Choose your care with care

Nearly three years have passed since I gave birth to my fourth child. I didn’t write his birth story straight away, because I just wanted to forget. In the immediate wake of his birth, I struggled with my feelings of sheer elation and burning anger. And now, as my little boy grows, he meets everything in life with either delighted happiness or intense anger. It is almost like he was imprinted with my emotions as I was giving birth to him, and the scurf of the ecstasy and rage of his birth has clung to him and never quite washed away…

choose your care with careI know the point at which I should have walked away from my midwife. I was attending a routine antenatal appointment, being as ever, obstetrically uninteresting, and I enquired about the possibility of having a physiological third stage of labour. This would be my fourth birth. I’d asked for a physiological third stage for my second birth, a homebirth, but my midwife had scared me out of it with the possibility of having to transfer into hospital with a retained placenta or a haemorrhage. I didn’t know about informed consent then. I knew only to quietly accept whatever treatment that medical professionals decided was necessary for me. I was a good patient. I then went on to request a managed third stage during my third birth, which resulted in a bad experience: labour was stressful, I already felt the threat of hospital transfer, I didn’t know the midwives at my homebirth, and so when I was given the syntometrine, my body clamped down and when ‘controlled’ cord traction was used to remove the placenta from my body, it felt like my insides were being ripped from me. It was agony. I screamed for gas and air, but they’d already put it away. And then I’d bled for weeks afterwards too. I know now that that bleed had not been normal; I’d felt faint and dizzy and weak for a long time after, and I had still been soaking several menstrual pads each day, even at two weeks postpartum. This had not been detected by my community midwives because they assumed my bleed was settling down.

I’d always felt that my third child had been somehow compromised by not having received his full blood supply at birth, so this time would be different. This time I would stand my ground and get the physiological third stage I wanted. I researched my options, and felt confident I could get my midwife to agree to it. However, she was clearly not happy with my request. This time, I stood firm, told her I’d researched my options, looked at the risk factors and how I fitted into those risks, and said they were risks I was happy to take. She laughed in my face. I should have walked away right then, but I didn’t.

Instead, I cried every night, panicking about my birth. Would I be allowed my physiological third stage? How could I get my midwife on side? I was already battling with her over my estimated due date. I charted my fertility, and therefore knew without a doubt that the scan date was four days out. Four days doesn’t sound like much, but at the end of pregnancy, it can make the difference between a natural homebirth and an unnecessary induction. The difference between a low risk birth and a high risk one. Yet, right the way through my pregnancy, my midwife remained dismissive of my assertion that my due date was wrong. I questioned myself. I re-read the research. I cried some more. I felt stressed. My older baby was sick, and had been in and out of hospital. My two eldest children had needs too. I endured weeks of SPD so bad that I could no longer walk – I couldn’t even climb the stairs or pick my children up from school. It felt like I was trying to cram years’ worth of reading and researching birth into the space of a few short weeks. I became exhausted with all the stress.

Wolf in sheep's clothing?Yet I clung to my midwife. I didn’t know I could change midwives. I didn’t know I could contact the supervisor of midwives, who could place me under the care of a different midwife. I didn’t think I could afford an independent midwife or a doula. I didn’t know about payment plans or hardship funds. I didn’t think I’d have time to build another trusting relationship with a different midwife or doula part way through my pregnancy.

 

Instead, I told myself I’d known and trusted this midwife for four years, and wanted to make this work. I desperately wanted to connect well with this midwife. I didn’t see that she wasn’t the right midwife for this birth. I didn’t see that she wasn’t with me. I didn’t see that perhaps she’d never been with me in the first place.

“Staying strong in the face of other people’s projected fears was my single biggest challenge of that pregnancy.”

My due date came and went. I am in no doubt whatsoever that the amount of stress I felt was preventing my body from going into labour. And the stress only got worse. I was now dealing with phone calls from relatives asking if I’d had the baby yet, if I’d felt any twinges, telling me I was taking a huge risk by intending to refuse induction – what if something happened to me or the baby? Why was I not following medical advice? Staying strong in the face of other people’s projected fears was my single biggest challenge of that pregnancy.

A couple of days past my due date, I called my midwife, fed up and desperate to get things moving along. I heard my own voice request a cervical sweep, despite my wish to avoid them. Despite my knowledge of the increased risk of infection. It was a sign that things weren’t right. I went along to the appointment she’d arranged for me, feeling like an inconvenience. I glanced at what she’d written on my handheld notes; her words betrayed that she too thought I was being an inconvenience. Resisting the urge to throw up which was welling inside me, I stripped off my trousers and knickers and let her stick her gloved hand inside me. Of course the sweep did nothing. Nothing but make me feel hopeless, miserable and degraded.

Despite my insistence that my due dates were wrong, I was scheduled a term +10 appointment. At just six days past my estimated due date, I went to the hospital, feeling upset, trapped and scared. I was hooked up to a monitor. Then I went for a scan. The baby didn’t move at all during the whole time we were in hospital. It was almost as if he was trying to hide from them. But his not moving caused a problem. The sonographer spotted a small pool of amniotic fluid to one side of my baby, which after being measured, appeared to indicate borderline polyhydramnios. The sonographer wasn’t entirely happy with that diagnosis, as she could see that all the baby had to do was move, and the pool of water would disperse around the baby.

PoolA diagnosis of polyhydramnios would risk me out of homebirth. I was devastated. After the scan, I was given another cervical sweep, during which the midwife was brutally rough. It hurt so badly I lay curled on the bed catching my breath afterwards. I cracked. Sobbing, I explained to the midwife afterwards that my due dates were wrong, but nobody believed me. She wasn’t particularly sympathetic, but could see that by now I was a total mess, so agreed to have a chat with the consultant about it. She reappeared a short time later to relay the message that the hospital would allow me my extra four days, as long as I took responsibility for it.

In that same instant, I’d been granted both a reprieve and dealt an obstetric slap in the face. How dare he, a faceless consultant who couldn’t even make time to come and see me in person, how dare he assume total responsibility for my body, my baby, my birth? Angry as well as upset now, I informed the midwife that this was my body, my baby, my birth, and therefore MY responsibility, right the way through. Yet I was also thankful to that faceless consultant for those extra few days. A second term +10 appointment was arranged for four days later. As soon as we left the hospital, I felt so relieved. And the baby started kicking away inside me, like he was leaping for joy at our escape.

The realisation that I’d just been risked out of a homebirth was hard. I knew and the sonographer knew that the polyhydramnios diagnosis wasn’t accurate. I then realised that the only thing that had happened was that the hospital had removed its support for my homebirth. I didn’t know that I still had a right to be attended by a midwife at home if I chose to go ahead with a homebirth. From my perspective, I had been denied access to midwifery care at home, therefore if I did go into labour over these next few days, the birth would be unassisted. I’d been toying with the idea of unassisted birth for this birth before; now it appeared I was left with no choice.

In between those term +10 appointments, I stumbled upon an article online which forced me to change the way I was dealing with the hospital. The article was about a woman who lost her homebirth to gestational diabetes and a planned C-section. After grieving the loss of her homebirth, she resolved to treat the day of her C-section as a celebration. She and her husband wore their best clothes and greeted every member of staff they met as a friend at a wedding. She ended up with a positive birth. I thought to myself, if this woman can turn her worst nightmare into such a positive experience, surely I can turn my term + 10 appointment into something positive?

“‘You never know,’ she said brightly, ‘They might even induce you today.'”

The morning of my term +10 appointment, my midwife phoned me, wondering what had happened to me. I explained what had happened during the last hospital appointment, and that I had an extra four days. She said that even borderline polyhydramnios meant I couldn’t have a homebirth. ‘You never know,’ she said brightly, ‘They might even induce you today.’ I was horrified. Induction was exactly what I didn’t want. Yes, I wanted to be delivered from this hell, but my hell wasn’t pregnancy itself. My endurance of these last few days of pregnancy were my gift to my unborn child, for the safest place for him was surely inside me if he was not yet ready to be born. I don’t think she really understood that. In a panic, I admitted I was scared. Terrified. There was a brief pause on the other end of the phone. A sigh. Then she said we’d see how the appointment went today, then discuss my homebirth plans with her tomorrow to see whether we could sort something out. I’d finally admitted I was scared of hospital birth. I felt relief flooding through me, quite literally: from the base of my skull, I felt a trickling sensation which ran down my spine. This is it, I thought. This is how labour starts.

And so, with a deep breath and a smile, I went into the hospital for a second term +10 appointment. This time, I greeted the midwives with a confident smile, even though I felt slightly wobbly inside. I was hooked up to a monitor again, but they gave up with it after a time, because the baby was moving so much they couldn’t get any decent readings. My scan was much more positive too. Predictably, the small pool of amniotic fluid was no longer there, and my fluid levels were measuring normal. Strangely though, I still consented to another cervical sweep. It wasn’t horrible, just ever so slightly creepy. The midwife was nice enough, seemed positive about my homebirth, and upon checking my cervix, said I was ‘favourable’. (Why did she keep her fingers inside me for so long?) She said she’d be surprised if I hadn’t had my baby by tomorrow. I was sent home with well-wishes for my homebirth.

That evening, I felt the sensations which had been ebbing and flowing all afternoon begin to intensify. Contractions became like waves, rising through me, distracting me from my conversation with a friend online, drawing me inward. Eventually, I went upstairs to my bedroom and stripped off. It was August; this is how I wanted to labour. I felt a sense of freedom as I patiently rode each wave of contractions, feeling calm and powerful. I was made for this. This was nothing I could not cope with. My husband just quietly allowed me to get on with it; he would support me when I needed it. I wanted to do this without pain relief. I could DO this! Then I rode two hard contractions as I leant over my birth ball. Those contractions made me feel sick. Surely birth must be close now? I debated calling the midwife with my husband. He asked me if this was really what I wanted. I knew my midwife was on call that night. I didn’t want a stranger at my birth. I told him to call her. Yes, I was sure. I heard him talking with her on the phone, explaining what the hospital had said, that I was fine to have a homebirth. After the phone call, he told me she had agreed to come. She was coming. I was so pleased, and yet it struck me at the same time that I’d probably made a bad decision. I no longer wanted to labour without any clothes on, so I threw on a nightshirt. The intense contractions suddenly ebbed away. Maybe I’d called too soon? Maybe I’d misjudged this?

When my midwife arrived, my husband offered her a cup of tea. She accepted, and he went downstairs to make it, leaving the two of us in the room, alone together. She said she needed to check my cervix. I consented, and reluctantly lay on my back to allow her to check my cervix. Once her hand was inside me, she informed me that I was ‘only 4cm dilated,’ which was exactly what she’d told me when I was in labour with my second child. I felt a little frustrated and disappointed at this. ‘If I just wait until this next contraction,’ she carried on to say, ‘let me see if I can stretch your cervix for you a bit.’ This too was exactly what she’d done during my second child’s birth. But I didn’t know about informed consent then. This time I knew this was not what I wanted. I wanted her hand out of there, NOW! All at the same moment, I tried to say, ‘NO!’ but my mind was being pulled inwards to cope with the next contraction which was beginning to rise within me, and she assumed consent and started to stretch my cervix. She hurt me. She HURT me. I felt violated. In my own house, in my own bedroom, on my own bed. The pain was more than I could cope with, yet I couldn’t protest. The only part of me that made any kind of protest was my right leg, which made a few feeble attempts at kicking her, but I struggled to stop myself from kicking her because I didn’t want to get into trouble for assault. As soon as she stopped, I escaped to the far corner of my bed, away from her and cowered. Several contractions at once rose and crashed over me, pulling me under, drowning me. I could no longer cope. She had broken me. I requested gas and air and the TENS machine – the only available pain relief – as soon as my husband returned upstairs.

My midwife called for the second midwife to come. This struck me as a little odd at the time, as she’d just told me I was ‘only 4cm dilated.’ In hindsight, I realise she was calling for backup. I spent the whole of my labour hoping for a supportive atmosphere, but sensed only an increasingly tense and hostile one. My midwife clearly did not want to be present at the birth, and I could not understand why. Why had she come if she didn’t want to be there? I didn’t know that she was most likely just fulfilling her legal obligation as a midwife to be present at my birth – she didn’t actually have the right to refuse us when my husband called her. When the second midwife turned up, I sensed that an ‘us and them’ atmosphere was developing. They chatted almost incessantly, trying to draw me into their conversation about people at the hospital, some of whom I knew from my breastfeeding support, asking my opinions on things which really didn’t seem to matter. I just wanted to quietly get on with my labour. I realised that my unwillingness to chat was being taken the wrong way – perhaps they thought I was being critical of the people they spoke of – but none of it seemed important. Didn’t they realise I was about to give birth? Desperately trying to get my head together, trying to return to my space in between things, I remember thinking, ‘As soon as you leave here, there will be another birth for you. You will forget and move on. My birth is just another birth to you. But where’s MY next birth? This is important to me! This is my last birth! I need it to be respected and supported.’ The respect and support never came.

I was kneeling on the bed, leaning against my husband, my rock, my refuge, my arms around his neck, when all at once my waters broke with a BANG! Suddenly, the attention was on birth. There was a brief lull, then during the next contraction I suddenly felt the need to straighten up and arch my back. Reaching upwards and over my head, I made to grab whatever was behind me. It was my midwife. I accidentally bumped heads with her as I grabbed her, and in my head, I apologised. I felt the baby suddenly shift inside me, a weird clunking sensation. Another brief lull between contractions. I leant back on my midwife’s shoulder to rest. During the next contraction, I leant forwards against my husband and wrapped my arms around his neck again, but that didn’t feel right. I moved him aside and dropped onto all fours, feeling and resisting the urge to push. I resisted and resisted the urge to push with each contraction that followed. ‘Don’t push, just breathe,’ I thought, and it felt good. It felt really good. Powerful. Intense. And then I gave one small involuntary push and the baby was moving. Moving earthside. And that felt amazing. None of the other births had felt like this. It was just incredible, awesome, like… just like a really intense orgasm. Somewhere far away, I could hear my midwife saying, ‘That’s it – push through your bottom,’ which struck me as absurd – I wasn’t pushing; besides, that’s not where you push! So I laughed. Suddenly I was being yelled at to, ‘Pant! Pant!’ But I couldn’t – I was laughing, and the baby flew out. I sensed the midwives’ disapproval and annoyance – quite possibly, as I later discovered, because I had sustained a tear – but I was beyond caring. My baby was passed between my legs and laid on the bed below me. He was beautiful, pink, perfect. I gazed at him, wanting to drink him in, claim him, feel that wave of love rise within me as I recognised him – ‘Pick him up then,’ interrupted the midwife. I obeyed, stripped off my nightshirt and held my fresh, new baby to my breast.

“I felt under pressure. I did not feel safe.”

Now we waited for the placenta. The atmosphere was tense. I knelt with my baby on the bed for a while, then leant back against the pillows and attempted a first breastfeed. The midwife and I checked the cord, which was beautiful and healthy and pulsating. I remember smiling after a few minutes had passed and saying, ‘So much for 2-3 minutes!’ This cord was pulsing much longer than that. When it did eventually go white and limp, the midwife said, ‘I think we can put the clamp on now,’ and just went ahead and clamped it before I’d birthed the placenta. My midwife was obviously uncomfortable with the physiological third stage. She kept glancing at her watch. I felt under pressure. I did not feel safe. I was balancing precariously on a tightrope between worlds, carefully guiding my newborn baby across the chasm between one world and the next, and she kept checking her watch. Eventually, after almost a full hour had passed, and my midwife was making noises to transfer me to hospital, I became irritated at their lack of faith in me and pushed the placenta out. It was whisked away immediately and I never got to see it.

My baby boy was born at about 2:45am on a hot August night. That same night, those midwives went on to attend their next birth. The second midwife had come to my birth straight after attending someone else’s. Like superheroes, I thought, and tried to joke about it. They weren’t impressed. I got the feeling that they disapproved of the birth I’d just had – perhaps they thought it shouldn’t have been at home, perhaps they resented the time-consuming third stage? I don’t know. All I know is that whoever’s side they were on, it wasn’t mine.

My birth was recorded as a 42+1 homebirth, but I was beyond caring. I felt jubilant. I had fought the system and won! And my prize was a beautiful, thriving baby. Every decision I made during that pregnancy and birth, every adversity I endured, it was all for this baby. And my reward was great: a healthy bundle of life, a baby uncompromised by his birth. He was worth every single step of that difficult journey I had made.

The first realisation that anything was wrong was when I opened the thank you cards I’d bought for the midwives. I sat and stared at the white, blank pages before me and couldn’t think of anything to write. Nothing. Nothing came. I couldn’t think of anything to thank them for. That was when I felt the first feelings of anger swelling inside me. I’d been belittled, ignored, unsupported, bullied and even abused. I wasn’t thanking anyone for that. I had fought for my baby’s right to receive his full blood supply at birth. I had fought for my actual due date to be recognised by the hospital. I had fought to keep my birth at home. I had fought for my responsibility for the birth of my baby. I had worked incredibly hard to keep my birth safe. What I had achieved, I had achieved myself.

After every other memory of his birth slowly faded, what remained were two sharply contrasting shards of memory: the truly awful way my midwife stretched my cervix, and the orgasmic moment of his birth. I wanted to frame my baby’s birth as positive. After all, birth is supposed to be a joyful event. I’d just had a homebirth. And homebirths are supposed to be good, right? I’d just achieved an orgasmic birth. And orgasmic births are supposed to be the ultimate positive birth, the Holy Grail of natural birth, almost. Yet somehow it felt all wrong. If finding the Holy Grail of birth felt like this, I didn’t want any part in it.

For a long time, I was haunted by the moments during which my cervix was stretched, enduring the agony, my inability to fight back or stick up for myself. I wanted to think I was the kind of person who wouldn’t take that kind of treatment, who could say no, who fought for herself. Yet faced with that situation, I hadn’t. I’d just let her do it. I felt ashamed. There are words birth advocates use for the kind of thing I’d experienced: violation, abuse, birth rape. I didn’t want those words associated with the birth of my baby, my beautiful, perfect baby. I didn’t want those words anywhere near his welcome into this world. Yet there they were, stark and heavy, hanging around the memory of his birth like shadows. It affected our sex life. Not only that, but it was hard to be in the same room where it had happened, hard to sleep in the same bed. I had to revisit it night after night after night. I tried to tell myself it was an accident – perhaps she hadn’t meant to do it? Perhaps she’d thought I was OK with it? Perhaps I was making a big deal out of it – after all, I had consented to the cervical check. Sometimes it mattered so much to me. Other times it mattered less. But really, it was NOT OK. I did not consent to her stretching my cervix. And what she did broke me. I had placed my trust in her and she broke me.

“I had discovered birth’s best kept secret, hadn’t I?”

I tried and failed to reconcile the way I’d been violated with the orgasmic sensation during that same birth. I’d been violated, laboured in a hostile, disapproving atmosphere which had been distinctly lacking in love, trust, respect or support. At first I was amazed and glad, as I thought I should be: I had discovered birth’s best kept secret, hadn’t I? But exactly how I’d discovered it unnerved me. I’d been belittled, coerced and disrespected. I’d been abused. I tried to look back over my birth to spot the point at which the atmosphere changed to one of love and support, but that point had never come. Was there something wrong with me? Was I connected up wrong? Was I the kind of person who got some kind of perverse enjoyment out of being degraded and abused? I felt confused and ashamed. I felt like the only person in the world who’d experienced orgasmic birth as a negative thing.

At the same time, I was struggling with sleep deprivation from feeding a baby with tongue and lip tie. I was lucky if I could scrape together an hour’s unbroken sleep each night. I also struggled with a lack of support. I struggled to get the kids to and from school, to keep up with what was going on at school, homework, housework, washing, cooking, shopping, the fact that I desperately needed regular and reliable help, but none came, save for a dear friend who visited my home for an hour or so when she could to play with the children. My daughter started pulling her own hair out and I helplessly watched her struggle with trichitillomania, which frightened me. The anger and confusion I felt because of my birth was affecting not only me, but my family as well. Just before my baby’s 2nd birthday, I reached a point where I could no longer cope with the anger and shame inside me. I had been trying so desperately to hold everything together for so long that I’d failed to notice I’d already broken a long time ago. I hated myself, hated the mother I was becoming. I lost the will to carry on, the will to force myself to get up in the morning, and even the will to live. 

AkhilandeshvariThe start of healing came at a barley field. I started going for walks on my own on sunny evenings. I was starting to get my life back together again, and I needed space to think. I’d come across an article about a Hindu Goddess called Ankhilanda who, according to Hindu tradition, is so broken that she is a symbol of strength. She is strong because her brokenness allows her to put herself back together in any way she chooses. One evening, I chanced upon a field of barley. The sun was setting, and there was a breeze which created ripples and waves on this vast ocean of lush greens and golds. It was breathtaking.

Mesmerised, I stood watching for some time, feeling the breeze blurring the edges of my being, reminding me that I am not separate from, but one with this Earth. Suddenly I was aware of not only a field of barley, but each individual stem of barley, each part of each barley plant, each molecule, each atom, each proton, electron, neutron. And I knew protons, electrons and neutrons can be broken further still: I recognised each infinitesimal speck of existence as a universal consciousness, so broken that it is whole, both the smallest building blocks of life and the wonder that glues them together. I saw something miraculous: that these infinitesimal specks of life can put themselves together and manifest themselves in any way they choose. Could I not too put myself back together in any way I chose? That day, I felt something I had never felt before: trust. I am trusted to break, for no matter how badly I break, I have the strength to put myself back together again, in any way I choose. I am trusted to have the strength to start afresh. I felt trusted with my marriage, my friendships, my children. I felt trusted to choose my own path through life and spirituality. I felt trusted with my life.

Shortly after the overwhelmingly positive and joyful freebirth of my surprise fifth baby, I stumbled upon some information which finally brought together the violation with the orgasmic birth. The time was right for me to read it. Finally it made sense that these two apparently polar opposites could belong as parts of the same birth. The article discussed women who had experienced orgasm during rape. Though I had been violated in birth, I found that their experiences resonated somehow with mine. I felt a little less alone. A little less crazy. A little less self-revulsion.

Gently, the reason why women might orgasm during rape was explored. Like the author of the article, I thought that if I was experiencing abuse, shouldn’t my body have shut down its pleasure response? Apparently not: ‘Quite simply, our bodies respond to sex. And our bodies respond to fear. Our bodies respond. They do so uniquely and often entirely without our permission or intention. Orgasm during rape isn’t an example of an expression of pleasure. It’s an example of a physical response whether the mind’s on board or not, like breathing, sweating, or an adrenaline rush. Therapists commonly use the analogy of tickling. While tickling can be pleasurable, when it is done against someone’s wishes it can be a very unpleasant experience. And during that unpleasant experience, amid calls to stop, the one being tickled will continue laughing. They just can’t help it.’ (What Science Says About Arousal During Rape)

Reading that, I just felt relief. It wasn’t me. It wasn’t that I was connected up wrong. I wasn’t a bit sick in the head. It wasn’t my fault. Orgasmic birth was just something my body had done. It had simply been my body’s physical response to birth. I couldn’t have helped it; it didn’t mean there was anything wrong with me and it didn’t make my midwife’s actions right.

And now there is a small voice growing stronger inside me, a voice of hope and healing, whispering that perhaps I could forgive my body’s natural, spontaneous response to the act of giving birth. It had happened neither in spite of, nor as a result of the actions of other people. Yes, I had been broken, but perhaps yes, I had already made the choice to reclaim my birth. It was certainly not as I’d hoped, but salvaged nonetheless. Maybe there is wisdom to be harvested in brokenness. Perhaps my body is stronger and more beautifully made than I believed possible. Maybe I could begin to look upon my fourth child’s birth as a beautiful, imperfect triumph for having the strength to inform myself, to fight for my birth, to advocate for my child from before he was born. Perhaps the love and faith and power came from within: the love of a mother for her unborn child is a powerful thing. The incredible truth is that in brokenness I am strong.

Three and a half years after his birth, we were sitting around the kitchen table and the conversation turned to birth. My children were interested in where they’d been born – one in hospital, four at home. They pondered what it would be like to be inside my tummy, and to be born.
Suddenly, my beautiful boy spoke. ‘There was fireworks when I was born, mummy.’
At first, I dismissed him, saying no, he was born in August, and we don’t have fireworks then.
He was insistent. ‘Yes there was! There was fireworks and it went BANG! And I fly like a rocket!’ My mouth dropped open. Yes, his amniotic sac had burst with a BANG, and he truly had been born quickly after that. Could it be that my three year old had memories of his birth?

And if birth professionals were aware of the possibility that babies could remember their births, would this make any difference in how mothers and babies are treated during pregnancy, labour and birth?

Erin Fairlight

 

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