Every year at this time, I replay the day my son was born. There is no memory ingrained in my mind as well as the events of that day and it's no wonder that women carry those feelings and memories so strongly. It's pivotal, emotional, and life changing.
That day, I woke up around 3:00 am with a back ache that was coming and going, waking me up, and I suddenly realized, "I think those are contractions!" They were mild throughout the day, coming and going in no particular pattern. I went for walks, getting shout outs from the neighbors about the size of my belly. I watched funny movies, ate pizza, bounced on a birth ball. I could tell something had changed, but it had definitely not fully kicked in. Late in the afternoon my midwife advised me to take a Benadryl and try to get some rest, so I did. And one hour later I woke up with a start to some strong contractions coming every 4 minutes. We called for the midwife and she got there around 6:00 pm. I remember her looking surprised when she saw how short the space was between my contractions as she listened to for my baby’s heart rate. I remember sitting on the floor, my husband talking me through a guided relaxation as my water broke. Things picked up quickly from there. I got in the tub and hummed my way through every surge, trying to stay out of the way of my body as it worked and repeating to myself "A woman in a coma can have a baby." I spent most of my time kneeling or squatting and suddenly I needed some help. I wasn't getting a break and things were so strong. My midwife checked me and said I was 10 cm and I could try pushing. I tried to push in the tub, but it didn't feel like it was working and I remember thinking "I made it this far, what if I can't push out my baby?" I got out of the tub and sat on the toilet where I pushed my hands against the walls on either side of me, bracing myself against the intense pressure I was feeling. "I don't think I can do this. I don't want to do this!" My midwife said "You are doing this, you've got this." I will never forget how her face looked at me like there wasn't a doubt in her mind that I could do this. That moment of doubt passed quickly as I was again lost in the task at hand. I got up and walked to my bed and squatted down next to it. Boom, I felt my baby's head move down low with that squat and suddenly I felt ready to push. I got up on the bed, lying on my side and 20 minutes later, at 9:25 pm, my baby was next to me, pink, crying, tiny, and beautiful. He was crowning and then flew out into the hands of my midwife in one tiny push. She had said to only give tiny pushes as he crowned, but I didn't even get a chance. He just flew out. And he has been flying around at that speed ever since.
I will never forget the words I heard the midwives say while I was pushing. I heard one say to the other, "She's so strong." And suddenly, that's the type of woman I was in my mind.
I had my baby, on my bed, in my house, with nothing but the sheer force of my own body. I saw my strength that day and from then on, I never stopped feeling the certainty of what I am capable of.
My birth story is about my baby. It's also about me. That's why our stories are so important. That's why birth matters so much. That's why the words we say to women while they are at their strongest, but also their most vulnerable are so critically important.
Have you heard all those sayings about how you manifest the thing on which you focus your energy? Like if you spend all your time focusing on the thing you’re afraid of, you tend to act in a way that makes that thing more likely to come true? Believe that idea or not, let’s talk a little bit about how it may look in labor and birth.
We all have fears when it comes to labor and birthing, whether it’s our first baby or our fifth. There is a fear of the unknown, the thought that this time we may not be able to do it. We are aware of all the variables and how unpredictable labor can be, so we cannot help but have fears and doubts pop up in our minds in the time leading up to labor. As common as those fears are, we have to avoid falling into the trap of focusing on those fears as our labors approach.
Let me give you an example. Say I am extremely worried about tearing during the birth of my baby. If I am focusing on that fear, what is likely to happen in my labor? At the moment of all that pressure that I need to move through, I will tense up because I’m afraid of moving my baby out. A mother birthing a baby through tense tight muscles is much more likely to tear than a mother that is focusing on relaxing every part of herself around that baby’s head. I’ve seen this be the case at births I’ve attended. So in this instance, by focusing on my fear, I tense up, and I actually increase the chance that my fear will come true.
So what do we do with these fears? How do we keep from focusing our energy on them? There is a beautiful opposite that we can focus on instead. The opposite of everything we are afraid of is everything we want. A fear of tearing might pop up in your head, but what you really want is for your tissues to stay intact through the birth. A fear of a home birth turning into a hospital transfer is really just about the desire to birth at home. The opposite of focusing on fear, is focusing on what you want.
Take your fear, and turn it around:
“I’m wondering why your labor seems to start and stop. A vaginal exam might give me a clue about why. We can also just wait and see, your baby is doing just fine. What would you like to do?”
This is what respectful care and informed consent look like in labor. It looks like a respectful, informative conversation instead of a directive. I never saw exactly what informed consent looked like until I met a midwife. She explained to me exactly what my options were, what the risks and benefits of each option were, allowed me to freely choose, and supported me in my decision whether she agreed with it or not. I wasn’t used to that type of medical care. I was used to not just recommendations, but being told what to do with my body. We forget, these are our bodies, our babies, our births. In a situation of true informed consent, the choices are yours, and so is the responsibility of whatever consequences those choices may have. We often hear the details about the possible consequences of what may happen if we don’t accept the standard medical treatment. Are we always told the possible consequences of what may happen if we do accept the standard treatment?
Recently I was at the doctor, and I was told I had cysts on my ovaries. I was told I had one option. Birth control. I told them every time I have taken hormonal birth control, it is mere days before I feel 100%, dangerously depressed. I was told, “If you don’t take birth control, you will have to deal with the pain. I’m not trying to scare you into taking it, but if you don’t, your risk of ovarian cancer goes up.” What about increased risks of breast cancer from prolonged birth control use? What about the toll of dealing with daily depression? Those risks weren’t discussed. Informed consent does not involve scare tactics. It involves a presentation or referral to current research. Options are presented neutrally as the facts and the statistics can speak for themselves. The belief behind informed consent is that when given a presentation of facts and options, a client can make an educated decision based on their own priorities, even if it is not the choice the provider would make.
This is your body. You have the choices, whether they are presented as choices or not. I used to allow the dental assistant to torture me with flossing my teeth at each appointment. I realized one day, “Wait a second, I’m paying you, and I really don’t want anyone else jamming floss between my teeth.” The assistant looked taken aback when she grabbed the floss and I politely declined. She told me she would be gentle and that it was part of their treatment program. I ended up giving in and letting her, because I felt pushed. Why push? Was that one flossing going to change the entire trajectory of my dental health? Was it critical that I be flossed? I said I didn’t want it. So in the same way, what are we doing to mothers when we take their power in labor by pushing them? When we take their power as mothers in regards to their choices about their babies? It never feels good to feel pushed into something we don’t want and women are at their most vulnerable during labor and as new mothers. Our job is to protect them, inform them, and honor their choices.
During my time as doula, I have seen plenty of times what informed consent doesn’t look like: