Thoughts on the NY Mag “Radical Doula” article

Here: Confessions of a Radical Doula
http://nymag.com/thecut/2016/03/confessions-of-a-radical-doula-c-v-r.html

Interesting read.

Home birth is not culturally alien to me: my brother was born at home while I slept in another room. I didn’t look into home birth for the little dude because I naively assumed that we had the best of both worlds now in New Zealand – hospital birthing rooms are spacious, with big birthing pools, comfy chairs, and nicely positioned support bars on the walls for labouring while standing up. It seemed like a great option.

It was only after the little dude’s birth that I read about how sensitive a labouring woman is to the environment, how anxiety can stall labour, how dim light is best, how changing location can interfere with progress. I remember with the little dude when the sun rose after my night of contractions that were just strong enough to prevent sleep, I felt them subside rather than strengthen. When I went into the hospital and was pronounced “not in labour” and sent home again, I couldn’t shake the thought that I wasn’t allowed back at the hospital where the baby would be born until the contractions were a minute long five minutes apart, but they never got longer than 40 seconds and never closer than seven minutes. I felt stuck at home. I felt like I was labouring in limbo.

Finally, my mother called the midwife while I was in the shower and said that I wasn’t coping at home any more and needed to come in. When I arrived, I was told that I was still not dilated enough to be admitted as “in labour”, but I could be admitted for pain relief. I couldn’t receive drugs to hasten the progress of labour because, being under 4cm dilated, it would be considered an induction not augmentation and unscheduled inductions aren’t done unless there is a medical reason. An exhausted mother didn’t count as a medical reason. I’d been told this earlier in the day when I first went in to be checked, and it was disappointing enough after 12 hours of contractions but to hear it repeated after 24 hours was fucking brutal. I couldn’t face going home. I took the pethidine.

Labour still didn’t progress quickly and after another six hours I had an epidural and syntocinon.

Another six hours later – 38 hours after the contractions got strong enough to prevent me sleeping through them – the little dude emerged, purple and floppy, as exhausted by the birth as I was, and needing immediate oxygen.

If it ended there I might have shrugged it off and focused on the ultimately fine outcome. But I was damaged physically as well as emotionally. I had no bladder control at all for the first week after birth. I self-diagnosed the rectocele and cystocele prolapses after extensive googling and this was confirmed later by my GP, who gave me the name of a physiotherapist who specialised in post partum pelvic rehabilitation. By the time the little dude was nine months old, I was able to do normal daily activities without feeling too uncomfortable. But the recovery basically stopped at this point.

The prolapses have meant that I think about the birth in terms of surely it could have been better, surely that didn’t need to happen. It made no sense to me – and still doesn’t – that I was expected to labour at home without professional support until things were far enough along that it was all going to be over soon anyway. I wish wish wish I’d had a doula as well as my mum and my husband. My mum, who had been present as a support person at three births in the 80s and 90s, also couldn’t understand this new system where you don’t have a doctor of your own as well as your midwife.

With the new bub, everything was so different. By throwing money at it, I was able to access a level of care more like what my mother had for free before they changed the system: a specialist doctor, with whom I had built up a relationship through the pregnancy, and a midwife. As it happened my midwife was away over the long weekend so I had one of the other midwives in the practice. She was fantastic. I’d never met her before but it didn’t feel like it mattered. She said “well done” after each contraction and she knew exactly when to start rubbing my back as the contractions built, and she was with me from the time the obstetrician broke my waters through to when the baby and I were relocated to the post partum overnight room to get some sleep.

I felt very relaxed heading into this birth. I’d been extraordinarily anxious when I first found out I was pregnant again, and deciding to get a private obstetrician was a big call. From the first meeting, I felt confident with her. Confident that she would be able to advocate for me if the hospital policies weren’t in my interests. Confident that she’d have a back up plan if things didn’t happen on their own accord quickly enough. But she didn’t need to, the birth was so smooth with the new bub. I still feel a bit like it was too good to be true. There is no female equivalent to the word “emasculated” but if there was, it would apply to my first birth experience. The second feels like it has restored my mana wahine. The midwife said to me afterwards “that was so beautiful, I wish we had been filming it, how you were so present in your body.” She was awesome. And it felt deeply comforting knowing there was a doctor for me too. One I already trusted.

The only times I saw a doctor during the labour with the little dude were when the registrar explained the risks of pethidine and when the anesthetist administered the epidural. I was never examined by an obstetrician.

New Zealand demonstrates that shifting to midwife-lead model of maternity care won’t necessarily bring down the number of cesareans and episiotomies, and won’t necessarily make women feel more confident in giving birth. We have different issues to the USA, but as with this doula’s confession, bad birth experiences abound here.

It may seem ironic that having elected to have a private obstetrician, I then had a labour without drugs or scalpels. But it’s only surprising if doctors and hospitals are seen as being in opposition to supportive and responsive maternity care. They don’t have to be. They shouldn’t be. I asked my obstetrician in the initial consultation whether I would need a cesarean the second time round, given that another vaginal birth would likely worsen the prolapses. She said that another vaginal birth would be preferable to a cesarean, despite the prolapses. No desire to cut me open unnecessarily. When we discussed a birth plan and I said I wanted to try without pain relief this time, she nodded and said that was fine. In labour, the only intervention she suggested was to break my waters when I was 4cm along. It made the contractions stronger which made the labour quicker which made me less tired and better able to stay focused: it was what I needed.

I wish that the discussion of maternity care could be framed like this: what does this woman need to labour well? Not “are there too many cesareans?”; not ” doctors or midwives?”; not “hospital or home?”, etc. The answers to specific questions will differ. I think my first labour would have been much better had syntocinon been administered earlier. My second, my body seemed to do everything it needed to, and I was glad that everyone around supported me to go with what was happening naturally. Two such very different experiences, only two years apart and at the same hospital. One traumatic and the other cathartic.

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