Good Birth vs. Safe Birth

[SarahM]

I am currently trying to formulate my thoughts on what seems to be a rather contentious issue of a Good Birth vs. a Safe Birth.
After a woman has had a traumatic birth experience, she is often given the usual placations of "well atleast the baby is safe". This is indeed what I have been told neumerous times despite the fact that it gave me a terrible start to motherhood.
I want to write an article about this attitude, that somehow no matter what happens during the birth the mother should just be grateful she has a baby at the end of it. To me, being told this kind of thing made me feel like I'd been abandoned by everyone, especially medical professionals. They handed me a live baby, washed their hands and left me with the emotional aftermath that took me to a very dark place.
Having a live healthy baby is indeed the immediate priority, but surely a GOOD experience is right up there in a very close second! It's a fact that a trumatic birth leaves mothers, and even familes, with PTSD and PND which can have devastating effects on families.
Am I alone in thinking this way or are there others out there that believe the same? I'd like to work on an article about this as part of my activism on birth but, as I said, I'm struggling to formulate my thoughts.
Inspiration needed please!

[Kacy]

You're absolutely not alone in your opinions. I find it very insulting and damaging for someone to say, "Well, at least the baby is healthy." Yes, that's wonderful. But the experience of bringing that baby to earth is so much more important than many people realize.

It can take weeks, months, years for someone to get over a traumatic birth experience, and often times they are forced to do it alone because they are viewed as overly emotional, dramatic, selfish. I think it's wonderful you're thinking of writing an article about this.

[AMotz]

I always tell mom's that they should grieve for the loss of their birth experience, just like they would grieve for the loss of a baby... They need to go through that healing process.

[UtahDoula]

Well I don't think that it is an either/or kind of thing. The way you phrase your question makes it sound like these two options are pitted against each other, when it really isn't so!
A good birth can be safe, a good birth can be unsafe.
A safe birth can be goo, a safe birth can be bad.
etc. etc.
We need to separate those concepts completely, I think. A cesarean birth CAN be a good birth. An unmedicated birth CAN be a bad birth (I'm thinking of moms who are traumatized - I know a few who had unplanned unmedicated births, and they all feel it was horrific.)
If we separate the two concepts, and acknowledge that it is NOT a tradeoff, a one or the other, but rather having a safe birth AND a good birth, then maybe we'll get somewhere.
Moms would know that it is OK to feel both grief at the birth experience AND joy at a healthy baby. Right now women don't grasp that very well. Care providers would (hopefully) be able to understand the importance of helping every birth be a "good birth" from mom's perspective AS WELL AS a safe birth.
Right now everyone acts like it is a seesaw that one it teeters into the "we have to intervene to keep your baby safe" territory - then it is not a good birth and they shouldn't even try, and that's a shame!
And have you read "A Good Birth, a Safe Birth" by Scaer & Korte?

[betterbirths]

I agree that more needs to be done to think about the mothers welfare after a traumatic birth experience. I feel that women are treated like they should not feel bad or troubled because they do have a healthy baby. If you have any other type of traumatic experience in your life, bad car wreck, robbed, raped, war vets or whatever else people don't blow it off and just say well at least you are alive now get over it. Trauma is trauma plain and simple.Often times people in other situations are diagnosed with PTSD and help is gotten for them.People are told to seek counseling or to seek justice, they are allowed to work through their emotions and deal with the pain and the loss. It changes people if they don't deal with the emotions and feelings that stem from it. I think birth trauma is even worse in some ways because it is often caused by the DR and is often unnecessary, women are hurt by people that they trust to help and protect them. If a women leaves feeling hurt and abused or mistreated and people are telling her to just get over it then she in my opinion is at much greater risk of PPD.
I think we as Doulas can help in a small way by helping women process their feelings and let them decompress by letting them the birth story, and letting them know they have the right to feel the way they do about the whole thing. Just a bit of validation goes along way. If one nurse looked at that mother and said to her " wow that was rough on you" it would let that mom know that maybe what she was feeling was valid and she would not go home wondering why she was "feeling blue". Instead she is feeling down and depressed and everyone around her is telling her to get over it and she can't figure out what is wrong.

Am I making sense? I never really consider myself a birth activist but this type of thing gets me going.

And just for the record, my thoughts on this, are the births where mom leaves feeling traumatized. I also believe that any birth can be a good experience for mom whether natural or C-Sec or medicated or unmedicated. I am speaking of births that are horrible for the mother and she does not know how to process it.
Ultimately the goal is a safe and good birth and sometimes to be safe you don't have a good birth experience, sometimes women have a traumatic experiences when there isn't a safety issue. I think that more needs to be done to help women through the emotional aspect of that

[earthgirl]

A woman who has had a traumatising birth must a) feel safe enough to voice her true feelings about the experience b) her feelings need to be validated by the professionals and her family c) be offered and/or seek help/counselling for possible PPD or PTSD etc. or simply grief counselling. This doesn't happen often enough. I feel so many women ARE traumatised by their birth experiences, but feel guilty because they have a healthy baby and feel they SHOULD feel happy, joyful .... Women are entitled to an optimal birth experience- whatever that may be for her as an individual, because that empowers her to be a great mother IMO.
If we believe that the children are our future, then we need to care for those mothers who will care for the future

Mothers have so much to live up to in society (numerous jobs, responsibilities, masters of multitasking, nurturer, putting others before self, and receiving much of the blame for any issues with her children) but most don't receive or seek the support from each other or our communities for many reasons. We need a circle of women for women in every community, but without getting into cultural factors I must say that sometimes I think we are our own worst enemies, and that the values of the society in which we live does not help us, but hinder us. Are too many women afraid to voice their truth?

[SarahM]

Thank you to everyone for your comments so far! They have been very inspirational!

South Africa (where I am) stands at No.2 or 3 as far high c-section rates go. IME women are convinced that this is **the safest** way to give birth because they are told this over and over by both doctors, friends and family. There is so much pressure on women to conform to this and I know that there are loads of women out there who are keeping the mask up because "how dare they" question having a baby in the safest way! That has surely been my experience with it all - to the point of people shouting at me "how do you know? you aren't a doctor!" when i question the reason for the interventions in my son's birth. So I suppose the reason I'm sounding like it can only be one versus the other is because it feels like it's been polarised to be that way, in my current environment. This article is also in part an attempt to inspire women to empower themselves and question things by realising that the experience is almost as important as it being "safe".

So obviously good and safe don't need to be too different things, and even non-medicalised births can be traumatic. Sadly, in my end of the world people are more likely to have people be understanding about vaginal births going wrong. I have seen this first hand when a woman who had a very traumatic, unmedicated, vaginal birth was told "My goodness you poor thing! Why on earth didn't you just go for a c-section! It's the safest way to give birth you know." at which point my blood was boiling but it wasn't my place to say anything.

Two analogies I have used in the article are 1) Saying "atleast the baby is healthly" is as undermining and hurtful as saying "atleast you can have another one" to someone who has lost a child. And 2) A person can be in a life-threatening car accident and be both devastated and traumatised at the same time as being glad they are alive.

The point is that when we give emotional wellness of both mother and baby the same degree of importance as physical wellness, we can ensure that in the case of a traumatic experience the mother and child receive the attention they need. We already have so much evidence available showing that traumatic experiences cause depression and PTSD, and that having these things at the time of becoming a mother (and family) can have far reaching effects, why is it so hard for people to put the two things together and allow mothers to grieve openly about their loss and receive treatment for it?!

I personally received a lot of counseling from professionals over my traumatic birth experience. I made space for myself to mourn the loss - both of a homebirth and of a piece of myself that I lost in the experience. It is only now, as my son's second birth approaches, that I have moved into the final stages of making peace with it. For more than a year I could not look at the black plastic I'd bought only weeks before the birth, when I still thought I would be having a homebirth. After much inner work, I finally took the plastic out and made a little fishpond in a quiet area of the garden. It was like I had finally buried the "death of the dream" and given it back to the earth to be used for better things.

Today I only keep my experience of the whole process and use it (like in the case of my article) to help others, or so I hope

(sorry to sound so flakey - i'm really not, but stuff like this really does help me!)

[earthgirl]

Sarah-
I just wanted to say that I am glad you worked through your own birth grief....what a great thing to do with the black plastic! Goodluck to you and thank you for sharing your story. Sounds like there is a lot of work to do surrounding birth in your area, I can imagine your frustration I am sure your article will inspire women and hopefully they begin to question what is safe.

[Firefly]

Sarah, I look forward to your article! You have a message that needs to be shared.

On a similar but slightly different note, I also have an issue with the notion of "safe/healthy baby" being touted the way it is.

"Atleast your baby is healthy," to me implies that there is something "bad" about the ones who are not. Of course people would prefer a healthy baby but all of my dear friends who have been blessed with children with special needs or who are "lacking" good health (for lack of a better word) still feel blessed with their babies. And some of them had amazing birth experiences but then had to deal with life threatening complications to babies life that had nothing to do with the birth! As they struggle to deal with their new circumstances would anyone be stupid enough to say, "well atleast you had a good birth experience?" (Well I suppose you just never know, people sure say some interesting things!)

[happy heartsong]

Such thoughtful posts! Doesn't it seem one needs to define their terms? What one person thinks of as good is not what another might think. Certainly we could come up with some underlying principles like- the mothers are respected, informed, have the decision-making power, etc. I think it's those kinds of things that define "good" rather than specific happenings.
I agree that safe and good are not mutually exclusive. People also do not recognize that nature's way provides for the safety of mom and baby.
Then we have to look at what health means. If we accept that trauma influences us and our babies long term what are the implications?
What makes an experience traumatic is the violation of the principles I mentioned earlier. It all ties together.
It expands even further- how do we treat the Earth?

[Doula Mary]

Quote:

Originally Posted by Kacy You're absolutely not alone in your opinions. I find it very insulting and damaging for someone to say, "Well, at least the baby is healthy." Yes, that's wonderful. But the experience of bringing that baby to earth is so much more important than many people realize. It can take weeks, months, years for someone to get over a traumatic birth experience, and often times they are forced to do it alone because they are viewed as overly emotional, dramatic, selfish. I think it's wonderful you're thinking of writing an article about this.

Right on
HOW you birth matters....it can profoundly effect you as a mother, as a nursing mother and your life...most women do not understand this concept.
Mary

[Doula Mary]

What I have found...is that even if there are things that are unexpected..and the birth plan goes wonky for whatever reason..if mom feels supported and feels like she has some power..she will still feel good about her birth.
If a mom feel ignored and helpless...then no matter HOW she births she may come away from it feeling trauma.
I completely agree that a planned c-birth can be a empowering experience...often though...it is the mother who understands that she must be a active advocate for her wants and needs.
Thus...helping her feel her birth power!
Mary

[b'earth angel]

Quote:

Originally Posted by Kacy You're absolutely not alone in your opinions. I find it very insulting and damaging for someone to say, "Well, at least the baby is healthy." Yes, that's wonderful. But the experience of bringing that baby to earth is so much more important than many people realize. It can take weeks, months, years for someone to get over a traumatic birth experience, and often times they are forced to do it alone because they are viewed as overly emotional, dramatic, selfish. I think it's wonderful you're thinking of writing an article about this.

So true Kacy. I often wonder how many women suffer from PSTD or PPD and don't even make the connection between a traumatic birth and the resulting emotional turmoil.

Quote:

Originally Posted by betterbirths I agree that more needs to be done to think about the mothers welfare after a traumatic birth experience. I feel that women are treated like they should not feel bad or troubled because they do have a healthy baby. If you have any other type of traumatic experience in your life, bad car wreck, robbed, raped, war vets or whatever else people don't blow it off and just say well at least you are alive now get over it. Trauma is trauma plain and simple.Often times people in other situations are diagnosed with PTSD and help is gotten for them.People are told to seek counseling or to seek justice, they are allowed to work through their emotions and deal with the pain and the loss. It changes people if they don't deal with the emotions and feelings that stem from it. I think birth trauma is even worse in some ways because it is often caused by the DR and is often unnecessary, women are hurt by people that they trust to help and protect them. If a women leaves feeling hurt and abused or mistreated and people are telling her to just get over it then she in my opinion is at much greater risk of PPD.

The major problem that I see w/acknowledging tramatic birth experiences is that for a woman to feel traumatized, there has to be someone inflicting that trauma on her. Here lies the problem, who would be inflicting trauma on a woman in labor? Nurses, doctors, hosptial administrators [rules, etc] and these folks do not wish to admit fault at all.
And to add insult to injury, if a woman who feels traumitzed by her doctor, nurse or hospital, decides to initiate a lawsuit, she's not going to get any relief unless there was a "bad" outcome, ie: dead baby, hysterectomy [maybe] or other disfiguration. It's likely not to even make it to a trial. So then she can also feel negated by our legal system.
I'm not sure what the answer is. I know that as doulas we do play an important role in helping mothers and fathers process births, the good and the bad. We can be the one becon of light in a dark, tramatic birth experience. [unless we helped perpetrate the trauma/???] We can encourage counseling, validate their feelings, try and help link them up w/other woman who experienced similar trauma.
I also felt grief after my dream of my first homebirth vanished. I felt controlled. I felt let down when I wasn't allowed to labor upright and suffered a bad tear. I really didn't have anyone but my doula to talk to since she was the only one who didn't tell me...."but you have a healthy baby". [my DH didn't tell me that either, but I don't think he understood the extent of my pain over this.] This is definately an issue that needs furthar exploration and clarification.
Best wishes on your article, can't wait to read it.

[cathy]

You are definately right. Unfortunately most of the people saying this have never or will never be in that position. It is a very sad, depressing, self confidence lowering start to women's motherhood. This fact should be acknowledged and the woman should be empathized with and helped but of course that might acknowledge that something is wrong with the medical model. I don't see change coming anytime soon in the hospital settings.

[joanna_b]

I just have to say that I am SO glad this issue is being discussed because I think it's extremely important.

This is exactly happened to me after the birth of my son and his birth turned out to be the most heartbreaking experience of my life. To this day, when I think about his birth, I don't think of it with any joy or happiness. Instead, I think of it with sorrow and sadness. Yes, my son was fine after he was born and yes, I had an unmedicated and vaginal birth, but it was still traumatizing, even with having a doula and fantastic support from my husband.

Up until week 32 of my pregnancy, things had been going relatively well. I had been preparing for a natural, unmedicated birth and had hired a doula. Close to 33 weeks, I felt my son doing all kinds of turns in my belly and commented to my mom that I thought the baby had just tied a knot in his cord. I brushed it off but in the next few days I noticed his movements had dramatically decreased, he was hiccuping all the time and I was starting to contract. At the urging of my doula, I went to see my midwife who examined me and found everything to be fine, except for the fact that I was already dilated to 1.5 cms. I spent the next 5 weeks on strict bedrest because the contractions didn't stop, I was still dilating and the baby kept dropping. I kept insisting that something was wrong but my midwife always said everything was fine. Even after she noticed my fundal height was still 32 weeks when I was 36 weeks, she still said everything was fine and refused to order an u/s for me, even though I had requested to have one and an NST at every appointment because I *knew* something was wrong. Finally at 38 weeks, I couldn't hold the baby in anymore and went into labor.

Upon arrival at the hospital, the nurse quickly noticed that the baby was having some pretty large decelerations with each contraction so I was hooked up to fluids and told to lay on my left side. The midwife came in (a different one than I had been seeing in the office) and did an u/s because she was concerned about what she was seeing on the monitor. When she did the u/s, she saw there was no fluid left in the sac so an amnio infusion was done, along with being hooked up to an internal monitor.

Throughout the entire labor, I was forced to stay on my left side and cope. I knew I didn't want pain relief so my doula and DH worked extra hard for me. I was able to "zone out" through most of the labor but I knew that the midwife, nurses and doula were very concerned. A couple of times, my son's heartrate would go so low that it wouldn't register on the monitor and then it would take a couple of minutes to come back up. During these times, my DH was sent out of the room because he was so upset. After 1 particularly bad episode, things got so dire that the midwife came in and checked me, found I was at 8cms and said they needed to do an emergency c-section right away.

The room was suddenly filled with chaos and tons of people. Since I didn't have an epidural in place, they started to explain that I would have to go under general anesthesia, all while they were throwing things onto the bed and getting ready to wheel me out. My son must have known what was going on and that he needed to come out right away because I involuntarily started pushing and he started crowning. It turns out, I had gone from 8cms to complete in less than 2 minutes. So there was chaos again because they weren't ready for me to birth the baby and as I was pushing, they couldn't find a heart rate. I remember my midwife getting right in my face and telling me I HAD to get the baby out RIGHT THEN. He was born in 3 pushes and literally thrown across the room to the recuscitation team. I later found out that he had wrapped the cord around his neck 3 times and his ankle once. While they worked on him, and thankfully got him pink and breathing quickly, the midwife worked on delivering the placenta. She had noticed the cord was very very thin and very long. As she was pulling the cord from my uterus, she came across a very tight true knot. You know it's never a good thing when your midwife says "HOLY COW!" Apparently, she had never seen a knot that was so tight. Couple that with the fact that he was so wrapped up in it and he should not be alive.

He had been trying to tell me for 6 weeks that something was wrong but I didn't fight hard enough to make sure the midwife knew something was wrong. The reason my fundal height didn't change after 32 weeks was because he had hardly grown since 32 weeks. He had severe IUGR and was very small. He didn't look like a full term baby, nor did he act like one. He wouldn't suck, he couldn't latch and he just looked very unhealthy.

After things had calmed down and I was moved to my postpartum room, the severity of what had happened and what could have happened hit me. I was so distraught by the "what could have beens" and "why didn't I do mores" that I freaked out and wouldn't let him out of my sight. The birth was scary enough for me but now I had to care for a child that wouldn't eat and wasn't ok and I didn't know how to do that. I was overwhelmed and needed support.

Instead, I got the "at least he's healthy" and "it doesn't matter now because he's healthy" comments from EVERYONE! It was so demoralizing having my entire birth experience, the most traumatic event of MY life, mitigated down into one little phrase. No one seemed to care what I had been through and no one understood or even tried to understand what I had been through. Someone (a family member) even went so far as to call me a "selfish princess B****" and tell me that it wasn't all about me. No one could understand why I was so scared and so unhappy and would cry so much, nor did they seem to care. They just wanted to hold the baby and get the kicks people get from holding a new baby. While they thought I was being selfish, I felt they were the people who were being selfish because they just wanted what made them feel good and didn't care about anything else.

The only person who understood was my doula and eventually my DH, after I had a very hysterical conversation about it with him. I realized that he had been using this phrase to cope with the experience himself, as he was traumatized by it too. But after our conversation, he understood that it was ok to be scared about it and that saying "at least he's healthy" was just suppressing the severity of what had just happened to us. After that, he was very quick to jump on anyone who dared utter this phrase. Too bad he had to leave when the baby was 12 days old because he was my only defense when I couldn't stand up for myself.

People continued to tell me this well into his first 2 months as I was having trouble feeding him and getting to latch. If I would tell my birth story, people would always tell me "at least he's healthy". I was constantly searching for someone to validate me, to validate my experience and to tell me that it was ok to feel the way I felt. To tell me that what I had gone through was horrible and that it would take me awhile to be ok. I needed someone to care for me and support me and I never got that, except from my doula who I rarely saw because life was too busy. Instead, I was made to feel guilty and selfish because I was supposed to be happy and thankful that I had a baby in my arms and that nothing else should matter.

Part of the issue I had with this statement was that my son was NOT healthy. No, he wasn't in the NICU and he was able to come home with me, but he still had tons of feeding problems and issues stemming from the IUGR. This caused a lot of grief and stress on me as I had to monitor every little drop of food he ate and had to feed him from a syringe for the first week of his life and pump and bottle feed him for the next month, until he was able to suck and transfer milk from my breast.

While I was able to have the birth some people would dream of, I was still scarred from it and his birth experience started me off on the wrong foot. I suffered from depression, high blood pressure, incredible anxiety, mood swings and sleep deprivation because of it. I wasn't the person I wanted to be and I wasn't the mother I knew I could be. I can't help but wonder how it would have been if people would have tried to empathize with my experience or had at least offered a kind ear and a soft heart.

People automatically think that birth is supposed to be an amazing and joyous experience and they don't understand that it's not just a "process". There are real emotions tied to it and it can be very damaging when those emotions aren't allowed to be expressed or validated.

You can bet that I NEVER say "at least your baby is healthy" or similar statements to people because I know how damaging they can be. I've come to realize that often times people will share their birth experience because they are wanting some kind of validation for what they went through or just someone to listen. I will never tell a mother that her feelings don't matter because the outcome was a healthy baby. She matters too. If you don't have a happy and mentally healthy mom, her entire family will suffer from it.

Anyway, that's the super long way of saying that I'm glad this issue is being discussed because I think it is very important to talk about and to spread the word to the public so they can realize how much impact their seemingly harmless words can have on a person.