It’s early January and Alex is just on twelve weeks old. Every morning I wake up to his soft cooing and warm wriggling against my side, and I look down at his round, smiling face with those two round, smiling eyes like dark shiny buttons, and I murmur to him the ritual sentence that starts our day: “Good morning Sunshine!” Then I think to myself what a treasure, what a joy, what a pure pleasure he is to me, in a life full of half-measures and equivocation. It feels like long, long ago that I was pregnant and facing the great unknown of childbirth.
When I discovered I was pregnant, I also discovered there were several alternatives for care when the GP, after confirming the pregnancy, asked me things like “public or private?” and “what hospital do you want to have the baby in?” I figured that with all that health insurance I had been laying out month after month I might as well go private. I was told to choose a hospital first and then go about looking for an obstetrician who delivered there. I googled a bit, and asked around a bit, and I was immediately confronted with the existence of two opposing points of view on the topic. Firstly I was told it was great that I was going private, only to be immediately told by the next person that no it wasn’t, it was a terrible idea.
I was struggling with the idea that my life had changed for good. I was having a baby that I hadn’t planned on, but one I wanted nonetheless, and the adjustment to this new life that was opening up before me was putting me in a spin. To top all that off I found that I was also having to get my head around a whole new world – the world of birth choices. The worst thing about it was I didn’t feel one hundred percent confident in any of the pieces of information I was hearing about. No matter how much research, reading and talking to people I did, I never came away from any one source saying to myself “OK, now I know what the best thing to do is.” In a teary phone call to my mother, I wailed, “It’s the most important decision in the world right now, and the impact might be enormous, and I don’t know what to do. I just don’t know who to trust!” Normally, I am completely confident in my ability to track down the facts and come to a sensible stance on an issue. Not this time. It was all so slippery and subjective. One person waxed on persuasively about the benefits of the home birth, and another proclaimed the superiority of the obstetric care at the private hospital. Neither were fully convincing, and both were highly subjective. It seemed that some women had good experiences in hospital and some didn’t. Some women had fantastic home water births with minimal intervention, but some didn’t. Some died. Of course, some died in hospital too. This was the most important thing in the world, and I couldn’t find any information that I trusted.
These days, I can’t imagine life without my son. That sentence is beyond trite and I apologise for that, but it’s true for me, just as it is for nearly all parents. It’s a biological imperative. You are genetically conditioned to prize your offspring above all else. He’s not even three months old, he can’t speak or communicate much beyond I’m hungry or I’m tired, he can’t walk or manipulate his environment very well, but nevertheless he has managed to cement his position as the most important human in his father’s and my life. We adore him. We put him first, his needs are placed ridiculously way beyond our own, and it is, as I say, a pure pleasure to do so. These days, it’s hard for me to remember the perceived enormity of the choice regarding his birth. And yet, it was so. As time went on and my pregnancy progressed, I almost became obsessed with the desire to experience a childbirth with very defined parameters, with as much control as possible.
In the end, I decided to go private. Much to the consternation of several of my friends. The first of the many, many stories began trickling their way in to me: “I’ve got a friend who went private and wished she’d NEVER…” “They rush you in and out…” “My aunty reckons…” I would outwardly profess to be ignoring all this, but they made a dent, all these anecdotes, and penetrated my defences. They coloured my thinking and I only realise it now. Looking back, I realise that going private was an expression of extreme risk aversion. This is an important thing to realise, where pregnant women are concerned. We are incredibly susceptible to over-inflating the probability of very unlikely events. Our risk management matrix is all coloured in red. I like to think of myself as a strong-minded outspoken person, but when I was pregnant, I was a mouse when confronted with even the slightest possibility of something going wrong. I discovered I would consider almost any measures in order to mitigate even the tiniest risk.
At the same time I began investigating all the ways in which a woman can birth a baby. I was under the impression that my obstetrician would allow me a wide latitude of control over the way in which it would all unfold. At this point Team One weighed in. I was told my obstetrician would not, in fact, be likely to let me exercise choice. I was told the obstetrician was only interested in his own convenience. He would pressure me into a caesarean or an induction, to “suit his schedule”. He and the hospital staff would conspire to rob me of my choices and treat me like an item on a conveyor belt. I must look at him as the enemy. Then Team Two spoke up. I must trust the obstetrician. He had years and years of experience and years of education. He had delivered thousands of healthy babies and he knew his business. I must look at the natural birth proponents as the enemy. I tried not to listen too much to either side, and I thought I was succeeding, but actually, I wasn’t. In fact, all these perplexing arguments and counter-arguments were slowly and surely inculcating a really distressing sense of mistrust – in my doctor, in my friends, and even in myself.
I want to stress that where other debates are concerned, none of this would be an issue. I would read a lot of material, probably examine some academic literature, but mostly be guided by the experts. The trouble was, in the case of childbirth, the experts didn’t agree. Sometimes it felt like midwives versus obstetricians at twenty paces.
I expressed my desire to avoid an epidural to my obstetrician. “Why?” he asked. I felt flustered – I don’t know why. I mumbled something about “increased risk of tearing” which I’d remembered from some of the reading I’d done. I was tersely told “Actually there’s no increased risk of tearing these days, the literature doesn’t support that at all.” Then, during an antenatal classes arranged by the private hospital the very next day, the midwives told us that one of the reasons to perhaps choose not to have an epidural was the “increased risk of tearing”. This infuriated me, but it was an impotent fury, because I was still no further forward to knowing whether an epidural really did increase the risk of tearing or whether it didn’t!
Another source of difficulty was the fact that sometimes Team One was right about stuff. My obstetrician really did look down on my attempts at self-education. He did sometimes treat me like a number. He very often forgot things about my history and had to be reminded frequently that I’d been hospitalised for fibroids. That little imp in my head that had been given a voice by all those competing sources spoke up and told me he couldn’t be trusted. Then again, Team One was quite often full of shit. In one antenatal class we had, the midwife airily mentioned using homeopathy as a suitable way to stimulate labour. My mother, a supporter of Team Two, told me that sometimes things went wrong, and if they did, the best place to be was in the hospital and under a specialist’s care. On the other hand, my friend from Team One made the convincing argument that it was a fallacy to view birth as a medical procedure. “That’s fine until something goes wrong!” Mum said, and there I went, back on the roundabout again. A lot of the time, especially as I got to the business end of the pregnancy, I just felt like I wanted to cry. Sometimes I did.
The other thing that I noticed was how many people there were placing value judgements on women’s birth experiences. I discovered, when I surfed the net and read forums, that the “right” way was to say no to painkillers. The worst thing you could do, evidently, was use pethidine. That made you a terrible mother – even before you’d given birth! To my disgust, I noticed that all of these people doing the judging were other women. Way to go, sisters.
In the end I did what most people do when confronted with two opposing but emotionally powerful arguments that appeal equally to their internal biases and fears – I cherry picked what I liked from each one. After the scare with the fibroids in the UK when I was told they represented a risk during delivery, I was determined to stay in obstetric care. I definitely wanted to birth in the private hospital. On the other hand, I wasn’t sold on the idea of a birth with lots of interventions. I didn’t want an epidural. I didn’t want a caesarean (unless as a last resort). I didn’t want to be induced. I was determined not to give birth in a prone position. I wanted skin to skin contact with my baby directly after he was born and I wanted the cord to remain intact until it had finished pulsing. I salved my need to feel in charge of events by focussing on a detailed birth plan.
In this way I catered to the individual demands both Team One and Team Two placed on my sense of anxiety and in particular, my need to feel in control of what was, in reality, an event that was completely out of my control in all its most important aspects. For this reason, I began to fix upon the Birth Plan as the talisman for childbirth. I felt as though as long as all the options (from what music was played and how dim the lights were going to be, to what painkillers I wanted to take) were established, reviewed, decided upon and mentally rehearsed, then things would go okay on the day. Team One and Team Two could yammer their babble at me as much as they liked; I felt like I had regained some confidence in myself as a person able to make an informed set of decisions and run with them.
And then my due date arrived. And nothing happened.
The thing about all this so far, is that it’s very mother-centric. It’s about what the mother wants. About how she wants to experience things. I’m aware it’s all coming across as horribly self-involved. But at this stage, whilst still pregnant, the baby is more than a concept but less than a firm, solid reality. Not one that you can hold in your arms anyway. Perhaps this bit will attract cries of denial from other mothers, but the way I felt about Alex underwent a drastic change the minute I saw his face and then held him close. Nowadays, in the joyful bustle of life with my baby, in the flurry of feeding, sleeping and cuddling with this beautiful, solid little human being, the thought that it was once vitally important to me to say no to an epidural feels foreign, and almost absurd. People ask me in a sympathetic tone, “How do you feel about how it, you know, really went in the end?” I honestly reply that it never caused me another bit of anxiety. But at the time it was the most important thing in the world, and on the 9th of October, so-called D-Day, it was already slipping out of my control.
My doctor saw me on the ninth, examined me, and told me I wasn’t dilated at all, although the cervix had softened. It’s difficult to describe the sense of shock I felt at the news. It was the first intimation that things might not go to plan. I had been fully expecting to be told things were progressing nicely for a baby later that day. While I sat on the patient’s seat perpendicular to his desk and processed the news, he told me he’d give me another week and if I’d still not gone into labour, I’d be induced. In fact, he’d book me in today for it, just in case. I wasn’t paying attention properly so I agreed hastily and went out to the waiting room to tell my mother. By the time I got home I was crying. I was fearful of the prospect of an induction and the onset of the much-maligned “cascade of interventions”. I’d heard horror stories about how much more painful labour was with an induction and because I was absolutely fucking terrified of having a needle in my spine, I knew I’d have to tough it out with just the gas. But Mum said to me, “Not to worry, a week’s ages away, you’ll go into labour by then, SURELY.” That was just what I needed to hear. I grasped onto that straw of hope and convinced myself she was right.
And then, suddenly, it was a week later. And nothing had happened.
On the morning of the scheduled induction, I broke down in hysterical tears. My mother and my partner couldn’t calm me. I raged around the house, crying and yelling. It was so unfair. Things weren’t going to plan, and worse, I couldn’t do anything to change it. “I won’t be induced! I don’t want to!” I shouted. I was reduced to behaving like a child. I wailed, “No one can make me do it!” My mother told me I needed to trust the doctor and let myself be guided by him, and if he thought an induction was appropriate, then it probably was. All the arguments from Team One about induction rose up in my head. To hear them speak, induction was practically satanic. They suddenly sounded horribly plausible. I remembered, with a sinking feeling, the way my doctor tended to rush through our consultations. Oh God, they were right all along. I’m being pressured into an induction! And it’s for no good reason – PLUS it’s going to distress my baby, fuck up my hormones and damage our bonding. I feverishly googled – always a bad idea, really. I found site after site from sources that would usually convince me that induction wasn’t such a bad thing, and there wasn’t all that much of an elevated risk of a C-section (and hence, epidural) after one. But. But. On the same sites, I was reading that an induction before week fortyone was even over was very premature. In fact, “normal” births could occur any time from thirty nine weeks to forty two weeks. This was exactly what Team One was always telling me. I sank into the nursing chair I’d bought specially for the sunroom and stopped raging. But the tears kept coming. My partner and mother were standing against the window opposite, looking down at me with compassionate anxiety. “I don’t know who to trust,” I kept saying. There was nothing they could say to reassure me.
I rang the doctor and told him how I felt. I was expecting a pissed-off sigh and an argument, but to my surprise, he immediately acquiesced to my request that we postpone the induction. I think now that I was surprised because by this stage in the pregnancy I was vacillating between Team One’s and Team Two’s respective dogmas. I’d made the connection that if an induction was a bad idea, then it followed my doctor was everything a bad obstetrician was painted as by Team One. The irony is that his pliability, in the end, rather than appeasing me, just made me feel more uneasy. He did tell me that, if I didn’t go into labour naturally over the next few days, I would have to have the induction before I hit fortytwo weeks. To this end, we rebooked me in for the following week.
And do I even need to tell you? Of course I didn’t go into labour.
That’s how I found myself in a hospital bed, waiting to have Prostaglandin gel applied to my cervix (which was still obstinately closed). I decided I’d let them go that far. They could apply the gel, and then we’d see how we were going. After all, I might go into labour after that, right? As the midwife got the gel ready she talked through the procedure. She told me the waters would be broken after the gel began to work. “But I don’t have to have that done, do I?” I asked. “Can’t we just do the gel and wait and see what happens?” She stopped and said, “Well, no. If we put the gel on, we have to break the waters.” I asked her, “I don’t have to have the oxytocin do I though?” She said to me, “Well yes. If you start with this, you have to go on to have the drip as well.” She thought about it and then added, “Oh, except if you go into labour before the drip is started! That could always happen.” She looked at me, and asked, “Do you want to go on with the induction? If you don’t want to, you don’t have to, you know that, don’t you?” I was filled with confusion. I hadn’t realised all the interventions happened as a result of each other like that. I wanted to prevaricate more, but I couldn’t. There I was, on a hospital bed with my legs spread and my pants off. It couldn’t be put off anymore. I asked her with more than a little desperation, “Well, what do you think I should do?” She smiled at me. “It’s your body and your decision.” I felt like throwing one of their expensive private-hospital comfortable chairs through the window. But I went ahead with it. By that stage, a creeping apathy had taken hold of me, and I felt not more than a little comfort in letting the medical machine take over. OK, I thought in resignation. I’m going to have this drip, I’m going to be induced, yes it’s going to hurt, but I can do it.
They tried the prostaglandin twice over the next two days. And I didn’t dilate at all. Not even half a centimetre.
My doctor phoned me from the labour ward where he was delivering a baby from a woman who had a functional cervix, to tell me that he was very surprised that the two attempts hadn’t had an effect. “I have to say, I think a caesarean might be the best way to go. I’ll be up there in about thirty minutes, why don’t you have a chat to your mother and your partner – and then we’ll all talk about, okay?” He was so sympathetic. I felt something welling up inside me. It was panic.
It was because I knew, that whether he was right or wrong, deep down, I thought he was right. Deep down, I believed him when he said I should have gone into labour after all this – and if I hadn’t, then I probably never would. And that the C-Section was the most sensible choice. I remember being sat on the bed, up on the twelfth floor, looking out over the peak hour traffic on the M1 as the sun went down. All those people scurrying home. I wished desperately and pointlessly that I was one of them. I watched two planes navigate a flight path over the horizon down to the airport and fiercely imagined myself a passenger. All I wanted to do was go home. I wondered if they’d let me just… go home. Then I realised that was just escapism. Yes, they’d “let” me go home. They couldn’t stop me. But if I went home now, I was just putting off the inevitable. I was going to have to just bite the bullet and do it.
When my doctor arrived to talk to me and my family about our choices, he spoke gently and sympathetically. He wasn’t in a rush. He said to me, “Look I’ve been doing this for a while now, and usually when you get a woman like yourself, who’s forty one plus weeks, we’ve tried the Prostaglandin twice and neither time it’s taken, you’re not even a centimetre dilated, I just think, you know, there’s something that just isn’t progressing. Whether it’s the baby or your uterus, something is inhibiting the process. There’s a lot about this that’s still a mystery to us, you know – sometimes these things happen. And I really do honestly think that a Caesarean is the best option for you. I think, that we could definitely try the Prostaglandin again, yes, and we might be able to dilate you enough to get the Amnihook in there to break your waters, and then you still might not progress, and then you’re looking at an emergency Caesarean – and you don’t want that.”
I realised he wasn’t an enemy. He wasn’t perfect, but he wasn’t out to ruin my childbirth experience. And I honestly believed, and still do, that he was telling me the truth. So I swallowed down my terror and agreed to the operation. It was scheduled for the following morning at ten am. The rest of the story of my childbirth experience is a complete and utter fizzer from a storytelling perspective. It went beautifully. I was made comfortable and aware of what was about to happen. The people involved were all professional, caring and generally wonderful. It was over ridiculously quickly. The needle into my spine, with its consequential numbness was nowhere near the horrific experience I was expecting. In fact, to my relief, I was able to wiggle my toes during the whole operation.
I will never forget the moment when they dropped the curtain over my chest and showed me Alex for the first time. It literally took my breath away. I think it was from that moment onwards that I suddenly realised something. THIS was what it was all about. It wasn’t about me. This wasn’t a smorgasbord of experiences for me to dial up for my own edification. It wasn’t some ultimate test of femaleness that I had to pass in order to be validated and accepted. All it was about, was getting that baby separated from my body, him safe, me safe. They brought Alex over to us and I snuggled him under the blanket, next to my chest. We held his hands and he held ours. His eyes were wide open and they were locked on mine. He drank up my image and I drank up his. The two of us was now the three of us. Things had worked out, they had worked out just perfectly.
I believe now that most obstetricians, mine included, are extremely risk averse. I think this is a product of our litigious times. I don’t know if I’m right or not about that. It’s just my hunch. I also believe that they have our best interests at heart. The reason for that is the same as the reason for being risk averse. It’s because they don’t want their patients to die or be injured. I think maybe the reason women get so heated up over being able to birth the way they want, is because they need to feel in control of as much of this scary process as possible. Maybe that’s not true for everyone, but it was true for me. The reason I believe this is because once the scary process was over, all that stuff I’d been so hung up on just didn’t seem to matter any more. Who CARED if I didn’t have a natural childbirth? Not me. Not any more. I think to myself, yes, it would have been nice if I’d been able to experience labour (well maybe not “NICE”, but you know what I mean), however there’s no emotional investment in that thought. It’s just a by-the-by observation. There isn’t a right or a wrong way to birth. I think, dare I say it, that there is a lot of undue importance and unfair value judgement placed on the way we birth and its effect on a child’s development and the mother-child bond. I believe that birth is the least most important part of it. The “important part” starts the second after the baby starts breathing. And it keeps going… And going… My mother tells me it never stops
Dedicated to my Mum.