech's guidance of the amniocentesis needle. Imagine what that must do to a baby in womb?...all safe and comfy listening to the rhythm of mom's 'pump' in the 'hot tub' and wham! stuck with a needle!…paradise lost… then later a fetal scalp monitor screwed into your head?....why I wonder do we have such problems with alienation and violence....who can you trust if you get terrorized, bullied and beat up in the womb?

Baby's born at home…or in homelike, safe and familiar places… have smiles* on their faces...not the haunting scream and look of a baby who's first vision of the world is a laser sharpened surgical steel scalpel ...through eyes blurred by mom's blood!

WE NEED TO STOP this mayhem based on myth-information!

OK ...I am standing down from my soap box….sorry.

*BIrth Without VIolence-Fredrick LeBoyer

March 30, 2011 | Unregistered CommenterCGK

Accctualllly, CGK, I'd like to take your comment and use it as part of a post. Your words were magNIFicent! LOVED what you had to say. Are you game? Care to use your name?

March 30, 2011 | Registered CommenterNavelgazing Midwife

I too just Googled '4th degree tear in childbirth', and found your article. Thank you for such an intelligent post.

My best friend just gave birth to her first 3 days ago and experienced a 4th degree tear. Baby is healthy and BIG (9lbs 5oz...she is petite), but when I went to visit her, she was/is in shock. Completely traumatized. I need to figure out how I can support her, because everyone around her (including) her husband is oblivious to how she feels. You wouldn't happen to have any thoughts on how I can do this???

February 9, 2014 | Unregistered CommenterLynnie

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