The Pitfalls of Going with the Flow in Birth - Page 2

Author // Melissa Bruijn, B.A. (UQ) & Debby Gould, B.Nursing (QUT) GradDipMidwif (ACU)

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The Pitfalls of Going with the Flow in Birth
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A birth that is safe and positive?

Debby suggests looking further afield for birthing information and knowledge than the regular hospital antenatal classes, and mainstream pregnancy books. “There is often a huge gap in women’s antenatal education,” she says. “Women are encouraged to just go with the flow, and then are naturally surprised and disappointed when their outcome is so different from what the books and classes told them to expect.” Debby recommends that women expand their understanding of birth to include education in a few key areas:

Knowing how women’s bodies work best. Finding out what our bodies need to be able to access their innate ability to do their job is strongly recommended. Influences such as sound levels (quiet allows focus), obtrusive interruptions during contractions (avoid), lighting (low is best), privacy, and feeling safe and supported are often important factors in determining our body’s optimal physiological ability to birth. “By knowing what our bodies need, we can ascertain if these needs will be met by purely following the hospital’s flow. If not, we can take steps to ensure our needs are met,” explains Debby. Dr. Sarah Buckley, an obstetric G.P. and mother of four, agrees. She writes, “We share almost all features of labor and birth with our fellow mammals. We have in common the complex orchestration of labor hormones, produced deep within our mammalian, or middle brain, to aid us and ultimately ensure the survival of our offspring.” Her book, Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth, outlines the way our bodies are designed to work. This information can support us when making decisions along any twists and turns of the path to birth.

Understanding how our health system works. “To birth in our system and emerge emotionally healthy, women may need to buoy themselves with knowledge in how decisions are made about their provision of care,” says Debby. Knowing how and why the hospital usually arrives at their “flow” decisions can make it easier to negotiate (if necessary) to get your own needs met, often in a positive way for both you and your health carer.

Support, support, support. Most of us expect to have our partners at the birth of our child. It is worth considering the research that suggests the presence of another support person who understands birth can greatly enhance the experience for everyone. Some partners are reluctant to “share” the birth with an outsider, and worry they will be made redundant in the birthing room if there is someone else there in a support role. But in talking to couples after the baby is born, this doesn’t seem to be the case. For many couples the actual experience of having extra support is usually described afterward as a blessing, and a part of their positive view of their birth and their role within it.

Research indicates that continuous caregiver support during childbirth has a number of benefits, including a “reduction of the need for medical intervention such as forceps, vacuum or caesarean, a tendency for shorter labors, and a reduction of negative feelings about one’s childbirth experience.”

Catherine, a mother of two young children, wishes she knew about this before her first child was born. “I didn’t think I would need any support, as I knew exactly how things were planned to go. I so wish I had someone to advocate for me, and explain my options in more detail, and offer me the continuous care I know I needed. I could see the birth just getting away from me, and I didn’t know where to turn.”

So who is going to provide this continuous presence throughout the labor if it is so beneficial? Usually not the obstetricians…they are generally only called in toward the end of the labor or if any concerns arise. Traditionally this support has been provided by midwives, but as we have seen, our healthcare system places many limitations on our health carers. And this is especially true of midwives. In our hospitals, midwives are generally unable to really get to know women prior to their birth. So they are unlikely to be aware of your particular needs, and the “flow” of birth you are looking for, and are often unable, due to hospital policies, to remain with a woman for her entire labor.

Many women are now seeking the services of models of care offering continual care from a known carer and/or a professional support person (known as a doula) who see their job as supporting both partners as they enter this new phase of life. A doula can stay with the woman at all times, as well as act as an advocate for her, to work with the midwife to ensure that, as much as possible, her birth is a positive event. Kay, 37, is a mum who experienced a vaginal birth after caesarean (VBAC), and hired a doula to support her and husband Jake.

Says Kay, “Having experienced hospital policy with the birth of my first child, which culminated in a possibly unnecessary emergency caesarean, I could not imagine giving birth in the hospital environment without the support of a doula. To know that I was going to take a doula second time round probably gave me the confidence to proceed with falling pregnant.” This confidence extended to Kay’s birthing experience, as she recalls, “The step into motherhood following a well-supported birth has been streets ahead of the step into motherhood following [my previous unsupported] birth where I felt a failure.”

Being involved in decision-making. This final tip from Debby comes with an assurance that “we don’t all need to be midwives and know every possible thing about birth to be able to birth well in our system.” Rather, it means knowing which questions to ask so you can weigh up each situation. Many issues that arise during birth can be resolved a number of ways—there is often no set path that must be followed. The hospital may not volunteer the fact that you have choices—as they may have what they consider to be the best path to meet your needs (as they perceive them), as well as the needs of their establishment. Once you know there may be options, the trick is determining which option is right for you and your family in your situation. How do we choose, when we are not doctors or midwives ourselves? Debby says, “Once women have attained the information about how their bodies work, they will have a better idea of what will support them in birth. We suggest to begin by using the acronym of B.R.A.N. to help to get enough information from caregivers that will enable you to choose from different options to meet your individual needs.” By asking “BRAN,” (see sidebar) you can get a wealth of information to enhance your decision-making abilities.

Why didn’t anyone tell me?

Perhaps we should check back with Kelly, who we met at the beginning of this article, as she was about to undergo an unplanned caesarean. Kelly knew she couldn’t control childbirth. She decided to go with the flow. But no one told her that in doing so she was potentially giving up her chance to be involved in one of the most amazing, empowering experiences life offers us.

A few months later, she is still upset, confused and affected by her experience. “What tears me up the most is that I am really questioning whether my caesarean was even necessary. Right from the induction onwards, no one let me know I had any options. I didn’t know if decisions were being made because my baby was at risk, or because the hospital’s timetable was at risk, or some other reason. I didn’t know that every intervention could have repercussions for the natural labor I envisaged. Now I am finding out about the choices I could have had…I am so upset. Why didn’t anyone tell me?”

So…when is it OK to go with the flow?

While we can’t control childbirth, we certainly can have a level of control over the environment we are birthing in, made possible by the knowledge we bring to the birth, the support we have around us, and the ability to ask the right questions. Once these things are in place, it becomes time to go with the flow—but with a different focus. Once a woman has this additional information and support, it becomes the flow of birth we are going with, not the flow of birth as dictated by an institution or a particular carer. It is then possible to surrender to the power of your birthing body, to follow the flow of this birth, knowing that you have set in place the people and the environment to support you in meeting your goal of “empowered healthy mother, and healthy baby,” no matter what path your birth follows.

By giving ourselves the gift of an informed, empowering birth, we are giving our new little family the gift of a strong, confident mother, who has the ability to create a gentle flow of family life based on what is best for herself, her child and her family

Pathways Issue 39 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #40.

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