Pressure to Have the "Perfect Birth"

[Schmickers]

I second what Tobily said.

I agree that it is important to keep an open mind. Caesareans save the lives of mothers and babies, there is no doubt about that. But you may find that those who do put pressure on you to have the "perfect birth", or even just a natural birth, are coming from a background of their own traumas and difficulties, and may simply want to save you from similar heartache.

We also live during a time where many ideas that have for several generations been held as "truths" by the obstetric profession, are starting to be questioned. Caesarean rates of 30% just do not add up in a species robust enough to take over the planet like we have! Research is coming out now that shows that babies that are born via caesarean are much more likely to die during the early days of life than babies who are not. As a result, as far as giving birth is concerned, we live in "interesting times".

Please, let me clarify, that as I said above, caesareans save the lives of women and babies. But this is only when they are used for appropriate medical reasons. The risks inherent in a caesarean birth are becoming more well known and it is important that before you make the decision to have a C/S, even in an emergency, that those risks are weighed up against the risk of continuing to have a natural birth.

The other reason that many midwives, doulas, and obstetricians are now encouraging women to do all within their power to aim for a natural birth is that there is a well-recognised phenomenon known as the cascade of intervention. It means that even small interventions at the start of the pregnancy or birth process can snowball into more and more serious interventions, as the complications of one set off the need for the next, eventually ending in a caesarean which could have been prevented if the initial, minor interventions had not taken place.

Do I believe that the obstetricians of the world are somehow complicit in promoting this state of affairs? No, I don't. what I do believe, is that they really shouldn't have much input into a normal pregnancy and birth in the first place. It's not what they are trained to do. OBs are trained to intervene surgically in an abnormal pregnancy or birth. Even the best OB has that background - in abnormal pregnancies and births - to fall back on. And so they favour intervention, because that is what they are trained to do.

When the only tool you have is a hammer, every problem begins to look like a nail!

In reality, midwives, who are recognised worldwide as being the experts in managing a normal pregnancy and birth, are the most appropriate people to manage a normal pregnancy or birth.

So you may find the reason so many people harp on about this whole natural birth thing is that the benefits of it are only now becoming well known. We have been brought up for generations to believe that birth is dangerous, that it is painful, and that the best thing you can do for yourself and your baby is to get an OB and go to hospital, when research is showing that the opposite of each of those statements is true. And because women (and *ahem* men) in the developed world don't necessarily know that, those of us that do are really keen to try and spread the world - for your sake, and for your baby's.

So, try to cut us some slack. We're not criticising the choices you make - honestly, we're not. We just believe that you have the right to make those choices after being informed, and we believe that many obstetricians may not adequately inform you, because they have a basic lack of understanding of normal pregancy and birth, because it's not their job.

Hope this clarifies.

the best feeling about having my own OB this time around was that I could let him do the worrying for me, I got a lecture on how birth is an empowering experience for women and that I was letting the OB take this away from me!!

I don't think the idea of being empowered is that you have to worry about birth. I think that it is that you have the opportunity to trust in yourself and not worry. But in support of you, the best thing about having an independent midwife was that we could let her do the worrying for us, so I understand exactly where you are coming from. I just hope he doesn't turn all of your problems into nails...

[doulacara]

Well said Schmickers and Tobily

I may well be a natural birth nut trying to impress her ideals on others.

I am one of the great number of women who went to hospital the first time believing that everyone there would have my best interests at heart.

No one told me when I asked for an epidural that I just halved my chance of being able to push my baby out unassisted. When I resisted the use of forceps, I was threatened, yes threatened, with a c/s if I did not agree. No one told me that forceps required me to have my legs in stirrups and an automatic episiotomy which took 2 months to heal. In fact, I didn't even know I had had an episiotomy until I was being stitched up.

Importantly, no one helped me cope with labour or made me believe that I was capable. I was given drugs as soon as I asked for them and told it was a good idea. What I really needed was someone to get me through the hard bits with support, not drugs. I just didn't know beforehand that I would need that. I thought that is what the midwives would do. I was unlucky that day and was assigned one who liked epidurals.

Do I think there is a conspiracy, not necessarily. But I do believe that the very nature of obstetrics sees birth not as a normal function with great natural variability that is celebrated, but as a potential tragedy that should be feared.

I also know that much of obstetric practice is not evidence based. Take, for example, the Electronic Foetal Monitors. There is no evidence that their use improves outcomes at all, but it is standard practice in most Australian hospitals to use them. The biggest contribution EFM has made is increasing the c/s rate.

So I guess I am one of those women, and I carry my birth baggage around with me - and I wish I had met someone like me before I had my first baby.

[butterfly*kisses]

Thank you for sharing your passionate knowledge and experiences doulacara.

As a mum of 3, all delivered by C/S - I would like to say that with my 1st I was cared for by a "Community Midwifery Team", due to my wish for a completely natural delivery. Sadly, I now know that my 1st C/S, that was put down to "Failure to Progress" was infact due to Cephalopelvic disproportion. We nearly lost our first bub due to my absolute desire to do it all naturally, and the "Team's" support of my desire. We went through 3 shift changes of midwives - who were all very busy. It was my mother who ultimately chased down the midwife to alert them to serious drops in bub's heart rate, and a serious emergency followed.

This was all ultimately (with the power of hindsight) unavoidable.....except for the fact that at no stage did any of the "Team" think to have my pelvis checked. Maybe this is not a routine procedure - but a friend of mine (with tiny hips) recently told me that her OB has a 'rule of hands & feet'. He surveys the size of the woman's hands and feet......small hands and feet = potential small pelvic inlet. With size 6 feet and child size hands, I could have used this wisdom.

I feel that the 'push' (no pun intended) for completely natural delivery was the catalyst for me nearly losing my precious son - when he was NEVER going to come out the conventional way - no matter how much I wanted a vaginal delivery.

I believe that the serious decrease in the infant mortality rates(at birth) is attributable to medical 'intervention' and monitoring. Yes, C/S rates are up too - but what proportion of those would have ended in tragedy for bub and/or mum anyway? I am most certainly in that category.

PS - I am very particular about making my children understand that C/S is not an alternative birth, rather an emergency situation. I hope that my daughter will delivery naturally when it is her turn.

I am sorry for my convoluted reply, but I keep getting distracted by 3 little pesky redheads! lol!

[BellyBelly]

I think the people who feel 'pressure' to have the perfect birth have to work it out within themselves. It's not the fault of anyone on BB or whatever - if someone is unfairly pressuring you then you are hanging around the wrong group of friends. You need to join a cheersquad of those who have the same aspirations as you, and will encourage you. I want a homebirth next and I feel no pressure, because I know I can do it, I have had a drug free birth before, within the hour of getting to the hospital (whats the point of the trip? I had no complications and felt NO pressure). I know I may need to transfer. So as long as you have a balanced view, know both sides of the fence, have educated yourself appropriately and have good support then who cares what people think, seriously... nothing in life is perfect, some of us are perfectionists, some not.

Midwives are the experts in normal birth. Obstetricians are not. They are experts in complications, they are surgeons, and as they say in the BOBB, they should be doing surgery, all day, everyday because that is what they are good at. They don't know how to do normal birth and it belongs to midwives, who have been turned into servants of the system with no power, insurance... it's like saying, lets replace all GPs with Ear, Nose & Throat Specialists incase those people with a cold get pneumonia.... overkill. Everyone has the right to choose and I am all for it, but there is lack of basic understanding here, and women wonder why they ended up with inductions, epidurals, forceps, infections post birth, PND.... just another thing to think about. Too confronting for some people to even consider. I would engage an obstetrician ONLY if I was genuinely high risk.

As a Birth Attendant (doula) I know there is a major problem at the moment. There is no regulation (which would be controversial anyway) and there are lots of trainers who teach different methods - online, offline, short courses, longer ones and I feel there are some major problems all round. They should NOT bring their own baggage into a birth and I do get very angry at some things I hear and see. There are good doulas out there, go on recommendations from friends - even BB members. Lots of my clients are word of mouth and thats how it should be. I heard yesterday one doula said on a public forum that she wanted to slap the mother for listening to the Ob. She is waaaay out of line. Keep looking, great doulas are so worth it.

[Georgi]

I do not believe the intent of this forum was to get opinions on natural v's medical intervened births. Sophiebear was wondering if anyone else felt this same pressure, not if everyone can give their opinions.

My reccomendation to you Sophiebear is that you should educate yourself on the birth process & try to be as well informed about labour as you can be. When discussing labour & birth with people, tell them you are preparing to 'go with the flow' & see whether you will accept pain relief/intervention once you have hit that stage. If you are well informed & educated about labour & giving birth, then you should be able to 'play it by ear'. Hopefully that will avoid the heated discussion about natural v's medical intervened. It is your choice, but you should make an informed choice.

[Natty]

Perfect Birth = Happy/Healthy/Well Baby + Happy/Healthy/Well Mum

It doesnt matter how your baby comes out the thing that matters most is that you and your baby are well, happy and healthy.

With my DD I thought 'nope no drugs'. After ten hours of oxytocin induced contractions (need it as BP was too high to wait any longer and it was MY choice - my Obstetrician advised not ordered it and final decision was mine) ravaging my body from ten minutes after they put the drugs in and only dilating 1cm, I decided to have an epidural (I am allergic to pethidine and pass out on gas) and I couldnt handle the pain anymore. I am very grateful that I had a qualified Obstetrician who came in and delivered my beautiful daughter who is totally unaffected by how she came into this world. I cannot praise enough the wonderful midwives and my Obstetrician who let/enabled ME to make the choices, who encouraged me, who kissed me and hugged me at the end and in total, respected my wishes as a birthing mother.

Doulacara - I am sorry you had a negative experience with an Obstetrician but not all of them are like the one you experienced. I cant agree with you when you say "But I do believe that the very nature of obstetrics sees birth not as a normal function with great natural variability that is celebrated, but as a potential tragedy that should be feared." My Obstetician and midwives celebrated my birthing process with me, encouraged me to make my choices and as a result of my very positive experience in a large Hospital environment, I no longer have any fear of giving birth the second time around.

As for me, with this little baby growing in my tummy, if I need drugs, I wont wait so long this time, if I need a c/s then I will have one (although from the huge amounts of reading I have done it would need to be a strong medical reason for me to have one - but that is MY choice).

There is no definition of a perfect birth. Each individual has the right to choose. One persons experience may not necessarily suit another and we have to respect every body's right to approach their pregnancy, birthing and parenthood in the manner in which they see fit for themselves. So come on ladies, stop pressuring each other and let each individual decide for themselves what their OWN perfect birth will be.

[PenStealingPoltergeist]

I also have felt the presure of those who feel they have had or want to have the "perfect birth". I have found some people incredibly insenstitive to the needs of others and I'm sure mums who want a natural birth feel the same way, as everyone recieves ridiculous comments at some stage from people, who are commenting on something that is none of their business.
I got a great birth the second time and it was a planned CS. This birth restored my faith in Ob's and made me want to have another.

[Trillian]

I think it is not so much that the 'natural birth nutters' are forcing their opinions on you, but that they had such a great experience they want to shout it from the rooftops and want other women to experience the rawness of natural birth that they did.

But the perfect birth will be different for everybody, and as it should be too. we are all individuals and so to will our births be individual to us and to what our needs are. A perfect birth may not always be one that is drug free, or intervention free, but my definition of a perfect birth is one where you feel empowered, and strong and that you are one with your birthing body - I am woman hear me roar type stuff.

Butterfly Kisses, I think you will find that none of your caregivers checked your pelvis because true CPD is such a rare thing. The correlation of feet and hands is a furphy - it may prove true in some cases but it would be coincidental and not based on actual physical size. There is a great thread that Kelly posted with links to a homebirth midwife site and these women are TINY and they all birth vaginally, often without a tear.

[paradise lost]

I had a homebirth (NOT drugfree, i used the gas and air for an hour or so AND i had the sintocin for the 3rd stage) and i copped it from all sides. I am really scared of hospitals and the medical research and factual evidence told me that i was as safe at home as in hospital so long as everything was normal. I had no reason to think it wouldn't be normal so i went ahead.

For ME i had a perfect birth.

I was changed by a profound experience of personal strength and power and satisfaction. Everything about me is different. I lost 20kg after birth, began running and hitting the gym, left my broken relationship, i was truly empowered and instead of saying as i had been for years "can i?" i began yelling "i CAN!" and got out of my life's rut pronto. My DD and i got off to the best possible start and so many challenges and issues since then i have been able to meet head on because i really really believe in myself and my capabilities. My body feels better than ever before (i'm even more orgasmic) and my sex drive is through the roof.

If another woman had to have a c-section to get those feelings and that outcome then i think she should absolutely go for it, i just HAPPEN not to personally know anyone who had that outcome from a surgical birth. Of COURSE there are births where women and babies will DIE unless a section is performed, like those with placental abruption or praevia or those who have CPD and have been pushing for 3 hours with the baby still not even engaged and getting distressed. But i don't advise my friends (who have ASKED for advice, i will discuss if asked and advice if SPECIFICALLY asked, but don't tell pregnant women on buses to have homebirths just because i did) on the worst possible outcomes. It's like someone asking for a tissue to blow their nose and you telling them, with the tissue, what to do if they blow and have a haemorrhage from a sinus artery!

You can only get your own perfect birth. The chances are that for many many women my idea of perfect won't fit, but if someone asks i'm not going to say i think they should go into hospital and have a ton of drugs and surgery because in MY experience, the ONLY experience i have, homebirth works and feels fantastic. If they have medical issues which require immediate intervention to save their life or their baby, asking a friend what to do is madness.

Someone saying that being told how they could have avoided their outcome is annoying worries me a little. If you had an unhappy time wouldn't you like to know how to avoid it next time? Or are people really replying to "I had a wonderful beautiful birth and i'm really happy with it" with "here's how to have it better next time.."? If someone asks me about an injury they got exercising and i know how they can avoid it next time i ABSOLUTELY tell them, because i don't want them to keep getting hurt when it's avoidable. I think it was Einstein who said the definition of madness is doing the same things over and over and expecting to get different results.

[myboysmumma]

You can only get your own perfect birth. The chances are that for many many women my idea of perfect won't fit, but if someone asks i'm not going to say i think they should go into hospital and have a ton of drugs and surgery because in MY experience, the ONLY experience i have, homebirth works and feels fantastic. If they have medical issues which require immediate intervention to save their life or their baby, asking a friend what to do is madness.

What an insightful post. With my original post, I was referring to those who berate and treat women who have made different choices with disdain; assuming ignorance because they made a different choice; hey they must have been ill informed! I have had more than a few uninvited discussions like this recently I found it particulary strange as I actually had a vaginal delivery - I just support the power of choice.

Great post!

You can only get your own perfect birth.

[sushee]

The hand and feet thing is, like Trillian said, a furphy. My mother birthed 4 children drug-free, vaginally, one 7 and a half pounds, and she is 5ft and has size 4 feet even after having had all her kids.

I am 5ft 4inches and had size 6 feet - 4 kids born vaginally, including an 8lb 1oz and a 7lb 14oz. My feet have gone up a size though since having my kids.

My sister is 4ft 10 inches, 48 kgs and size 5 feet, and has 2 kids birthed vaginally too. With her 3rd child, born in Australia, her ob told her she wouldn't be able to birth vaginally because she's too small and convinced her to have a c/s! He completely glossed over the fact that she has birthed 2 children vaginally previously, so obviously wasn't too small at all. She hated having a c/s, was sick for weeks, and regrets not having tried a vaginal birth again.

According to some ob's perceptions of the size of feet/hands and size of pelvis correlation, none of the 10 kids between us would have been able to be born vaginally, yet they were!

[butterfly*kisses]

Just to clarify, my original comment was "small hands & feet = potential small pelvic inlet.

Further, I am average height - with proportionately large hips - so it was all a HUGE shock that my "great birthing" hips were infact USELESS!

I would love nothing more than to have a natural delivery - but alas.

[Mumma2three]

I just wanted to pop in quickly and give my experience. DD1 was 12 hours, hospital birth. I begged for the epidural. They were actually trying to persuad me otherwise (just think about it a bit longer etc). I found the whole birth very satisfying and as the epidural was turned off at the end, I still had full feeling. I found everyone involved was fantastic (OB and midwife). I didnt' need forceps or anything and I had no problems after neither did bubs.
DD2, was a very quick birth at hospital (1hour 54 mins entire labour) so there was no intervention. I had two midwives (no OB ) whom I'd never met, and they were just AMAZING. I truly believe they were sent to me for a reason, they both were the best. One was male and I had heard there were two men there and leading up had not wanted a male, but it turned out the be the best thing, he was LOVELY and SO calming!
So for me, 2 hospital births (very different to each other) were both very rewarding experiences. I do believe that no matter where you are it can go either way. I just felt comfortable knowing there was medical staff on hand if needed. Also this was at a sydney hospital that's coping alot of grief lately, but I can't complain at all. xo

[Trillian]

Butterfly Kisses, I know you said potentially small inlet, but I just wanted to clarify for someone reading who may take that at face value kwim? But then again a small inlet can still birth a baby. I remember a comment I had written by my Dr on my yellow ante natal card with my first baby and it said "outlet not unduly large" - lovely comment I thought, but what does it really mean? It may have been smaller than an 'average' sized outlet but it did the job for me perfectly, I vaginally birthed 4 babies, 3 of them quite large ones so it proved to me that size if often irrelevant and you can't possibly know how well your 'outlet' will serve you until you are in the throes of labour.

Sorry to go off tangent there everyone, just following the course of the discussion.

[satya]

I didn't feel any pressure to have a natural birth. I always planned to go with what the midwives and doctors said and that's what happened. I have had a number of people ask if I had a "natural" birth, but they were meaning a vaginal birth, not one without drugs.

I always intended to use gas & an epi, but ended up using gas & peth (forgot to ask for an epi and they didn't offer it). How and why anyone would want to go through labour without drugs completely escapes me.

I don't believe that doctors have an agenda. I laboured for 17 hours (and had about 12 hours of pre labour) and the doctor only got involved after I'd been pushing for almost two hours. Lucky he did as I had shoulder distocia and my bub probably would never have come out without the use of syntocinin and the ventouse.

If anything I think those around me IRL have a certain kind of respect for me having gone through such a long labour and not having had an epi (silly cos it wasn't my choice) and for also having avoided a c section.

Personally I think whatever it takes to get a healthy baby is what you have to aim for, regardless of other peoples opinions. It took me 14 years to hold a bub in my arms so I would have gone along with anything that was suggested.

[Smoke Jaguar]

To burst a bubble - of course doctors have more than just your best interests at heart! They have time schedules, hospital policies, Medicare, AMA agenda to consider in what they do, don't kid yourself! I'm not saying they are bad - they definitely have their place in births that present complications (complications that are not induced by the system itself, that is, as well as complications generated by medicalisation), I'm just saying that they are not independent entities in white armour seeking to make every birth trouble free. OB's are trained for complications - they don't need to see women who are free of complications because those women don't need their skills
It doesn't really matter how long you've been waiting to have a baby, every mother I know wants the best for their child. Because I very much wanted my baby, I was not going to go along with what someone in a white coat or a list of medical qualifications told me. Doctors are fallible, too. I do not revere someone with a tertiary qualification or 6!
I'll enlighten you about drug-free, Satya. At no stage was I in 'agony', nor was I ever afraid of what was happening in my body. I looked forward to my son's birth from a very early stage in my pregnancy and put complete faith in my body's inherited wisdom to do so. I wanted to be completely present for him when he did arrive, giving us both the best chance at establishing breastfeeding. We knew what the effects of pain relief were on the baby and decided that we didn't want anything to cross the placenta - I wanted him and me as lucid as possible. I knew that there are more risks involved in medicalising normal birth than by letting my body birth naturally, and for these reasons, drug-free was my only option. And it was beautiful - not only the result, but the whole labour and birth process, as well as the end result.
Look, if women want to believe that their birth requires medicalisation, that's up to them. What I really resent is the 'recruitment' drive that these women embark on. It is these women who harp on about how you 'don't have to be a hero', 'take the drugs', 'will be in so much pain', and think that because that's how they think, it must be this way for other women. So many women are all too willing to believe that this is true. I don't know why! If someone told me that birth could be magical and wondrous and someone else told me it was horrific...why would you want it to be horrific and thus prepare for horror, pain and trauma? It makes absolutely no sense to me. If you don't have to place yourself under medical care (that is, if you are not a high-risk pregnancy), then why would you? And why try to disempower others by telling them they are foolish for believing it can be a great thing? And yet this happens everyday - to women by women who are supposed to be their friends
I would rather be the woman some people think are mad for believing birth to be orgasmic, than the woman who cuts off at the knees another woman's aspirations for a peaceful birth by being negative and advocating subservience to a doctor where it's medically unnecessary That's just me. I don't sell myself short

[soniebon]

At the end of the day i dont care how it happens as long as it happens safely and without too much pain and that im ok,baby is ok,everyone healthy and someone there to scrape hubby off the floor,if by chance i have to have a C/S then so be it,if i have natural i will choose an epidural,at the end of the day it is your body and your choice and any successful birth is positive powerful one..and nobody can tell you whats right for you,everyone is an individual,i think so many people forget we are just that,individual..just my 2 cents
bon

[meow]

Speaking for myself I know what an amazing experience I found it to be very present, in control and drug free for the birth of my son so I do try and share that experience for others in the hope that they will not be scared of giving birth and discover the experience they can have without interventions.

That said, I would never actually pressure a person to go that way and I don't scorn people who don't choose to (or medically can't) birth the same way I did. Perhaps your friends are just hoping to educate you on the over medicalised industry in the hope of a great outcome for you? Obviously whatever you want to do is the right thing so long as you are making informed choices.