Sunday, 30 October 2011

Natural birth vs Caesarian

As James approaches his thirteenth birthday, I've been thinking a lot about birth.  Today I see in the News that  women will be able to choose whether to give birth naturally or via Caesarian. It made me remember a piece I wrote over twelve years ago after my son James was born – unnaturally.  I read it back and found a whole pile of anger rising up - even after all these years.  Because we still judge women on the way they give birth. We still judge women on breastfeeding.  We still judge - full stop. Anyhow.  This is what I wrote - for the Daily Mail if I recall - all those years ago.  And I wonder, I really do. Has anything changed?  

"The operating theatre lights were glaring as my baby was born.   The surgeon was laughing about football and the radio was blaring some loud rock song.   I had been pumped full of every drug going before having a six inch incision carved into my belly.  It was about as far away from natural birth as you could imagine.   Yet I wasn’t complaining for one moment.
This might come as a surprise to people who have read my features and books on natural health over the years.  It certainly came as a surprise to me.  When I discovered I was pregnant I automatically assumed I would give birth in a pool in a room lit by candles scented with aromatherapy oils.  I would use my yoga breathing and engage in the full primal ritual of pushing out a baby the way women have since time immemorial - without the help of doctors and drugs.  Then I would take my baby to my breast - no nasty formula milk for him.  So what happened?

In our NCT class we all merrily dismissed the pain-free options - epidural was virtually a dirty word.  Pain management was the name of the game.  But at 4am when I was being induced with Prostin pessaries (a hormone designed to kick off labour) I needed more than a back rub.  The pains were fierce and unrelenting.  I hadn’t slept for over 48 hours and was sobbing with exhaustion.  And this wasn’t even labour.  When the night duty midwife asked if I wanted a shot of pethidine to help me sleep I virtually kissed her.  Within five minutes I felt a wonderful lassitude seep through my limbs and into my mind.  I slept.  Drugged up to my eyeballs.  Bliss.
After my second night of misery ended again with pethidine, I decided that enough was enough.  I wasn’t going to be a stoic any more.  I was going to flush my principles down the toilet and chicken out.  I ordered an epidural.  “Sensible girl,” said the midwife.

Labour was interesting.  I lay in bed strapped up to a drip, wires hanging all over the place while Adrian and I watched television or, for a change, watched my contractions as they appeared on the monitor. The epidural wore off twice - and I coped.  But at no point was I tempted to say “Forget topping up the epidural; I’ll go it alone.”   After fourteen hours the obstetrician said we had a problem.  My baby was in a posterior (back to back) position and seemed stuck.  I wasn’t even going to be able to give birth through the natural channel - we were raced off to theatre and James was born by section - at a whopping 12lbs 8oz.
The whole experience made me think long and hard about natural health and childbirth.  At first I felt guilty.  As if, by opting for a pain-free birth I was somehow letting down the side. Virtually every book I had read insisted that natural childbirth would empower the woman and be of enormous benefit to the child.  Yet I have never felt as unempowered as I did when I was writhing in pain.  It wasn’t “good” pain.  It just hurt.  I felt weak and miserable and desperate. 
The more I thought about it, the more I pondered whether we haven’t lost the plot a bit here.   I wonder if we are, to coin a phrase, throwing the baby out with the bathwater. Yes, women were designed to have babies naturally.   But if we follow that argument we would have our teeth drilled without anything stronger than a whiff of neroli oil.  We would breathe our way through surgery. 
Don’t get me wrong.  I’m not saying all women should have high-tech births. But I feel we all need to be far more open-minded, to drop the dogma which has grown up around childbirth.  I am concerned that there is a fanaticism springing up about natural health - a kind of “all or nothing” approach.  Nature is good ergo science is bad.   Nature is good.  I had a huge range of homeopathic remedies following my section and needed very few analgesics afterwards. But science is good too.  If I had given birth “naturally” at home on Exmoor it’s possible that neither James nor I would be here today.   In an ideal world conventional and complementary medicine work hand in glove - they should not be at battle with each other.

The dogmatism extends to breastfeeding.  I never even thought about it until James was born.  I would breastfeed and that was that.  Breast is best.  End of story.  Except James would not breastfeed.  He took one look at my nipple and screamed.  I joked that he’d probably had a bad experience with breasts in a past life and didn’t worry too much.  The midwives all said he would take to the breast - give him time and his hunger would persuade him.  Except it didn’t.  The days passed and as each new midwife came on duty she would take her turn in trying to fix him on.  Each one came in with a look that spelled quiet confidence - she would be the one to latch on the problem baby.  Each time they tried and each time James shrieked.  I stopped making jokes and began to worry.  He started to get jaundiced and became very listless.  Eventually even the most confident midwives became concerned and gave him a bottle of formula.  He gulped it down in one, burped and went to sleep happy.

I felt terrible.  I scoured the books looking for advice or just plain comfort.  There wasn’t any.  “Keep persevering” was the message.  The implication was that there is no such thing as women who can’t breastfeed - only women who won’t.  And women who won’t are “bad” mothers.  I read over and over how breast milk and only breast milk can give your baby all it needs, tears streaming over the page.  I looked down at James, quietly (and very happily) sucking on his bottle and sobbed all over him.  He wouldn’t get my immunity; he might get allergies; he might not be as intelligent - all because I couldn’t (wouldn’t?) breast-feed.  Nowhere did the books tell you what to do when your baby just wouldn’t have anything whatsoever to do with your nipples.

My own community midwife was wonderfully supportive. She tried everything she could think of and then agreed I was fighting a losing battle.   “Don’t beat yourself up - you gave it your best shot,” was her sensible counsel.  But as I read yet another book I couldn’t find it in my heart to believe her.  Somehow I had failed.  

Once again there was no middle ground.  Yes, breast is best but what if you just can’t breastfeed?  Every time I took out a bottle rather than whipping out a boob, I felt the world was looking at me and quietly condemning me for not caring properly for my baby.
We’re caught once again by dogmatism, by the childbirth fascists who insist there is only one way to do things.  It’s a trend, says my health visitor (another great source of comfort), a reaction to the years when formula was fashionable just as natural childbirth is a reaction to the over domination of hospital and drug-based childbirth.  She reminds me that most of my generation was brought up on formula and that we seem to have coped okay.  I have stopped reading the books now.  I have even managed to stop feeling guilty.  Now I just feel angry instead.

I’m angry because, while well-meaning, the barrage of “natural is the only way” is putting women under terrible pressure.  It’s tough enough having to cope with pregnancy and childbirth in the first place without the pressure of having to do it in one “right and correct” way.  Of all people, I know the benefits of natural health but I really think we need to bring some balance back to this issue.  Natural births are great.  But so too are high-tech births.  If you want drugs, fine - have them.   Then use natural therapies to offset any side effects.  If you want a natural birth, go for it - but keep an open mind and if the pain gets too much, ask for pain relief and don’t feel you’ve failed.  Do try to breastfeed if you can - but if you can’t it’s not the end of the world.  Formula milks are now highly refined - most now do a pretty good job of imitating breast milk.  In fact, if the mother is not well nourished the baby might even do better on formula as they contain optimum levels of vitamins and minerals.  Many also now include the essential fatty acids which can improve brain function (and very few breastfeeding mothers include those in their diets).  

Birth is not a predictable event - every one is different.  So by all means have a birth plan but be prepared to be flexible.   That way you won’t be devastated if fate throws a spanner in the works.  Providing you give your baby all the love and the best possible emotional “nourishment” you can I don’t think it really matters how he or she is born.   Looking back, I don’t care that I had the drugs, the major surgery, the high-tech hospital birth.  My only regret is that I wasted precious hours, days and even weeks with my newborn baby languishing in a quagmire of guilt."   


Sessha Batto said...

The only part about childbirth that matters is doing WHATEVER it takes to have a happy, healthy child. The same extends to feeding - some refuse the breast, some refuse the bottle (Lurch did, so I ended up breastfeeding for a year, despite my plans not to as I was returning to full time work just 5 weeks after his birth). Everything I did seemed to piss off the doctors, nurses and every other woman in labor on the ward!! I've since decided that the flexibility demanded of you from the moment of birth is merely a warm up for the even greater flexibility you need to raise a well rounded healthy happy child. There is no bad way to give birth, just relax - believe me, the pain doesn't make you value your child more, and it doesn't make you a better person, it's what you do AFTER the birth.

zenandtheartoftightropewalking said...

Very, very true, every word of it.
I wont bore you with my birth story but it was similar, though somehow I made it through without a C section.
When we were at the vicar factory, where N trained,I was surrounded by women who actively attempted to make women who didn't do things their way feel small and inferior. I retaliated by extreme bad behaviour, which included an artistic conversion of the Tampax machine in the ladies' loos into a Durex machine complete with a fine print line that said, "insert baby for refund"under the exit slot. I wrote about the whole thing in a novel, yet to be published and when I read it, I still feel angry because it meant I could never have the 2nd child we'd originally planned to have.
I still get angry about it all and find myself wanting to hit people.
Painfree childbirth? is that the same as painfree toothache?

theotheralig said...

Nearly 30 years ago, I had an unexpected high tech birth - no caesarian but only by the skin of my teeth. My son was 3 weeks early and I had not considered the bottle. After a week in hospital it was clear my son, like yours was not up for breast feeding. I bottle fed him. My lovely GP threw the dogmatic and judgemental La Leche league fanatic out of my home when he arrived to check up on me and baby and found her browbeating me. My second child was breastfed for 13 months. I would never judge anyone for birth choices or babyfeeding outcomes.

Jezri said...

I remember so well my attempt to breastfeed and the terrible guilt that followed when I couldn't. I really hate when I hear statements about lazy, selfish mothers that don't breastfeed. My milk never came in. When I found I couldn't, I thought maybe if I pumped. I could bottle my milk and my baby would still get the best. No dice. You cannot pump what isn't there. It was the hardest decision to use formula. I felt like a failure and tried again with my second child. Still no luck. Finally I just realized it didn't matter. All my children are healthy and smart. That is all that matters.

Zoë said...

I did the pregnant thing 4 times _ did all the NCT brain washing too, and like you it was much too late by the time I realised what really mattered was a healthy baby, and a healthy me. I did the whole birthing plan thing, both were born in theatre, and my babies were running around on two legs before the guilt I felt for being such a useless women/mother began to lift for failing to breast feed successfully, or deliver naturally.

I should have realised as soon as these women started to compare potty training successes, and infant prodigy predictions that this really wasn't the way to raise happy healthy content kids, or to be a Mum.

Not sure I agree about elective C sections though - that really isnt natural and comes with its own hazards, which I hope women fully understand first.

catsyellowdays said...

I've had both types of births with and without analgesia (frankly both were pretty awful) and used both feeding methods and both boys are happy and healthy. The benefits of one over the other are so marginal that it's really not worth worrying about and they are certainly nothing to feel guilty or superior about. It's what you do over the next two decades that detemines whether you are a good parent or not.

Anonymous said...

yes yes yes yes yes! First child, placenta praevia 1st grade (or 4th? whichever's most dramatic and worse, naturally!)Literally No Choice, it's caesarean or die, we both die in a tide of haemorrhage. So I took the caesarean and had to have it 2 weeks early lest early labour prompt the haemorrhage (sp??) so the milk didn't come in and he wouldn't feed. And I'd lost 4 pints of blood in the caesarean as they'd cut an artery so I was weak and weepy and frail and pale and he was jaundiced and the NCT crew were giving me "you're crap" looks. And I tried breast feeding for 9 weeks, hired an electric pump and everything into the tube of which my poor ragged nipple shot desperately. Oh God. Next child, effectively first labour, 4 hours start to finish, twinge to birth. Out he shot. Bloody painful, pretty quick but he breast fed. For 18 greedy months. It was fab and SO much easier.
Yes, never judge anyone. You don't know their story, their sad rags of miscarriages, their failed attempts. Just what it is about the pregnant / new mother condition which makes everyone think they can leap in with a disapproving opinion I don't know. What's important is that the child is born, and loved and looked after.
12'8" BLOODY HELL! More or less both of mine added together!
(PS stupid blogger not letting me add this, this is milla!)

Ashen said...

I had a traumatic experience of miss-diagnosis in hospital during adolescence, so I was keen to have a home birth for my child. Coming from Holland to the UK I had to be assertive, but prepared myself psychologically for the eventuality of hospital ... if needed. I was lucky, my son was born at home. The midwife arrived in a police land rover, it being January and the narrow lanes in deepest Somerset were iced-over. Breast feeding worked, everything was ideal.I was lucky.
In my therapy practice I heard innumerable birth stories, many women felt dis-empowered, like being induced without good reason, merely for the benefit of a doctor's schedule.
Stanislaf Groff did interesting work on birth experiences, first cellular impressions, and it's easy to derive from this chart an ideal pattern (good attachment) for mother and child.
The way I see it, every child born brings along a need that is best served by a certain experience. Who are we to judge what this need activates? We can only do the best we can. The rest is up to a greater wisdom than ours. And like some here indicate, how we welcome and care for the child is what matters, if we have that choice.
I just wished incubators for premature born babies were better designed, more womb-like, responding to a baby's movements.

Midlife Singlemum said...

The one thing I can say that's fantastic about having your child aged 46 (and there isn't much) is the fact that I was old enough to have confidence in my decisions and not feel guilty or in any way a lesser mother for them. I chose to book a planned C-section, I topped up breastfeeding from the first day, we watch tv as much as we want, DD has a bath when I think she needs it, I am very laid back and trust my instincts. No one can make you feel guilty if you refuse to feel it.

Frances said...

Jeeeepers, Jane.

Think that my fullest comment will have to wait for an email, or that long longed-for opportunity for us to actually meet.

Snapshot comment is...I always wished that I could have child, never did, and it's way too late now. During all those interim decades, I have, however, had the opportunity to interact with hundreds of folks who are at least young enough to have been my children, and now grandchildren.

Not the same, I know as having a baby, but I do cling to the notion of having been the unofficial sort of god mother to so many youngsters, listening to them, not giving too much advice before I actually have had the opportunity to learn what their individual ears might receive.


Rob-bear said...

"I know when I'm in a room full of women, that the smart thing to do is keep my mouth shut," said male Bear.

But speaking ethically, you and your baby need to go with what works for the two of you. Don't let anyone tell you differently. (Tell 'em the Bear said so.)

Exmoorjane said...

Huge thanks for all your responses - which show, so clearly, that (as always) there is never a One Size Fits All solution. I'll shut up now.

Ashen, a very good point on the incubators...

Kim Curran said...

Great post, Jane. And should anyone need a reminder that the ONLY thing that matters is a healthy baby and mother, then take a look at the situation in Ethiopia (when my friend runs a maternity charity). There 1 in 7 women die in childbirth. 1 in 7!

I doubt very much that Ethiopian women judge each other on how they choose to give birth or raise their children. They know that making it through childbirth – whatever it takes – is blessing enough.

Frankie said...

Good post, Jane.

People really need to back the fuck off and stop judging women for the choices they make about their bodies and babies.

It's not productive, does nothing to help women, and can do so much to hurt them. It stinks of entitlement.

(As a general disclaimer, I should point out that I suffer from completely rational rage whenever people start telling me what I should do with my uterus and any fruit that may spring therefrom. It makes me want to punch them.)

banana_the_poet said...

I did the NCT thing too - but played hooky for the one where they showed a film of someone giving birth ;p

That was over twenty years ago. Then a week after my due date - knowing Sprog was according to the midwife going to be over 9lbs, I had a rare blood group and it was during the 1st Gulf War and blood was in short supply and having heard clicking noises from my womb that everyone medical refused to take seriously AND being under 4'11" - I followed my instincts and insisted on an elective caesarian. Andy & I had to sit outside the consultant's room for I think it was four hours to see him. It was only when we mentioned we would probably sue if anything went wrong if they refused a caesarian that he agreed.

As it turned out - Sprog was born with a cleft palate and because it was an elective caesarian there was a obstetrician on hand to diagnose a genetic disorder immediately.

I later found out hubby had had an older brother who died at birth from the same condition.

Having a cleft palate meant that feeding was a nightmare and the type of cleft meant breast feeding was completely impossible. That said I was still hooked onto a milking machine to try to pump out mother's milk - which was a horrible experience and didn't work.

I think planned caesarians are not a bad thing if there is a good reason for it. I also think that making the birth experience into some kind of holy grail is a bad thing. Great if that is how it turns out - but it shouldn't be aimed for as a prize any more than the 'perfect wedding day'.

Both experiences are simply temporary processes to go through to get to the main event ie parenthood and marriage which are about ongoing relationships.

I side-stepped both 'prizes' and have to say the treatment I got when Sprog was born put me off having any more kids and he is well and truly an only child.

As for trial of labour - as I said to the consultant at the time - if you were going to give me an appendectomy you wouldn't advise me to run up and down stairs for a few hours and then donate blood directly before the operation would you?

Stick to your instincts I say. If a Mum knows a 'natural' birth would traumatise her - then that is grounds enough to choose Caesarian in my opinion.

As it was I had some mild hormonally induced post natal depression which lasted about four years - but bonding was not a problem. I also got a horrible infection caused by the lack of hygiene and house-keeping standards at the hospital. Nobody should feel guilty about the choices they make as long as they are made from the best of intentions for the overall health and welfare for the unit of the mother and child.

Oh and this made me laugh - the word verification is bledlet

Jane Steen said...

I remember when my oldest was under the lights for jaundice and I was hooked up to a breast pump. The doctor on duty swung by and sneered "you won't be able to do that all the time, you know." If only my postpartum-addled brain had been quick enough, I might have informed him that feeling like a dairy cow was not my choice of pastime.

The kid would not suck properly. How many times did I point that out to the staff? I was told I had a mental block against breastfeeding. I tried for six miserable weeks until my milk dried up and I could legitimately switch to formula.

I nearly didn't breastfeed my second. I was no good at it, was I? But I decided to give it a shot. Never had the slightest problem.

It was nearly three years before we knew the whole picture: my oldest daughter (now nearly 20 and medically very healthy, thank you) had a chromosome disorder causing pervasive developmental delay, mild mental retardation and low muscle tone. If the buggers had actually LISTENED to me, we might have found out a little sooner.

Gillian Philip said...

Your post nearly made me cry Jane - it's so very close to what happened to me. I knew I'd let my twins down by failing to deliver them 'naturally', so I was determined to make up for it with Proper Breastfeeding. Except that my daughter couldn't. I struggled on for five weeks, watching her lose weight (and all the time breastfeeding my happy, growing son), angry with myself and her, suffering regular bouts of mastitis exacerbated by desperate pumping, until we were both admitted to hospital - where an incredulous pediatrician stuck a formula bottle in her mouth. She's never looked back, but I'll never stop feeling guilty about those weeks when - photos tell me the truth - my daughter resembled a famine victim. And I stuck with breastfeeding because of the guilt. The guilt now is justified; the guilt then wasn't, and I wish I hadn't been such an idiot. My only excuse is that my head wasn't screwed on straight after the birth.

Good for anyone who can give birth naturally and breastfeed. And good for anyone who goes for drugs, caesarians, or formula milk. You're so right.

SJH said...

As the mother of 3 and grandmother of 5, I was delighted to read this. I had my children with epidurals but no caesareans and am genuinely distressed to hear young women now bemoan their 'failure' if they have a C-section or an epidural or any help that's considered 'not natural'. How can it be a 'failing' to produce a beautiful child? As my obstetrician said to me all those years ago, the object of this exercise is a live, healthy baby and mother. None of that has changed, nor should it. It seems to me there is far too much 'bullying' women into how to give birth. Frankly, it's nobody else's business and if you want or need help, make sure you get it and to hell with a birth plan.

Natural Childbirth said...

Very, very true, every word of itNatural child birth is most easy process for healthy baby....even greater flexibility you need to raise a well rounded healthy happy child.

Emily Phillips said...

I remember with my son I decided to take a Bradley class and try to do it naturally. We were all gung ho that natural was the only way to go and spoke often about the irresponsibility of epidurals and formula companies. It's safe to say we were on the home birth bandwagon.

Then we all went off to have our babies and met back 3 months later to have a reunion. Out of the 5 moms: 1 had an emergency c-section, 1 had a 36 hour labor and finally transfered to a hospital and got an epidural out of exhaustion (she broke her tailbone trying to push), and 1 was unable to nurse and was suffering from crippling post partum depression because she felt like she had failed her baby in some way by giving him formula.

I remember looking around the room at all these amazing moms with their healthy babies and being amazed how the general feeling was that they had "failed" at birth in someway. We didn't fail, we made plans and they had to be adjusted because of unforseen circumstances but because our community was so dogmatic about the "right way" to give birth these mom's were left with feelings of guilt and shame. It is sad that the natural birth pendulum has swung so far in the other direction.

I am a natural birth advocate. I even co-founded a website that promotes natural childbirth and breastfeeding. But I my mission now is to be a place that is a middle ground for the birthing community. Our mission statement is to "bring natural birth out of the alternative and into the mainstream". And I truly believe that can only be done by be fully open and accepting and realizing that the goal for everyone is to have happy health babies with empowered moms.

Alright, I'm off my soap box. Thank you for your wonderful post, it's voices like yours that keep organizations like mine going :)