By Lalita Iyer
When I was 12, one night, my cat climbed into my bed and burrowed herself in the space between my ankles. Around 4am, I felt something wet around my feet. I woke up to see that she had given birth to four kittens and was licking them clean of her placenta. The next morning, she was out, hunting for garden lizards, leaving her babies in my care.
The human race is ironically the only one where babies don’t decide how they are born. Strangely, neither do mothers, although there is a lot of information overload on the subject. There are birth support groups, blogs, doulas, prenatal consultants and birth educators. But despite knowing it all, and having a definite birth plan, most mothers still succumb to procedures considered routine by hospitals, doctors, and the caregivers. What mostly remains is a sense of shock and violation at the rapid turn of events during birth.
Giving birth is like getting your first menstrual period. You never share gory details until you are prodded. Did things go as you thought they would? As you had planned? Was there a medical emergency? Were you told your baby’s life was in danger? Did things seem too rushed for your liking? Did you sense urgency or impatience in the medical staff around you when you were not ‘performing’ as you were told?
That is sure to open up a Pandora’s box.
If the questions are never asked, a mother’s real birth story never gets told.
What women need
A typical pro-natural birth plan would insist on the mother being allowed to drink and eat during labour, to keep the number of vaginal examinations minimal, to deliver in a normal room and not be taken to the operation room, to have no episiotomy (cut in the vaginal area) unless absolutely necessary, to have her partner and midwife be with her during labour, to have the baby placed on her chest immediately after birth even before cutting the cord, to cut the cord only after it has stopped pulsating. Basically, to let things happen naturally and have the doctor around for support in case of emergency and not for unnecessary interference.
Which is why choosing an ob-gyn is perhaps as important as choosing the sperm to make the baby with. There is no rushing into this decision. Just like you don’t marry the first guy you date, you don’t have to go with the first doctor you consult. Having chosen one, and expressing all your concerns to him/her, you might, at some point have to step back and be convinced that he/she will only act in your interest.
How normal is normal?
Perhaps the biggest myth in the whole childbirth process is that of the ‘normal’ birth. What exactly is normal in childbirth?
Technically, a normal delivery is a non-interventionist, natural, vaginal birth. When people say ‘normal’ what they are implying is natural birth, which is so not the case, 99 percent of the time. ‘Natural’ birth, as the word suggests, is how nature intended it. Which means your body tells you when it’s ready to give birth, and you do a series of things that make it comfortable for you to do it. Like squat, or take a sip of water or pace around restlessly, looking for a comfortable spot (like my cat did), and well, just do it! ‘Normal’ is not being made to lie on a bed and put on a gown. Normal is not being refused water or food when you want it. Normal does not involve people terrorising you to push or breathe or whatever it is they normally tell you to do.
It is every woman’s dream to have a perfectly ‘normal’ delivery especially if her pregnancy has been more or less stress-free. (C-sections are things that happen to someone else.)
The new normal:
– Asking a woman to lie in a supine position when her body is almost defying gravity (a prerequisite for a natural birth) is considered normal.
– Withdrawing any form of food or drink from the woman about to give birth is considering normal. (Although the body’s natural response in times of stress is to chew or drink something.)
– Asking a woman to ‘push’ when her body tells her otherwise is considered normal.
– Giving her a synthetic oxytocin drip hours before her body is ready for labour, is considered normal. Although oxytocin (the hormone that induces contractions) is released by the body in adequate amounts at the onset of labour.
– Giving the woman an enema (which helps accelerate one of the routine bodily functions of egestion) is considered normal.
– Restricting the woman from any form of movement while all she is dying for is to pace up and down, is considered normal.
– Giving the woman a spinal anaesthetic or epidural, which immobilises her from waist downwards, and then asking her to push when she cannot feel a thing, is considered normal.
– Performing an episiotomy, which is a cut in the perineum (area between the vagina and the anus) for easy passage of the baby from the vagina, is considered normal. This, when the perineum is fully capable of tearing itself in adequate measure and healing the tear on its own.
– Shoving a suppository up the woman’s rear or dousing her with a laxative for weeks after birth to ease passage of stools is considered normal.
– Taking the baby away to be bathed and put under UV light immediately after birth while all it needs is skin-to-skin contact with the mother is considered normal.
My friend Shaila recently gave birth to a baby girl. Around two days before her due date, her water broke. She was taken to the hospital where they started timing her contractions. Since the progress was not as prescribed, she was given oral prostaglandins (those hormone-like thingies that are supposed to make labour smooth). Four hours later, she was still not officially in labour, so she was put on a Pitocin drip (a synthetic hormone to induce labour). Six hours later, the contractions were still not that far apart, so more prostaglandins and another drip followed. By the end of the next evening, she could bear the pain no more and asked for an epidural. She still didn’t go into labour and the epidural wore off in a few hours, so she was given the second epidural.
Finally, the doctors packed up at midnight saying the baby would probably be born the next morning. In two hours, she went into labour and was given the third epidural. By this point, she was too fatigued to push. So two of the doctors applied fundal pressure (where they actually press your abdomen from the outside, trying to force the baby into the birth canal), performed an episiotomy, and the baby was finally yanked out with forceps. Needless to add that she (the baby) was shocked, traumatised and refused to cry. She had also contracted an infection on account of the mother being in ‘dry’ labour for thirty hours, and was sent to be kept under observation.
It was a ‘normal’ delivery.
(Incidentally, under ‘normal’ fall ‘induced’, ‘forceps’ and ‘suction’ births.)
Her ob-gyn later told her that if her baby was even 100 grams heavier, they would have had to perform a C-section. This was supposed to make her feel better.
C-section: That bad guy
When you are pregnant, you are always warned about the dreaded C-word, about doctors in the fast lane who plan their vacations around your due date, and hospitals who have set their C-section fangs on you and will exploit you when the time comes. You are to be on your guard with such doctors, you are told by birth networks, friends, mommy predecessors and so-called childbirth educators.
In routine birth discussions, including a pro-natural birth networking group that I was part of, normal and caesarean births are talked about as the haves and the have-nots. Those of us that had C-sections are made to feel short-changed for the rest of our lives because we didn’t have a ‘normal’ delivery. Even those manicured baby books that show cosy pictures of serene women surrounded by picture-perfect bassinets apologetically allot one hurried paragraph in the end to the C-section victims.
C-sections are looked at as failures. People who are plain lazy. Or shit scared. Like the guy who could not pass his exams, but got grace marks and was pushed to the next grade. When you have a C-section, you will have enough of “Poor you! You had a C-section!” What they are thinking, but not saying is: “So you took the easy way out? Didn’t have the balls to push, eh?”
So you go along building this ‘good vs evil’ image in your head about normal and C-section births. And then you also hear about the more exotic, yet natural birth options, like hypno-birthing, water birthing, or even home birthing.
I thought I was a great contender for a normal birth. No complications, did Iyengar yoga till my eighth month, ate well, never threw up, had excellent test reports, and was very active and in great health and spirits.
Around week thirty-seven, I felt some turbulence within, like an earthquake. At first I thought the baby had engaged (positioned itself in the pelvic cavity just before the onset of labour). My sonography revealed that my baby had turned breech. He was now head upwards, leg downwards, and looking down at the world from a vantage point. I was later told it happened to all small women as their pelvis lacks room for the baby’s head to engage.
I furiously read up on the Internet and found that there was a slim chance of breech babies turning back again. I got heaps of advice.
‘Try visualisation. Draw the image in your head. Imagine your baby doing a gentle somersault inside, and it will happen.’
I pretended to direct my own little movie of my breech baby straightening out, but no luck.
‘Try hoisting your pelvis high up in the air and lying down with a pillow under your shoulders. You will create space in your pelvis, and the baby will be drawn to it,’ said a yoga expert.
Turns out, the baby was enjoying looking up at my pelvis.
‘Do somersaults while swimming.’
This I found ridiculous and impractical, considering how bottom heavy I felt and somersaulting suddenly didn’t feel like one of my skills.
‘Talk to the baby, ask it to turn again.’
I would sit up in bed in the middle of the night, asking Tia (my name for the baby girl who eventually turned out to be a boy) to turn back, so that her extremely fit mommy could have a natural, vaginal birth. Nothing.
‘Write letters to the baby.’
‘Try Reiki. Prayer. Magnetotherapy.’
‘Have you tried Homeopathy? There is this wonder pill called Pulsatilla 200.’
‘Flower remedies. Hypnotherapy.’
I tried some of the above and gave up, feeling a bit silly and desperate. I decided to enjoy my defiant baby finally. The words C-S-E-C-T-I-O-N were looming large, as I was told no private hospital would risk a natural birth for a breech baby (apparently, the risk was far higher than for C-sections).
My ob-gyn then told me something I still remember: ‘There is a reason the baby has turned. Let’s not do too much to undo it. Yes, you might have a C-section, but you might as well go into it with the right frame of mind. If you think you are going to be miserable after a C-section, you probably will.’
I embraced my impending C-section and stopped fighting it. It worked. It certainly made me calmer. Yes, I did feel the tug of my stitches for a few weeks and although I was walking around the next day, it took me a while to be truly mobile, drive my car, go to the market, the parlour, the movies. But at least I didn’t go through 20-odd hours of invasive labour, a bad episiotomy and the resulting constipation, I thought.
But what is worse is the post-mortem. When I told a fellow mommy that I had a C, she sighed and said, ‘Oh, no!’
I reminded her that my baby turned breech and a normal vaginal delivery could not be possible. Her reaction: ‘Are you sure it was breech?’
If I was feeling a bit low about my longer recovery period, this set me back further.
Another friend, Mythili, opted for hypno-birthing, but had a bad time with an episiotomy gone wrong at the end. Apparently, she was cut too deep and bled so much that her haemoglobin dropped to six and she had to be given iron injections to recuperate. When I asked her why she didn’t put her foot down for the episiotomy, she said she was too fatigued to fight. To add to her misery, her baby just wouldn’t latch on to her breast, and she was dying of the pain of engorgement.
When I heard these stories, my C-section story didn’t seem that bad. I was discharged on day four and no one believed me when I told them I had a C; they expected me to be lying like a wounded soldier. I was up and about, although in discomfort, but my face belied my real feelings. I was doing yoga by month three and returned to my pre-pregnancy size by month five. I was lauded by one and all. Only I knew that my body had been permanently altered. The scar on my bikini line and my pelvic wattle (the overhang) will stay with me for life.
The unbearable lightness of the epidural
Before the anaesthetist gave me the epidural, he poked my arm in two different ways and explained to me the difference between pain and sensation. So what the epidural was going to do for me was to convert the pain into a mere sensation as my baby was being dug out. I thought that was liberating. I was wrong. An epidural is like a bad relationship. Long after it has ended, the tug still remains. And a part of you is altered forever. So it is far from the emancipating device that it’s made out to be. It just trades a temporary sharp pain for a permanent dull one.
Why doesn’t anyone tell you this?
In a sense, all women are carrying some baggage about their birth stories – some told, some partly told, some never told. With a few exceptions, all stories have one thing in common: a feeling of shock and bewilderment – “I didn’t know this”; or a sense of betrayal – “Why didn’t anyone tell me this?” Women lounge in the exotica of baby and new-found motherhood and selectively obliterate any form of painful or discomforting memories about childbirth and the embarrassment of their post-birth bodies. The carefully choreographed euphoria of motherhood veils everything.
But don’t ever believe anyone who says, “When you hold the baby, you will forget everything.” Because we always remember the bad bits. We just choose not to share them.
Excerpted in part from Lalita Iyer’s I’m Pregnant, Not Terminally Ill, You Idiot! (Amaryllis). For more on her fascinating book, read this interview.
Lalita Iyer occasionally blogs on mommygolightly. She tweets @Lalitude.
April 15, 2016 at 9:46 am
theladiesfinger Ugh. So much wrong with this.
April 15, 2016 at 10:20 am
theladiesfinger Lalitude haha…good one! Best part is : No one told me this U0001f605..and yes we do forget everything once we hold the baby 🙂
April 15, 2016 at 12:30 pm
theladiesfinger Lalitude I’m with you girl!! I actually have a speech prepared when ppl ask me how I allowed the doc to do a C-sec
April 15, 2016 at 8:28 pm
Powerful essay. In 1991 I was living in Bali. Back then, it wasn’t modern like it is now. I was in labor in the middle of the rice fields for 55 hours. There was no way this 9.5 lb baby was getting out of my 5 foot body. We drove an hour to the nearest hospital. Dingy, dark, not looking too sterilized. Not only did I get a c-section, but they knocked me out without telling me. All the way knocked me into unconsciousness. I was the last one to see my baby because it took me 2 hours to wake up out of the deep anesthetic chamber I was in. To this day, no one may touch the part of my belly that was cut open. It’s been 22 years. I did not feel ashamed of having a c-section, though there were plenty of women out there trying to make me feel bad. I had a healthy, solid baby boy that grew into an incredible man. Our connection was strong from day one and although I remember every detail of that birth, my focus is on how I raised that boy with all my heart. 55 hours of labor in a ‘third world’ country. No hot water taps, a cat scurrying into the operating room, knocked out to oblivion and here we are, alive, well, and thriving. Thank you for this piece of writing. It is supportive and welcoming to all that can happen at birth. For those women who had natural births, please don’t shame other women if they did not. It’s traumatizing enough without your judgments.
April 16, 2016 at 12:06 pm
Oh my god whoever wrote this has very poor grasp of the difference between humans and cats! Humans dont (can’t) birth like other mammals because of our erect posture meant pelvic changes which leave little space for what tbe author considers Norma birth. Unexpectedly poor article TLF 🙁
April 18, 2016 at 7:00 pm
This is a disappointingly ill researched article. I am a doctor and have seen a good deal of the natural process of childbirth. Allow me to point out where you did not get you facts right. Because, in a matter like this, it is important to not have false information out there. It would be a tragedy if a woman died of aspiration pneumonia just because she insisted on feeding while in labour.
1. Women are kept nil per oral intrapartum. This is keeping in mind the real possibility of converting a normal delivery into an operative one. Kerala, where I work, did not attain the lowest maternal mortality indices in the country by insisting on vaginal deliveries. The woman is kept NPO to prevent her aspirating gastric contents after administering anaesthesia (Mendelson syndrome) causing aspiration pneumonia. Which would increase her morbidity and mortality by a great deal.
2. Regarding episiotomy. I am in favour of routine episiotomy, because unlike what you think, the body doesn’t know what exactly is the adequate amount of tear. It tears by the laws of physics, and that is determined by the size and lie of the baby and the resistance offered by maternal tissue. . Moreover, the tear is a haphazard and irregular one. A surgical incision gives a much better result when sutured back. But more importantly, a natural tear, once healed is weak. The tear involves the mucosal layer, the skin and the underlying musculature. The same muscles that form the pelvic support mechanism. This greatly decreases the support to pelvic organs thereby increasing the risk of pelvic organ prolapse in later years.
There lies a much greater immediate threat. Complete perineal tear. Whereby the anal spincter mechanism too gets involved, resulting in bowel incontinence.
It’s my understanding that the risks of forgoing an episiotomy are disproportionately high. Better safe than sorry.
Of course, every woman has a right to refuse an episiotomy. I personally have seen none that would take the risk.
3. The pitocin drip. Pitocin is another name for oxytocin. And the body doesn’t always produce enough. Or the uterus might be too fatigued to respond adequately. Ideally, the newly babyless uterus contracts post birth, leading to its thick musculature acting as living ligatures, hence stemming the profuse blood loss from the raw inner surface of the uterus. Failing which this leads to the unfortunate complication of atonic post partum hemorrhage,where the blood vessels bleed unchecked. The woman rapidly loses blood and goes into shock.
So your objections to a pitocin drip seem misplaced.
4. I’m at a loss as to how a human could possibly give birth like a cat. Can you spot any anatomical similarity between a human and a feline pelvis.
5. A woman is asked to push only when strong contractions come on and her vaginal findings indicate a favourable cervix.
6. Doing per vaginal examinations are warranted because without these, you would miss a prolapsed cord which would lead to the baby suffocating inside the womb during active contractions. Or an arrested descent.
7. An enema before parturition helps prevent a loaded rectum, because that head is gonna need every millimetre of space it can get.
Also, it prevents a possible unsterile mess later.
To have a hospital birth or a home birth or just having a doctor on standby is a woman’s choice. But any woman who takes the decision to forgo the standard protocols should be aware of the risks she takes.
There are institutions and doctors that do procedures to lighten their work and waiting time. But to say the whole of modern active management of labour is pointless is irresponsible at best.
I’m a little hurt this came on the ladiesfinger 🙁
April 20, 2016 at 4:03 am
I think your intent got lost in translation. What you are trying to say is that women should not be overtly concerned about the delivery being normal or cesarean. What is coming across is that any medical intervention is terrible and not normal, and that women should go to a room, squat and the baby will pop out.
August 12, 2016 at 4:51 pm
What kind of doctor are u in modern obstetric 2016 we dont do any of these things becours a lots of resurge and experiences have told us that its not needed and most of the intervention is harmfull for the woman in labour. ..and u shall make no harm. So Im sorry to hear that doctors in India are not updated at all this things u think is needed for birth was used in the Vest world in 1950 and stoped long a go.
Im sorry for the women in Kerala that has to suffer in labour becours the doctor dont know better.
August 14, 2016 at 11:18 pm
urmilamg91 thanks for taking the time to clarifyall this. Sometimes we forget that death is the most natural eventuality of all, and science and medicine may be unnatural but it could save us
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