Are we unwittingly perpetuating fear of C-sections; and contributing to birth trauma outcomes by doing so???

Are we unwittingly perpetuating fear of C-sections; and contributing to birth trauma outcomes by doing so???

You’ve all read the headlines, the sensationalist introduction to link to new studies on the latest medical research, the byline underneath the headline:

“Moms beware! C-section may harm your baby’s ‘concentration’ “

“Mother’s agony as anaesthetic wore off during C-section”

“Are women losing ability to give birth naturally? They’re relying too much on C-sections and drugs, says expert”

“The mothers made to feel guilty about their C-sections by OTHER MOTHERS”

“A study revealing the prolongation of labour, thanks to epidurals, has been useful in identifying the iatrogenesis – doctor induced harm – at the root of the cesarean problem”

“BIRTH IS THE KEY in breastfeeding: a natural birth unlocks breastfeeding potential and so much more”

“Induced labor may double the odds of C-section”

“Cesarean birth without labor associated with breastfeeding problems say two new studies”

“C-section babies more likely to become overweight”

Then we have the commonly rolled out “statistics” on how having a doula attend your birth means a “40% decrease in the risk of having a cesarean” or how “One-to-one midwifery care reduces C-sections and improves health care”, and the ever so helpful article entitled: “How to reduce your risk of having a Cesarean”, followed by a provocative article asking “Once a Csection, always a Csection???”….I saw that one and thought of the brave, courageous ladies who come to share their hopes and fears in the VBAC Support Group and thought “oh dear – how would you be feeling about your planned VBAC after reading that tagline?”

There I was, scrolling away on my Facebook page the other day – and the newest well intended article about how Csection babies seem to have a higher chance of having Autism, ADHD, obesity related illness, a bad temper*, longer eyelashes*, multiple nipples*, a recurrent ingrowing toenail* and a tendency to smile later* than babies born via the vaginal canal popped up in my news feed. Following my own positive experience of a C-section and subsequently well documented break up with the Natural Birth Movement these articles do intrigue me and I almost always click in to read them, review the science, consider the message and absorb what I can to support my son’s health. I read the article and noticed my mood had worsened. So I observed the feelings, felt them. Fear, worry, dismay, guilt….and then the thought struck me:

“Are these articles doing more harm than good – are we perpetuating fear of Cesarean birth and contributing to birth trauma by doing so ???”

First of all it is important to say: I don’t know the answer. I don’t believe that there is a binary answer to the question. I’m questioning whether or not I should even pose the question publically or just ponder this further alone?! As a disclaimer I will also point out that I have no science to back up this question or subsequent questions.

The criteria for experiencing birth trauma are well clarified by the Birth Trauma Association with a very clear list of potential contributary topics which contribute to birth trauma.

  • High levels of medical intervention
  • Traumatic or emergency deliveries, e.g. emergency caesarean section

These are two very clear very distinct definitions from a list of sixteen identified contributary factors. How do these events lead to trauma in some mothers but not others? They are not unusual birth outcomes. Is it the physical trauma of the body within these birth circumstances leading to a psychological trauma, or these birth circumstances having been feared/dreaded/denied as a possibility by the mother/never considered as an option meaning that when these circumstances unfold in this manner; the subsequent experience is therefore psychologically traumatic? It’s a bit of a chicken vs egg anomaly. How could we ever really study the impact of having read articles denouncing the perils of Csections on any women, let alone a wide ranging statistically meaningful group of women? Perhaps the only thing we can really do is to be conscious of the question as we encounter another article with a shocking headline?

When it comes to the notion of birth trauma and headlines like these contributing to birth trauma; the more comprehensive question would be

“By repeatedly using sensationalist and confrontational headlines when we publish these studies and their findings regarding birth by Cesarean are we:

a) setting women up with irrational fear of a procedure that sometimes becomes inevitable in an emergency?

b) paving the way for great disappointment in not “achieving” the optimal spontaneous vaginal birth?

c) laying the foundations for trauma by inherently invalidating and dismissing many women’s experience of birth by cesarean as suboptimal? ”

I certainly don’t believe that if we are perpetuating the fear of Cesarean birth in this way that we are doing so consciously – although unfortunately I have seen well meaning birth workers commenting on how “graphically violent” an image of a baby being born by Csection was (which seems a little counter productive to the notion of unconditional birth support).

I read the research, studies and their findings keenly (despite the way the headlines are worded) as a birth professional too; as I stand for informed choice. Informed choice in childbirth should be fundamental, always – whether the choice comes in an emergency situation, a semi emergency situation or even as a choice earlier in pregnancy. I can see and have seen that risks, benefits and options are not always explored fully with expectant or labouring families by medical professionals; and so I can see that by using sensationalist headlines information comes to parents through other channels which otherwise they may not encounter. New research which is consistently being conducted means that sometimes people who made a certain set of choices a few years ago, may well discover something that would affect their decision were they given the opportunity to make the same choice again now; sometimes those people are deeply effected by these articles too. I hope their concerns can be somewhat allayed by reminding them that we do our best with the knowledge that we have at the time.

Above and beyond being crucial in women having all the information they need to make informed choices for their families, the publication and sharing of the research is important and meaningful in the evolution of how we collectively approach birth as mothers, fathers, birth workers, health care providers and policy makers; how medicine and medical protocol advances; and how we can best support our babies’ health post partum, throughout childhood and onwards into adulthood; catering to the specific needs which are unquestionably sometimes a little different to babies who are born via the vaginal canal. This is wonderful as we are actually able to develop practices like seeding the microbiome of the mother’s vaginal canal into the newborn baby’s body post Csection, in order to best replicate some of the benefits of vaginal birth. For more information on this practice head over here. It means that the procedure of the C-section itself can be adapted to offer the mother and baby some of the psychological and physical benefits of spontaneous vaginal birth by performing “Natural C-sections” or at the very least “Gentle C-sections”. For a personal account of a Natural C-sectionby a mother who took part in a study currently being conducted by UCLH in the UK please head over here.

It does seems clear to me though, that some of the aforementioned headlines could be perceived to be perpetuating fear of Csections; intentionally or not.

The question does then broach the bigger picture of the presentation of birth within mainstream media, and the notion of birth as a feminist issue (although birth as a feminist issue deserves it’s own book – let alone a blog post!). I was reminded of the visual presentation of health crisis in the media recently when my beloved grandfather had a heart attack and said a number of times to the emergency healthcare providers; “I can’t believe I’ve had a heart attack – I wasn’t rolling around on the floor groaning in agony with a puce face at any point”. Women’s impressions of birth from mainstream media are often equally misguided, and can range anywhere from “I gave birth on the toilet – I didn’t even know I was pregnant” to “my waters broke as I left the expensive department store, I gave birth in the taxi on the way to the hospital into the taxi drivers hands” to “I fainted in the street and was rushed into hospital via blue light straight into theatre to be put under general anaesthetic and my baby was delivered by emergency C-section”. Certainly any of these situations are possible: but all fairly unlikely. The reality is that there are many opportunities for you as parents to ask questions, discuss your desires for your birth plan, discuss and negotiate the “What Ifs?” or grey areas of birth preferences, and to sometimes even say “I hear that the protocol states we ought to do something to further the progression of my labour right now; but I do not want to and am not ready to agree to any intervention”. Indeed when looking at the reality of pregnancy and planning birth preferences; there is usually very little ‘high drama’ to attract big audiences or a large readership(!)

What can we do with this question? I’m not even sure: doula it? Hold space around it? Consider that client we know who is currently going through the fog of PND or PTSD after having experienced a birth outcome she wasnt anticipating? Consider the heightened intuition of the client who is 39 weeks pregnant and who we know who is digging deep for faith in her body as she prepares to VBAC after having stalled last time she laboured at 3cm? Consider holding space for those clients and others like them before we repost the article unthinkingly and unquestioningly?

It feels important to me to ask the question of myself and the communication I contribute to the discussion around birth; specifically via Caesarean birth.

And so in the name of desensationalising Caesarean birth, in the name of anecdotal evidence to allay your fears about the shocking headlines telling you the dangers and suboptimal outcomes of Caesarean birth: let me finish by telling you the last chapter of a beautiful birth story of a mummy and baby boy I know very well (ahem ahem blush blush) who ended up meeting eachother in the bright, blue, loving and gentle theatre of the OLVG through a stargate wound as opposed to having met in their living room after the full journey through the vaginal canal.

It wasn’t what they had planned.

It was exactly what the mother had feared the most.

But it was beautiful, truly beautiful.

It was deeply healing.

It was what she needed, despite having had a doula, an independent midwife and a best friend as birth attendants to try to  avoid it.

It was a whole host of things underpinned by a whole host of emotions; but it was their unique, wonderful birth story.

She experienced that heart burstingly ecstatic moment right there in the theatre.

The wonder.

The bonding.

The magical miracle of birth, albeit a different kind of magic to the magic she’d been hoping for but magical all the same.

Breast feeding worked out.

The wound healed perfectly and quickly with no infection or complications.

And to date there are no health issues to report in her son, partly because she reads all the articles she can on the health impact of Caesarean birth, and makes the choices that feel right for her and her family in order to best mitigate any “potential long term health impact”.

Words can’t always express the emotion of birth; but I believe these photos capture some of them – a big big thanks to Claudia Van Dijk (midwife from vive: vroedvrouwen in verbinding who took them.

10582889_10154527089210462_4595273778823943543_o

10679545_10154527090370462_1037262398706742935_o

10514170_10154527091955462_5995710067755016371_o

10687353_10154527091190462_444272507571813017_o

1399536_10155057348220462_3061518875571634576_o

*Please note* no studies currently prove any link between babies who are born via csection to having a higher chance of having: a bad temper, longer eyelashes, multiple nipples, a recurrent ingrowing toenail, or a tendency to smile later (you’ll be glad to read).

Ina May Gaskin comes to Amsterdam – and YOU are invited!!!

Ina May Gaskin comes to Amsterdam – and YOU are invited!!!

HBA-Ina-Mays-Guide-to-Childbirth.Ina-May-Gaskin

Maybe you have heard the rumours???

Often described as “The Mother of Authentic Midwifery”, “America’s Most Loved Midwife” and notorious for her practice’s exemplary results and low intervention rates, Ina May Gaskin has gained international notoriety for promoting natural birth: and it is true – she is coming to Amsterdam!!!!

Maybe you thought, “Tickets will be sold out – no chance I’ll be able to join”

Well the daytime event with Ina May Gaskin on the 25th September 2015 was so popular it sold out in a matter of days, but the organizers and Ina May got together and decided to arrange another event on 24th September 2015 and so here is…

> > > YOUR INVITATION < < <

to join us for………..

AN EVENING WITH INA MAY GASKIN

24/9/2015

19h00 – 21h30

@ CREA Theatre, Nieuwe Achtergracht 170, Amsterdam

This event promises to be an inspiring evening listening to Ina May’s stories from the notorious natural birthing mecca “The Farm”
Ina May is keen for the last hour of the event to be a dialogue: so bring your burning questions!
What do you want to ask Ina May Gaskin?
ina-may-gaskin-photo
Event costs:
#EARLYBIRD# 65.00 euros* before August 31
75.00 euros* from September 1
*Prices are BTW inclusive
 Birth-Story_612x380
HOW?
To register for your ticket now before the event sells out and still at the early bird price for another five days, please e-mail Lievnath Faber at lievnathfaber@gmail.com
or
Dana Esther Lindzon from Mamawise at dana@mamawise.nl
Ina May’s books will be for sale at the CREA before and after the event, please bring cash should you wish to buy (no PIN on site)

I’m attending with the organisation: so I hope to welcome you to the event and enjoy the evening together!
In case you haven’t already seen it – check out Ina May’s TEDTalk

LaborQuote_Kindred

What would I gain from having a doula in my birth team???

What would I gain from having a doula in my birth team???

image

As a coach and a doula I do a lot of networking online. I was very grateful yesterday to receive this very honest and curious question from an expectant third time mother:

{Q} “As I have only really heard of Doulas on USA TV shows, can I ask what… (sorry I’m trying to word this as my intention is far from to offend you but to learn if this for me)..would I get from you that i wouldn’t get from my midwife, husband, my mum and friends? I’m trying to work out if this service is going to give me anything extra than I’m already lucky enough to have? Thanks x”

{A} “Your midwife’s two priorities are the physical health of your body and the physical health of your baby; my priority is empowering you to make the best choices for your emotional, psychological and spiritual health, and then supporting you and those choices to optimise your enjoyment and empowerment through your birthing experience. A doula supports those aspects of your husband’s/wife’s/boyfriend’s/girlfriend’s health and enjoyment, and if relevant your other children or other birthing partner. In other words your midwife will focus mainly on your cervix, vagina and baby’s health, I’ll focus on making sure you are feeling positive, peaceful, comfortable and powerful as the latter stages of pregnancy, labour and the post partum period unfold.

Your husband/boyfriend as a male (or your wife/girlfriend/friend as a non labouring female) has the potential to be both having their own profound experience as well as being or feeling a little lost in the experience. He can read a lot of books to prepare him, he can empathise as much as his imagination allows him to, he may feel scared, exasperated, helpless, overwhelmed, overjoyed, traumatised, frustrated, squeamish or traumatised at any given moment during labour, birth and immediate post partum.

Michel Odent has infamously asked three confronting questions of fathers being present at a birth:

First question: Does the participation of the father aid or hinder the birth?

Second question: Can the participation of the father at birth influence the sexual life of the couple afterward?

Third question: Can all men cope with the strong emotional reactions they may have while participating in the birth?

For the answers and full exploration of this topic read the full article here: http://www.midwiferytoday.com/articles/fatherpart.asp

A doula can support your partner in their experience of labour, both practically (ie popping the kettle on, making cups of tea, topping the birth pool up, making the placenta smoothie after birth, taking photos with you all in frame, letting him go to the bathroom and take a break for a moment), emotionally (a hand squeeze, a hug, a shared look, a hand on the shoulder, a safe word if he’s squeamish) , and all in the name of helping him to support you best. I love this article, and this quote from it “Our doula really helped bring me together with my wife as she gave birth. My wife remembers my constant support and never failing love or knowledge. She remembers the doula as a nice person who did some stuff in the background. We won’t give birth without a doula.”

Your Mum is your Mum. You were connected at one stage by an umbilical cord, or by adoption papers; either of those things carry a lot of emotional baggage – in a good way most of the time, but sometimes some women find that emotional baggage doesn’t actually keep them in the best place for them to experience their own power during labour….some women need their mothers and can’t imagine labouring or birthing without their mothers in the room. If your mother is there; then a doula can support your mum in supporting you in the best possible way; taking away the things that might take her away from the – the practical and emotional things above. Or, if your mum is not there, then a doula can mother you; take care of your every need in a nurturing way – but without the same weighted emotional ties. And she would probably offer to text your mum to keep her informed of the process so that you are kept away from the bright light of the mobile screen which isn’t so conducive to the labouring mind.

Your friends are family you choose, you mention them so I’m assuming you are close and that’s wonderful that you know they are there to rally around and be supportive. The thing is with friends that we often have a certain point with friends where we stop just before we ask them ‘one more thing’ – because we think “Oh but they’ve already done so much” or “ Oh god should I share that info or is that just TMI” or “ I know she’s having a really tough time with her husband right now – I can’t have a pregnant moan about the fact that I sent my Tim out for hazelnut icecream and he bloody came back with macadamia nut brittle instead” etc. A doula is there to listen to the TMI stuff, to go that extra mile and make up an extra batch of xyz as needed, to realise the difference between a hazelnut and a macadamia and to not think you’re a pregnant or labouring diva but to just get to know you and do those extra little things in just the right way for you….so your friends can come round, have a cuppa, have a two way moan because you know you’ll save that extra moan with your doula so you have space for their stuff too.

Other things a doula does above and beyond the team you mention:
– She helps you inform and empower yourself about birth so you can plot out your birth preferences not based on what the hospital protocols/home birth team/birth centre normally “allow” but upon what will work for you and your family, what will make you feel safest and what will hopefully mean a positive, peaceful and empowering birthing experience as opposed to birthing a healthy baby at any cost.
– Unwavering, non-judgemental and non-phased birth support at any birth you choose or need to undergo. In a Pennine stream, in a hospital theatre, in a birthing pool in your living room, the local birth centre or on your kitchen floor: a doula will be there calm and unwavering, with a hug, a smile and an eye to eye look reminding you of your power and strength when you need it most – whatever the setting whatever the situation.
– She holds the space around labour, birth and the golden hour post partum. What does that mean? It means helping you to keep your surroundings during the last weeks of pregnancy as calm, safe and peaceful as possible, and during labour means protecting that space and reminding those who may come in and out of it to respect it, promoting oxytocin amongst everyone who comes in and out; and that oxytocin will help you and your body to remain saturated in it (Oxytocin is one of the main hormones in the birth hormone cocktail)
– She records your birth story for you; the time you really got into the zone, the funny thing you said whilst eating a sandwich, the time the midwife arrived, the time your waters broke, the time the delivery kit was mobilised, the moment baby crowned, the moment baby was fully earthside…and if you’re lucky she will be able to take a few photos too!
– She can offer alternative pain relief methods such as massage, acupressure, rebozo, aromatherapy.
On top of all that I would say that I personally can offer:
– Years of counselling and coaching experience to support in listening, overcoming and setting intentions and goals around pregnancy, labour, post partum and breast feeding
– Reiki and polarity massage before, during and after birth
– Alternative support in helping you with Optimal Foetal positioning )including Moxa for breech presentation
– Massage, acupressure, rebozo sifting and aromatherapy as above
– Birth photography
– Currently offering preparation of placenta smoothies and portioned placenta for the freezer, plans to offer placenta encapsulation in the not so distant future
– Excellent tea making skills; and a penchant for choosing the right herbs to support good health throughout”

I received this reply following my answer:

“Wow thank you for this information, I’ve read, reread and read again for good measure ( it’s peaceful here at 5.30am lol) I think your work of empowering the person going through the labour and pregnancy and her partner is such an incredibly amazing thing and understand how and why many many couples would need and want you by their side especially for a first birth or after a previously traumatic experience. Having laid here digesting your words and reflecting on my previous birth experience ( emm c-section, sick mummy, very cardiac sick baby and then natural, long but brilliant personal birth with my hub by my side then straight home to breath in our own space) I feel my husband and I are all we need to create an environment in which to bring our third child into our family. I do feel for my second child my husband ( his first) would have really gained so much from you bring there from what you’ve said above. I hope you don’t mind but I’ve sent your comment above to two friends who are both due to give birth in August ( one first time parents and the other a mum who’s going to be a mum and a dad soon) who I think will both be very interested in your support.”

What would you add to the list of benefits of having a doula beyond the great statistics that are out there?

Did you have a doula?

Did you not have a doula but wish you had? Why?

Did the experience live up to your expectation?

What would you tell someone who was thinking about having a doula to support them and their family?

A quote I love which is a good one to end on (and also features on my business cards) is this one from John H Kennell MD:

“If a doula were a drug, it would be unethical not to use it”

(So impressive are the positive birthing outcomes for mothers supported by doulas)

Still need convincing?!
Here are some other articles on why you might like to hire a doula:

http://expectingthebestbirth.com/50-reasons-to-hire-a-doula

http://taprootdoula.com/2015/03/23/stop-worrying-and-hire-a-doula/

http://www.bellybelly.com.au/pregnancy/doulas-what-is-a-doula/

#worlddoulaweek 22-28 March 2015

#worlddoulaweek 22-28 March 2015

I am a birth doula because I believe passionately that if we change our birth stories, one at a time; we can change the world – one mother and one baby at a time.

To have the honour of supporting and nurturing a woman during her pregnancy, labour, birth and postpartum period; to help her stay in touch with her power, her vulnerability, and her courage; to hold and protect those sacred spaces during this time in her life to allow her to surrender into them; is utter oxytocin-fuelled loveliness.

To celebrate: I’m currently able to offer my voluntary services as a doula for three families within Calderdale and Kirklees, in exchange for evaluation of my service and support to facilitate my full certification and for my ongoing learning.

I am looking for families that are due to give birth somewhere in the next 2 to 10 weeks; as this will give them the optimal time to enjoy the benefits of being supported and nurtured by a doula.

If you engage me to support and serve you as your doula, you can expect:
– to be listened to and be heard
– to be seen and be appreciated
– to be encouraged and empowered
– to be served and honoured
– to be nourished and nurtured
– to be supported unconditionally; no questions, no judgements, no compromise

Having completed an advanced skills course with Penny Simkin on supporting survivors of abuse (sexual, physical or emotional) and PTSD sufferers, I am very well equipped to support women who have survived childhood or adult abuse, and would be pleased to be able to offer such support on a voluntary basis. I am also interested in supporting single mothers, and mothers having a VBAC, please make contact directly.

Here’s to healthy, happy and relaxed pregnancies;
here’s to cherished and empowered labouring goddesses;
here’s to nurtured and confident mothers:
here’s to the benefits of the extra support, information and nurture that doulas can offer!

Doulas: cherishing, nurturing, informing, coaching and empowering women throughout pregnancy, labour and early motherhood.

Ilena J Standring
Doula & Coach
Amsterdam

+31(0)648688308