My Birth Scar

My pregnancy and birth were uneventful medically, textbook in every way - except the tear. In the standard lithotomy position in a hospital with a CNM guarding my perineum, my labia minora split horizontally in two as my child entered the world.

Cue the inept stitch work from a CNM who had too many patients and was in a huge hurry. Not enough stitches were used and days after I was discharge the too few that were there snapped while ambulating. Suffice it to say my labia didn't heal correctly, it didn't heal together, two pieces of flesh cleaving and fusing as it should have. A trip back to the CNM the next day and I was told, "There's nothing we can do, it's a purely cosmetic issue now - deal with it, you are wasting our time unless it's infected."

I hate my wound, for a long time I couldn't bear to look at it or touch it. It makes sex less enjoyable and sometimes uncomfortable (the skin flaps get grabbed by my DH and pulled inside during thrusting) and gynea exams just aren't as much fun as they used to be *snark*.

I call it a wound because I am still wounded by it, although it has healed. To add insult to injury I cannot get it repaired until after I am done child bearing, as plastic surgery on that delicate area has the same risks as Female Genital Mutilation.

Here's why I feel I need to be done childbearing beforehand - "[I]n nursing school I helped out at the delivery of a woman who'd had labiaplasty several years before, and holy shit. It sort of, um, shredded. One of the most horrific things I've seen in my career. It took them a really long time to sew everything back together, and I have a feeling she would have happily gone back to some slightly asymmetric or (gasp!) flappy labia if she could have."

http://jezebel.com/5402091/report-vaginal-plastic-surgery-has-same-risks-as-fgm

Other sources about vaginal rejuvenation or vaginoplasty, includes info about labiaplasties.

http://news.bbc.co.uk/2/hi/health/8352711.stm

http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Gynecologic%20Practice/co378.pdf?dmc=1&ts=20121129T0006283149

I fear that if I get it fixed before I am done child bearing it won't stretch properly, as scar tissue is inelastic and it may pop again creating a far more terrible tear in the same place. Even if I do not get it repaired I still worry about it tearing in the same place and becoming a vaginal wall tear. I never feared child birth before but this tear makes me rethink having more children.

4 years after the the initial tearing, it's hard to watch my birth video because of it, I resent my midwife for the lithotomy position, I resent my daughter (a bit) for causing it, I can't masturbate or have sex without touching/thinking about it (usually negatively), when I shave I have to be extra careful not to nick it as it protrudes further than the other side. Oh an did I mention that my stitches didn't completely dissolve, every few months I feel like I'm being stabbed from the inside out as bits of stitch work make their way to the surface and have to be delicately removed. I used to think my vulva was gorgeous and now it looks and feels sad all the time. My scar is still very much a wound that hasn't healed.

Education

It should be a given that your doula has taken a training course of some kind. I am not of the school that believes a certification makes a great doula (I am not a certified doula, either), but definitely a weekend workshop should have been had. Whether it’s DONA, CAPPA, toLabor or any of the other groups one might find (Radical Doula has a great list here), attending a training will have been infinitely helpful to your doula.

Experience

This doesn’t necessarily have to be hands-on experience since some of the best doulas I’ve met have been newbies, but there is a great deal of information out there that women can learn via books and videos. They can also learn at meetings where doulas gather to talk about cases. Watching videos of doulas, she can see what makes a good doula, how the woman touches the laboring mom, what kinds of suggestions she makes to her as the labor progresses and how to move about the room unobtrusively. I talk more about experience below in Referrals. Ask your doula-to-be how she’s come by her experience and these might be some of her answers.

Knowledge

This doesn’t have to be just book knowledge, but books cannot be overlooked when a doula is educating herself. What the doula reads and assimilates can help her practice immensely. Much of what I think a doula could do to up her knowledge is to read midwifery texts. Reading Heart & Hands and Ina May’s Guide to Childbirth are two really good books to read to get a feel for the rhythm of labor and delivery. The Birth Partner and The Ultimate “How to” Guide for Doulas are great doula books to read. I haven’t read Experienced Doula: Advanced Skills for Hospital Doulas, but the Amazon comments seem to recommend it. If it lives up to the title, it should be a good one.

Referrals

How do you know how the doula’s going to be interacting with the hospital staff? How will you know until you are in the throes of labor? The best way is through recommendations. This, of course, would mean your doula is experienced. This won’t work if your doula is brand new. But, not to knock new doulas (who might be awesome out of the gate), but I would really encourage at least a little bit of experience before venturing into a doula-client relationship. The question becomes, how can a doula get experience if women only hired experienced doulas? Most doulas start out helping friends and family, not being hired outright by strangers, so developing clientele, even if it is friends and family, is a great way to garner the recommendations she will need. This is sure to be my most controversial advice, but I do stick by getting referrals as a way to learn how a doula acts in labor and birth. You still might come up against a doula that isn’t a good fit in labor, but the likelihood would be less. How a doula interacts with the hospital staff can mean the difference between an awesome birth and a train wreck, so recommendations can’t be taken casually.

Asking the Right Questions

Knowing what kind of doula you want will help you here. Are you looking for a motherly-type doula? Or a take-charge doula? Do you want a doula to tell you what to do throughout your labor? Or do you want to lead the way? I know this can be a challenging question, but imagining yourself in labor can help you decide what type of woman you are and what you’re looking for in labor.

A good doula is able to mold herself into what you need, so if you change your mind in the middle of things, she should be able to move along with you.

So, what to ask?

- How many times will we meet? That answer should be at least twice during the pregnancy and once or twice afterwards; most meet with you twice afterwards.

-When do I call you? The answer should be “Whenever you want to.” Doulas should be available via phone, text, email throughout the pregnancy and then physically available from 37-38 weeks along. I say 37 or 38 because doulas have different beliefs about call-time. If you suspect you will go early (and not just because you hope you go early!) you might make sure you hire a doula who will come earlier.

- What If I have pre-term labor? Will you come? Most would if at all possible, but if you’re having pre-term issues, it would be good to ask the doula this question.

- When do I call you in labor? Again, the answer should be “Whenever you want to.” (I tell women, “If you think, ‘Should I call Barb?’ the answer is ‘YES!’”) Women need to be able to touch base with their doulas in early labor even if the doula is hours away from going to them. Through repeated phone calls, the doula and client can decide when the right time to get together will be. Depending on whether the doula is meeting you at your house or at the hospital depends on how far along in labor you will see each other. If you want a doula sooner than later (you think), mention that to the doula. Make sure she goes to the mother’s home before you find out in labor she’ll only meet you in the hospital.

Now, I have no qualms about a doula meeting you at the hospital instead of in your home. It’s what I do if I doula. I am uncomfortable laboring with a mom at home when she isn’t monitored, so only do monitrice work when a woman wants me to come to her home in early/ier labor. But, many doulas don’t have any issues with going to women’s homes and that’s fine, too. Just be sure you know what your doula will do before you get there.

Some answers you might hear include: When you can’t walk or talk through a contraction; When you feel you need me or When your contractions are less than 5 minutes apart. All of these are valid answers, none better than another.

- Who is your back-up? No matter how wonderful your doula, things happen and sometimes she won’t be able to make it to your birth. She or her kids might be sick. Someone in her family died. There might be another client in labor and she’s already committed to her (because the other woman went into labor first) or because her car broke down… all of these but the car have happened to me with clients over the last 30 years. It’s rare, but can happen. I have a couple of great (female) back-up doulas that are glad to meet with clients beforehand, but don’t have a monitrice back-up (yet). I am clear with monitrice clients that this might happen and I will refund them the difference if I have to send a doula instead of my going when she’s in labor. It’s best if your doula is able to connect you with her back-ups, even at least with a phone call so you know how to reach her/them if necessary.

- How do you see your role? This answer can be endless and this is when your own expectations come into play. Typical answers would be: As someone to soothe you when you’re in labor; To help you before, during and after the birth and As an educator to help you know your options in birth. It is important for a doula to be a teacher of some sort… not necessarily a childbirth educator, but have a teaching gene. She’s going to let you know your options in birth, help you learn how to communicate your wishes to the hospital staff and will probably help you get started breastfeeding (if that’s your choice). Will she help you with your birth plan? Most will help you with that, even if they start with a standard birth plan off the Internet. If she’s a good and experienced doula, she will help mold the template into your unique birth plan. (There’s nothing worse than presenting an Internet birth plan to the labor and delivery staff.)

During the interview, take note of the type of person she is. Is she direct and clear? Will that come across as bossy to the hospital staff? Or is that a trait you appreciate in a person? Is she meek and mild? Will she have the strength to guide you in labor when you need someone strong? Is she full of ideas for your comfort measures even now or is she only focused on labor? A doula who has information for you at the point you are in your pregnancy is a great doula! She will have loads of ideas in labor, too… and she isn’t afraid of sharing them with you. It also gives you a glimpse into her experiences.

- What kind of births have you seen? Has she been to VBACs? Twins? Cesareans? Moms with preeclampsia? Inductions? Natural/Unmedicated births? Moms who’ve hemorrhaged? Births with certified nurse midwives? Home births? Birth center births? Shoulder dystocias? The more complications she’s seen, the more births she’s been to –because they are generally rare and you have to go to a lot of births to see some of the more unusual ones. What does it matter if she’s seen complications? She’s not the one managing them, right? What it can tell you is that she will have acted/reacted in an emergency, helping her client through a crisis. This can be crucial to a woman’s postpartum adjustment period, how the complication went down at the time. Especially with cesareans since those are so common; it helps if the doula has gone through this with a client so she can guide you if you’re going to have one, too. Knowing the cesarean ritual helps the woman to prepare for what’s coming and can help her assimilate what happened postpartum. If she’s been to natural births, that lets you know she can work with a woman through the whole birth experience without medication… this is a totally different experience than when she has an epidural. Helping women through pain for hours and hours takes stamina and creativity. Then, working with women with epidurals, as different as it is from natural birth, takes a different type of creativity… does she work with peanut balls? Does she know the routine side effects of epidurals? Will she be comfortable sitting on her hands while the mom and dad sleep, sometimes for hours?

As you can see, there are many more ways to tell if you’re going to have a positive/good doula than just a personality mesh, although that can’t be overlooked either. After everything, do you and the doula get along? Does she look you in the eye? Does she include your partner in the discussion? Does she have ideas for him/her to help in labor, too? Is this someone you wouldn’t mind spending 20 hours with in a small room? If she irks you in any way, I’d say PASS on her and find another one. If she annoys you in the interview, how is she going to affect you when you’re tired, hungry and in pain? Find someone who will comfort you. You deserve to have the best doula for your pregnancy, birth and postpartum. I know she’s out there!

When I commented, “The woman’s Internet “advisors” are just as guilty for this baby’s death,” a woman replied that no they aren’t, that we each make our own decisions.

So, who is responsible for the baby’s death? Is it the Internet for its anonymity and copious amounts of misinformation in the name of “telling the truth?” Is it the midwife who wrote in her notes that there are "’lots of political issues’ relating to home births?” Is it solely the mother’s because ultimately she made the decisions?

I bet those Internet advisors will find a way to incriminate anyone but themselves and the mother because mothers are rarely accused of doing anything wrong when it comes to home birth deaths. Even when it is their fault.

There are others culpable, though.

Entire websites are set up to convince women that medicine is evil, that doctors have nothing but dollars on their minds and that cesareans are the worst thing possible in a woman’s birth story. I could name five off the top of my head, but if I know them, then others do, too. There are a few that take the opposite stance, that home birth is evil and home birth midwives have nothing but popularity on their minds and that giving birth naturally is just for the experience. (I strive to be in the middle.) Neither is 100% correct, but desperate women cling to the fringes. Why is that? What are they looking for besides answers? Why do they look for the information they hope is true instead of balanced information? I’d need a psychology degree to answer those questions. It’s rather pitiful and sad, though, that they do… that there are women right now doing the exact same thing. And there are plenty of women out there validating their wishful thinking.

How many deaths and injuries need to occur before the Internet advisors start taking responsibility for their actions? Will they ever figure out the role they play in all of this? I would like to think so, but don’t hold out much hope for it. I don’t know how to get these women to own up to their behaviors, their advice to unsuspecting women who desperately want help over the wires.

Or how do we comfort the despairing woman? How do we help her so she doesn’t turn to the edge of sanity for information? Women can be so damaged; there has to be a way to help them before they go over the edge of sanity… the sanity of not taking medical advice from strangers.

I never write about sports, but this piece of information bears a short post.

Jason has become the first American to come out who plays a major team sport: NBA basketball. H’s a free agent at the moment, but has played for several NBA teams, including the Celtics. He’s gone to and won many competitions and has his share of awards.

Before Collins came out, before his trade to the Celtics and Wizards, he asked for the number 98 to honor Matthew Shepard who did a horrific death for being gay in 1998. Quite an honor and loud-spoken commentary.

Collins just came out on Monday… I just laid my hands on the Sports Illustrated story today… so it’s still early to see what lashing out there will be, if any at all. So far, things look good. Big names in all sports venues are rallying to his side, supporting his choice to come out now instead of later.

I just wanted to offer my support to Jason Collins for being himself… not necessarily brave or wondrous, but just for being himself. Thanks for coming out.

The guidelines, in bold italics, state; (my comments in afterwards):

- There should be no preexisting medical conditions.

This would rule out thyroid, heart, renal disease and more. Most home birth midwives wouldn’t have a problem with someone with thyroid disease, but would risk out for more serious diseases and conditions.

- There should be no diseases during pregnancy.

This would include not having women with diabetes in their practice. CPMs generally accept and keep women with diabetes as long as they aren’t on insulin. For the rest of the diseases of pregnancy, Preeclampsia, Pregnancy Induced Hypertension, HELLP Syndrome, etc., most midwives would risk out. There might be some midwives who wouldn’t recognize the lower levels of these issues and a few might not appreciate the gravity of the diseases, but most would.

- No one with twins, triplets or higher should deliver at home.  

We know this is one that is ignored too much.

- The baby needs to be vertex (no breech).

This one is also ignored too often, many/most midwives believing that breech is a variation of normal. It is not. The number one reason a midwife ends up arrested is because of a breech death. (This is my informal observation over the years.)

- The pregnancy should be at least 37 weeks, but no more than 41 weeks.

The 37-week limit is a common demarcation point although some midwives would deliver a woman under 37 weeks with specific clients, believing it’s okay to step out of the rule for special circumstances. This is one of the issues I have with CPMs; they don’t have hard lines, but find so much ambiguous. It’s part of what women want in a midwife, being seen as an individual, not a number, but there does come a time when hard lines should be drawn in the name of safety.

- The AAP says that labor needs to be spontaneous or induced as an outpatient.

Induced?! What were they thinking?

- Pediatricians should advise parents who are planning a home birth that AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board.

This means they recommend only Certified Nurse Midwives, not CPMs.

- There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant.

This would include intubation, something the majority of home birth midwives do not do. However, even if one learns intubation, we don’t get a chance to practice it and it is a skill that requires constant practice in order not to injure the baby. It is a nuanced skill that nurses practice a lot and/or use more frequently than a home birth midwife would ever have the chance to do, mainly because most of the babies we see are from (or are supposed to be from) low-risk women. So the likelihood of ever being able to do this regularly is remote… something we might just have to scratch off the list of being able to do… keeping us from being 100% accepted by the AAP.

- A newborn infant who requires any resuscitation should be monitored frequently during the immediate postnatal period, and infants who receive extensive resuscitation (e.g., positive pressure ventilation for more than 30–60 seconds) should be transferred to a medical facility for close monitoring and evaluation.

30 – 60 seconds is too ambiguous and ambiguity is the hallmark of CPMs. I wish they had said 30 seconds and left it at that.

- Home birth mothers and caregivers also should take any infant with respiratory distress, continued cyanosis, or other signs of illness to a medical facility.

I’ve seen, many times, a baby with central cyanosis receive blow-by oxygen for extended periods of time. “The baby just needs to nurse!” is what so many midwives believe. Annoying. That the baby does transition eventually reinforces their actions, but what of the babies that do have problems that need to be watched by an NICU staff? What happens to them? They are delayed and delayed going in.

- All medical equipment, and the telephone, should be tested before the delivery, and the weather should be monitored.

This is always done in my experience.

- A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency.

Something that cannot be done for many midwives whether because of legalities or hostilities in the community.

- AAP guidelines include warming, a detailed physical exam, monitoring of temperature, heart and respiratory rates, eye prophylaxis, vitamin K administration, hepatitis B immunization, feeding assessment, hyperbilirubinemia screening and other newborn screening tests.

While many home birth families refuse Vitamin K and Erythromycin eye ointment, midwives who can, do carry it for those that want it. When a midwife can’t do something, like the Hep B vaccine, she would send the baby to the pediatrician to have it done. Same with the bili checks; blood work is done via the pediatrician, so it isn’t ignored, just that we don’t typically do that lab test. There are home bili tests, but they aren’t as accurate as blood tests. In my experience, even with the home tests, if there is a question, the midwife would send the baby in to be checked by the pediatrician.

- The baby needs to be monitored every 30 minutes for the first two hours and consider transitional care to be 4-8 hours postpartum.

Midwives at home monitor more frequently in my experience. Not a complete newborn exam every 30 minutes but absolutely doing vitals. Most midwives stay at least 3-4 hours postpartum. Now maybe we should stay a minimum of 4 hours?

- If warranted, infants may also require monitoring for group B streptococcal disease and glucose screening.

This would be something I would hope all midwives do, but I know too many don’t even test for GBS in the pregnancy, much less treat with antibiotics in labor. This must change. I worry how may babies have to die of GBS before home birth midwives get the connection between testing and a live baby. Then there’s the LGA babies that need to be tested for glucose levels, but midwives often merely go by symptoms and even then don’t test. I would like to see glucose monitoring of newborns become more common.

- Comprehensive documentation and follow-up with the child’s primary health care provider is essential. They want to have the baby see  a pediatrician within 24 hours after the birth and again 48 hours after that first visit.

A variation of this is done by most midwives. Some will say the baby needs to be seen within the first three days and others within the first two weeks. I err on the side of caution and liked my clients to see the Pediatrician within the first three days. AAP takes a much more conservative take and wants the babies seen much sooner and more often,

As I’ve read through the articles about the new guidelines, there have been some comments from CPMs saying they are glad for the guidelines because all CPMs do them already. As you read above, that isn’t true at all. There are specific items on the list, namely risking out for diabetes, intubation and vaccinations, that most (if not the great majority of) CPMs do not do. These need to be known and if we want to win the hearts of the AAP (and the public), we might consider adding stringent limits with diseases and intubation into our repertoire. And many midwives are wont to limit their clients to normal, vertex, singleton mothers and babies, instead being led by clients and their needs, not adhering to what is proven safe for those wanting a home birth. It’s frustrating when midwives take these high/er risk women and things go wrong. It makes all midwives look careless and ignorant of risk. If we were able to adhere to strict standards, perhaps CPMs might finally be included in the professionals’ recommendations. I don’t see that happening any time soon.

When we get standards from others such as this and we’re able to compare the requests with the realities, it is perfect for giving the CPM areas where she needs to increase her education and skills training. I’m often asked what exactly do I think midwives need to learn and this post is perfect for that. Tops is learning to adhere to the Standards of Care of not step out of the boundaries just because the midwife feels sorry for the mother. There is nothing mentioned in this piece about malpractice insurance and that should be a requirement, too. I can see, with increased education and skills training and standardized education (not the haphazard methods there are now to become a CPM) and malpractice insurance, CPMs finding a more accepted place in states. But there are still too many challenges that don’t fit the exacting standards of ACOG or AAP. I hope we midwives strive for what their looking for, not minimize their requests. It is in our self-care that we will be able to garner more and more respect. With respect, we get laws on our sides, Medicaid payments, all states with CPM laws and a great reputation. It’s time we had a great reputation.

The biggest concern seems to be having to do extraneous things that have nothing to do with midwifery… orthopedics, cardiology, geriatrics, psychiatry… all seemingly so far from birth work, but in reality, have everything to do with birth –if you just look with a soft-focus lens.

Everything you do in nursing school (and nursing in general) has something to do with midwifery, even if they seem so far away.

Why would you need cardiology in birth work? Part of the job of a midwife is to determine if mom has a heart murmur or not. Heart murmurs can be indicative of underlying cardiac conditions that need to be addressed by specialists. Also, listening to newborn hearts is a crucial part of immediate postpartum care. If you’ve listened to a thousand hearts, most of which are normal, you are able to quickly determine if there is an abnormality in the heart you are listening to. As an apprentice midwife (out of hospital apprentice), you don’t get the chance to listen to the wide variety of hearts that you do in nursing school. It’s a distinct advantage to be able to hear so many hearts.

What would geriatrics have to do with midwifery? Besides listening to the heart advantages, there is also the ability to work with folks with depression, orthopedic issues (more on that in a moment), chronic pain and family dynamics… all aspects that have to do with the care of women in the childbearing year and beyond.

Orthopedics? What in the world does that have to do with birth? One of the first things a midwife does with a new baby is check his or her clavicles to see if they are broken. Knowing what a break feels like as well as how to refer out if necessary or even how to fix it can be crucial for a midwife. Plus there are other physical conditions a newborn can have that a midwife needs to be aware of: hip dysplasia, club foot or femur fractures can all be a part of what might happen in birth.

Time in psychiatry is infinitely helpful because midwifery is all about the psychology of things. Getting to know a family, deciphering whether there is abuse in the family or not, understanding eating disorders and more are all covered in the psych portion of nursing school, something that isn’t typically covered in non-nurse midwifery education. It’s something we pick up along the way. I learned a lot from my own years in therapy.

So, putting the positive spin on nursing school can help keep your eye on the prize of the nursing degree.

What of possibly losing the idealism of out-of-hospital or natural birth? Won’t nursing school ruin the belief that birth is normal?

I always find that question so interesting. If you have the belief and there is nothing to counter it, you’ll stick with the belief. If, however, you have information that shows otherwise and you change your viewpoint, then that is the perception you’re supposed to have. If there is nothing to change your point of view, then you will stick with it. But, nursing school does change perceptions because there is new information, why wouldn’t it? Does it make you not believe in natural birth anymore? Not in my experience. It widens your attitude towards birth, eventually bringing the two (or more) positions into alignment. Is there a way to be a nurse and still believe in home birth? Absolutely! There are plenty of nurses who have their babies at home. They are probably more discerning about whom they choose to oversee their births, but they do believe in their abilities to be safe while birthing at home.

You know you’re going to learn new information. Why wouldn’t you want it to blend with your already strong knowledge of birth? Do you really feel you will be brainwashed? Or might your beliefs be questioned. Now, that isn’t such a bad thing. We should be able to stand strong in our beliefs even as someone stands in front of us showing us counter-proof. If we shift, we are brilliant humans, using all the information at hand and developing a new mindset. There is nothing wrong with that.

Will you see things that make you crazy? Absolutely. Will you want to reach out and stop people from doing things that you know to be dangerous or bad? You bet. Will you do it? Or will you stand there and learn. You will learn. Even when someone does something that you think to be dangerous, you must sit still and learn because there really might be another way to do what you’re watching. And even if you say to yourself, “I will NEVER do that to a woman,” put the skill in the file drawer because you never know when you might need to do just the thing you’re finding abhorrent. I remember learning how to do controlled cord traction. My mind screamed at me to stop; it was a horrible thing to do with a placenta. But, I sucked it up and learned. Was I ever glad when I had to get a placenta out from a hemorrhaging mom. I never thought I’d use the skill, but thankfully, I paid attention and learned anyway. I’ve learned there can be a reason to use any skill you acquire along the way, no matter how awful it seems at the time.

And that’s the way it is with nursing school. Even with all the things you think you’ll never need to practice home birth midwifery, you are wrong; you will utilize every extra skill and piece of education that comes out of nursing school. Midwifery school, even more so. But that’s a different post.

I hope this helps those wondering about nursing school and having concerns or second thoughts. I hope you’ve found some peace about the possibilities that await you in a place completely foreign from anything you’ve ever known. What an adventure! I only wish I had gone that route when I was your age. But now I get to share my old lady wisdom with you all who might go on to be awesome nurses and possibly certified nurse midwives. I am all the way behind you. Go for it!

“They get a little buzz and feel a bit tingly high from the relief of pain and the fentanyl and smile from the high. It seems a shame that they are unaware that they could get that high by learning how to find the place inside themselves that releases it naturally, or by surrounding themselves with other high people. Also, if the woman feels the fentanyl high, then the baby must be getting it also….”

Her interpretation of what women are feeling is bizarre. It isn’t that they are high, they are relieved! Is the baby relieved? Probably from the stress hormones’ minimization.

The really long article waxes poetic about unmedicated birth, saying,

“The biggest lesson I’ve learned from 25 years of assisting births is that there are no two people on earth alike. Each woman is a completely unique entity with different tastes, needs and desires. By enabling a woman to birth at home—or in any place she chooses—where she can find the position, place, smells, atmosphere and surroundings she needs to birth, she can birth practically without pain. I am not only referring to people who meditate and do hours of yoga every day. I’m talking about Mrs. Couch Potato, too. I could describe hundreds of women who did not feel much pain during birth.”

I haven’t been a midwife for 25 years, but I can surely tell you that there were plenty of women who felt a great deal of pain in their home births. Some so much, they transferred to the hospital for pain relief; not many, but a few. Pain is one major reason first time moms transfer to the hospital.

Cohain also says,

“The task of labor is to breathe and relax for 30 seconds of contraction. This can easily be accomplished by the most unimaginative person by walking slowly and counting 10 slow breathes. An imaginative person can connect to the place in her body where she can release her natural endorphins and get a natural high. She can surround herself with a few people who love her and get a contact group love surge. She can connect to her power or whatever power she wants to let flow through her—it’s much like the energy you get watching a great concert, or a shooting star, or a child take his first step. As this energy flows through her she can imagine herself powerful and giving life force to others, praying for the health of sick people she may know. She can kneel down in soft, green grass and suck in nature’s bounties. It can be tiring, but the longest it will last at significant strength is 12 hours.”

30-second long contractions are in early labor and that is typically the least uncomfortable time, but for some, it is still painful if the baby isn’t in a great position. And the longest hard labor lasts is twelve hours? She must have some speedy women giving birth around her.

I’ve been to births that sound like what Cohain describes above, but they were the unusual, not the typical. I’ve also been to hospital births that were just as ethereal as these home births she describes. Has she not?

“Watching a woman get an epidural reminds me of watching a teenager have a bad drug trip. Birth is not a terribly painful process in the comfort of home, although going to the hospital doubles it.”

It makes me very uncomfortable to read such statements. Sure, staying in the bed without movement can be more painful, but more and more hospitals are “allowing” women to move around in labor, even as they are tethered to monitors and an IV. Saying that birth isn’t a “terribly painful process” at home discounts all those women for whom birth is terribly painful.

Cohain even attacks the verbiage used around epidurals, although, as far as I know, she gets even that wrong. She says,

“Although the euphemism, ‘She took an epidural’ is universally used, no woman can take an epidural. She has to be given it.”

In my 30 years of experience with epidurals, the woman got an epidural, she didn’t take one. Have you all heard of taking one?

There is great detail about a woman in a hospital bed and getting an epidural, including the erroneous information that says,

“The anesthesiologist takes a large gauge needle on a 5 or 10 cc syringe and starts digging into the laboring woman’s back. The hole has to be large enough to fit the drug-bringing canula which goes in 4 inches, or 10 cm, in and up her spine. Blood flows down her back in a half-centimeter stream from the hole. It hurts to be stuck.”

First, the woman gets a shot of lidocaine so she doesn’t feel the needle going into her spine. The doctor also doesn’t “dig” into the woman’s back; he knows precisely where he’s going. While it does sting like a bee sting for the lidocaine poke, the insertion of the needle and then canula are typically felt as a lot of pressure, not pain.

At one point, she says that Bupivacaine is an opioid, which it is not.

And her belief that women get high from epidurals is laughable if she weren’t so serious. Accusing women of wanting to get high in birth is downright rude; women are wanting to have pain-free births and have that option in a free world.

It’s sad to me that Cohain doesn’t seem to have seen some beautiful hospital births, that the only lovely births she’s seen have been home births. I’ve seen some hospital births that were more wonderful than some home births.

I’m tempted to write a birth story where a woman starts out at home then transfers to the hospital for an epidural, words billowing melodiously. It could happen.

TJ: I sometimes feel judged as a midwife because my birth experiences weren't 'midwifery enough', but fortunately many women I care for don't ask.

MS: I don’t tell my story because nobody cares to listen to other peoples stories.

NgM: I don’t find that true at all. People love hearing others’ birth stories.

HS: Always. And crazily enough, it depends on who I'm telling it to what ~type~ of judgment I feel.

EB: It hasn't occurred to me to care.

AF: I love to share my stories.

The first one is a thriller full of tension and drama, and honestly, Hallmark movies don't get nearly the ratings of The Walking Dead.

The second one is pretty boring with the exception of the kid peeing on the OB as he was held up for me to see. That's about the only part I share often. Humor sells too.

Do I tell them often? Nope. I don't get asked much now, and I didn't get asked much when they were young either. The average person is not interested.

The people who think birth is supposed to be this amazing transformational experience don't think much of my stories because they aren't about magic moments and soft focus pictures. I'm not interested in rewriting my experience to fit their favorite narrative.

CF: You know what's funny? I actually had a pain-free, intervention-free birth (thanks Hypnobabies) and was too embarrassed to share my story for awhile. The moms I knew seemed to enjoy sharing their stories, which they were overwhelmingly not happy with, but they didn't seem receptive to hear about enjoying my pregnancy and having fun while giving birth. I almost ended up feeling like I was apologizing for having the kind of birth I did. It took my best friend helping me to understand that women wouldn't know this kind of birth was even possible unless it women shared those experiences. I was so scared of women feeling like I was saying their experience was less than mine if I shared, but that wasn't ever what I was trying to get across. So I've found myself carefully framing my story to make sure they still feel validated and heard and that they know I truly believe that each story is unique and worth celebrating.

SBN: Yep. With both - the epidural-first-time-mom-not-quite-my-own-advocate and my non-meds one that was serene and minimal. You can't win.

HS: Seeing an interesting trend on this thread.....It appears a lot of moms who've had positive experiences (whether natural, augmented, or surgical) feel reluctant to share their stories. So many women love to share their horror stories of birth, either their own or someone else's, that hearing a happy one is almost taken in offense.

CK: It's a rock and a hard place when you want to vbac. Especially when you want to vbac with no epidural. Have you ever been on magnesium sulfate? That is some nasty stuff, and a huge game changer when your plan for pain management includes lots of movement and a tub.

EC: No, however I don't share much in mixed company because so many people have negative stories. Mine are both mainly positive and I think that can annoy people. Same thing when I share about my breastfeeding success. So I guess it is a kind of judgment, or maybe they are afraid that they are being judged by me (they're not!)?

HMD: Certainly. People think, "how boring..."

LSA: It depends on who it is I'm telling it to.

SSC: My first pregnancy was really enjoyable but the birth was awful and my second pregnancy was not as enjoyable but the birth was wonderful. I find that you just can't win. I frame telling stories about both based on the audience.

HMD: Mine was neither happy and exciting, nor terrifying and dangerous. But it was anti-climatical to the pregnancy. I should write that up, with pictures.

AF: You should go with the narrative: "My pregnancy nearly killed us, the c-section saved our lives.".

I think that's fairly accurate.

CK: Yes. My first had heart issues, so he was born via c-section. My second was a vbac attempt +preeclampsia +OP +failed induction. I feel like I’m being judged when I talk about it, but I know a lot of it comes from my own negative feelings about both births.

DH: I always feel bad for mothers with pre-e that really puts them between a rock and a hard place.

AF: Pre-e puts you into a high risk pregnancy which can usually be managed effectively by an experienced HCP. I don't see the "rock and hard place" unless a woman has a problem with managing a serious condition properly.

AS: No. The only people I tell my story to are friends, family, and coworkers, and none of them are judgmental

MF: Yes - but it never matters - for it hurts more not to tell people about Finley (her baby that died). And with Toni-joi's I am the one that judges the choices I made.

APH: No, but it's not something that comes up these days. My baby is 17!

SM: Often. I don't care much. I still share.

DRS: I had a c-section because of breech position with my daughter, and felt judged before I (had the) birth, with all the advice on how to flip her, being 4'10", it was unlikely. With my son I fought hard for a VBAC and had a hospital delivery, went into labor naturally, but had an epidural, he aspirated meconium so was in the NICU for 5 days. After that experience I could care less about judgment since I fought hard to do my bet for him and he is now EBF and healthy!

EEC: Well, I had C-Sections, so yes.

SWM: It depends who I tell it to....

MM: Every time.

EG: No, but I try to frame the stories for the audiences. I've had an induction-epidural hospital birth, a narcotic hospital birth and then two homebirths. I can relate to almost everyone!

JB: I no longer tell my story, bits and pieces yes, but not the whole thing. I no longer share it because my trauma has grown into love for myself and my journey. Am I still pissed about parts of it? Sometimes. When I did share my story a lot I felt my own self judgment the most. When I hear other birth stories, as I have learned to love my own, I have learned to love and accept their stories. Before I processed my journey, I judged others as harshly as I judged myself.

GS: Yes.

LSL: After my first Hypnobabies birth I wanted to tell everyone how awesome and comfortable it was. I was laughed at and made fun of by main stream mom friends and got the attitude from my natural birthing friends that I wasn't one of them since it wasn't a painful experience. I had another pain-free hands-off  Hypnobabies birth a few years later and I still don't share that story unless I know someone well.

SB: Yes and no. Those people who hate homebirth or are anti-midwife judge me for having di/di full term twins at home. Everyone else thinks it is great, including me and my family.

NgM: Here I am talking about not judging and my first thought about your birth, SB, is “No way!” I don’t hate home births nor am I anti-midwife, yet I still question your smarts in birthing di/di twins at home. I wonder if you’ll change that viewpoint over the years as I did my UC birth. How much judgment was in that comment? Bad, Barb… but being honest.

TR: Yes all the time. I had an emergency c-section and our baby had to be resuscitated. Since then I've had 4 more sections. I just don't offer that info anymore.

KS: I've come to peace with my first birth that led to a c section, the other 2 I feel went exactly as they were meant to, and the interventions that happened were needed - I managed the timing of them and never felt out of control. I don't feel judged at all when telling my stories.

AB: A lot of people think that I'm insane for homebirthing.

LA: Knee jerk: uh, no. Thoughtful answer: it depends on who I am talking to. I never feel judged about my hospital birth, my unassisted home births (some planned, some not) tend to leave jaw drops from most, and inspire horror from most medical professionals.

KDK: No. But I generally don't share in a judgmental atmosphere and I'm confident and unapologetic about all my births from my C-section to my storybook VBAC. Usually I get FAR more judgment surrounding the number of births I've had vs. the kind of births I've had.

RAJ: Yep.

AN: I find that the only people who really ask are the types that want to judge. I had an uneventful unmedicated hospital birth so it usually passes without judgment from either the NCB camp or the mainstream camp.

EWC: Yes frequently, especially my first.

SC: I only tell if people ask. The only people who ask are the ones who either really love me or really love births, or both, so no, no judgment. I do sometimes mention to others (especially mamas expecting their first) that I had a really easy, short labor and delivery... I leave it at that unless they ask, but I think it's nice to hear positive, non-scary stories, since people mostly hear the bad stuff.

MH: I don't share my birth stories mostly. Very few know them.

KS: Yup.

MM: Not in real life, but on the Internet in most birth related groups I often feel like I need to add a disclaimer about why my inductions were 'necessary'. The judgment doesn't bother me (it's people on the Internet for goodness sake) but I do hate that I find myself trying to justify irrelevant aspects of the events that gave me my three beautiful sons.

HH: There is nothing better to start the conversation with "I've had 5 sections." to be judged.

DH: At times, yes, (depending on who I tell it to) - like I was stupid for taking such risks (VBAC and attempted VBAC that ended rather dramatically - but safely - in a cesarean). One person, a dad, actually, asked me, "So, you had an emergency c-section?" I told him, "That depends on who you ask." I'm not sure he knew what to think.

LW: Yes, in the best way possible! Judged as a WINNER!

AMJ: Yep. Homebirthers seem to think I shouldn't have transferred (for prolonged first stage/swelling cervix/length of time since waters breaking), and non-homebirthers seem to think I should have just been in hospital all along….

TP: I think you showed courage and common sense.

MC: I'm judged more as an activist because I was a failed induction c/s... like the attitude is "who are you to be on a soap box when you did this"

ST: Yep.

BR: Always.

KW: Nope and I'm especially proud of my unassisted birth.

MB: I couldn't care less if someone else wants to judge me!

ALB: Yep.

NgM: I remember the first time I felt judged. It was by my future Bradley class (a group of us were in an exercise class together) and I had just told my hospital birth story, showing the pics and everything. It wasn’t right away, but when I realized these were natural birthing women, I asked how they could stay quiet about my birth and they said they knew I would eventually figure out the error of my ways if I hung out long enough. I was so embarrassed. I’m angry that I felt that way now; one should never be ashamed of one’s birth story.

I was totally judged for my Unassisted Birth (no more than by myself nowadays), thought I was crazy for doing what I did. (I concur.) The third birth (a car birth) was always told with such humor, no one could possibly judge any part of it, even though I wasn’t home birthing (membranes ruptured seven days before labor started… oh, is there judgment there!?). I also didn’t care what anyone thought, so wouldn’t have noticed judgment if there was any.

What can we do about judgments with birth stories? Is there a way to change the culture from one of “How could you do that?” to one of “How great that you did that!” – no matter what kind of birth it was.

Notice how many women said they judged themselves. What kind of culture exists that causes a woman to second-guess her birth? Why can’t the birth stand alone, without a comparison or contrast? Is there a way each of us can phrase comments that don’t make it sound like we are judging? Can we just state: “from here on out, there will be no judging and the assumption is there is no judging” so we can just go on, women feeling safe to tell their stories? That’s what I’d like to see.

And then there’s the compulsion to judge women’s births. We need to nip that urge, too, before it smears its ugly self all over a woman’s story. How do we re-program ourselves to not think, “She shouldn’t have x, y, z, but should have a, b, c instead.” Is it human nature to judge? I’d love to ask a sociologist! But, even if it is inborn, there are ways to de-program those thoughts so we don’t hurt those we’re talking and listening to.

Can we just listen with an open heart? Hearing the woman’s story for what it is? This is what I propose. That we suspend our thoughts and judgments so we are able to listen, really hear, what the person is saying as she tells her story. So many of us know what it feels like to be judged, imagine what it would be like if we all took the time to be in the moment with the story, not second-guessing or re-creating it with our own prejudices. Wouldn’t that be awesome? I say we all start doing this now and encourage those around you to do the same. Judgments suck, all the way around. So let’s eliminate them and allow women and their births to just Be. As they are. Beautiful and powerful and awe-inspiring, no matter how they unfolded. Or difficult and painful and achingly sad… if that is how the birth went. Allow the experience to be what it is, no matter what. What kind of world might we create if we were all able to let go of our judgmental selves? I believe a rather nice one.

Eliott was born at 9:27pm on March 18, 2013, the midwife Lauren doing the delivery. As he was born, his cord was clamped, then cut, and Lauren placed him in the blanket I was holding. I started to put him in the isolette… a habit… but then immediately said, “I’m going to hold him” and walked to the rocker and proceeded to hold him for the next hour, rocking him the whole time. 

When I got him, he was so warm from Meghann’s body and I held him close until the only warmth left to feel was my own. Then I held him closer, wanting to keep him warm. I looked at him, described his body to Meghann and Brian and they chose not to see him at the time. Meghann ended up not holding or looking at him, but Brian did see his body, from the neck down. No one but me saw the head, which, to me, looked like a bunny. Meghann said she wanted to think of him as a bunny, not as a deformed baby. I understood. Brian held his son after I’d been holding him a little over an hour. 

Before he did, I went and got a warm washcloth to clean Eliott of the little bit of blood there was on him. It felt ritualistic to me, bathing the dead. I gently washed his little arms, his back and then his long, thin legs. I wrapped him in the ultra-soft blue and brown blanket Meghann brought for him. He was ready for Brian to hold him. Brian sat on the end of Meghann’s bed, crying softly over his son. It was a tender and precious few moments. 

Then the Pastor and his wife came in… family friends… and then Brian’s mom and sister arrived and then Linda, Meghann’s “cousin” came in. As soon as everyone was assembled, the Pastor said some beautiful words about Eliott’s birth and death and how he would forever have an impact on us. After that, Linda continued with a lovely prayer, referencing Meghann’s grandmother who’d passed and whose name (Jacoba) was reflected in Eliott’s middle name of Jacob. Most of us cried through the lovely sentiments. 

After the prayer, the Pastor and his wife left, the rest of us spending time together, my holding Eliott again until I passed him off to Brian’s mom, so she could hold her grandson, too. 

It was a long time before Brian was ready to see his baby and when he did, I set Eliott up so you could see his body, but not anything from the neck up. His body was perfect; it was his head that wasn’t normal. Brian, Jenny (his sister) and Linda came in and I introduced them to the sweet baby. After a moment, I excused myself, as did Linda, so Brian and Jenny could have some time alone with the baby. Jenny came out, too, giving Brian some time with his son. 

After they were finished, I did the newborn procedures with Grace, the RN, in a room off the patient room. We weighed Eliott and he weighed 1.7 ounces and was 5 ¼ inches long. Very tiny. We did foot and handprints on a Memento Birth/Death Certificate and then Grace did a Plaster of Paris of his hands and feet. The whole time, I talked to him and let him know how loved he was and I moved him when he needed to be moved and did the footprints myself. I also got a thumbprint of Meghann and Brian on the paper. Their thumbprints were much bigger than Eliott’s feet. 

Grace gave Meghann and Brian many gifts from an organization that gives clothes and toys to grieving parents. Meghann decided on one knitted sock to put Eliott in before he left them and wrap him in a white blanket. Up until that point, I’d wrapped him in the beautiful brown and blue blanket Meghann had for him… soft as could be. Meghann and Brian also had a bracelet that had Eliott’s name as well as a little stuffed penguin that I kept wrapped in the blanket while we all held him. I had put the blanket he was born into away so we could take it. I also took the cord clamp he had on for awhile. Meghann’s keeping the bracelet, penguin and blanket as well. 

I left about 4 hours after the birth, leaving Meghann and Brian alone for the first time since we got there that morning. They were ready to be alone with Eliott and I was ready to go lay down.

It was a beautiful birth. I loved holding my grandson, looking at his bunny face and perfect body. It was such a privilege to be with him as long as I was able. 

I’m at peace today. Feeling better than in the last week. I will miss sweet Eliott, but am glad to have the experience behind us. It was something no mother should ever have to go through.