By Stephanie Ondrack
Q: What can I do to try to have a good birth experience?
A: Good question!
We know from surveys of new mothers that one of the main factors in the experience of giving birth, is feeling respected and “heard” during the process, and retaining the power to make the decisions and call the shots. Whether the birth is vaginal or caesarean, natural or medically-assisted, doesn’t seem to impact a woman’s feelings of satisfaction as strongly as whether she understood and agreed with any interventions being performed, and had the final say in all decisions made. Women who feel that procedures were done to them without their full understanding of the reasons, or without their explicit consent and endorsement, sometimes feel traumatized after the birth. Some women look back with regrets, questions, and doubts, feeling like a victim in events that spiralled out of their control. On the other hand, women can experience these exact same interventions with pride and ownership if they were on board with all decisions, and felt sure of their power to agree or decline at every step along the way.
Another approach is aiming for an “undisturbed” birth, as much as is possible according to your circumstances. When women are able to labour freely—free from restrictions & limitations, free from unwanted advice, free from inhibitions, free from time limits, free from expectations, they can more easily slip into the hormonal “high” that colours the birth experience. The cascade of hormones that causes cervical dilation and effective contractions, also diffuses the mother’s mood, allowing her to relax, ‘space-out’, and be carried gently along with the labour with no sense of concern or urgency. The hormones can buoy her experience so that her awareness is hazy, peaceful, and positive. The hormones in question, however, are shy hormones, highly vulnerable to interruption and stress. The slightest disruptions such as the turning on of a light, whispers in the background, a new person entering the room—can cause a small pause, a long stall, or an
abrupt halt to the labour’s progress, as well as the mom’s sense of peace, which can instantly give way to tension, stress, or panic. Imagine how much the gentle flow of hormones can be affected by a common interruption such as a cervical exam, a drive to the hospital, or some poorly chosen loud words by someone in the room. An entirely undisturbed birth is rarely possible nor desirable, since a certain amount of observation and monitoring does improve outcomes, but aiming for the fewest disruptions within one’s personal scope (taking all safety and medical considerations into account), can allow the mom’s hormones to do their work of giving her a quicker labour, and a more peaceful experience. For example, limiting the number of vaginal exams down to medical necessity only, or barring medical students from repeating procedures, or whatever steps make sense for you.
As you may know, research shows us over and over again another key influence on birth experience is labour support. The support must be in addition to the woman’s partner, who, as wonderful as he or she might be, is also experiencing the birth of their child and the novelty of becoming a parent. The partner cannot double as an objective yardstick and advocate, since he or she is primarily involved, and intimately connected to the mother. It can be hard to stand by a loved one without wanting to “rescue” her from the experience, which can undermine the mother’s progress and intentions. Effective labour support has to come from a third party: a professional doula, a family member, or a friend with some birth experience. Having a doula, or other labour support person present, greatly reduces the risk of almost all medical interventions, while greatly increasing both parents’ reports of satisfaction with the birth.
Even in the case of a surgical birth, or other medical necessities, all the above suggestions apply. The experience for mother and baby will still be optimized if all procedures take place within a context of dignity and respect. As much as possible, medical interventions can be fully explained, the family’s concerns and choices can be accommodated, and the sanctity of a mother’s right to make decisions on behalf of her own body and baby can be faithfully upheld. Even at a scheduled caesarean birth, a labour support person (doula or doula-like friend) can help with comfort measures and communication, preceding and immediately following the birth, as well as ongoing postpartum support. If medically safe, allowing labour to start on it’s own prior to a caesarean delivery—and even labouring for a few hours!—can further contribute to both mother and baby’s positive birth experience. The hormones from labour help prime both parties for imprinting and bonding, and also activate breastfeeding instincts in both parent and child. They are also associated with a safer third stage labour, higher likelihood of breastfeeding success, and lower risk of postpartum depression. Some medical conditions are not safe for trials of labour prior to a caesarean, but in other cases the only downside in scheduling inconvenience, which might be outweighed by the benefits bestowed by the hormonal cascade.
Choosing the right Caregiver
Finally, choosing the right caregiver should be the final consideration for a great birth experience. Every doctor and midwife has their own philosophy, their own beliefs, and of course their own personality. It is important to find someone who can support whatever kind of birth you want, who will answer all your questions, who makes you feel comfortable and in control. Your caregiver should be willing to discuss pros and cons of different decisions, and should always make it clear that the decisions are yours. And you should like your caregiver. Despite his or her credentials, you must have a simple feeling of rapport and trust in this person. If you have misgivings, your labouring hormones are less likely to flow freely.
We cannot control or predict much about our births, and there is nothing we can do to guarantee that birth will unfold according to any particular ideals. But we can learn from other women’s experiences, and set ourselves up to handle whatever circumstances arise as much as is in our power. We can buffer ourselves with information, with labour support, and with a plan to allow birth to unfold in as uninterrupted a way as possible, while remaining flexible and open to the unforeseen. We can’t control what cards we are dealt, but to a certain extent we can stack the deck in our favour, and we can definitely control how we play the hand we get.