Birth and Failure

Women are known for placing high expectations upon themselves.  We take care of everything and everyone, often neglecting ourselves in the process.  Setting high expectations for ourselves is no different when it comes to birth.  We spend months preparing for birth, educating ourselves, reading books, writing birth plans, and creating a “vision” for what we hope it will be like.   We try to wrap our heads around what we can’t possibly ever know…how our labor and delivery will go.  

I’ve met women who have birthed in and out of hospitals who have felt dissatisfied with the experience of giving birth, or more importantly the outcome.  These questions keep occurring to me, “Can we fail as mothers at giving birth?  Did I fail when my healthy baby didn't survive child birth?  Did my friend fail who transferred from birth center to hospital?  Did my sister fail when she had a cesarean?  How and why do so many women feel they have failed in some way?” 

After experiencing both a hospital birth (with which we brought home a healthy baby boy) and a freestanding birth center birth (with which our baby did not survive the traumatic delivery), I’ve come to see the ways in which the Natural Childbirth (NCB) advocates are actually setting women up for failure.  When we are taught first to “trust birth and our bodies” and that “birth works”, what then are we to think when birth doesn’t work?  When we are taught that “birth is as safe as life gets”, how do we make sense of that when our babies are injured or die as a result?  When we are taught that the hospitals are ill-intended, for profit, will strap you to a bed, will withhold food, and full of unnecessary interventions that will ultimately harm us and our babies, how can we feel good about having to transfer to the hospital or worse, have a cesarean?  Did our births not go “right” because we weren’t strong enough…didn’t push the right way…didn’t tolerate the pain…weren’t patient enough…that it just wasn’t meant to be?  Was it because we didn’t “trust birth” enough? 

Conversely, I’ve met women who have experienced labor and delivery in the hospital setting who also felt this sense of failure too, because the birth they hoped and planned for had too many interventions or ended with cesarean.  In preparing for hospital birth, many women write birth plans (as we were encouraged to do by our Natural Childbirth educator) to communicate their “vision” for what they hope their labor and delivery will be like to the hospital staff.  In a way this prepares women to be disappointed too, when things don’t go the way they had hoped or envisioned.  Some women are so dissatisfied that they seek out-of-hospital birth for their next pregnancy.   These mothers didn’t like the feeling like they weren’t in control or that they weren’t a part of the decision making process.  They didn’t like what seemed like an endless array of interventions or the way their OB talked to them.  They wonder if they really needed Pitocin or if their birth needed to result in a cesarean.  These women have questions too, and they are turning toward the world of unregulated, out-of-hospital birth proponents for the answers they want to hear.  

While I empathize with the disappointment hospital birth can bring, isn't the bottom line taking your baby home alive?  Isn't the point keeping mother and baby safe before it is about creating an experience?  Doesn’t safety trump any vision or birth plan we hold going into the unknown?  The priority has to be safety for every mother and those who attend their births.  Speaking from experience, I’d much rather bring my baby home alive then have had a picture perfect, intervention free, birth in a candle-lit room.  

This isn't to say that there isn't a great deal of room for improvement in the hospital setting or that interventions couldn't be used less often, but sometimes (more often than credit is given) these interventions are absolutely necessary.  We should not fear them, nor should we feel anything like a failure when they become necessary.  Sure hospitals and OB care could do a better job educating women about birth and appreciating that some women really want to be a part of it, to be fully present.  Some women do aim for un-medicated birth and deserve a staff that can support that effort well, while maintaining that mom and baby are within safe guidelines for doing so.  The truth is we can't control birth, no matter how much we'd like to, and in no way is a mother failing for being unable to control the way things go. Women shouldn't feel like accepting or asking for pain relief will somehow cause her child to be a drug addict later in life (as Natural Childbirth advocates teach) or that having a cesarean will prevent her baby from breastfeeding. We have to find an element of trust with the care we are receiving that allows for professional judgment on our behalf, and we have the right to expect that professional judgment to be honest, ethical, current, and responsible.     

With so many women walking away from the experience of birth feeling like they somehow failed, we need to consider why and how to address this as a culture.  First, birth isn’t always about the “experience”, it’s about the mom and baby coming out alive and well when it’s said and done.  I do think there is value in thinking through an upcoming birth and in talking about hopes for labor and delivery with a care provider.  The two keys here are honesty on the part of your care provider about the realities of birth and coming to a mutual agreement that safety is the ultimate priority, even if it deviates from the original “vision”.  Women need to appreciate everything our obstetricians and responsible midwives are doing to keep us safe, and our care providers need to work hard to understand a mother’s goals, both knowing they may not be met if it means an alternate plan will ensure safety.  In addition, I wonder how much we could learn about each other if we sat down with our care providers for an honest follow up conversation about client satisfaction, disappointment, and how/why decisions were made during their labor and delivery?  

Can a mother fail at giving birth?  I believe the answer is no, a mother cannot fail at giving birth.  She can feel dissatisfied, disappointed, manipulated, but she cannot fail.  Rather the failure comes in the care givers who choose not to recognize that birth doesn’t always work and that sometimes we need help.  The failure rests on the shoulders of care givers who don’t appreciate that birth can be inherently dangerous.  A great disservice is being imposed on women everywhere to paint birth as this peaceful, perfect, painless (orgasmic if you're into Ina May) image that ultimately is false for many of us, and not because we chose it or didn’t do our part.  I believe our society has a responsibility to be honest about birth, its dangers and its beauties alike, and a responsibility to remove judgment of each other for the way in which our births have gone.  Success should be defined by improving practices across the board and celebrating every baby that is born safely, regardless whether it was “natural” or not.