Stand and Deliver!: And other Brilliant Ways to Give Birth
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Dedication
For my mother,
who was there from the very beginning
Epigraph
Sorry you can’t define me, sorry I break the mould, Sorry that I speak my mind, sorry don’t do what I’m told, Sorry if I don’t fake it, sorry I curse for real, I will never hide what I really feel.
Christina Aguilera, Stripped, 2003
The great thing about childbirth is that it is the last time you can behave appallingly, swear, lay down the law, shriek, groan and bash your husband in the chest, and be forgiven. You are the star, the primadonna; make the most of it. Once the new star arrives, to the sound of your last furious swearword, you will have to behave again, and be gentle and self-sacrificing. Enjoy your last fling.
Libby Purves, How Not to Be a Perfect Mother, 2004
Contents
Cover
Title Page
Dedication
Epigraph
Ten Great Things About Birth
Introduction
FIRST STAGE - LET’S START AT THE VERY BEGINNING …
Chapter 1 … A Very Good Place to Start
Chapter 2 Let’s Talk about Sex, Baby
Chapter 3 My Body Is a Temple
Chapter 4 Free Your Mind (and Your Ass Will Follow)
Chapter 5 Can You Feel It?
Chapter 6 Away with the Fairies
SECOND STAGE - BIRTH STORIES: BRILLIANT WAYS TO GIVE BIRTH
Chapter 7 Introduction: Water, Water Everywhere
Chapter 8 Water Birth in Hospital
Chapter 9 Water Birth at Home
Chapter 10 Laughter Birth
Chapter 11 Standing Birth
Chapter 12 Induction Birth
Chapter 13 Hoot Hoot Hout Birth
Chapter 14 IVF Birth
Chapter 15 Breech Birth
Chapter 16 Twin Birth
Chapter 17 Epidural Birth
Chapter 18 Yoga Births
Chapter 19 Caesarean Birth
Chapter 20 Vaginal Birth after Caesarean (VBAC)
Chapter 21 Helping Hands: Useful Contacts
THIRD STAGE - EIGHT WEEKS TO GO
Week 32: Where Do I Want to Give Birth?
Week 33: Antenatal Classes
Week 34: Know Your Birth Rights
Week 35: Write Your Birth Plan
Week 36: Tour the Hospital
Week 37: Glossary of Big Words Doctors Use around Birth
Week 38: Women Who Birth Well
Week 39: Am I in Labour?
Week 40: Physical Signs of Early Labour
References
Recommended Reading
Acknowledgements
Copyright
About the Publisher
Ten Great Things About Birth
1 All that huffing, puffing and sweating does wonders for the skin.
2 You get your wardrobe back.
3 Everyone says how clever and wonderful you are, when the baby does most of the work.
4 At last you can join the other mothers round the table who used to stop telling their birth stories when you walked in the room.
5 You have instant rapport with every mother on the planet.
6 Without drugs, you get the most tremendous hormone high.
7 With pain-relief, you get to try different drugs legally.
8 In labour, you can act out being ‘the ultimate Diva’.
9 You come the closest you’ll ever get to being God, bringing forth life.
10 You get a baby to keep at the end.
Introduction
I promise not to wave joss sticks, play whale music or bombard you with photographs of women in labour and babies being born. There is no free video of ‘Stephanie’s Labour’ on offer (which instantly put a stop to my husband attending another antenatal class). The only graphic pictures are painted in words, which, in their reading, I hope will give you a clearer picture of what you want. Cartoons from my talented Times colleague Jonathan Pugh also attempt to lighten a subject that you may feel is unlightenable (little do you know yet that if you could only laugh your way through labour, your birth might be trouble free).
After my first baby, I used to joke to the newly pregnant that ‘birth was over-rated’. I had had a typical ‘natural’ birth with plenty of medical intervention – IV drip, syntocinon to strengthen contractions, foetal monitoring, epidural, stitches, syntometrine injection to deliver the placenta. I didn’t understand why medics and midwives were intent on this sort of delivery as being the holy grail for women. OK, I got to leave the hospital earlier than the women who had caesareans, and I didn’t have to wear the ugly white legwarmers to prevent blood clots, but I was still waddling around with the rest of the ward, feeling like I had been bucked off a rodeo bronco.
I laughed cynically at the tales of Sheila Kitzinger describing birth as a giant orgasm, and at my friends who were forgoing pain relief for a more intense experience. I had yet to understand that while my delivery was described as ‘vaginal’ (an adjective I loathe, so I have kept its use to the bare minimum in this book), there was little that was ‘natural’ or ‘normal’ about it. (‘Normal childbirth is now the recognized medical term for birth without intervention; ‘natural’ is out of fashion.) I had had glimpses of what it might have been like – giggling uncontrollably with my girlfriend Lisa in the delivery room and connecting strongly with my midwife before the epidural needle was put in – but nothing that suggested an epiphany.
Well, the epiphany came at my second birth, driven not out of desire for something better but out of fear of something worse. When my doctor told me at my 30-week check-up that one of my twins was lying across my stomach, and therefore I would have to deliver them both in an operating theatre with 12 people present, I froze. And when he announced that the first could be delivered normally and the second by caesarean section, I didn’t sleep properly for two weeks. My dreams were full of glinting knives and open wounds, with people watching me perform an impossible act. There must be an alternative, I thought, falling back on a journalistic habit of researching the subject over and over, calling hospitals and organisations, speaking to anyone who would listen. I knew I didn’t want the huge upheaval of a major operation followed by newborn twins and a demanding toddler to care for. Where would family bonding fit into that? I felt resentful that I was being railroaded into something that I didn’t want or felt I needed. And now I understand that a bad birth is not one that ends up with an emergency caesarean, but one where you feel coerced into something that you don’t feel you need. My doctor’s prognosis was a frightening ending to an easy pregnancy. I was deeply unhappy, and set about on a journey to get the birth I wanted – a journey which inspired me to write this book.
Knowledge and support were my two weapons in the fight to do it my way. And, having achieved it, assisted by two remarkable midwives, I now understand that a good birth is the best present a mother can give herself. The less intervention from other people, the quicker the recovery (the quicker the recovery, the better for all the family). For all my talk of ‘birth being over-rated’, I suddenly understood that it was under-rated. Thousands of women are being denied the opportunity to have a really good birth experience because they are unaware of the politics of pregnancy. They don’t know they have rights despite current hospital protocols, shortage of midwives and cultural indifference to their plight.
Because of this indifference, the spiritual and psychological effects of being prodded and poked in hospital, or monitored like a bomb that is about to explode, have often been overlooked. The darker side of a poor birth experience may be mentioned in hushed whispers to health visitors or close friends, but new mothers are often so overwhelmed by the demands of looking after a new baby, or so grateful for its safe arrival, that they are unable to speak out for themselves at the time.
When a birth goes well, however, it is an ‘uplifting’, ‘empowering’ and ‘intoxicating’ experience, as all the birth stories in the second part of this book affirm. Someone who has felt in charge and in control of her birth is in a good frame of mind to bond with her baby, to nurture, nurse and wallow in those precious twilight few days that follow the beginnings of life. A good birth produces hormones, especially when breastfeeding, that shore up a woman’s reserves and help her to feel confident about herself and her own judgement for days, weeks, months and years afterwards. If a mother can look back at the birth and think, ‘Well, I certainly gave that my best shot,’ then she can take that confidence into dealing with the scraps in the playground that follow.
This book argues that mother and baby are so closely entwined from the beginning of the baby’s life, that anything that is good for the mother, is good for the baby, too. I don’t buy a doctor’s diagnosis that a pregnant woman is being ‘selfish’ if she wants something other than the standard hospital fare. If she’s looking after herself, she’s looking after her baby, too. It’s not for nothing that the flight crew on board an aircraft tell parents to put on their own oxygen masks first before helping their children.
The birth stories told here are all experiences with positive outcomes. This is not so the book joins the shelves of cuddly toys and sentimental parenting magazines, where impossibly beautiful models nurture perfect babies and tell of their hospital deliveries with exclamation marks and phrases like, ‘and then he just popped out!’ My view is that women will be given enough warnings and negative advice throughout their pregnancy from well-meaning medical professionals and tactless strangers without hearing more from me. I am neither a medical professional nor, I hope, a tactless stranger, just someone eager to pass on the advantages of getting it right first, second, third or fourth time around.
The women interviewed have all held on to their sense of self in spite of being bossed about by the establishment. Their stories are deeply personal and many are told in detail, sometimes with milligrammes of blood loss, in the hope that they might inspire others to try for something better. Some of the women have given birth abroad, in Spain and America, countries with even higher intervention rates than Britain. I hope their positive experiences will build up your confidence, as a few good birth stories did for me when I was casting around for alternatives to my twins’ birth.
There is nothing to fear from reading any of the following chapters, only something to gain. It may be the knowledge that a contraction at its most painful peak lasts only 90 seconds, or that labour might stop suddenly on arrival in hospital because of the rush of adrenalin that comes with being moved to a new and unfamiliar place. The experiences include my own, because my own fight to have my twins normally challenged most of the so-called ‘birth rights’ that are accepted as standard by our National Health Service. Like all the other stories included, it has a positive outcome. The birth of my twins was a turning-point for me in understanding why the opportunity to have a good birth should be every woman’s right.
FIRST STAGE LET’S START AT THE VERY BEGINNING …
CHAPTER 1 … A Very Good Place to Start
From the moment I realized as a little girl that my biological destiny was to have a baby, childbirth hung over my head like the sword of Damocles. Unless you are a child of a flower-power mother, and strew daisies on the floor while Mummy laboured in a yurt, birth seems a frightening and mysterious act. You know it’s going to be awful because you have watched ER on TV, and seen the actresses pinned to beds by machinery, flailing around like salmon on the end of a line. You believe it is just as likely to happen in the back of your car, because these are the horror stories that you read about in the papers. And, most of all, you are convinced that it will hurt more than having all your teeth removed with string and a doorknob, because every stand-up comedian has cracked that joke (and no one ever heckles). Our cultural conditioning around birth is so firmly implanted on our mind map that it is amazing women fall pregnant in the first place (well, perhaps not, post-Sex and the City). We all live under the illusion that a ‘cure’ will be found during those nine months of gestation.
Well, I’m here to convince you today that birth can be fun. Say it extremely quietly, but there are plenty of women who have actually enjoyed giving birth. So much so, that they want to go and do it all over again AS SOON AS IT IS OVER (now you understand the hushed whispers). Don’t believe all the doomsayers. Birth does not have to be like sitting O levels unprepared. If it goes right, it can be a wonderful, transforming, empowering experience that can change your image of yourself and your life for the better. I’m not saying it won’t hurt. The ‘ring of fire’ has never been more aptly named. I’m just saying that pain and pleasure go hand in hand, especially if you add to the cocktail some powerful hormones to help it all along.
The birth of a baby is a defining moment in every woman’s life, and the better it goes, the easier her transition into motherhood. So, how do we rid ourselves of all the cultural conditioning that makes us think that birth is a bad thing, a terrifying and horrible experience to be endured rather than enjoyed? Through cultural unconditioning.
Cultural Unconditioning
This is going to be very hard. You need to think about all those frightening little snapshots of birth that you have picked up over your non-childbearing years, write them down, screw up the paper and throw them in the bin. How you think and feel about birth is going to have a bigger effect on your eventual labour than that epidural that you have already booked. If you can look forward to it, have confidence in yourself and trust in the physiological process, then you’re already halfway there.
Getting to this point is not always an easy ride. Somewhere in your psyche there is the shock of your first impression of birth. For me it was a video shown at primary school, of two legs and a human baby coming out between them. It was probably a biology class, but all I remember is looking away, shocked by the bloody violence of it all. Distanced in a clinical way by the medium of video, it became a scene from Alien rather than a sacred moment. Even then I could see that birth should be an intimate and private event, not open to voyeurs.
But if that image shocked me at a tender age, it did at least clear up how babies get out. Before that I believed they came out of my tummy button, an otherwise seemingly pointless part of the body.
Assumptions and ignorance about our bodies is rife among even the most educated women, and pregnancy is a good time to reacquaint yourself with your body. One 70-year-old midwife from southern Arkansas described how, when she was in labour with her first baby, she, too, didn’t know where the baby was going to come out. At a conference in the 1980s she related: ‘When I was alone in labour, I looked all over myself. I had a mirror and was looking all over my body. When I opened my mouth, I thought “That must be it!” When I saw that little thing in the back [her uvula], I thought that was the baby’s big toe. I thought I was going to have to throw up the baby. It wasn’t till the midwife came and washed between my legs that I suddenly realized where the baby was going to come out!’1 Most of you will be further along on these issues than the midwife and my younger self, and some of you may even have studied the birth pictures in Dr Miriam Stoppard’s and Sheila Kitzinger’s pregnancy books. Once again, you are wiser (and braver) than I am. I still have to peep at shots of other people’s births through my fingers – three babies later – and not because I get distracted by the beards and long hair in the photos (for some strange reason, all birth books only feature Seventies’ casualties). If you, too, cannot stomach these images, don’t worry. It won’t affect your labour. When it comes to your birth, you will be heading up the important part, up top. You can leave the messy stuff to the professionals.
Doctors and the Medics
When you go into hospital – a place that will always bring up some anxiety of being ill or visiting sick relatives – you do so as an intruder. As a woman you are not ill, just pregnant, but as you sit in the waiting room as one of many, you may begin to experience new pinpricks of fear that weren’t there before. In the ultrasound department, this fear may be coaxed out by giant posters on the wall showing photographs of your baby in utero looking like a visitor from outer space. Other posters will carry information about how you could already be harming your baby by smoking or drinking. In the waiting room there will be more posters of mothers cradling a newborn with a headline telling you Why Breast Is Best or another showing a baby sucking on a bottle of sugar, warning of the perils of giving juice in a bottle. The hospital atmosphere itself might make you start thinking new thoughts: ‘Will this baby be all right?’ or ‘Why do they want me to take a blood and urine test? Does everyone have these, or can they see that I am a bit thinner/fatter/taller/smaller than the woman next to me?’
Sometimes, talking to a doctor can be more confusing than enlightening, as strange words are used, as if you were already in the know: ‘We are measuring the nuchal fold,’ says the radiographer. ‘We are looking for protein in the urine,’ says the midwife, as if you had some understanding of its significance. The use of language like this builds a barrier between you and the people with the stethoscopes round their necks, and often you feel a little more helpless and a little more ignorant than before you went in.
Of course the picture I am painting may be far worse than in your corner of the country. Here in London every hospital antenatal appointment is double-booked, so you can wait over two hours for your precious five minutes with the consultant. Even in those five minutes, if you have a medical student present the doctor may not be addressing you but teaching while talking.
Testing, Testing, One, Two, Three
As well as the brief chats with the doctor, there are also all sorts of tests that you may have in your pregnancy. The main thing you need to know about all these tests is that of all the 760,000 women who fall pregnant in the UK every year, only a tiny, tiny percentage will have to alter the course of their pregnancy after being screened. Some of the tests, such as routine screening for gestational diabetes (where you are given a glucose drink to take beforehand and, unsurprisingly, your blood sugar levels go wild) are being abandoned now anyway. Peter Brocklehurst, Director of the National Perinatal Epidemiology Unit, has this to say about the GTT (Glucose Tolerance Test): ‘The test is unreliable, doctors do not know how to treat it, and anxiety in the minds of the woman and her carers could be raised, increasing the risk of the pregnancy ending in a Caesarean.’2
I’m not suggesting that some of these tests don’t have a place. The urine test to find out whether there is a certain protein in the pee to indicate pre-eclampsia (a pregnancy-induced condition that is treatable by early delivery of the baby) is a life-saver. But for the hundreds of thousands of women who are tested routinely during their pregnancies, and then retested because the result was mis-read or read as a ‘false positive’ – and who sometimes having to wait weeks for the result – this most magical time can turn into a fearful one. There is a lot to be said for ignorance being bliss, and my mother would argue that her 1960s generation, pre-ultrasound, was a lot better off when they simply looked forward to starting a family come what may. And this from a woman who didn’t know she was carrying twins until she went into labour!
Ultraconfusing Ultrasound
While ultrasound has its uses (such as assessing more accurate dates, identifying twins and the presentation of the baby for delivery at the end of the pregnancy), it carries with it ethical dilemmas that far outweigh its uses, and any mother who doesn’t want to be scanned during pregnancy is quite within her rights to refuse it.
When you learn that 20 years ago, when scanning was in its infancy, thousands of women were scared silly by being told their babies had ‘golf balls’ in the brain (which turned out to be perfectly healthy brain tissue), it reminds you how recent all this new technology is. The other day, a woman rang the AIMS helpline in tears when a sonographer told her to ‘come back next week, I can’t see the baby’s head’.
Some radical groups maintain that the effects of ultrasound on growing babies and adults in later life have never fully been researched. While the effects are obviously nowhere near as dramatic as the rise in childhood leukaemia after X-rays were used on pregnant women (and Britain was the last country to stop irradiating pregnant women), it nevertheless makes you wonder why we are exposing something as fragile as the beginnings of life to unproven technology.
What is also forgotten in the rush to wave the magic radiographer’s wand is how vulnerable pregnant women are to information. It’s no surprise that most women don’t want to know the sex of their child in this country (it is given as a rule in the States – unless the parents specifically request otherwise). We want that growing baby to be as protected as possible, a mystery up until the moment he or she is born. We don’t always want early expectations heaped upon him or her because of gender, size or some minor birth defect.
My first son was born with a cleft-lip and palate that was corrected by plastic surgery when he was three and six months old, and I am still glad that the ultrasound department failed to pick up this ‘anomaly’. It would have added anxiety and worry to the whole family during an otherwise stress-free pregnancy. I wouldn’t have changed the course of my pregnancy knowing this, but I might have looked up unregulated sites on the internet and then worried myself stupid with other people’s tales of woe.