I was recently sent a beautiful video of how nurses process their own grief when they've supported families through perinatal loss. The quality of a medical caregiver's presence can be pivotal in helping families who are dealing with grief, and my hats off to those who, with exquisite sensitivity and compassion, make a seemingly impossible path just a little smoother and more light filled. While for the most part the video was a guide to how nurses can move through their own emotions surrounding difficult experiences, it brought up important observations for me. They came up when one of the nurses was discussing her own personal experience of pregnancy from the perspective of one who sees stillbirth and tragedy on a pretty regular basis. She describes being a student in her childbirth education class, and how couples would discuss things they wanted for their birth experience. This nurse admits, "I don't care about episiotomies or anything. I just want to be alive, and my baby to be alive."
My heart just broke for this nurse. I witnessed someone so steeped in the experience of being a relatively frequent witness to tragedy that she dared not invest her heart in any desires towards her own birth process. It was almost as if wanting more than simple life was an audacity. I have seen this with clients who have experienced previous perinatal loss and are expecting a subsequent baby. Where once they were innocent, concerned with cloth vs disposable diapers or about the risks of epidural, or prefering to refuse a routine IV during labour, their innocence is shattered by grief and the fact that life can seem cruel. Once bitten, twice shy.
Herein lies a very important issue at the heart of some of the problems we face as consumers of medical maternity care: our doctors and nurses, given the high volume of births they see ranging from the mundane to the highest risk possible, fairly frequently witness death as a result of pregnancy and birth. It's clearly not something they can avoid, as this is the occupation they signed up for. Remember, this exposure doesn't mean there IS generally a lot of death as a result of birth if you look at overall outcomes. The exposure comes comes from witnessing high volumes...hundreds of births per year, many of them, depending upon the hospital centre, extremely high risk. As they say in the labour and delivery wards, most of the births are regular to the point of boring. It's the small percentage of drama that keeps everyone on high alert. It is all part of the job of being one who assists women on this journey to motherhood. But if the experiences of trauma and loss go improperly processed, there are aspects of this frequent exposure to heartache that have can have a negative impact upon us as birthing women.
To see death in the labour and delivery ward is not the same as being in geriatrics or ICU, as many patients in those wards are expected to pass because they are old and/or sick. But when a couple is expecting a happy start to family life and that dream is tragically extinguished, not only do caregivers mourn the death of a sweet, innocent baby, but bear the burden of parents' acute shock and grief. To witness a mother holding her lifeless baby, those months of hopes and dreams just gone, or to see a father simply shut down, his shock rendering him broken spirited, is emotional suffering I cannot even describe to you if you haven't seen it yourself.
We are blessed in developed nations to have access to these caregivers who can save us and our babies when emergencies occur, we truly are. More tragedies than we could imagine are prevented with this incredibly skilled care. But sometimes Nature overrules and no matter what is done, no matter how many years of studying someone has undergone in surgery and pathology, no matter how much experience they have, no matter how careful they were, no matter how safe the situation might have appeared minutes before all hell broke loose, someone dies. Sometimes it can't even be identified why. And in our culture, this is perceived unacceptable.
In order to truly understand where medical caregivers are coming from, and to glean an essential insight into one of the reasons why our birth culture may appear as wounded as it is, it's important to look at a few thing. Take the personal grief the caregivers most likely feel in reaction to their experiences of tragedy into account (nobody goes looking for that feeling, and in fact tries to avoid it all cost). Mix it up with the weight of responsibility doctors and nurses carry for us (we go to THEM for care, expecting THEY will keep US safe). Now throw in the fact that in the midst of overwhelming grief, sometime parents might feel they need someone to blame (which will usually be the caregiver who, being the responsible expert we entrusted our lives to, "should" have been able to do SOMETHING, or something different from what was done, to avoid the devastation they are now suffering). This cocktail of pressure can potentially create a powerful fear of future emergencies, disasters waiting to happen, and ultimately, the unpredictable mysterious nature of uncontrolled, unfettered physiological birth...which, on occasion, leads to grief. And it is this fear which surrounds and permeates the hallways of the hospitals these medical professionals practice in, as well as the rooms in which many of us attempt to birth normally.
In some schools of psychological theory, it's believed that when we experience a trauma, there is a disassociation of a portion of our presence from the experience. It is a protective function of our minds, serving to spare the psyche from unmanageable pain during a time attention is needed for survival. But at some point, that trauma and the emotions involved (that were neatly tucked away to help us function in the world) need to be revisited and processed in order for us to heal and move on, to re-associate essentially. Shamans of old believed that a piece of one's soul actually fractured away during trauma, and got left behind in that traumatic experience, existing in a different dimension indefinitely, longing to come home. One of the ways they would seek to heal their tribes people would be to conduct a ritual of soul retrieval. The shaman would go into a state of trance, and supposedly travel in different worlds of non ordinary reality to seek those pieces of soul, bring them back to his patient, helping to reintegrate the lost piece so it felt welcome. The patient would experience a cathartic release of the emotional energy caught up in the lost piece, and then they would live a more whole and balanced life with that blessed reclamation, being able to maintain a normal instead of wounded perspective of the world.
If a person does not eventually process the disassociation that served at the time of the trauma, a person can be easily triggered into post traumatic-like reactions in situations that resemble the original trauma. Even the thought of a repeat of the traumatic occurrence can trigger rushes of adrenaline and fear. This is a very painful way to live, as access to many of one's internal resources are limited.
All this is to say, I believe our birth culture functions around massive chunks of missing soul pieces, if you will. I make no personal accusations here, as many of the caregivers I know and love are very well integrated and can weather the occasional loss of life inevitable in childbearing without becoming traumatized. But I believe collectively, Medicine just may be learning, working, treating, and intervening from a place of post traumatic stress. And no wonder! Imagine this (and I am not making up this scenario): you're a nurse, and you've just helped with the delivery of a stillborn baby who died right at that 41 week and three day line, the non-stress test you set her up for and ultrasound having seemed perfect the day before. You're still wiping tears away after having wrapped up the little body for the parents to hold, inside wondering if you could have had any power to change this outcome if you had just a little more forcefully encouraged the mom to induce a few days earlier when you put her on the monitor. Part of you is worrying about how the parents might react if they somehow wonder the same thing, and this will haunt you for a long time. Then suddenly there are premature twins down the hall who need delivering fast to a pre-eclamptic mom and all hands are needed on deck! On the way to that family in crisis, you run into a patient you know from care you've given her prenatally in the hospital, who is just admitted in labour. She is wanting to birth naturally and has this list of mundane f$#*&#g requests she's flapping in your face, requests you've heard a million times from a million people! You are holding so much in your heart and mind right now and this woman wants things that you might, with the perspective you've gained from your job, have discovered are luxuries and trivialities apart from a living baby.
I stop here to take a deep, long, breath of understanding, of compassion, and of true honour for all you are capable of and willing to do to keep us and our babies alive. I invite everyone here to do the same..take a second to breathe and put yourself in that place. Empathy is crucial to truly understanding, gratitude amplifies our loving energy far more than angry blame, and this opens our hearts to the beginnings of healing. Let us start by seeing the big picture behind what we perceive as the fear based medical practice that we feel puts our birth experiences at risk.
The average person who is effectively attempting to retrieve missing soul pieces can usually get away from their triggers to gain perspective. The woman who is constantly traumatized by an abusive partner can generally begin to heal when he is out of the picture. It takes a lot of psychological work for her to come to a place where she doesn't perhaps perceive all other men as threats or go into shock when she sees someone wearing something he used to wear, but with support it can be done. A recovering addict must remove himself from people, places, and things for a while that he associated with using his drug of choice in order to heal. While still raw and processing his emotional pain, the associations with the drug of choice can be a powerful trigger back into addictive behaviour.
So what about the medical care giver who, after having experienced the trauma of a baby dying on their watch, has to go back into the trenches and keep going, knowing they will inevitably see tragedy again at any random time? Well, chances are they're going to up their game in the vigilance department. And given that they're pretty vigilant to begin with, this is saying a lot. If they've seen uterine rupture during an attempted VBAC, VBACs may be something they're deeply reluctant to do in the future, for a while anyway, until the event is sufficiently behind them and they feel open to trying again. If they tried a breech birth and the baby died, chances are, they're going to be unwilling to revisit that scenario again any time soon and prefer to perform Cesareans on their patients with breech babies. Because of a seemingly large infant, many caregivers will not be willing to allow a vaginal birth given the higher risk of shoulder dystocia and the devastation that can potentially entail. Why? Because they've seen it! It's normal human behaviour. If your house gets broken into, you'll probably get a better lock or alarm system and never leave that one window open again at night, regardless of the lovely breeze that used to come through. If you've been mugged, you're going to be on higher alert when you're walking down the street alone at night, or skip that route altogether, even though you may have walked it happily and safely every night for ten years. It is human to try to avoid pain and recurrence of trauma, and a health care provider is psychologically no different. In fact, it's deeper than that, as they are not trying to spare their feelings necessarily, but someone else's. They are also at the mercy of many rules, no matter what their personal beliefs, rules created by that collective deep seated fear of unpredictable old birth and death.
The build up of post traumatic stress in Medicine doesn't help birthing families in many aspects. One could argue that aggressively applied obstetric care has reduced death all around, and sure, there are truths to that, such as the fact that experience gained in dealing with trauma provides practice with how to work with complications more effectively. I'd sure like the guy dealing with my stuck baby to have oodles of experience in doing so. But consider how fear-based care may
not be so great for us. For example, in North America the Cesarean rate has risen crazily in the last decade or so, while outcomes have not really changed in response to this impetus to get babies out surgically. This is testament to the fact that women and babies aren't actually generating any more emergencies than before, but that Medicine is scared. Scared of messing up, scared of allowing the unknown to emerge, and scared of not pulling out all the stops to get a baby out in decent shape. Women are scared too, as seen in some North American hospitals where more Cesareans are planned and preferred over vaginal birth. As a result of fear begetting fear begetting fear begetting even more fear, we have become a bundle of simmering panic threatening to erupt.
The belief of health care providers and many parents that technology and medications are always being logically and judiciously applied, or the fact that arcane practices are being imposed upon birthing women routinely regardless of their good health or what they may want, (lithotomy, continual fetal monitoring, etc) illustrates that we as a culture are servants of Terror when it comes to normal birth. We say it's all about safety for Mom and Baby, that the hyper-vigilant, agressive "just in case" approach is for the best. But our North American statistics don't always prove the safety of our methods of trauma prevention the way we may hope. Yes, overall we do a great job! But we can do better. When we compare our maternal/newborn outcome statistics with those of some other developed nations in which there is generally a lot less fear surrounding the birth process, a different story emerges. In these countries, trained, skilled midwives are attending the majority of normal births in birthing centres or at home, and obstetricians are usually reserved for complicated pregnancies and births. We see that they are enjoying better and happier outcomes. Our fear centred, overly managed practices are not serving mothers and babies as well as the mother/baby/wholistically centred practices they have in Holland and Norway. A mother's positive experience of birth and postpartum is very important to these cultures. In Holland, a woman whose role is similar to that of a postpartum doula comes to the mom's house daily to tend to her for weeks after she's given birth. And this is at no cost to the family, the government pays for it. Our focus is single minded in that a live baby/live mother is all that's really important; well-being is simply icing on the cake, which is an attitude very harmful to women in general.
I in no way want it to be thought that I don't believe we should have OBs deal with normal births anymore. I will address this more in Part 2, but I want it out there for the record.
Normal, physiological birth has come to be considered a radical act in many circles. Many caregivers AND many women HOLD NORMAL BIRTH IN CONTEMPT, even though many have never even seen what that looks like. The fact that birth is SO out of balance, meaning that regular old labour and birth is rarely seen in modern hospitals, reflects a physical manifestation of massive collective terror. Aspects of that are profoundly unhealthy to women, their partners, and babies; physically, emotionally, and spiritually. Surrounding this truth are some groups of people who are yelling that natural birth is the ONLY way and that medical care providers are essentially butchering and assaulting most women in their care. This is unfair and it doesn't help! There is so much fighting and hatred and gnashing of teeth in the name of change that small, easy steps to heal aren't actually being taken as much as pot shots. I have heard midwives called "witches" by doctors, doctors called "butchers" by midwives, and women called "irresponsible" by anyone who feels threatened (essentially frightened)by their desire to birth on their terms. It feels very heavy, almost desperate, and sometimes I lay my head in my hands with sorrow and don't quite know what to do. We have to move through this in a way that makes everyone, birthers and caregivers alike, feel as safe as possible, leaving us all with feelings of integrity.
If how we make choices about birth and how we react to birth is a reflection of our reverence for this mysterious energy that is Nature's design for bringing forth life, we are in trouble. I am being asked more and more to hold support groups for women who feel deeply disturbed by their birth experiences at the hands of well meaning, but disconnected caregivers who seemed terrified of letting them do what they wanted, like birth on their hands and knees or not take pain medication. And if our culture's disassociated, fear-triggered approach to birthing can be seen as a metaphor for the "as above, so below" principle I'd have to say I think Birth is demanding her soul back.
The divide that exists between medical caregivers and consumers who want normal births is this: we birthing customers usually
don't see babies die in our every day lives. Our perspective of birth comes from somewhere..well, more
normal. Most people don't see volumes and volumes of babies born and witness worst case scenarios, or even the occasional time a normal birth simply ends badly for no foreseeable reason. We are aware that it happens, and we are scared of it happening to us, but it's still all just concept. We are not usually coming to hospitals triggered by tragic experiences of birth loss. Though we are not ignorant (we know bad stuff happens), we do come to birth with a certain innocence. And I think this is okay. It doesn't help us to be armed with terror. Terror interferes with that important oxytocin flow. We come to birth with dreams. Here is where we get to the crux of the matter: regardless of what caregivers have experienced of trauma, resulting in personal wishes and/or sets of hospital rules prescribed to over manage our potentially trauma-filled births, as compassionate as we may feel for the place they're coming from, we still want the right to dream of our good births. And we want to have our good normal births encouraged. Not just in word, but in deed. We want those dreams to flourish without "being put in our place" by the fear projections of the sadly wisened. We do not want our wishes of empowerment and joy to be trivialized by those who have seen it all and would prefer us to not have high expectations for fear of "being disappointed". We want partners in our intent to have whole, happy births, and only saviours if that becomes necessary.
It is somewhere here, between fear and dreams, where something must give and release the pent up emotional energy we're held hostage by and a new way, one rich in safety AND meaning, can emerge. We emphatically DO have the power and the resources to accomplish this. Real healing is essential...and entirely possible.
Stay tuned for part two: How Do We Have Our Cake and Eat it Too?: Retrieving Birth's Soul
There is a lot of controversy as to whether or not there is value to this, as many babies turn posterior during birth..but because of the fact we see a large percentage of natural births, we also see (as anecdotal as it may be) that many of these malpositions during labour occur after mothers receive an epidural. We know that for moms who have healthy, normal pregnancies and their babies are determined by their caregivers to be head down and stable, the principles of OFP may potentially contribute to a smoother birth. Can we tell where babies are lying in their mom's tummies? No, of course not, that takes years of midwifery/medicine experience. We ask Moms when we are asked if we know where their babies might be upon our discussions of OFP, "Where do YOU think your baby is?" We ask where the mom feels kicks and a bum, and if she wishes, we feel along with her. It is in the spirit of bonding, exploration, and empowerment,and helps moms get accustomed to our touch, establishing a deeper rapport that we bring to her birth experience. To validate to Mom that her instincts were right on, or to perhaps explore further if she is unsure, we invite her to listen to her baby's heart, having her place the device over where she thinks Baby's heart would be heard. Parents love to listen to this, and their eyes light up when they realize they figured out the mystery. Never is anyone listening to the heart rate for any diagnostic reasons, nor are doulas ever trying to diagnose position or lie. If nobody hears a heartrate, we know it's because none of us know enough to find the right spot, no big deal. When parents ask about their baby's positions, most doctors tend to consult the ultrasound papers and say, "it's head down" and that's that. So discussions about fetal positions and their being proactive about it piques their curiosity to know more about their bodies.
