My journey towards natural childbirth

When I try to recall my first impressions of birth, and where they came from, I can think of a few things.  One is an American movie that my Dad used to like and let me watch a number of times, called "Look Who's Talking".  It's about a married couple who have a baby and all the struggles the couple go through in the process.  Oh, and, when the baby is born, it's really cute and you can hear it's thoughts.  I remember the pregnancy was shown to be a big pain.  The mother was uncomfortable, she was moody and emotional and she was really thirsty all the time.  In one scene she drank a whole carton of orange juice.  When it came time for her labour, the contractions came on suddenly and it was all panic and agony as she rushed outside to hail a taxi, sped to the hospital (yelling at the driver to speed up) and cursed her husband for putting her in this mess as she pushed the baby out.  From watching another movie more recently, it was pretty much the same thing.  Panic, pain, fear.  Who'd want to go through that?

This negative impression was sadly reinforced by my mum's accounts of giving birth to me and my sister. She went a 10 days past her due date, I think, and was told she needed to be induced.  The doctor she had been seeing was busy playing golf when she had the procedure, and so she had to be with an unfamiliar staff, as well as student doctors who frequently came in and observed her.  My mum is a rather modest woman and so I don't think this would have been relaxing for her, to say the least.  Since she was having a chemical induction with the syntocin drip, she really found the pain unbearable, she even said she felt like she was being ripped in half!  Not encouraging stuff to hear as a girl contemplating becoming a mother.

As a teenager, I saw my step-mother give birth to my two half-brothers.  The first birth, my Dad took my sister and I to the hospital just as she was pushing the baby out.  This was a fairly positive experience.  She didn't seem to be suffering.  She was lying on her back, legs in stirrups.  She had had an epidural and when the baby came out, we got to cut the cord.  I was in rapture when I saw the sweet baby, looking around at his new environment, kicking his legs like a little frog.  The second birth, though, I must say, was a bit disturbing.  My step-mother had an induction and the whole process went very fast - she gave birth within two hours!  She decided to try without an epidural this time and only used gas and air towards the end. It was hard to watch, as she didn't seem to be coping too well and became loud.  This from a woman who frequently bears the pain of severe migraines with quiet resignation.  She was in good spirits afterwards, though, and said that the pain didn't matter because it only lasted a short time.

My sister then became a mother before me, at a young age, and she too had a difficult pregnancy with nine months of nausea as well as a long labour that she found traumatic.

All of this left me quite fearful of pregnancy and birth.  When I looked at pregnant women, I thought they must feel like they were sitting on a ticking time bomb as they counted the months and weeks towards the day of agony.  It didn't comfort me to think it would only last a day, or at worst, a few days.  It didn't comfort me that you would forget the pain.  I knew what it felt like to be in pain or discomfort (like when I burnt my hand or cut myself) and even a few minutes feels like an eternity. And, getting a baby at the end is a good reward, but I wasn't convinced it was compensation enough for what people seemed to go through on TV etc.

So, as you can imagine, I was somewhat anxious about the birth of my own baby when I fell pregnant and kind of assumed I would probably have an epidural, and maybe other things too.  However, I had already heard a little about the benefits of labouring without drugs from the time when my mum was pregnant with my youngest sister and I had already heard about the downsides of elective Cesarean section.  So, I hesitatingly began researching more about what natural birth was and it's benefits. As I read more, I realized that it may actually be something I wanted to pursue.

It seemed that every form of chemical pain relief had risks for me and/or the baby.  Just look at the cons listed on this Mayo clinic page.  I also learnt that they can interfere with the birthing process, thereby leading to a more complicated delivery, complicated afterbirth, and can possibly affect the health of the newborn and its ability to breastfeed.  It was really important to me to have a straightforward birth and for my baby to get a good start on breastfeeding.

Still, it took me a while to get my head around the idea of forsaking all chemical pain relief. I never, in fact completely ruled it out, but my hope of having a natural birth increased somewhat when I discovered the concept of hypnobirthing.  It's basically a way of achieving a comfortable, and even painless, childbirth through self-hypnosis.  I had already heard of people using self-hypnosis to undergo normally painful operations if they were allergic to anesthetic, and so I believed it was possible, but I wasn't sure I could achieve that kind of mind control.  I would have liked to have been coached in person and have that person actually attend the birth, but settled for a home-study course produced by "Hypnobabies". This course explained that self-hypnosis consists of two aspects - one is reprogramming the sub-conscious mind and the other is learning relaxation techniques. I'll briefly address each of these.

For the first aspect, the course explains that we all have preconceived ideas about childbirth and that "what the mind expects, it will create".  That is, if we have been trained to believe that birth is painful, we will expect that and then our bodies will experience pain.  Between our conscious mind and our sub-conscious mind, there is a kind of filter whereby we decide what to accept into our deepest beliefs.  In order to disable this filter, we have to go into a hypnotic state (which is basically a relaxed, passive state).  Once in that state, we can listen to positive birth affirmations and learn to believe and accept those statements or "hypnotic suggestions".  This part includes learning a new vocabulary to describe terms associated with birth that are free of the normal negative associations, and which describe birth positively, like "birthing time" instead of labour, "birthing wave" instead of contraction, and never mentioning pain.  Only "birthing sensations" or maybe "discomfort" if necessary.

The second aspect is entering a relaxed, hypnotic state, whereby you don't feel pain, but only "pressure".  Various techniques are used, including visualizations of "hypnoanethesia" spreading around the body, going loose and limp and focusing on deep, slow breathing.  By the way, the breathing that they teach is similar to that taught by the Bradley method.  Both methods also encourage the mother to move freely throughout the labour, which assists the descent of the baby.

Both of these methods work, it seems, because they fit into the physiology of birth.  Firstly, the hormone that initiates contractions is oxytocin.  Adrenaline, the hormone of fear and anxiety, undermines the effectiveness of oxytocin and, according to Hynobabies, fear can cause the lower abdominal muscles to work in opposition to the upper abdominal muscles, causing pain.  However, in a relaxed state, they argue, contractions are not really painful, but just powerful sensations.  Furthermore, deep breathing can reduce pain because it oxygenates the blood and one reason for pain is the accumulation of lactic acid from muscular contractions.  Oxygen allows the lactic acid to be broken down.  Finally, there is this thing called the fear-tension-pain cycle.  When you are in pain and fearful, you tense up because you are fearful, which increases your pain levels, causing more fear and so forth. The more your fear pain, the more pain you are in. So, purposefully relaxing, even if you are fearful or in pain, can reduce your overall pain and also release natural painkillers, endorphins.  Other things, like being able to move into natural positions in response to the descent of the child, swaying the hips, being in a darkened room, surrounded by familiar, reassuring people, can reduce fear, increase relaxation, and increase the release of natural pain killers whilst allowing labour to proceed without 'stalling'.  

The reasons for all of these are well documented in lots of places around the web, so I won't go any further into it, but it's a very interesting area.  Basically, when women are not conditioned to fear birth, are with supportive care givers who can minimize fear and the woman is free to labour and birth as she instinctively wants to, her natural ability to birth shines through and medical intervention is needed far less than it is administered in hospitals.  Giving birth in this natural way, where the natural hormones are not interfered with, can be a very empowering experience, as there is a rush of joy and a sense of accomplishment at the end.

Many of these ideas came across in a number of films, articles and stories I read and these gave me confidence that I could have a positive birth experience.  But, I came to realize that my best chances for achieving this involved finding a place to birth where I could control the circumstances to some degree and fully relax.  I would also need to be somewhere where they wouldn't interrupt my concentration during hypnosis. I imagined getting to hospital and having to fill in forms (in a foreign language) and having all sorts of exams and tests... not to mention if I didn't feel comfortable with the way the staff treated me...this would definitely break my concentration and maybe set off the fear-tension-pain cycle in a major way!  And, if this article about the situation in Serbia is true and if Bosnia is anything like this, I had good reason to run away as fast as my pregnant belly would allow.

Another part of the Hynobabies course involved staying healthy during pregnancy to reduce the likelihood of complications.  And, it presented a lot of information about routine hospital practices which can increase the likelihood of complications and make it harder to have a comfortable birth.  Through this, I realized that having a natural birth was not just about avoiding pain medication, it was also about not interfering unnecessarily in the physiological processes.  I say unnecessarily, because there is certainly a place for interventions, but it seems that hospitals apply them far too broadly based on their own convenience or on population data that doesn't adequately consider the individual case of each mother and baby. Furthermore, once you have upset that balance, the body often needs further medical help because you have taken away what the body needs to do what it's meant to do. Once you get on the bandwagon of interventions, you basically can't get off.  For example, if you have had interventions and pain medications in your labour, it is safer to have a 'managed' delivery of the placenta.  However, if you have managed to stay drug free, a natural 'third stage' is quite safe. See here.

Another big example of one procedure leading to another is induction.  That is, starting labour artificially. The worst kind is with a syntoccin/pitoccin (artificial oxytocin) drip, although other methods can also be quite nasty.  Syntocin (which is also used in 'augmenting labour') really interferes with the body's ability to produce it's own oxytocin, thereby majorly disrupting the body's own management of the system.  Syntocin contractions are said to feel much more painful because the drug doesn't affect the brain in the same way as oxytocin.  Since it's more likely that the baby goes into distress with an induction (because of the intensity of the contractions), the baby's heart rate needs to be continuously monitored, which means the mother becomes basically strapped to the bed, and this itself increases the sensation of pain.  There are also risks for the mother in overstimulating the uterus and uterine rupture is possible.  Also, once you have had this kind of labour, you are more likely to want an epidural to manage the pain, which can lead to difficulties pushing, which can lead to tearing or instrumental delivery.  First time mothers who are induced are also more likely to need an emergency Caesarian section. There are many articles talking about these risks (e.g. this).

Although there are some valid and neccessary reasons for inducing, the most common is for "prolonged pregnancy".  Take a look at this article from Midwifethinking and this article from the perspective of famous midwife Ina May Gaskin for more information about inductions for being 'overdue' and how it's not always neccessary.  I was hopeful to avoid an induction, and that is one of the reasons that I felt the need to have a private midwife who would be more responsive to my individual situation and health and not feel the need to arbitrarily send me for an induction if I went too far over my due date.

There are many other hospital procedures like that, many of which can interfere with the birth process, but which can be hard to fight if the hospital insists that these are it's policies.  For example, the routine use of glucose drips that restrict movement and potentially cause hypoglycemia in the baby, prohibitions from eating during labour, continuous fetal monitoring, restrictive ideas about how long labour or pushing can safely last, not allowing waterbirth, insistence on performing episiotomies, coached "purple" pushing, restricting movement during the pushing phase and insisting on an actively managed third-stage (birth of the placenta).   Also, it is important to consider a hospital's policies for dealing with complications, such as waters breaking hours before labour, the presence of meconium, breech presentation, or having a vaginal birth after previous Cesarean section.  These situations are not necessarily emergencies, but many hospitals have extreme stances on them.  Not to mention the way the hospital treats the baby when it's born, such as early cord clamping, taking the baby away from the mother for tests and examinations immediately after birth, bathing the baby (washing away beneficial bacteria and healthy vernix coating), giving formula instead of allowing the mother to exclusively breastfeed, observing it in the nursery away from the mother, routine injections that may not always be necessary, and so on.  I know that not all hospitals have all of these policies, but most have at least a few of them, which is why I became wary of hospitals.

The more I thought about it, I also just didn't like the idea of being in a hospital.  I felt that simply being in the place for sick people would make me expect pain.  Staff looking at me, expecting me to have pain, would also make it more likely for me to play that role, and this would also increase the sensation of pain.

Isn't that a bit risky, you may ask?  Well, generally speaking, physiological birth is safer.  Even hospitals will tell you to avoid coming in too early because that way, you will be less likely to be given medical procedures, which even they acknowledge, do tend to increase risk. Only when the risks of interventions outweigh the risks of complications that have arisen are they beneficial.  Furthermore, examples from the animal world can be very enlightening. I once read a story of how a breeder of valuable racehorses knew never to intrude on the labouring mare, as interfering risked the saftey of both mother and child. The veterinarian would simply hide and secretly observe the mare and only intervene if there was some major deviation from normal.

Through much investigation, I realized that a good midwife does very much the same thing as the veterinarian I described. She is an expert in normal birth.  She is is not trained to address major complications, but does have the experience to spot them before they become critical and can refer the expectant mother to specialist care.  As I was quite healthy and having an uncomplicated pregnancy, I felt I would be safe birthing in the comfort of a home environment with an experienced midwife.

I must admit that the leap to deciding to have a homebirth (and not just at a birth centre) was a bit scary.  It was partly precipitated by not having access to a birth centre (by the time I arrived in Australia, the only one in the city was fully booked), but it was also that I felt I would have more choice in regards to how I could respond to various potential (minor) complications.  Even birth centres have policies that can be overly restrictive when it comes to things like waters breaking early or going overdue. And, when deciding to stay at home, I was reassured by being very close to a hospital in case something went wrong. Finally, I had a very supportive husband who was, at times, even more enthusiastic about homebirth than I was!

Towards the end of my pregnancy, I started to think about having an empowering birth, not just a safe and comfortable one.  I started to move a little away from the hypnobirthing philosophy.  Maybe it was due to the influence of other mums I spoke to, maybe it was because I couldn't keep up with practising hypnosis five times a day!  I still believed that it could be possible to control your mind such as to eliminate pain but I also considered that maybe, learning to accept some pain and surrender to it with courage was part of God's way of preparing the woman to become a mother, a rite of passage in a beautiful, transformative process.

In the end, I did experience discomfort, maybe you could say pain, but I found it really manageable, and it was very healing to see that the negative image of birth I had received didn't have to be true for me. I wasn't excessively anxious or fearful.  I was patiently awaiting the arrival of my baby. The hypnosis techniques, as well as breathing deeply, really helped me to stay calm. There were times when I felt like it might be getting too much, where I thought it might help to yell out in pain. I tried this, but I could feel it instantly increased my heartrate, increasing fear and making me feel out of control and in more pain.  So, I stuck to being quite, breathing through it and visualizing positive things, like being with my baby in a "special place".  When I felt huge pressure opening up my cervix, I tried to imagine a romantic encounter with my husband on the beach. I think this helped!  In addition, using comfortable positions, being in the dark, listening to soft, gentle music and immersion in warm water all helped me to stay calm and manage the sensations.

For most of my pregancy, I found it hard to get my head around the idea that I was becoming a mother. In the first trimester, I didn't even allow myself to think too much about being pregnant, as I knew the risks of miscarriage were higher.  By the third trimester, I was enjoying being pregnant and I liked the look and feel of my big belly.  I looked with hope to the birth of my baby, but also with much trepidation, wondering if I was ready for this huge responsibility.  Even around my due date, when people asked me if I was sick of being pregnant, I said "No, I like being pregnant", maybe because I still felt a little unprepared.  So, I think I needed the long, quiet, contemplative labor I got.  Even the pain served a purpose of making me feel grateful for the gift I was about to receive, and when I got through it, the sense of accomplishment made me feel really strong and happy. I certainly needed that strength in the early days to get through the rigors of early parenthood, what with post-partum soreness, sleep deprivation, the steep learning curve of settling a baby and breastfeeding through painful nipples.

All in all, I got the birth experience I wanted.  It was a beautiful, empowering journey into motherhood.  I'm truly grateful for this because I realize that many women are not entirely satisfied with their birth experiences. I have read articles which say that the pain of labor doesn't matter because you forget it afterwards and you are rewarded with a beautiful baby.  I think this is not entirely true.  There is evidence that women who suffer traumatic births are at a higher risk of post-partum depression and even post-traumatic stress disorder. This kind of trauma can result from fear that hasn't been addressed, from environments that promote fear, from unnecessary interventions that cause complications and from inhumane protocols.  For many women, their birth experience reverberates not only into their early parenting, but also into the narrative of birth they share with their children, and so the negative image of birth persists.  It can also affect their desire to have more children.  This is such a shame because birth has the potential to be a beautiful experience.  That is why I feel motivated to share what I have learnt about birth in the hope that together, we can help create a system that respects physiological birth.