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Reading birth stories: An exercise in critical thinking

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
There’s been a birth story floating around facebook for the last couple of days “My true feelings regarding my homebirth experience”. It is a story of a woman’s very traumatic homebirth. It has attracted a lot of attention and generated discussion about and criticism of the ‘natural childbirth movement’.

I first became aware of this birth story back in December when the woman’s birth photographer released photos of the birth and her own perspective on it. I found that story in an anti-natural childbirth group, posted for the purpose of mocking the woman, her photographer and homebirth. Not long after seeing the story the woman at the centre of the story came forward in that group and advised that she is no longer supportive of homebirth.

I feel like there are a few points that she makes within her story that bear exploring. Given that she is using her experience to spread an extreme anti-homebirth message I feel that it is appropriate to look more closely at the story and see if it really does contain the message that homebirth, ALL homebirth, is dangerous, traumatic and to be avoided.

The issue that I have with this story isn’t that it is fear mongering or that she shares a traumatic homebirth. As a birth trauma sufferer and advocate I believe that it is important for women to realise that birth trauma can happen in ANY birth location. And I believe that it is important to share these stories – so that women and society in general are aware that birth trauma happens and so that women find the support they need. Women who have traumatic homebirths can feel particularly isolated – the fact still remains that very few women plan a homebirth, and therefore there are not as many women having traumatic homebirth experiences. Some women who have traumatic homebirths feel guilty in sharing their stories. Just as my caesarean stories could seem like an ideal birth and outcome for someone who has had a traumatic homebirth their traumatic homebirth could be my ideal. And homebirthers seem to be acutely aware of this.

Birth trauma can be very isolating. Image courtesy of Wikimedia Commons.

The issue is that this story could just as easily be transplanted into a hospital setting. This woman shares her story because “I don't want another person to make the same mistake I did.” Implying very clearly that her “mistake” was to plan a homebirth, with no consideration of the possibility that she may have been left with exactly the same feelings even if it had taken place in a hospital.

This woman suffered birth trauma. The one thing that most birth trauma stories have in common is the feelings that occur during the birth. Feeling: unheard, unsupported, isolated, scared, misled, and like you have no control over your body or decision making. These feelings can be difficult to process and lead to ongoing feelings of trauma. And they can colour the way a birth story is told.

It is really important to note that these feelings are not exclusive to homebirths where there were complications. Women can find that they have these feelings regardless of birth outcome or birth location. There are no guarantees in any birth situation and it is therefore necessary to ensure that you are well prepared, educated, have chosen the best care giver for you and have a strong support network around you to help you to work through any unresolved feelings or trauma following your birth. These things are important no matter where you plan to birth your baby. Because birth trauma can happen anywhere.

Women who suffer from hospital based birth trauma are often told that it was their expectations, rather than their treatment, which caused the trauma. Women are told that birth is hard and tough and undignified and painful and awful. And that to expect a positive and happy labour experience is just expecting too much.

What were this mum’s expectations of her homebirth? “I wanted to be that pretty momma — laughing during labor — sitting in the pool looking glamorous and happy.” This was her fifth baby. Yep, her fifth birth. And it was her second homebirth. Surely by that stage she had some idea about what to expect during birth. No matter where birth happens it is an intense and transformative experience. While some women do laugh through labour and birth easily (either at home or at hospital) for the vast majority labour and birth is hard work. While you are more likely to have an unhindered physiological birth at home…You do still have to actually labour and give birth.

Being bullied during your pregnancy and birth can lead to birth trauma - regardless of your birth venue. Image courtesy of Wikimedia Commons.

“I was misled, lied too, and manipulated. Informed consent? Hah. I wish.” This is actually a fairly common comment from women who have suffered birth trauma in a hospital. I hear it now and then from women who’ve had homebirths, but I hear it almost every day from women planning a hospital birth. Women planning a homebirth are often very well aware of their responsibilities in relation to informed decision making and therefore ensure that they are very well informed. I am assuming from her story that the lie she was told was: “I was told that it was safe. That I was low-risk.” Where’s the personal responsibility for informed decision making here? Who was she told this by? What additional research did she do? Remembering that “safe” is a subjective feeling rather than an absolute situation, did she FEEL safe? Obviously not. So what did she do about it? Did she change care providers or move the birth to a hospital? Did she put strategies in place to ensure her feelings of safety were met? And again…this happens in hospital situations often. Women who comment that they were told that a caesarean is “safe” often feel let down if they go on to suffer complications. Women who are told that an induction is “safe” often feel betrayed if they go on to end up with a caesarean as a result. Taking personal responsibility for informed decision making is important in ANY birth setting – and it is exceptionally important not to confuse “low risk” with “risk free”. ALL births hold some level of risk.

This mum suffered from serious complications during her birth. “My baby was born in the brow presentation and he also had shoulder dystocia.” This could be a VERY traumatic experience regardless of where you birth your baby. Shoulder dystocia cannot be predicted and is a life threatening complication. Having no idea what was going on would certainly compound the feelings of trauma. This woman needs support to help her process those feelings. But would this have been just as scary if it had happened in a hospital? Maybe the OB or Midwife at hospital would have found bub in brow presentation and sent the mum for a caesarean and she may (or may not) have been spared a traumatic birth. However it’s not that unusual to hear of babies positions not being accurately “diagnosed” until the baby is coming out.

Perhaps a caesarean would have spared this mother the trauma she went through. Image courtesy of Wikimedia Commons.

Belinda from Qld tells me that “no-one knew my son was a posterior brow presentation until we were in theatre so no-one was concerned”. However due to the fact that her son was stuck “Theatre was a crazy circus with the OB yelling…and sounding very distressed”. Belinda describes her experience of a brow presentation in hospital as “very traumatic…to the point my partner later said he was nearly going to leave theatre”.

Shoulder dystocia also happens in hospital settings and can be quite traumatic – despite the presence of OBs, Midwives and neonatologists.

Rebekah from Victoria has experienced a traumatic shoulder dystocia in hospital. Her son was 9 pound. “Still in shock I asked the student midwife if he was going to be okay. She stared at me blankly.” Rebekah’s next child was also born vaginally and, whilst not a true dystocia, he had sticky shoulders. She went on to plan a caesarean for her next birth in order to avoid suffering such a traumatic birth again but then for her fourth birth she vbac’d her 10 pound 3 ounce daughter, complication free.

And to show the complete Oranges, and Birth Trauma Comparisons subjectivity of birth trauma, shoulder dystocia can also not leave a mum with feelings of trauma as was the case for Gerri from NSW. Gerri experienced a shoulder dystocia with her 5.6kg baby boy during her homebirth. Gerri’s midwife and doula assisted her into different positions to try and help bub out but her midwife needed to hook a finger under his posterior shoulder to help him out. This happened quickly and bub was breathing within minutes. Gerri did not, however, suffer from birth trauma as a result. “Bub was fine, I was fine, my IM was competent & all worked out for the best. I still think my hbac was a wonderful experience & its hurtful when others disagree.”

The woman in this birth story had a traumatic experience. It’s not okay to dispute that or to invalidate her feelings. “But just because my son is okay, does NOT mean that my home birth was okay.” It sounds like this woman may have been hearing a variation of the healthy baby lie that caesarean mums have been hearing for decades. Where no-one cares how your birth went because “all that matters is a healthy baby”. It’s never okay to tell women that just because they and their baby are alive that their birth experience doesn’t matter. Birth is NOT just one day, but is an experience that many women carry with them. And women need support and care to help them to process any trauma and find a path to healing. This woman says that she has been shunned by her community; that people don’t want to hear about her story. It sounds like she is now feeling isolated as well as traumatised by the birth.

This mum states that “No one saved my baby. No one saved his life. They only RISKED his life.” I wonder how different this comment would be if bub had been born in hospital. I often hear comments to the effect of “I’m so lucky I was in hospital because bub’s heartrate dropped after the induction and the doctor was able to rush us for a caesarean and get baby out”. Women who comment that “saving” a baby from iatrogenic complications doesn’t make the doctor a hero are often shouted down. And if you suggest that the doctor was risking the baby’s well being by performing an unnecessary induction you will be told quite sternly that the doctor is a wonderful person and how dare you criticize him?! However there are also many women sharing stories where they firmly believe that their hospital based care provider risked their baby’s life by performing unnecessary procedures without the fully valid consent of the mother. It happens in hospital and at home and highlights the importance of informed decision making and choosing a care provider who has the same birth philosophy as you.

It is important to choose your care provider carefully. Image courtesy of Wikimedia Commons.

This mother wishes you to take her experience and learn from it. However it is really important when using birth stories as a research tool that you read a wide range. You cannot say that you have made an informed decision about homebirth if all you have read is one woman’s experience. There are as many different birth stories as there are babies and it is important to read widely. Just as you wouldn’t use one resource for a university essay, neither should you use one birth story to inform your birthing choices. It is also important to ensure that you are critically analyzing any stories that you are reading just as you would analyze any other document that you are using to inform yourself. Ask questions as you read: Does the author have a vested interest in getting you to see from a particular perspective? Is the story (or article, or research paper…) objective or subjective? Is it based on one experience or several? Don’t stop thinking and questioning!

This mother wants everyone to know that homebirth is not safe. Because of her experience. But her experience is her experience. As an aside, I’m also left asking: What of her previous homebirth experience? She doesn’t share any information about that. We are often told that one (or, literally, thousands if the numbers in birth trauma groups are put together) bad hospital experience doesn’t make hospital unsafe. Yet one bad homebirth experience makes homebirth unsafe? If this experience had happened in hospital with bub being resuscitated and separated from mum would she be telling the world that hospital birth is unsafe? This woman’s story could have been used as a very important lesson for women about listening to their instincts, choosing their care provider wisely, ensuring they are well educated about birth and what to expect – instead it has been turned into an extreme anti-homebirth message. This woman doesn’t wish to be the poster girl for homebirth, instead choosing to be the poster girl for the anti-natural birth community.

This mother’s story doesn’t prove that all homebirth is unsafe. I would suggest that it proves that homebirth was not the best option for her as she did not feel informed, confident and safe. Every woman needs to make decisions around how they feel about their birthing choices within their own context. Complications and birth trauma can occur in any setting and it is important to ensure that you choose a care provider that you have confidence in. Surround yourself with loving support that makes you feel nurtured and safe and birth on your terms.
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Regarding if she HAD opted for a csec, if she had any complications from that she might have concluded that many babies are born with brow presentationo and that is not a reason for a csection. Either way has potential for regret.....

I know of women who have had horrendous hospital births and others who have had wonderful (sometimes unexpected) home births. I think scaremongering is awful, especially when directed to pregnant women who are already nervous about their impending birth!
Great article. Complications are generally unexpected so then setting isn't a cause.
I felt similarly as I read her story. And it is Her Story. Her feelings matter and I hope she is finding the support she needs to process it. Her Story is not My Story, or Your Story, so as lizzi says: think critically!

Why do you want or need a particular birth. If your approach is a 'romantic' one, like it seems the story in question was, and you transfer the responsibility to your carer (OB, midwife or even doula) the chances of being dissatisfied, or even traumatised, are high.

The best thing I took from that story was how important it is to Own Your Birth. No matter where or who with, you plan Your Birth.

Thank you lizzi, for the clarity.
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