Guilt, or not

Slate published an interview yesterday with the “Skeptical OB”, a critic of the natural childbirth movement. Link is here. It’s an interesting contrast to the Radical Doula article I discussed last week.

Childbirth has always been risky. People used to die giving birth, and people used to die being born. In the days before antibiotics, mastitis (or “milk fever”) could also be deadly. Death in infancy was common. Breastfeeding has been done many different ways in different cultures. In most times and places it was fairly common for women to feed children other than their own. The use of animal milks for infants also has a long history (goats, apparently).

The Skeptical OB is critical of the way the pro-natural birth, pro-breastfeeding stuff can promote “unnecessary guilt in women who don’t abide by its standards.”

I haven’t read the book, just the interview above and the free online sample which includes the introduction. The introduction frames the issue around guilt as well, “I have made it my mission to help women escape the feelings of guilt about their birth experience that trap them long after their children are born” and “My goal in this book is to release women from the guilt trap…”

I’d probably quite like a lot of this book, but I wish that guilt wasn’t presented as the problem. I don’t feel guilty about the birth I had with the little dude – I don’t feel like I failed at anything; I feel like I was failed by the system of healthcare, which didn’t respond properly to my needs, and didn’t give me the medical options that I wish I’d had. Guilt isn’t the problem.

The natural childbirth narrative might tell me that my birth with the little dude could have been fine if I’d be supported better at home, that the slow progress was the result of stress, etc. There may be some truth in that. The obstetrician I had with the new bub said she would have given me syntocinon sooner, which is what I had always thought should happen – both during labour and especially afterwards.

If childbirth without synthetic hormones or pain relief or incision is considered the gold standard, it’s probably because of the possibility of births like my most recent one, which was so totally fine that I can’t get over how fine it was. I sound like a hippy dippy earth mama when I say that the pain felt productive – but it’s true. I was glad not to have an epidural, I was glad to be able to feel the sensations properly so that I could respond to their signals. If we have a third child, I hope to have a similar labour.

Breastfeeding the little dude was hell at first. He couldn’t latch or suckle until he had his tongue tie and lip tie op. Breastfeeding the new bub was immediately fine. I hadn’t realised that breastfeeding could be so easy straight off the bat. Bub’s feeding now is about the same as the little dude at nine weeks. He just seems to know what to do. The little dude at two weeks old, well, I wrote about it at the time: The one about the milk. I called it a “horrendous ordeal” and “soul destroying”. His ability to feed was so compromised by his tongue and lip issues that the dentist who did the oral surgery told me he would have struggled to take milk from a bottle as well (he also said that the lip tie was extreme, and that we were saving ourselves thousands in braces down the line). There’s been some controversy lately about the rates of tongue and lip tie diagnosis, and the possibility that some babies are having unnecessary intervention. The new bub was diagnosed by the hospital midwife as having a tongue tie, but he was feeding fine from the start, so we haven’t sought any surgical intervention.

If things had been slightly different, I might have ended up feeding the little dude formula. It was very significant that my mother and my mother-in-law had both breastfed their own children. I saw it as normal. And while I was pregnant, my mother-in-law had told my husband that his job was to do everything else so I could get feeding established. But even so, if I hadn’t been able to see a lactation consultant quickly enough, I might have resorted to formula because it was such rough going, and after the trauma of the birth I didn’t have much emotional fortitude left. Had that happened, I’d have been gutted, because I really wanted to breastfeed. I’m not sure I’d have felt guilty though. I probably would have felt deeply disappointed at the outcome, maybe let down by a lack of resources for assistance. I don’t think I’d have blamed myself.

I have a theory that maternal guilt is often sublimated anger and disappointment. Women shouldn’t feel guilty for having epidurals or caesarean sections or for formula feeding (our bodies our choices). But women should be able to honestly express sadness about painful or disappointing experiences, and anger when we think those things could have been prevented had things been different and has better support been available. It’s important to be able to express those emotions.

If someone says “there’s no need to feel guilty”, the subtext can be “it’s not legitimate to feel anything negative about that experience”. Even tiny examples reflect this – such as telling a mother that she doesn’t need to feel guilty for letting her kid watch heaps of tv and eat nothing but toast and bananas last Thursday because she was having a really rough day and just needed to sit down. If the mother tells someone “I was so tired the other day we just watched videos non stop and I didn’t even give my kids proper food”, she might receive a supposedly reassuring response like “you’re a good mum and you did what you needed to do, they’ll be fine”. The response presumes that she feels guilty and that she’s mentioning what happened so she can assuage the guilt. These responses reinforce the normalisation of guilt as a pervasive mothering emotion, and are a disservice to mothers. Because maybe if the emotion is examined more closely, guilt falls away anyway and she’s actually feeling overwhelmed by everything and under-supported and ripped off by expectations of perfect motherhood, and in need of a proper break.When we tell her “it’s ok, you don’t need to feel bad about it”, the subtext is “buck up, truck on, do what you gotta do to get through the day, don’t focus on your own feelings”. This makes it harder to allow space for negative feelings to come to the surface.

Negative feelings about childbirth and breastfeeding are particularly important to acknowledge, away from the framework of guilt. It’s totally reasonable to be distressed by an unexpected cesareans or episiotomy. It’s not buying into mother-guilt to say “I feel terrible that I couldn’t get breastfeeding to work, I feel like I missed out on an aspect of motherhood that was important to me”. Glib extortions to let go of guilt can silence women who are struggling to find language for their emotions, or struggling to process their emotions, and who therefore fall into patterns of speech that graft onto the primary negative emotion that women are allowed to express without being seen as bad mothers: guilt. Instead of telling women not to feel guilty, we should make space for women to express other negative emotions about motherhood. We need to stop assuming that when a mother says “I feel bad”, she means “I feel like a bad mother”.


Thoughts on the NY Mag “Radical Doula” article

Here: Confessions of a Radical Doula

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.

Turns out labour and birth can be fine

Baby born this morning at 12.15am. I’m still at the hospital with him. He’s asleep in his little hospital perspex box next to me. I’d forgotten how noisy newborns are. He’s sleep mewling. Wonder what is happening in his baby dreams.

The birth was amazing, couldn’t have been more different to last time. I’d had periodic clusters of strong braxton hicks all day but had tried to rest lots in between. In the afternoon they picked up enough that I thought they might be seguing into labour and arranged for the little dude to go to my parents’ for the night and for my husband to leave work early. At around 6, my husband and I went for a walk round the block and the contractions continued. I called the midwife when we got home. Then unlike last time, the contractions did what they’re supposed to and got stronger and longer and closer together while I laboured at home. I went into the hospital at 9pm and the obstetrician examined me and I was 4cm dilated. I hadn’t reached that stage with the little dude until about 28 hours of contractions so this was amazing news! The obstetrician broke my waters and I laboured in the pool for a while, then the shower, and the midwife and my husband rubbed my back, then I felt I needed to rest more between contractions and got on the bed. Obstetrician examined me again and I’d gone 2cm further. In the examination she deliberately stretched the cervix slightly and the contractions immediately picked up. I got off the bed at the next contraction, feeling like I couldn’t lie down through it, and laboured some more in the shower. Before long I felt like I needed to push. Obstetrician was concerned that I might not be dilated enough so I had to get back on the bed for another check, but I was dilated enough and the baby was born on the bed after a 25 minute second stage.

With the little dude, I was pushing while still on the epidural and I couldn’t feel anything. It was so much easier pushing without having had pain relief, following the cues of the contraction. His head came out and then on the next push he came all the way on out. Only a slight tear for me, no need for an episiotomy this time. When the little dude came out, I was dazed and he was rushed away but this time I had the picture perfect thing of the baby being passed straight up to hold and feed.

He looks exactly like his big brother did as a newborn.

I’d had pethidine and then an epidural with the little dude and I wasn’t sure how I’d manage strong contractions. Turns out my contractions last time had been strong, they just hadn’t done anything. I kept saying to the midwife last time that it wasn’t the pain, I could handle the pain, I was just exhausted. This time, the whole way through I felt that the pain was within manageable bounds. I tried to think of it as an intense sensation like cold water or vertigo rather than pain as such. My yoga teacher had recommended visualising the contraction as a wave of feeling and yourself as a surfer riding the crest of the wave down your body. This was a really helpful image for me.

So my husband is pleased that a good birth makes me more amenable to a third baby…

Meanwhile I’m not sure how the starkness of the contrast between this time and last time makes me feel. In some way, redeemed and vindicated in my sense of myself as person whose body can do stuff? In some way even more disappointed in the outcome last time?

People brag about their drug free childbirth experiences, like it’s a badge of honour that not everyone can manage (kinda like the smugness that can accompany exclusive breastfeeding). I feel sort of proud of how it went, like you might feel after climbing a tall mountain and coming down again feeling fresh and full of vigour. Last time I climbed the same mountain and came down limping and wounded. But I suppose comparing the two, I reckon that to come off the mountain limping and wounded demonstrates extra strength, extra determination, not less.

Coming to terms with the hard stuff

I don’t know Holly Walker but we have some mutual friends and acquaintances. I loved her piece on the Wireless recently, about anxiety, and on the Ruminator, a while ago, on growing up and dealing with hard stuff. I went back and re-read the growing up one just now. This bit:

It’s not just because we have a small child that we haven’t been out for so long. It’s mostly because the combination of Dave’s illness and my anxiety means that in our new reality, it’s not something we’d usually attempt (in our household a Don McGlashan gig warrants special effort). In the recent past, I’ve thought this makes us exceptional, more than usually unlucky. I’ll be honest; I’ve spent a lot of time feeling sorry for myself.

But I started to think, licking my ice-cream back in the darkened theatre, that rather than set me apart, these experiences are my passport to life as a grown-up. The older we get, the more experiences we accumulate. After thirty years, it’s not surprising that they start to include the tragic, heartbreaking, and incredibly difficult to bear. To bear them anyway, and go on finding the joy in small things – that’s what grown-ups do.



I wasn’t quite a grown up when I had a baby. I had all the hallmarks – relationship, job, etc, but I still felt self-consciously young a lot of the time. In the first year of parenting, especially the first six months or so, I lost my footing a bit on my sense of who I was, and I came out slightly different, shaped by that first glimpse that my body and mind weren’t always going to bounce back quickly from what life had in store.

It’s taken me a long time to figure out how to feel about this, to allow myself space for the sadness without being lost in it. And still, when I read about people who’ve had worse experiences, I feel selfish for being sorry for myself. Yesterday I had a little cry thinking about the day the little dude was born – then today I felt like a fool for being so precious as to think I deserve to have everything easy all the time. I want to chide myself – life’s hard, toughen up, it could have been worse. I’m way too invested in a self-image of someone who copes with stuff and doesn’t complain. I know this is stupid, I know this attitude isn’t helpful.

I’m five weeks out from the due date for this baby, and two years have gone by since the little dude was born, and it’s probably a good idea to confront all the baggage I have about the last time round. The last fifteen hours of the labour felt like a strange nightmarish state. I remember it only hazily. When they told me they were going to perform the episiotomy, I couldn’t feel pain because of the epidural but I could feel the pressure of the surgical scissors and I felt the moment when the cut went slightly wrong and I saw the expression of concern pass over the midwife’s face. I can put words to this in a way that I hope lets other people understand how I felt, like I’m writing a story about someone else, and that helps create a bit of distance.

I can tell you about the numbness that shot through when they said my baby wasn’t breathing and he was whisked away, and then the hours following when I couldn’t hold him, and I was too exhausted and too shocked to feel much at all.

I can describe the worst moment, later that day, when they kicked my husband out because visiting hours were over and I stayed in the hospital with my baby and I felt like a child myself who had been abandoned. I remember one of the hospital midwives told me off for cuddling the baby in the bed, because I might fall asleep, and I remember crying myself to sleep that first night, so tired. I remember tripping over the catheter when I got up in the night to feed him, and struggling to get him to latch, and pressing the button for assistance. A different midwife came and she was so nice to me.

I can mention how the next day, my nipples were covered in blisters, and the next couple of weeks were an exercise in pain and frustration trying to get breastfeeding established, and the only silver lining was that my husband was on paternity leave so I wasn’t by myself.

It’s harder to talk about the pelvic floor issues, about the extent to which dealing with the ongoing problems is a limiting factor in my life, but hidden, and obviously a strange topic to mention, so it’s something that I have to be reminded of all the time but can’t easily explain to people. Shortly after I returned to work last year a colleague asked whether I had gotten back into running yet, I lied and said that I couldn’t find the time. Another colleague, also a mother, said that she found the opposite – running was the best exercise to squeeze in when you didn’t have much time.

I know. I loved running. I miss running. I’ll never be able to run again. 

I’m not totally reconciled to that, but I have to accept it, so feeling a residual strand of sadness about it is ok.

In the first year, I struggled to communicate how I was feeling to friends – we’re not good in this culture at talking about experiences that make us sad. I couldn’t even begin to broach it with new acquaintances. Two years on I can look back and feel a retrospective tenderness towards past me that I didn’t let myself feel at the time. Maybe that’s part of growing up.

Breastfeeding and childbirth – parallels and retrospective

So I breastfed the little dude for 16 months, stopping after I found out I was pregnant with number two because no no no way nup nope not supporting two other beings with my body, one extra is quite enough thanks.

I’ve read a few pieces recently on some of the other mama blogs I follow about breastfeeding, and I’ve been thinking of the parallels between a birth experience like mine was (heavy interventionist, fairly traumatic, and with an ongoing legacy of damage to my pelvic floor muscles that will require surgery to fix when I’m done having more babies); and a breastfeeding experience that ends in formula. I know a lot of the homebirthy-type feminists have written about these issues – about how women are alienated from the capacities of our bodies through a patriarchal system that sees us as a potential barrier to scientific care of the babies. How we are not equipped to see childbirth as something we can do, and how we are therefore not supported to do it in a non-medicalised setting. An alternative feminist analysis is that the pain and danger of childbirth has been minimised by men who prefer to believe that women complain unnecessarily over the idea that women live through extreme pain in order to produce each new person in the world, and that this stigmatises the use of pain relief and other interventions which would otherwise be routine. Thought-provoking stuff. From my own experience, I suspect there is a lot of truth in both.

In my circle of friends and acquaintances who have had babies in Wellington in the past few years, there seems to be an alarmingly high proportion who have Bad Birth Stories and/or Bad Breastfeeding Stories.

I was so lucky with breastfeeding, it so very nearly didn’t happen. When the little dude was 8 days old and refusing to latch and clamping down and yanking and fussing at the breast, I was soaking through my nursing bras and dripping milk on the floor and dealing with engorged painful breasts and several blocked ducts and blistered nipples. If a few things had been different, we might have ended our breastfeeding relationship that day. The engorgement was actually a blessing, it gave me an overabundant supply that enabled me to produce enough milk to feed my baby despite his extremely compromised latch. I was fortunate that my mother breastfed me and my brother, and was so affirming of my efforts. My husband had been sternly instructed by his own mother that his job when the baby was born was to do everything else so that I could take time to breastfeed. My worst day was a Sunday, which  meant that I could go straight to the free Monday clinic the very next morning. I was able to afford to go to a private lactation consultant and got an appointment on the Thursday of that week. And finally there was a dentist in our town who does the laser surgery that was needed to address the little dude’s fairly severe tongue-tie and lip-tie. We had to pay quite a lot for the dentist to do the surgery, about $200. It’s simple procedure, essentially burning through the excess frenulum with the laser. It didn’t take long. It can be done on the public system, but there is a waiting list which can be months long. Needless to say, not everyone has the money. (Side note – the dentist said “on the positive side, this level of lip-tie would eventually need to be treated and fixing it before his baby teeth come through means you might end up saving thousands in braces down the line!” Thanks dentist.)

Once we were sorted, we were sorted. The little dude was an extremely eager feeder. He didn’t take quickly to solids, he was still having almost all his food from my milk at 7 months. For the first few months, I felt that breastfeeding was the intermediate state of separate but joined, after he exited my body and became his own being in the world. Breastfeeding mediated our relationship, it symbolised comfort and nurturing that he received only from me, and it shaped my sense of myself as a mother.

It had limitations too: an intermediate state of separate but joined meant that we were kinda joined. I never went far away or for long until he was in creche, whereupon the breastfeed he received as soon as I arrived to pick him up was the best comfort and reassurance I could provide.

Some people find they faced insurmountable obstacles to breastfeeding, and others find they didn’t really like it, or want to stop earlier than they thought they would, or do it out of a sense of duty but never really enjoyed it. For me, it was just right – until suddenly I felt like it was time to finish up when I saw the two pink lines, and so we did. I hate to think of other women who read about my breastfeeding experience and feel saddened that they missed out. Though when I read about positive birth experiences, it makes me sad, but I also think it’s important that all the different stories be told. It’s ok to be sad about what might have been. Especially when there’s a next time to think about, and there’s scope for next time to be different. My experience breastfeeding started badly and then turned out fine. My birth went from bad to worse. In childbirth, I was at the mercy of hospital admission policies and felt like I had no power to follow through on my instincts within the constraints of the system. Breastfeeding could have gone the same way, except I was able to access good professional support and also had some strokes of luck with my milk supply and support from my family.

New Zealand’s health care system has a confused and problematic towards pregnancy, childbirth, and breastfeeding. It has adopted the idea that these are natural processes and should be allowed to occur without unnecessary intervention; but at the same time, if something goes wrong, we’ll go down the intervention route – basically episiotomy or caesarean for childbirth, and formula for feeding. This sounds reasonable enough until you realise that experiences can’t be divided into “all goes well” and “all goes wrong”. The New Zealand Maternity Clinical Indicators makes for grim reading. We have a very high rate of caesareans and episiotomies. My totally anecdotal diagnosis of the problem is that the health system doesn’t seem to give much space to the middle ground of “things are not going so great and we don’t need to look at the Last Resort yet but we do need to do something other than just wait and hope it gets better.” It seems more like the attitude is “don’t worry, it’ll be fine, don’t worry, it’ll be fine, don’t worry, it’ll be fine FUCK IT’S NOT FINE FUCK”.

Since the late 1980s, when I was born, the introduction of the Lead Maternity Carer (LMC) model has sought to bridge the gap between the “medical” mode of care and the “natural bodily function” mode of care. Women see a midwife during pregnancy for free, or can pay to see an obstetrician. Midwives are contracted by the Ministry of Health, and there’s no formal referral system – you basically just find a midwife based on word of mouth or google. The midwife attends the birth at a hospital, birthing centre, or a home; and if the birth is at a hospital there will also be an obstetrician available if needed (in theory). The hospital system is managed at a regional level, so there are real differences across the country in facilities, policies, and resources. Women who elect a midwife as their LMC might not see an obstetrician at all – but if there is a reason for the midwife to refer the pregnant person to an obstetrician, it will be free. When it comes to the birth, the midwife is not employed by the hospital, and is subject to the hospital’s admission policies. The most common model is for the woman to labour at home with any chosen support people, and for the midwife to be present at the hospital once the woman is dilated enough to be admitted according to hospital policies.

With the little dude and breastfeeding, I want to once again emphasise that the lactation consultant and the dentist who did the oral surgery were private, completely removed from the health system. The lactation consultant at the hospital didn’t examine his mouth and just gave me lanolin cream for my blistered nipples and was completely fucking useless and it makes me furious that this is the level of support available through the public system. Because the birth went badly, I don’t entirely know what should have or could have been different to make it go well. Too many factors, and I have no point of comparison. It’s simple when you have a near miss to identify what made things go well, but when you have a crash it’s harder to know how it could have been avoided.

This time I’m going with a private obstetrician. I wanted to have an initial consultation with an obstetrician to get some guidance on whether vaginal birth with a rectocele and cystocele prolapse is even possible, or whether I should plan for a caesarean. We talked about my experience with the last birth, how I was a week overdue when contractions started, and then I had an extremely long first stage and then an extremely long second stage (my second stage, known as the pushing bit, was over 3 hours – the little dude’s head was not quite at the right angle), how the episiotomy extended almost the whole length of the perineum and how the little dude was born in respiratory distress and had to go to NICU straight away. The obstetrician was reassuring in many ways. First, and actually this was most important, she was resolutely affirming of my view that NONE OF THAT SHOULD HAVE HAPPENED. It’s been hard for me to talk about my birth experience because so often I encounter the attitude of “yeah well birth is bad, duh”. And I’m like, no, uh, my birth was really bad. And then I feel all shamefaced because I don’t want to oversell how bad it was? But I feel like it was fairly bad? So the obstetrician was all “yeah that sounds horrific”. Second, she also seemed to agree with me that my midwife hadn’t done anything wrong. I really liked my midwife and I felt well supported by her and even though I was not in a great place when I was finally admitted to the hospital at 10pm, 2.5cm dilated, after 24 hours or so of regular painful contractions and nearly 40 hours of continued awakeness, I could tell that she was not pleased the hospital had refused to admit me sooner (hospital view: not dilated enough, baby not in distress, go away). I feel like the hospital let me down badly. I feel like the health system let me down badly. And I feel like things could have been even worse without my wonderful midwife (who has since moved to Christchurch).

The obstetrician straight up said that the hospital would have admitted me sooner had I been her patient. The reason they don’t want to admit people “too soon” is not primarily an issue of beds, it’s primarily an issue of managing the workload of the obstetricians who are there on a given day. It follows that they are willing to bend rules if you BYO doctor. I’m very aware of the privileged position I’m in that I can pay for the additional private care this time. And I’m angry both personally and on behalf of the women of New Zealand generally that the medical care we get during birth is hit and miss.

It remains to be seen how this birth goes. I don’t feel anxious about it any more. The first consultation with the obstetrician and subsequent appointments have removed that anxiety. It reminds me of how I felt after the appointment with the lactation consultant. I turned up desperate, really desperate, holding my borderline starving child and with my blistered and destroyed nipples literally wrapped in cotton wool to prevent chaffing against the nursing bra, which was fast becoming wetter and wetter. She asked me to describe what was going on, and I immediately felt (and yes, I have to use this word, it is genuinely appropriate) empowered. I can use words to describe experiences! That is something I’m good at! You have asked me a question and now will listen to me! She asked me to describe the little dude’s behaviour at the breast – was it eager, was it reluctant? I said without a second’s pause “frantic”. I remember that so clearly, that when I said frantic, she sort of smiled like asking me for the word had been a test and I’d just given an unexpectedly perfect answer. After I had finished describing things, she examined the little dude, and she said something like “I thought from your description that this sounds like textbook tongue-tie and possible lip-tie also. It is both, let me show you his mouth so you can see.” I knew there was something wrong with the little dude’s ability to feed. I was so not surprised (another memory of the early days, my husband said “maybe just one bottle of formula”, I respond “THERE IS NOTHING WRONG WITH MY MILK I AM DRIPPING ON THE CARPET, THERE IS SOMETHING WRONG WITH HIM!”). I left feeling enormous relief that I had been heard and validated and we had a plan.

This is the bit that was the same with my first obstetrician consultation. I went in somewhat anxious – what if she rolled her eyes at me and told me that childbirth was just like that, what if she told me that it would be the same again and I had received perfect care and there was nothing more that could have been done? What if she told me that it was somehow my fault, something I could have done differently? I had a list of questions/concerns to run off with her. I had written it down and slipped it into my wallet to pull out in case I forgot. I never even needed to because she covered them all off without me having to raise them. No, I didn’t have to worry about an interminably long first stage – she would make sure that if I was past my estimated date and had been having hours of steady contractions painful enough to prevent sleep, I would be admitted. No, I didn’t have to worry that my pelvic floor was too weak to push the baby out. Yes, another vaginal birth will make it worse but it’s still a better option than a caesarean unless there are other reasons for a caesarean. Once I’m done with babies I can see a gynocologist to assess the damage. If the episiotomy scar is too tight to allow the perineum to stretch, it’s ok, she can cut out the bad scar tissue and then make sure it’s stitched up in a way that promotes better healing. I’ll write about it afterwards (still a very distant event, this birth), but for now, I feel pretty damn relieved that I’ve been heard and validated and we have a plan.

CW: childbirth, moping

I’ve read a few blogs by other mother bloggers recently about the challenges of finding simpatico mum friends in real life. The internet fills a big void – it’s one of the reasons I blog and one of the reasons I read other mum blogs. I’ve been lucky with our antenatal group, we still catch up periodically and we were a great source of support for each other last year. I’m grateful for that group, but we still have a “most neutral self presented” vibe, and we talk mainly about kid stuff. I am more honest on the internet than I would ever dare to be in person until a firm friendship had developed. Yet there are limits to the conversations had with childless friends. I wish mainly that some of my pre-existing close friends had children; instead almost all of them are overseas gallivanting.

There are lots of other mothers at my work, and we get on well, but they are a bit older. My pre-existing friends are unlikely to all end up having kids at the exact same age as each other, but I’m clearly going to remain an outlier. Sometimes when I mention that my younger brother is in Europe people respond “ah, that awesome period of life when you just travel and enjoy being a young adult”, and part of me feels wistful for what I never had. Another part of me knows that this is a petty first world problem, that I have no right to feel sad at not upping sticks and doing a big open-ended overseas trip before having a baby, that I’m lucky and shouldn’t complain and I’ve had more overseas travel in my life anyway than 95% of the world could ever hope for, and I should just shut up. But then it feels super rough when one of my closest friends is running marathons in Spain and I’m changing nappies and doing futile pelvic floor exercise in the knowledge that one day I’ll need corrective surgery and even then I probably won’t be able to take up long distance running again ever, and I used to love running before… 

I try to remain philosophical – there are much worse things in life, people used to die in childbirth. But when my childless friends ask about the labour, I don’t know what to say. It was horrendous. It was absolutely horrendous. I still feel angry and hurt that Wellington hospital wouldn’t admit me sooner (I wasn’t dilated enough, despite having had contractions regularly for 14 hours), and that when they did admit me eventually (after 23 hours), they wouldn’t give me an epidural straight away because I still wasn’t far enough dilated. So my only pain relief option was pethidine, and if I didn’t want pethidine then I would have to go home again because (you guessed it) I wasn’t enough dilated. I had the pethidine, but then when the little dude was born and couldn’t breathe for himself, and had to be taken away from me to NICU, and hooked up to all the machines, I always wondered was the pethidine partly to blame? And when I eventually got the epidural, and had a bit of a rest, and then they finally decided to start me on syntocinon, and I thought – well fuck if I was going to be having an epidural and hurry up hormones anyway, couldn’t I have had this a day ago and spare me the misery? When it came time to push (33 hours), the epidural was still going too strong for me to feel the contractions and work with them, and the little dude’s head wasn’t at the right angle, and I couldn’t move around because my legs were out of action, and I wonder whether that was a factor in the pelvic floor strain? I wonder whether I would have needed such a whopping great big long episiotomy if I’d been able to move around and get gravity on my side instead of pushing with my feet in stirrups like something out of a movie about how bad childbirth is. Remembering all this still makes me sob. Remembering that when the little dude emerged (36 hours), I held him only glancingly before he was taken away, and then I had to wait and wait while they stitched me up, and I had my phone next to me and my husband rang because the nurses in NICU wanted to know whether I could come in and feed him or whether to give him formula. And my midwife made me eat a piece of toast before I could go.

All these things, I can write them here, that feels ok, but I haven’t said them to anyone apart from my  husband. I haven’t said these things to my friends without kids because what could they possibly say in reply? I’ve alluded to some of it, but that’s all. I haven’t said these things to friends with kids because I don’t want them to pity me, and I don’t want to hear about their 6 hour labours and how they run to work every day.

So I say them to the internet, because somewhere out there, someone else feels the same. Somewhere there’s someone else who is 28 and wants to punch people in the face / burst out crying when they say how “having a baby young means that at least your body bounces back more quickly!”. Somewhere there’s someone else who knows that the joy of pregnancy with a second baby will be marred with the fear, the fear of how it’s all going to go next time. If I write this, I can imagine a reader, and I can imagine that if we ever met we would be firm firm friends.