Me holding Sasha for a few seconds before she was rushed to the NICU due to meconium aspiration (inhaling her first poop)


Rewriting Your Birth Story

This is Part 1 of a three-part series on Natural Birth. Click here for Part 2 and Part 3.

Like a lot of first-time moms, I hoped for a natural childbirth. And I did everything I could think of to give myself the best chances of having one: I got a midwife, read Ina May Gaskin, took prenatal yoga. In the end, things went pretty awry. So awry that I came out of childbirth with PTSD, horrific flashbacks, and pain that persisted for the next three years. And I wound up wondering obsessively: Could I have done anything differently to make things less traumatic?

Me meeting Sasha for the first time after 25 hours of labor, including an IV drip, Pitocin, an epidural & an episiotomy

Me meeting Sasha for the first time, after 25 hours of labor, including an IV drip, Pitocin, an epidural, an oxygen mask, a catheter & an episiotomy

I had questions for my midwife. Lots of questions. And I wanted to ask them face to face. So we drove down to see her at Pennsylvania Hospital, where we were met with an out-of-the-blue snowstorm. Which was so weird, because is was snowing like that the last time we drove to that hospital—the day Sasha was born.

Philly when Sasha was born

Philly when Sasha was born

Philly 4 years later

Philly 4 years later

In this episode, I get my questions answered—both by my midwife and by maternal care researcher Saraswathi Vedam, who tells me something that will forever change the way I tell myself my birth story.

Resources for Choices in Childbirth

If you’re pregnant and hoping for a birth with as few medical interventions as possible, I encourage you to check out the resources below. If you’re like me and you wanted a normal birth and didn’t get one, these resources may answer some of your lingering questions.

Survey. Listening to Mothers is a periodically conducted survey, which collects data on women’s experiences and attitudes toward pregnancy, childbirth, and maternal care. If you’re interested in learning more about the rate of different types of interventions, how they’ve changed over time, and how women feel about those interventions, these surveys are a fascinating read. You can see a summary of the most recent survey’s major findings here.

Studies on intervention. In this story, I mention a study by the American Congress of Obstetricians & Gynocologists stating that cesarean is overused on first-time, low-risk moms. You can read that report in Safe Prevention of the Primary Cesarean Delivery. This review from Cochrane Libraries and this study from the American Journal of Obstetrics & Gynecology examine the adverse effects of epidural on mom and baby. If you’re looking for research on Pitocin, this study from BMJ finds a significantly higher risk of severe postpartum hemorrhage with the use of Pitocin in labor, and this one from Obstetrics & Gynecology finds that elective induction significantly increases the risk of C-section in low-risk women.

Studies on place of birth. If you’ve ever tried to get a straight answer on where it’s safer to have a baby, hospital or home, you will find that the existing studies are confusing and conflicting. Saraswathi Vedam, who I interview in the piece, has evaluated the research for quality and veracity, and she has compiled a list of the best available data in her paper Home Birth: An annotated guide to the literature. Several of the studies she cites—this one from Cochrane Database of Systematic Review, this one from BMJ, this one fromBJOG: An International Journal of Obstetrics & Gynaecology, this one from the Canadian Medical Association Journal, and this one from the journal Birth—suggest that planned home birth with a qualified attendant and planned hospital birth are equally safe, when it comes to low-risk pregnancies in high resource countries. The caveat is, hospital births come with more frequent medical interventions.

Book. And if you’re looking for a book with a straightforward explanation of normal, physiologic birth, check out Immaculate Deception II by Suzanne Arms. It’s a classic that has held up.

Have you managed to revise YOUR birth story? Tell us how in the comments.

91 thoughts on “PODCAST #27: Rewriting Your Birth Story

  1. Trauma and healing…

    I went into my first birth with confidence in my OB, faith in the system and faith in myself, my reading, my strength, that I would be given options, explained risk/benefit, and be able to have the birth I wanted assuming no major danger… And like many women, I was so, so sadly wrong. I was healthy and active the whole pregnancy, hike 4 miles up a mountain that morning. But when I went into labor and went to the hospital, one barely high BP reading started the cascade of intervention. Without confirming blood tests, the nurse bullied me into getting Magnesium Sulfate and said I had Pre-E. You read about interventions, but nowhere does it explain Mag. It was awful. I ended up getting an epidural many hours later, then my BP crashed so bad (because I didn’t need high BP meds in the first place) they had to jack me up with Epinephrine. Everything stalled and they were about to put me on Pitocin when I just had had enough and said “no”, I wanted to speak to the OB first. She was rude and pushy despite me crying and shaking, and I basically gave up and said “fine, but the lowest dose possible”. Hours later, a different OB delivered my baby using vacuum extraction WITHOUT asking me. I had a 3rd degree tear. In hindsight, I knew he vacuumed to rush the process (10pm, you think?) and did not allow my perineum to stretch or did anything to protect it (nor did anyone at any point ever suggest perineal massage or oils to me). The delivering OB also took me off the Mag right away and said I did not have Pre-E. He explicitly said, if I do this again, and have a slightly elevated BP to insist on an epidural first before Mag. Because of the drugs and rushed extraction, my son had fluid in his lungs, was transferred to a NICU 2 hrs away and I didn’t see him for 24+ hrs. I was traumatized and it cost us over $20,000 since we were self-employed, with insurance, but couldn’t get maternity coverage. I just knew in my heart it didn’t have to happen this way.

    So for my second birth, I found a midwife practice with a birth center in a hospital. It was truly the best of both worlds: The compassion and patience of midwives with access to every possible modern intervention and partnering OBs if necessary. With a midwife practice and seeing many different midwives for my appointments, I had to retell my first birth story over and over again. And I sobbed every single time. It wasn’t until one of the midwives told me that I had PTSD because of the birth, that I finally understood the impact of my story and why I just couldn’t come to terms with it. I should have been happy, my son ended up being perfectly healthy. But I just couldn’t get past the trauma of his birth. The midwives, and especially one, really wanted to help me heal and not go through that again. I learned about perineal massage, Ina May, the Brewer diet, and made a very clear birth plan, including a clause if I had a slightly high BP. Long story short, for my second birth, my BP was fine, I had amazing support of midwives and a doula, had an all natural birth with zero medication, just a slight tear. My daughter stayed on my chest for hours, never left our room and we were ready to go home two hours after the birth. It wasn’t just the birth experience I had hoped for, it was truly a healing experience.

    What’s sad to me though, is even though my experience is common, it is still taboo to talk about with first time moms in their pregnancy. Not that we need to scare pregnant women, but we need to discuss honestly and openly the decision making process during childbirth, the incentive structure and litigation concerns that doctors and hospitals base their care off of, and the actual protocol hospitals take when you check in. Also, like a previous comment above mentioned, the ramifications of these decisions long term can change someone life and family forever. I’ve known several women who wanted multiple children only to have one child because of a traumatic birth. While intervention can be necessary and life saving, women deserve the respect and the real information on the risks, benefits and motivating factors for every decision in the birth process. Choose your care provider very carefully.

    1. Karen, do you have any suggestions on what would be helpful for pregnant first-time moms to know without scaring them? Like, what info would be empowering?

      1. Partly a response to Karen, partly to Hillary:

        I went into my labor with a similarly misplaced trust in the healthcare system to look after my best interests. Interventions have left me with physical trauma that, seven months out, I am still recovering from (at least I hope I am still improving…) and a PTSD diagnosis.

        I am not a healthcare expert, but I really have to question the fear and stigma surrounding cesarean section. There are of course risks, as there are with any abdominal surgery, but I have yet to see a really convincing risk-benefit analysis of c-section vs. the many other types of interventions — or even of natural birth. Here is one article that does attempt to address this — and I wish very much I had seen this before I gave birth:!po=27.7778

        Quality of life should be weighed into the risk-benefit analysis.

        It is deeply upsetting and problematic that these issues are not discussed with women, for fear of scaring them. Women should be as informed as possible as they prepare for this life-altering event, and how their choices may affect their quality of life.

        For women pregnant with their first, I would recommend learning about their pelvic floor — the anatomy and function, what it must go through during childbirth, and what measures can be taken before, during, and after labor to protect it. Be aware of how interventions can affect the pelvic floor (e.g., see above article). I would suggest learning about this with someone else who will be present at the birth — a partner — who can advocate if interventions are recommended. I myself was not in any state during labor to ask questions or to do a careful assessment of what was happening to me. If possible, find a doula or midwife who has some first-hand familiarity with pelvic floor PT.

      2. That is the million dollar question isn’t it. I think the information is out there. But it’s buried inside books and intimidating documentaries that first time moms don’t necessarily want to read or see. It’s buried in the experiences of other moms, who don’t want to offend anyone by sharing. It’s almost like mothers need to come out of the closet and just be willing to openly and honestly share their experiences. Birth is such an emotionally charged topic though, it’s hard for mothers to take the cloak off and open up. Likewise it’s hard for soon-to-be mothers to take the optimism goggles off and get a clear picture of what really happens, even with the information available.

        I think books like Ina May’s Guide are wonderful, and written in such a positive and honest manner. The one thing I think holding back that book and it’s valuable information is the hippie perception of it. Bear with me… When I first picked up that book, the farm, the spiritual stuff, the orgasmic references, and the stories in the beginning of how these women came to find the farm led me to believe it was just for hippie chicks. You know, like the ones that don’t shave their armpits and only use all natural products and oils and that whole culture… (not judging that lifestyle, just noting that mine seems different) I am not a hippie chick. I try to be mindful, not wasteful, eat organic when given the option, but I like my laptop and smartphone, and I like to shave and wear deodorant. And I like the idea* of modern medicine and all it’s capable of. I was never even introduced to Ina May’s book with my first pregnancy. And before I experienced a real hospital birth, I don’t think I would have been able to relate to the women that chose to move to the farm. I liked the idea of a hospital just incase. I just didn’t know what I didn’t know, which, is the essence of the whole problem.

        With my first pregnancy, I knew plenty of mothers, but no one offered to share with me their honest birth story. I wish they had. I would have been open to hearing it, and genuinely would have taken any advice or wisdom they were willing to share. But, as it was, I went through the whole pregnancy just not fully aware. All I knew was from the hospital birthing class, pamphlets and unhelpful books like “What to Expect…”.

        After giving birth, it does feel like you’re suddenly part of a club, a secret club of women who get it. And I realize it’s impossible for a woman who’s never given birth to truly know what it’s like to go through it. But why is this club so hush hush? After all, the answers to most of our big problems lie within education and awareness. But we don’t really educate new pregnant women, or their partners for that matter.

        Problems aren’t solved when they’re brushed under the rug. Look any at of the big health topics in the past century. HIV, cancer, smoking, mental health, alzheimer’s, diabetes, heart disease, skin cancer… Of course we cannot prevent these health issues 100%, but with awareness and education, we have reduced these problems and improved outcomes for millions of people who face health issues. Why is childbirth any different?

        We need to come out of the closet. We need raise awareness like pink ribbons have done for breast cancer. We need to not be afraid to speak candidly with women and their partners. I realize not every mother might be up for this. That’s ok. There are plenty of mothers who are, but who just don’t want to offend anyone. We need to offend people, with the truth. Obviously any campaign to raise awareness surrounding birth needs to be managed diplomatically and delicately, but the point is, we need a campaign.

        I may be more outspoken than most. I will share my story, in a matter-of-fact (not intended to induce fear) way, with anyone. I will unabashedly tell a friend “You can say ‘NO’ to pitocin” (or induction, or a cervical check, etc…) and try to point them to the most accurate and unbiased scientific research I can find on the risks/benefits of all these procedures. It’s so complex though, as so much can happen and the decision making in the moment is nearly impossible for the woman in labor. So I also try to educate anyone who will listen on the importance of labor support, wether it’s a midwife, doula, or knowledgeable friend who has been through it to be by her side and helping to communicate and facilitate good decisions. Fortunately, at least in my experience, the midwives I worked with always took their time to explain what was happening and options. Thanks to sharing my disrespectful hospital experience with a close friend, she switched practices to a midwifery group and had a great experience. I got to be there for her birth, while I was pregnant with my second. It was such a dramatic difference to see the respect given to my friend in labor, and the care with how she was presented information and options compared to my first birth.

        One of my best friends is pregnant with her first right now. I have sent her Ina May’s Guide, The Business of Baby, my copy of The Business of Being Born, various links and tried to talk with her about the choice of an OB vs Midwife, doula or no doula, pitocin, epidural and her perineum. Mostly though, she doesn’t want to talk about it. She wants an all natural birth, and is going with an OB practice at a hospital that has a high c-section rate. She doesn’t think she needs a doula and her insurance won’t cover it. She said to me, “the difference between you and me is that I trust my OB”. I told her I did with my first too. But she also doesn’t want to read about what can go wrong because she doesn’t want to spend her pregnancy consumed with fear. Which I understand. I told her I just wanted to give her as much information as possible, and to let her know that doctors and nurses will want to do things their way. I didn’t want her to be surprised when it didn’t go her way. I left off with one last suggestion again to read Ina May’s book since it was informative and empowering, and will fill her with positive and capable thoughts.

        Everything in life is a risk analysis. But like that article from the NIH says: “Women have a right to consider the evidence and weigh the potential risks and benefits, and thereby participate more equally in the decisions concerning their pregnancy and mode of delivery.” Ultimately, without education of these risks and benefits, and support in labor, we are leaving women out of the equation when it comes to choices made about their body and their baby. Women deserve better.

        (Sorry for such a long reply. Love the podcast, thank you, keep up the great work! And I’m pregnant with my third — AH!)

        1. Wonderful reply.

          I have been thinking exactly along the lines that you put forth, that we need some sort of public awareness campaign — something like what has happened for breast cancer, skin cancer, etc. After my own difficult birth experience, I’ve often wondered why there hasn’t been one. Perhaps one reason is that for the most part what we are talking about here is not a question of life or death.

          Before I gave birth, I did not do a lot of reasearch. My reasoning was that giving birth is such an intense and unpredictable event, meticulous planning might only set me up for disappointment. I read a few birth stories, talked to my mother and a few friends about theirs, and went to a childbirth class. I wanted to give birth in the hospital (just in case), but I chose midwife care and a doula. I knew that there was a good chance I would end up with a c-section, but I was ok with that. In some ways, I feel like by chosing to have a midwife and doula, I was lazier about education myself about my choices in the hospital, as I thought these women would be there to help me make informed choices. It turned out that when a perceived emergency arose, both of them stood by and let the doctors do their thing. Without wishing to get into the details, I had a difficult forceps delivery, when I believe — after research and talking to numerous doctors — it should have been clear that a c-section was the right choice for me (hence my vocalization about c-sections…). Immediately afterwards, my doula said to me, “well, it was an assisted delivery, but still better than c-section.” After months of pain, discomfort, and pelvic floor disfunction, I cannot disagree more. My ability to care for and enjoy my baby has been compromised much more than it might have had I had to sacrifice the first couple of hours with him, or had been unable to breastfeed. I think my doula was just of the opinion (like that mentioned in the article I linked to) that vaginal, no matter what means, is preferable to c-section.

          In my childbirth class, it was mentioned that interventions such as pitocin, epidural, etc., greatly increased the risk of c-section or instrumental birth, but the risks and benefits of these final interventions were never addressed. It seemed like the message was, interventions are just bad because you don’t get a wonderful natural birth. Discomforts of pregnancy were discussed at length, but never were any of the physical problems or complications following birth. If I had known how prevelant pelvic floor problems are in even a normal birth, I think I might have been much more on my guard when forceps were brought out. Instead, because I had heard so often how much I should want to avoid the dreaded c-section, I did not protest.

          Ina May’s book and the natural birth advocates have made a lot of progress in helping women to find better ways to give birth. Unfortunately there doesn’t seem to be the same kind of support for women who want a hospital birth, or who want to consider interventions or procedures such as epidural or elective c-section.

          I have difficulty talking about my experience with pregnant women — not because I am afraid of offending them, but because I am still so traumatized by my own experience. I hope that I will reach a point where I may do so in the matter-of-fact way that you do.

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