No matter what we were picturing, it is never exactly as we imagined. It might be faster or slower, it might be harder or easier, there might be more or fewer medical decisions, it might not be in the location we planned… But even aside from these obvious differences, birth always entails an element of the unexpected. It is one of those rare life experiences that takes us outside of our usual frame of reference, to the far edges of our consciousness, into the extremes, the in-between–beyond the framework of our imagination.
No one opens their birth story with ‘it was exactly as we expected…’. No one talks about their birth as if it were a usual, humdrum event. No matter how mundane from a medical perspective, no matter how ‘textbook’, the way we experience birth is transformational. It’s transcendent. From the most negative to the most positive, from the traumatic to the ecstatic, birth can always be described as unexpected.
In this Summer issue, we discuss several specific instances of the unexpected during birth: The unlikelihood of the due date, having a baby with Down syndrome, having an intersex baby, and what about an unplanned caesarean... But even if nothing so obvious takes your birth down an unanticipated path, even if your own path was entirely as predicted, we think you’ll be able to relate to the sense that giving birth–having a baby–always feels astonishing. It is never, ever, exactly what we expected.
A. Not very. In fact, only about 4% of babies arrive on their so-called ‘due date’.
So why do we call it a due date when it applies so rarely? The way we calculate the due date is a very old practice based on the assumptions of a German doctor called Naegele in 1812. He derived his theory from a biblical notion that women gestate for ten lunar months. He proposed calculating from the first day of the last menstrual period, adding one year, subtracting nine months, and then adding seven days to arrive at the ‘due date’.
This method has a few flaws. One, is that a lunar month actually has 29.5 days, not 28. This would move the due date to more than two weeks past his calculations, which, as any pregnant person will attest, is a significant oversight. Another flaw is that he assumes all women have twenty-eight day cycles, and ovulate on day fourteen. We know this is absurdly untrue, as cycles vary widely from person to person. Another flaw is that babies develop at their own individual timetable, which is very different for each baby. Some develop faster, and some slower. After all, we don’t all hit puberty on exactly the same birthday, either.
Babies can actually be full term anywhere from 37 – 42 weeks gestation, which is a five-week long window. Approximately 85% of babies are ready to be born within this time frame, which means that an additional 15% of babies are born even earlier or later.
But for some reason we still insist on using this archaic due date system, even though we know that only a tiny minority of babies will be born on their exact due date (4%). In fact, so seriously do we take these due dates, that we use misleading language about when the vast majority of babies are born. Forty-one weeks is not ‘overdue’—it falls exactly within normal range. But we use terms like ‘early’ and ‘late’ as if we believed the due date to be accurate.
Even ultrasound dating only gives a two-week range of accuracy, slightly better if done before twelve weeks, and worse if done later. The margin for error increases the more the baby grows, so that ultimately, the window isn’t much clearer than Naegele’s method.
So please don’t expect your baby to arrive on your so-called due date. Statistically, the majority of first-time mothers give birth a full eight days after their due date, while a smaller number give birth prior to the due date. The only truly unusual outcome is to give birth on the actual due date itself. So when it comes to expectations, I propose stepping back and viewing your estimated due date as more of a due month. Or even a due-season. There is no compelling reason to narrow our focus down to such a misleading single date. So how likely are you to give on your due date? Not very likely at all.
They say life is what happens when you’re busy making other plans. I don’t know what exactly I had planned, but receiving a prenatal diagnosis of Down syndrome (also known as Trisomy 21) certainly wasn’t part of any plan I had.
Fear of the unknown immediately consumed me, and my pregnancy went from being a joy and celebration I could share with those around me, to being a very dark and lonely time. We were grieving a dream we thought we lost. We were scared of what lay ahead. It seemed like something bigger than we could handle and that we were alone. But we took a leap of faith and believed that our son is exactly who he is meant to be and that being his mother is exactly who I am meant to be.
Our unexpected outcome has taught me to be an advocate for my son and all those differently abled. Our son has opened our eyes to the beauty in difference and that more often than not, we have more similarities with those around us than differences. Our experience also shed light on a medical system not well equipped to emotionally support new parents with receiving a Down syndrome diagnosis. To this day, you’re handed a brochure or a piece of paper that’s been photocopied a hundred times. Through this experience, our non-profit organization Baskets of Love Down Syndrome Support Societycame to be.
We believe new parents of a child with Down syndrome deserve more. New parents deserve to be loved and supported. They are welcoming or have just welcomed a child. A child worth celebrating. It wasn’t until we met other families of children with Down syndrome that we started to heal. A community rose around us and supported us in a way we desperately needed. It’s scary, yes, but everything is going to be okay and that little extra chromosome turns out to be a gift you never knew you wanted.
In the middle of the night on the day our son was born, when all was quiet and it was just the two of us, I vividly remember holding him whilst sitting in a wooden rocking chair too hard for my sore body. Tears flowing and falling on his just washed hair, I whispered promises to him. A promise that I will always be there for him. I will always be his momma bear, protector and advocate. I promised that he would always be mine and I would always be his. In that moment I saw his perfection. Every fibre of his being. Every chromosome. All of him. He lifts us in a way I could never properly describe and I’m so grateful that our outcome wasn’t what we were hoping for. It’s so much more.
There are times I struggle to believe that I am enough for him but with the heartaches there is so much more joy. So much love. There is no better combo. He has shown us that we never lost our dream. No one can ever tell you what your journey will look like. I wish I could put into words the moment when somewhere in the middle of all the therapies and appointments and frustrations that I knew I would never trade him for the world. That without his 47 chromosomes he wouldn’t be who he is and I couldn’t imagine our world without him.
It’s a remarkable phenomenon how far we’ve come since receiving our prenatal diagnosis when I was curled up in bed sobbing so hard I thought my head would explode. Today, I’m curled up in bed with him, soaking in his laugh and loving him so hard I think my heart might explode.
A positive pregnancy test result. All the emotions arise. Excitement, shock, fear, doubt, and the most intense bliss flood you. There is a light inside of you. Every thought you have has a new emotion attached to it, your mind is spinning with what’s to come. Your body starts to change, adapting to this new life that is within you. The dreams begin. You picture yourself with a growing belly, and with that you start to dream of birthing this light that is within in it. How will I be in my birth time? You ask yourself. Will I be loud? Will I be primal? Will I be in water? Who will be with me? Will I be at home or hospital? Drugs or no drugs? So many questions, and the visualizations are strong.
When I ask my clients what they fear most or what they really want to avoid the most common answer is,
A caesarean section.
Yes. I hear you. Let’s sit with that. Let’s dig a bit deeper. When we think about a caesarean we attach it to the words emergency, fear, sterile, forced, loss of control, surgery, blood, stillness and recovery. I could go on.
During our pregnancy we do all the things to prepare for the expansion of our family. This new little human that will rock our world and flip it inside out and bring so much joy and new experiences. What we don’t do is visit the place inside of us that has our fears tucked away deep. We do that because this is supposed to be the most positive time of our lives. You are growing a life, what could be more beautiful? Why touch on the dark negatives?
I want you to go to that dark place. Crack it open and shed light to it. Let’s make it less scary. When we don’t visit our fears, and work on them, they are only magnified if they do happen. This is when we see trauma, pain and negative birth experiences that can cause damage that lasts possibly a lifetime.
For some the pregnancy becomes high risk and those dreams are plucked away one by one. For others something during labour occurs and we see it cascade towards a section. For a smaller number, there is a true emergency. Many of these are out of our control. Loss of that control is what is terrifying. Let’s acknowledge that we can only do so much to avoid a caesarean. What we can do, is be prepared for the possibility of one, and how we can make it a more positive, empowering experience. It is the birth of your child after all.
Choose a care provider that is going to support you in your wishes. That has your best interests in heart. Someone who takes the time to actually get to know you and will do their best to help facilitate your dreams. Keep your birth yours, hear your voice and give you the ultimate say in what happens. If your pregnancy takes a turn and more support is needed, trust that your primary care provider will assist you in the addition to your team, and be by your side as you navigate these new waters. with that, choose the birth place that will support you and make you feel safe! Do the research into your chosen hospitals stats. Home is your territory and you can feel the most powerful and comfortable there, and for some the hospital is their safe place.
Hire a doula! More support is always a good thing. Doulas are the best drug, and will help keep you on course and remind you of your goals. Doulas reduce your chances of a caesarean by up to 50%. They are there for you, only you! No judgement, no agenda, no bias. This is your birth, and they want you to reflect back on your birth day feeling proud and bad ass.
Be healthy. Eat good food, move your body, laugh, love, and honour yourself in this time. Go for massages, acupuncture and chiro to help support your body in labour. Take charge!
Take a prenatal class. Educate yourself! Ask questions, read and pull in the positive stories, block out the negative. Build a community of other pregnant families, and create your support team.
Most importantly, visit that scary place. Talk about cesareans. Whether it’s your health, your babies, or your birth took a u turn and a belly birth is your only option, how can we make it better?
Make sure it is needed. Not forced. Ask questions. Ask more questions. This is your birth and you still have a say! Have your doula present, ask for all the names of those present and see the faces behind the masks. Ask for delayed cord clamping, immediate skin to skin, take pictures and make your wishes be heard! It may be an operating room, but it’s still your special day and you have rights.
Pay attention to your reaction when someone tells you they had a caesarean. Congratulations is in order because they worked hard! They did everything they could to avoid it, they pushed themselves to a place they never imagined. They discovered their true strength. A belly birth is not an easy birth but it is still special! They still deserved to be honoured and celebrated. They said yes, with so much hesitation and fear behind it. They handed themselves over to science, they let go of their dreams. They lay there with no feeling and all they can see is white and green and bright lights, covered faces hovering over them. Their bodies shake, and their breath taken away as their light is pulled from their body. They only exhale when they hear the cries of their baby, that is behind a sheet. Turning their heads following those cries, yearning to touch and smell their babies. Those few minutes feel like eternity. This is not how they dreamed of welcoming their baby into this world. It’s not even over yet. Recovery. It’s slow, and hard and yet we see parents pushing through and still smiling. They too were just born.
So know this, if the unexpected happens and you find yourself on that table with bright lights. You are strong. You are brave. You are worth celebrating and we honour you. You did the harder birth. You did what you had to because your love for that baby is so great. This is love.
Visit those dark places and discuss how they can be empowering for you if they happen. When you reflect back on your birth it should be a memory that makes you smile and reminds you of how strong you really are. Your child also deserves to hear how they came into this world, and that it may not have been the most ideal, but it was still the best day!
Michelle Maclean is a birth and postpartum doula in Vancouver. Serving over 1200 families since 2005. She is the mother of two girls and recently gave birth as a surrogate. Michelle is the doula trainer at Pacific Rim College, and oversees the Holistic Doula training. You can find her at www.thedivinechild.ca
This is likely one of the first questions you received, after you received congratulations on your pregnancy. In the first trimester, maybe someone dangled a ring on a string over your belly. In the second trimester, maybe you had a revealing ultrasound. Maybe you’ve decided to wait until you meet your baby. But how does a baby come to be assigned male or female, and are those our only outcomes?
Sex is a configuration of several parts. Our chromosomes, internal reproductive systems, genitals, and hormones all contribute to what is currently defined as sex. This does not include the secondary sex characteristics that develop in puberty, nor one’s gender identity or presentation. Yet babies are often assigned male at birth (AMAB) or assigned female at birth (AFAB), just based on the appearance of their genitals. Other times, a newborn’s genitals do not align with medicalized expectations for male or female classifications, welcoming new parents into the fold of an unexpected, ongoing, and contentious conversation.
Intersex is defined by the World Health Organization as, “a congenital anomaly of the reproductive and sexual system”. Meaning that people are born intersex, and while the origins are related to one’s sexual configuration, it is an umbrella term without fully defined parameters. Note that intersex bodies are medically defined as an “anomaly”, though we don’t have an accurate picture of the prevalence of intersex people.
Some groups cite an old statistic that roughly 1 per 2,000 (0.05%) babies are born visibly intersex, meaning they have ambiguous genitalia. Of course, this does not include the intersex variations which cannot be visually assessed, often chromosomal or hormonal, and may or may not be discovered later in life. Other studies, which account for all intersex conditions place the estimate closer to 1.7% of births. As common as having red hair. Still, this estimate can be misleading by collapsing all intersex variations into one category, though some are known to be more common than others. We still have a lot to learn, which means we need to ask important questions.
With no concrete parameters, and a lack of knowledge of prevalence, how can intersex bodies be called an anomaly? Why are some bodies considered less natural than others? How do our bodies come to be? And how do we then come to be assigned as intersex, female, or male?
Your baby’s sexual development began at conception. The ovum and the sperm that made your baby likely donated one sex chromosome each to form the zygote. There are less common developments as well, a few births per thousand, where babies will have a single sex chromosome (monosomies). As well as births with three or more sex chromosomes (polysomies). Ova can only provide X chromosomes, while sperm can either provide X or Y chromosomes. If your baby has two X chromosomes, one from the ovum and one from the sperm, they are considered ‘genetically female’. If your baby has one X chromosome from the ovum, and one Y chromosome from the sperm, then they are considered ‘genetically male’.
An example of monosomy is Turner syndrome. Turner syndrome is also called monosomy X, as people with Turner syndrome have only one sex chromosome: the X. People with Turner syndrome experience abnormal growth patterns, are generally shorter than people with two X chromosomes, do not develop feminine secondary sex characteristics, and are infertile. Compare this with a polysomy (called Triple X syndrome) where people have not one X chromosome, but three. With three X chromosomes, people develop feminine secondary sex characteristics, and are generally taller than people with XX chromosomes. Triple X syndrome is more common than Turner syndrome.
The most common intersex variation related to chromosomes is Klinefelter syndrome, which is diagnosed in 1 in 600 people AMAB. People with Klinefelter syndrome have two or more X chromosomes, in addition to their Y chromosome. People with Klinefelter syndrome are often tall, infertile, and produce low testosterone – as a result, their secondary masculine sex characteristics are often not fully developed. Chromosomes are just the first piece in the larger mosaic of how sex is assigned, as they prompt further development of internal reproductive systems.
All fetuses, regardless of their chromosomes, have the capacity to develop either ‘male’ and ‘female’ internal reproductive systems. These systems rely on cues from the fetal body to develop further. You may have heard we are all ‘female’ in utero, unless a ‘male’ system develops. This is somewhat misleading. In truth, we all had universal potential, by possessing two internal reproductive systems. These systems are called the Wolffian (‘male’) and Müllerian (‘female’) systems. The Wolffian system must be prompted in order to develop, while the Müllerian system will develop without additional cues. Gonads, which develop as ovaries or testicles, are neither Wolffian nor Müllerian. Internal reproductive system development is prompted by chromosomes, but it is fetal hormones which sustain and influence their course.
Congenital Adrenal Hyperplasia, sometimes called Androgenital Syndrome, results from low cortisol during development. It can affect anyone regardless of their chromosomal arrangement, however people with XX chromosomes will develop a masculinized appearance as a result. Androgen Insensitivity Syndrome is the name for people who develop external feminine genitals and secondary sex characteristics despite having XY (‘genetically male’) chromosomes. A study which interviewed people with Androgen Insensitivity Syndrome, found that each participant was satisfied with having being raised feminine. All identified as women, and none desired surgical or hormonal alterations to their body. Most were satisfied with their psychosexual development and their sexual function.
The medical community and intersex advocates have historically had conflicting views on intersex bodies. The broader medical community diagnoses them as having disorders of sex development (DSD), defines being intersex as an abnormality, and urges parents to consent to “corrective” or “normalizing” surgery. Intersex advocates have chosen the term intersex for themselves, consider being intersex a variation rather than an abnormality, and urge parents not to consent to elective surgeries, but rather to consider the risks of surgeries to their child’s physical, psychological, and emotional health.
If you learn your child is intersex at birth, our recommendation is to take your time. Find relief in the knowledge that you have all the time you need to learn about your baby before any choices will present themselves. Surely, this is just one of many ways your child will surprise, challenge, and delight you throughout their life! Find out what specific intersex variation they have, as each is unique, and educate yourself what that specific variation means for their development throughout their life. Find a community to connect with intersex people and their family members, you are a member of this community and you are welcome here.
Some people go their entire lives without knowing they are intersex, as many intersex variations cannot be visually assessed and do not inherently pose any identifiable symptoms or conditions. Some people find out when trying to conceive, others during puberty. You may be the first to know your child is intersex, when you first meet.
Certainly someone has asked you. Consider it yourself, do you know if you’re having a boy or a girl yet?
Emma Mas is an apprentice with The Childbearing Society, and a doula working towards DONA certification. She’s originally from Seattle, but made a home in Vancouver after graduating from UBC with a degree in Psychology and Family Studies. She came to birth work while working as BC Women’s Hospital, meeting thousands of families shortly after birth, though her position as the Coordinator of the UBC Early Development Research Group.
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Postpartum and the transition into motherhood is a highly transformational period that is rewarding, challenging and stressful all at once. Many aspects of this journey are not talked about.
Many women are left wondering: Is it normal to feel sadness, anger or grief alongside love and joy? How do I let go of perfectionism and feelings of guilt? Will I ever be able to accept my postpartum body? How do I navigate my relationship with my partner now that we have a baby?
In this four-week postpartum group we will discuss postpartum body image, perfectionism, coping with difficult feelings, communication and relationships, and embracing your new identity as a mother. Attending the group will give you the opportunity to build community with other women who are on similar path. The intention of the group is to feel less guilt and shame, less isolation and aloneness and more self-compassion, greater sense of community and connectedness to yourself and others.
The group will be led by Lorilee Keller, a registered clinical counsellor, certified intuitive eating counsellor, and doula in Vancouver, BC. Her counselling practice specializes in women’s health, including reproductive and perinatal mental health. She will provide guidance and emotional support as she leads you towards embracing your new identity as a mother.
The group will run on Fridays June 21, 28, and July 5, 12 from 10:00am-12:30pm at Childbearing Society. Cost $180 includes all 4 weeks.
(or “Shifting the Paradigm from ‘avoiding pain’ to ‘discovering pleasure’”)
Are you worried about birth being painful? Are you wondering how you will cope?
What if there were ways to make the experience more positive, maybe even pleasurable? What if you could look forward to your birth with enthusiasm rather than fear?
In this 4-hour seminar, we delve deeply into our cultural ideas and expectations around birth: the history, the anthropology, the medical science, and the social constructs. Participants will examine their own assumptions, and explore where their beliefs come from and how they influence our decisions. Graduates of this seminar will leave with a broader understanding of physiologic birth, what it entails, and how it’s shaped by our instincts and environment.
Through this seminar, participants will clarify their values around birth and parenthood, gain insights into our birth culture, and learn practical steps to not only cope with pain, but to actually make way for pleasure. This seminar gets rave reviews from past participants.
Be prepared to question everything you thought you knew! Be prepared to actually look forward to giving birth.
The Childbearing Society is approximately forty-five years old. We have been going strong since the early seventies, consistently featuring the same kind of high quality prenatal and postpartum classes that we continue to offer today.
As I read this issue that explores birth over the years—what has changed, and what has remained the same—I think about how The Childbearing Society has had to be flexible, ever shifting to accommodate changes in the birthing world, incorporating new information, adjusting to policy changes, and expanding or shrinking according to the needs of the day. This kind of endurance based on openness reminds me of the nature of labour: it is the capacity to surrender to the process, to yield to the unpredictable powers, that is often germane to coping, to finding the strength of endurance. It is this kind of steadfastness and flexibility that has enabled The Childbearing Society to remain true to the vision espoused by our founders.
What began as a grassroots initiative—a small group of parents and nurses who wanted to help pregnant families understand their choices, improve the birth experience for babies, and advocate for family-centred maternity care—remains essentially unchanged to this day. We are still a non-profit society, we still operate as a democratic collective, and we continue to represent the leading edge in perinatal education. We are the local group, the Vancouver group, the alternative to the mainstream classes. We are fact-based, information oriented, and eternally supportive of all of the parents, babies, and families who come our way. Our aim, as always, is to empower people to make their own best choices.
In this issue we look at birth through the ages through several lenses. Our Question of the Quarter ponders differences in immediate newborn care then and now; our past president reflects on changes she’s witnessed throughout her impressive career in maternity wards; an acupuncturist weighs in on how the role of alternative treatments has shifted over the years, and one of our instructors looks at ways the paradigm around how birth is perceived has shifted over time. All of these articles consider ways in which birth care has improved versus ways in which we may have taken wrong turns.
I think our founders would be quite proud if they could see the path that The Childbearing Society has faithfully maintained over the decades, a path I think we will continue to pave equally far into the future.
Q. My grandmother tells me that when she gave birth to my mother sixty years ago, she wasn’t allowed to feed the baby anything until after 24 hours. Whereas when my baby was born, my midwife wanted me to try breastfeeding him right away. Why is this? What has changed?
A. Good question! What has changed is our perception of newborns and their needs.
It did indeed used to be common practice in some places for babies to be “NPO” (non per os, or nothing by mouth) for the first 24 hours. These were the days when most babies were kept separate from their mother in a nursery, fed on a strict schedule that had nothing to do with their hunger, and most often fed formula (which was deemed to be more “scientific”).
Many babies were under the influence of strong medications and anaesthetics that the mothers had been given during labour. The babies were often disoriented from the medications, disorganized from the separation from their mothers, and stressed by the protocols that were common at that time, such as bathing, suctioning, and other procedures ranging from unpleasant to invasive. As a result, babies were often defended and distracted. Their primary drive for skin contact and their instinct to bond were dulled by the medications, and derailed by the delays and discomforts of standard care.
At that time (indeed until fairly recently), it was common practice to clamp and cut the umbilical cord as soon as baby was born, thereby depriving baby of a large percentage of their blood volume. This also contributed to the general impression that newborns were drowsy and minimally responsive, with weak muscle tone and poorly coordinated reflexes.
In the past, we also had less appreciation for the value of colostrum. For a long time colostrum was believed to be just drips or crumbs that preceded the arrival of real milk. It was not recognized for the salubrious ambrosia that we now know it is. Colostrum comes in very small quantities, so babies are born with an extra layer of fat that is specially intended to carry them through until the mother’s more plentiful, more filling milk comes in. But at the time, people saw little benefit to feeding baby on such meagre drops, and since the quantity of colostrum is so sparse, reasoned that it meant babies did not require nutrition or calories right away.
Also consider that within the first day of life, all babies go through a significant physiological transformation as their digestive and excretory systems are finally put to use. As they transition from an umbilical to an esophageal intake of nourishment, their intestines encounter foreign substances for the first time. If newborns receive mother’s colustrum, it coats the baby’s gut with beneficial bacteria that facilitates digestion and fosters the development of their immature immune system. Some babies don’t digest alternatives to mother’s milk very well during these first couple days, as their systems are still highly immature and vulnerable. They might fuss, vomit, or react poorly if given a milk substitute too soon.
With all these influences contributing towards neonatal indigestion, drowsiness, and uncoordinated reflexes, it comes as little surprise that babies may have exhibited fewer feeding cues within their first day of life, and when fed formula, did not always tolerate their measured feedings well. Thus, it became quite common in some hospitals to wait until later, after the babies had been given a day to mature. Now we understand that un-medicated babies that have not suffered any separation from their mothers or unnecessary interventions, are usually alert, ready and eager to try nursing within the first hour of being born. All they need is unfettered access to mother’s chest, and they usually know just how to do the rest.
Sixty years ago, we didn’t know that the constant suckling newborns do to extract the sparse yet thick colostrum also serves to activate the mother’s prolactin receptors, which helps bring forth her milk. The constant suckling likewise stimulates the production of oxytocin, which fosters milk flow and bonding behaviours. The colostrum helps clear the intestines of meconium, so the baby’s digestive system can complete its transition from foetal to neonatal. Who knew that the first twenty-four hours of suckling were so important?
Sixty years ago, no one would have believed that brand new babies were capable of the self-directed efforts they make to find the breast and, their amazing ability to start feeding, their mobility, awareness, and the sense of purpose they possess. Who knew that newborns were so ‘human’! It is interesting though, that while newborns were once deprived of all food for their first full day, we now weigh them several times with focused concern, during that same period. While we have learned to appreciate a newborn’s immediate capability and motivation to nurse, we now impose an opposite restriction when we routinely intervene with supplements if baby loses “too much” weight within those same first twenty-four hours. Funny how the times change.