Tuesday, April 26, 2016

When life hands you lemons...

Ina May Gaskin, a well-known certified professional midwife in the homebirth community, published this quote in her book Ina May’s Guide to Childbirth: “Remember this, for it is as true and true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.” This quote is used constantly by “natural birth” advocates to remind women that their bodies were made to give birth - that nothing could ever go wrong as long as you trust your body and the birthing process. These natural birth proponents tell women, “Your body is perfect and can never produce a baby that it cannot birth naturally. You only create problems when you step into a hospital and let doctors and nurses take control of your labor and birth.”

These sorts of arguments had led me to believe strongly in myself and my body during my fifth pregnancy. Besides, my previous homebirth had a good outcome. Why should this birth be any different? My hour long prenatal appointments were filled with laughter, excitement, and small talk. We would usually do a quick check of my measurements and then those long appointments were filled with the midwife discussing her family, other births she had recently attended, or her vacations. As my due date got closer, I began to have some concerns about the measurements of my fundal height, my lack of a due date (no ultrasounds), and the position of my baby. I was told, “Stop being irrational and everything will work out once labor hits. Besides, your body is not a lemon. We trust birth, we trust our body, we trust ourselves.”

So why did my baby almost die from my homebirth? Why didn’t he turn? Why did he get stuck for almost 9 minutes and get deprived of oxygen? I thought my body wasn’t a lemon!? I thought my body was made to birth babies flawlessly if I avoided the hospital. Suddenly those hour-long appointments and the professional-sounding credentials didn’t really mean anything. I realized what a completely lacking skillset my midwife possessed. I realized that the homebirth system was built on lies and empty promises. I realized just how important the medical professionals at the hospitals really are.

My fifth child’s birth was the most traumatic event of my life – both physically and mentally. Although his survival brought us tremendous relief and joy, my husband and I made the decision not to have any more children. But, life happens, and I once again found myself pregnant and wondering how I could face the prospect of giving birth after such a traumatic experience. Could I ever trust a lay midwife again after my previous experience? Could I trust an obstetrician or Certified Nurse Midwife (CNM) in a hospital? While my experiences argued that I could not trust a lay midwife, my years of homebirth indoctrination suggested that a birth in the hospital was not only inferior to a homebirth, but also inherently more dangerous for my baby.

I knew one thing: I would never again entrust the safety of myself or my baby to any individual who lacked the skillset to intervene in my birth should such an intervention prove necessary. The memories of my midwife seeking guidance from an online blog group or the blank stares that were given when the birth failed to progress littered my mind like an unholy collage to intentional negligence. Although I knew I could not trust a lay midwife again, I still had reservations about giving birth at a hospital with an obstetrician or CNM.

I decided to set up a consult with the Obstetrician who delivered my firstborn child 13 years prior. When the Obstetrician introduced himself I blurted out, “I almost lost my baby at a homebirth here in town, I am pregnant again, and I am scared!” He sat down with me, asked about all my previous births, and we went through my homebirth records page by page. He then asked what kind of birth I wanted. He explained that the hospital environment could offer me a “homebirth-like” vaginal birth experience, a more pain-free vaginal birth with an epidural, or a cesarean birth due to my increased risk of a second shoulder dystocia. We discussed the risks and benefits of each option in depth.

For me, the most important factors in my decision were my increased risk for a repeat shoulder dystocia and the fear of further traumatic injury to my still-healing pelvic area following my previous homebirths. My obstetrician explained that because I had a previous shoulder dystocia, I was at an increased risk of having that same complication with this birth if I chose to have a vaginal delivery. In addition, I was still healing from the trauma to my pelvic area and tailbone that occurred during my previous homebirth. Ultimately, I decided on a cesarean birth not because I wanted an “easier” birth experience for myself, but because I felt that it represented the least risk to myself and my baby.

At the beginning of each prenatal visit, my obstetrician always verified that I still wanted a cesarean birth. By ensuring that I understood the risks and benefits of each available birthing option, he enabled me to make an educated decision about what was best for myself and my baby. By continuing to reassess my birth preferences, he also ensured that my decision was not based on an emotional response to my previous traumatic birth during a single visit, but was rather the product of my consistently having weighed all of the risks and benefits.

After having relied on the faux professionalism of lay midwifery for so many years, it was simultaneously a peculiar and incredible experience to be back under the care of true medical professionals. The experience was peculiar because, in addition to having a venomous opposition to birth in the hospital setting, lay midwives and the greater homebirth community had always spread such negative, and ultimately dishonest, claims about obstetricians and Certified Nurse Midwives. Indeed, an innate distrust and fear of medical professionals is a fundamental principle of homebirth and lay midwifery.

The Midwives Alliance of North America (MANA), the most well-known organization advocating for lay midwifery and homebirth in the United States, openly deceives women and perpetuates this fear and distrust. In their position paper on homebirth, MANA states:

“There is no significant statistical difference in outcome in terms of maternal or perinatal mortality between hospital and out-of-hospital birth; however, there is increased morbidity in the hospital. Complications for mothers and babies associated with the unacceptably high rates of inductions, cesarean sections, and other overused interventions in U.S. hospitals are well documented and cause for concern.”

Although I was once easily deceived by these incendiary claims, I now know that they lack only the merit of being true. To support these baseless claims, MANA references outdated studies conducted in Canada, Sweden, and Great Britain – countries whose health care systems could not be more unlike that of the United States. These and so many other outright lies espoused by the homebirth and lay midwifery communities formed the basis for the negative feelings I had related to hospital birth in general and, more specifically, cesarean birth.

As I sat and spoke with my obstetrician, however, my experience was anything but negative. I was, for the first time in years, able to acknowledge all of my fears and concerns about birth without being told that these emotions would lead to birthing complications. For years I had been told that positive affirmations and prayers empowered women to trust their body to do what it was made to do – birth a healthy baby without complication. Fear and negativity, however, eroded a woman’s trust in her body’s innate ability to birth and led to complications and adverse outcomes. The subtle implication in this absurd line of thinking is that mothers are at fault for adverse outcomes in birth. I was, according to advocates of lay midwifery and homebirth, ultimately responsible for causing the shoulder dystocia that threatened my baby’s life. My obstetrician would offer no such feelings of guilt. He explained that I could manage risks to myself and my baby while also ensuring a positive birthing experience for us both. I began to see that, unlike my previous homebirth experiences, this birth experience would take place in an atmosphere of mutual trust and respect where I could rely on the expertise of medical professionals while these same professionals showed respect and deference for my needs and emotions.

I continued to feel relatively confident with my choice in a cesarean birth until I was about 7 months along. It was at this time that I literally became a tightly-wound ball of anxiety. I had spent 13 years of my life fearing this surgery. I had never been exposed to positive cesarean stories. The stories that I had heard detailed how terrible the surgery and subsequent recovery was. I had also heard that you could not appropriately bond with your baby and that you could not effectively breastfeed after the cesarean section. In fact, these horror stories (along with a passion for breastfeeding) had effectively led me to look into homebirth in the first place.

To help deal with the emotions I was having, I spent a lot of time watching cesarean videos online, talking to labor and delivery nurses, and listening to mothers who had positive cesarean birth experiences. I also realized that I was thinking of my cesarean birth as an intervention that would take the place of my birth effectively leaving me without a birth experience. Eventually, I was able to view my upcoming cesarean as the birth of my baby – an event that brought the same excitement and anticipation that a vaginal birth did!

Toward the end of my pregnancy, I had a few “false alarms”. Strangely, I began to look forward to bypassing the advanced stages of labor. Because I now associated labor with the traumatic experience of my previous homebirth, I wasn’t sure if I could labor calmly or peacefully. I felt reassured in my decision to have a cesarean section and this gave me a great deal of comfort.

The night before my scheduled cesarean, painful contractions began. I tossed and turned all night, unable to get truly comfortable. I wasn’t sure if this was true labor, another false alarm, or just pre-surgery jitters. Once the sun came up and I was still having contractions, I decided to call the hospital once my kids were off to school to see if we could arrive ahead of our scheduled time. At this point, I was pretty sure that I was in the early stages of labor.

From the moment we walked into the hospital, our experience can only be explained as exceptional. As we got settled into our room, each and every member of the labor and delivery team was caring and courteous. I immediately felt a sense of calm come over me. I knew I was in the best place that I could be – a place full of amazing medical professionals whose ultimate goal was a healthy mother and baby. The pain of my contractions faded into the distance as did the fear that had plagued me throughout the night. My obstetrician came in and asked if I was ready to have a baby. I was laughing, I was excited, and I was ready to birth my baby.

A nursing instructor entered our room and asked if it would be okay if nursing students attended our birth. My husband and I spoke about the outstanding experience that were having thus far and we thought about all of the wonderful nurses that worked tirelessly to make this experience possible. There was not a doubt in either of our minds – we were honored to have nursing students at our birth. We hoped that by adding to the learning experience of these amazing nursing students, we were in some way giving back to an honored profession that was giving so much to us.

I briefly chatted with the nurse anesthetist while they finished prepping the operating room. She asked if I had any birthing preferences that she could help me achieve. I decided that I did not. I told her that I did not care about immediate skin-to-skin contact, immediately holding my baby, or even immediately breastfeeding. I told her that the one thing that I wanted more than anything else was to hear my baby cry – the one sound that would mean my baby was alive, safe, and healthy. Knowing that she couldn’t promise me this, it still made me feel better to say it out loud: “Please, oh please, just let me hear those cries. That’s all I need to get me through this. I want to hear his cry.”

I was wheeled into the operating room and the reality of the situation hit me like a ton of bricks. I was really doing this. I was facing my biggest fear and I chose to do this. The lights were far brighter and the room far smaller than I imagined it would be. I looked around at all of the medical professionals, each of whom were there for one specific purpose – to help me birth my baby. There was no question that everyone gathered in the operating room was well educated and a consummate professional, a stark difference from my homebirth experiences. I gladly hopped onto the operating room table knowing that I would be meeting my baby very soon.

Right before they administered the spinal anesthesia, I once again felt a momentary flash of fear. I wanted to run out of the room so badly! My nurse noticed that I was nervous, so she made small talk with me and held my hand. She took my mind off of everything by taking the time to CARE. Those four little letters sometimes don’t get the attention that they deserve in our healthcare system, but my nurse ensured that I knew that everyone in that room did care. The next thing I knew, I saw my doctor walk in and my husband was by my side. I knew it was go time!

As the surgery began, all I can remember is feeling incredibly sleepy. I thought, “Please brain, stay awake! I’m about to meet my baby!” And then I heard it. Oh how my heart turned into mush when I heard my baby cry. I got a peek of him over the curtain and my husband and I both started crying. My sweet boy was here! He was crying! He was pink! He was alert! There simply are no words to describe the elation that a mother and father feel at the sound of their baby’s first cries. My husband went to stand by the pediatrician while she completed a quick newborn assessment. The next thing I know, I had this beautiful little baby boy placed on my chest. Oh, those sweet little cries! They were music to my ears that caused so much love to swell up in my heart that I could barely contain it.

While the obstetrician completed the surgical procedure, the baby went back to my hospital room with my husband and the nursery nurse. I joined them shortly thereafter and I got over an hour alone with my baby. I was able to breastfeed him and he latched on perfectly. I got to look him over, count all of his fingers and toes, see what color hair he had, and I got to smell and kiss his perfect little head. I was ecstatic. I had conquered my fear head-on and had done everything that I could to ensure the safest birth for my baby. It was all worth it!

My recovery was not even close to being as awful as I had heard it would be. I was up and walking by that evening. When the nurse helped me get up and walk my incision burned a lot, and I may have cussed a little! She assured me that this was normal, so I made sure to get up often during the night to walk around. When my nurse finally removed my bandage, my incision looked neat and clean. Right away I felt so proud of it. It has become a badge of honor. My entire recovery went smoothly and I had no complications. I was amazed at how little pain I was experiencing, and the burning feeling was gone by the time I returned home two days later.

I felt just as bonded to my cesarean baby as I was to all of my other babies born vaginally. In addition, I felt far more empowered during my cesarean birth experience than I ever did during my homebirths. I have learned that you can only truly be empowered when you are given all of the relevant information in an atmosphere of full disclosure – an environment that cannot occur at a homebirth or with a lay midwife.

I have come to understand that medical professionals simply want what is best for us, even when we do not fully grasp each and every action that they take. At these moments, when we do not understand, it is our responsibility to speak up and ask. Each of the interventions that the homebirth community and lay midwives decry as annoying, unnecessary, and counterproductive to the birthing process, actually does have a purpose whose basis is planted firmly in evidence-based practice in order to ensure optimal outcomes for both mother and baby.

I feel foolish and even selfish for once being so adamantly opposed to the medical birthing community. I have learned that the method by which a baby is born is not the most important thing. We should never idealize or romanticize the concept that one mode of birthing is inherently preferential to another. A mother’s single priority in deciding how she will birth should always be obtaining information from a qualified professional so that she can ensure the greatest possible opportunity for the safe birth of her baby. It took me almost losing my baby to finally understand this concept.

There is no immutable law that promises us that our bodies, when left to nature, will always function optimally. Our bodies can and will be lemons from time to time. While the human body is absolutely amazing, it is certainly not perfect. Some of us will need eyeglasses to help us see better, some will need dental work. Others will require surgical interventions such as an appendectomy or a cardiovascular surgery to correct a naturally-occurring dysfunction in their body. Likewise, some women will require interventions in their labor such as a cesarean section to ensure the safe arrival of their child. It is okay to admit that our bodies are not perfect.

My good friend, Dhanya Bramhill-Smith, offered this to counter Ina May Gaskin’s quote: “Your body may be a lemon. It may require extra help and intervention to start labor or to get your baby out safely. It may grow a baby that is too big for you to birth vaginally. It may require you to have a cesarean birth. Your body may be a lemon, but your heart is not. You were created with the capacity to love your child however they come into the world. You are an amazing mother. And that ties in no way to what your body can or can’t do. Your heart is NOT a lemon.”

Ultimately, when life hands you lemons, make lemonade! The fact that your ideal drink would have been tea matters little when you are thirsty after a long, summer day.

Special thanks to Shannon Medical Center in San Angelo, Texas for their outstanding care during my delivery and hospital stay. Thank you to Dr. Kelly Wilson, MD for providing outstanding prenatal and postpartum care. Your constant and unwavering professionalism served as a lighthouse during this stormy time in our lives. Thank you for all the hours you spent listening to me, educating me, and ultimately respecting my decisions and autonomy. Finally, thank you for doing what you do – for delivering our son to us and then moving on to help the next family in need. Thank you to our amazing pediatrician, Dr. Michelle Sarraff, MD. Your hard work and continued dedication is greatly appreciated. You have provided our baby with the best of care from his first breath and for this, we humbly thank you.

Thank you to all the wonderful nurses who kept me calm during my cesarean section and for the nurses that helped care for me and my baby during my recovery. I enjoyed all of our conversations and all the laughs we had just as much as I enjoyed the tears of joy we shed together. Thank you to the amazing nursing students from Angelo State University who were professional, kind, and eager to learn during our birth. You will make brilliant nurses and I’m so glad you shared our birth experience. To each and every person who was present in any capacity during our birth, words will never be enough to show our gratitude. Each and every one of you served to ease my fears and made the birth of our baby safe and incredible.

Ashley and Kris Martin

Holden Wilde

October 21, 2015

7 lbs 14 oz

19 inches long

Homebirth Photograph by In Bloom Photography.

Pregnancy announcement, maternity, and newborn photographs done by Kensie Lee Photography.

11 comments:

  1. You have a very unique perspective having had hospital and home births, vaginal, and cesarean births. The one thing that sticks out to me the most is your tone. You aren't coming off as better than anyone else which is what happens so often when moms discuss anything. You have such a goood grasp of how it feels having been on two sides of this issue and yet it is clear that your goal and hope is that more babies are born healthy.

    Things could have ended in such a tragic way at your last home birth, I'm glad that you and your baby made it.

    It's truly incredible to see someone put such an honest writing out there, even if parts of it make you feel sad or make you feel bad, you let it all out. Your genuiness is apparent.

    You are a strong woman to put yourself out there in this way to help others. I'm so glad that your kids are healthy..and at the end of the day that is what matters most.

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  2. Congratulations on the birth of you son. He's beautiful. And I'm so happy you shared your hospital experience in this way. There's so much negative about the hospital and it not being the best place to birth your babies and doctors don't take the time. That has never been my experience. So I'm glad you were able to help dispense some of that nonsense around doctors, hospitals, and nurses. And I might be a little jealous that you were up so quickly after your c-section ;).

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  3. You are an amazing woman and mother. I started following your blog and Facebook page last year, and I am amazed by your strength, perseverance, and knowledge as you fight for what is right.
    I am a labor and delivery nurse in Kansas, and I see so many situations that could only be described as horrific, and because they occured in a hospital the outcome was so much better. I shared this post with my fellow L&D nurses and they are in awe of you and they all loved it. Thank you for preaching what we have always wanted!

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  4. Thank you so much for sharing your story and experiences.

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    1. Thank you so much for taking the time to read it!

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  5. I had a lot of perineal damage from my hospital birth. It's a delusion that bad things will never happen to you in a hospital.

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    1. Do me a favor, reread this and put your thinking cap on. Once you're done, point out where she specifically said bad things will never happen to you in a hospital. I sure hope the next time you read this, your reading comprehension will have improved and you will actually be able to grasp the point.

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    2. No one ever said that being in a hospital can prevent every suboptimal outcome. I will be having reconstructive surgery in the near future due to damage suffered during the unmedicated vaginal delivery of my first child in a hospital. I am alive today only because I chose to give birth in a hospital where prompt medical attention from professionals prevented a pph from a cervical laceration from killing me. Am I happy that I have pelvic floor damage? No. But in the grand scheme of things, I am overwhelmingly grateful to have survived childbirth so I can mother my children.

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  6. This is my story. You wrote my story for me. I couldn't put into words how angry and sad and HURT I was about my botched home birth but you did it. My midwife didn't care about me or my son. She wanted to be right. My son is 2 1/2 and my husband and I are just now thinking about having a second and the next time around, I'm very much looking forward to a cesarean. Thank you for this.

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  7. Wow, my wife and I were amazed by your blog. 6 children, that is mighty impressive. We are expecting our first but due to some issues also have a scheduled cesarean. Hearing your experience and also hearing about how you faced your biggest fear was definitely moving. We cannot wait to be parents and your post reassured us.

    Roman Dean @ Mac MGI

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  8. As I read your story I'm here in the hospital following a csection from a failed home birth with a story very similar to yours! I've been reading stories and statistics online all night as it is the only thing that is somewhat comforting me right now-I feel so alone in this ordeal as no one I'm close to truly understands what just took place. I don't know if I'm more hurt and confused over my birth or feeling like my world is thrown upside down because everything I once thought and believed in is out the window -like u I can't believe all of these things I thought about the medical community and labeling things good and bad etc. only to be here now and it's causing me to rethink everything I thought I knew in my life-I could go on but I just needed to connect with someone who understands even if only online :) thank you for sharing your story I hope I can me just as brave..

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