A few weeks ago, one woman’s birth stories raised the ire – and fear levels – of women in different parts of the world. Things were a-buzz in cyberspace when actor & author Emily Woof’s article titled “Lets Be Honest About Childbirth” was published by the Guardian in the UK. (you can read it here) After a traumatic homebirth-transfer-caesarean, and then a dramatic VBAC-turned-dire-emergency-caesarean, Ms Woof understandably has a story to tell. She has, till now, resorted to silence as a way of coping, and we understand why. But now she has broken her silence, and unwittingly opened a Pandora’s box of birth myths. The biggest myth is exposed in her final paragraph, where, we believe, she has come to the wrong conclusions about her experiences. The truth about traumatic birth must be told if women are to have any chance of healing, so this is Birthtalk.org’s response to her article…
Keeping the silence
I can completely understand that women such as Ms Woof keep their silence about traumatic birth. My own first birth was also 10 years ago, and also very traumatic. I had a healthy son, but the birth had a ripple effect that made its way out into our whole life. Any attempt to discuss it was met with ‘you should be grateful’ and ‘just move on’. So silence, to me, makes sense.
However, whilst Emily Woof’s article is well written & brutally honest, it is also sadly lacking in important information, leading to misperceptions and incorrect conclusions being drawn by herself, and thus, the reader.
And this is not her fault. Her births were both horrific. And she has every right to feel traumatised by them, and to need to process and heal emotionally from such experiences. I am shocked by how bad they were.
Let’s really be honest about childbirth
This article, however, is not about honesty in what childbirth is. It is about what childbirth was like for Emily Woof. And, more importantly, it is about a woman not even given the time and space to grieve for her births, or any acknowledgment that she would have something to grieve. It is also about poor care. I am astounded at the care she received in her second birth, and saddened by the care she received in her first birth.
For me, all this article does is raise questions. And the answers to these questions may change the way Emily Woof would write her article if she was given the opportunity to ask these questions herself.
With her first birth, her antenatal education was not appropriate. She was told birth was about remaining in control (it’s not). And that a birth plan would take care of that (it won’t). And then told by her childbirth educator that ‘when she’s screaming for drugs, it’s not what she really wants.’ We find ourselves shaking our heads at this ‘advice’. Note the teacher’s use of ‘when’ she’s screaming…not ‘if’. What a lack of confidence in Ms Woof and the birthing process, by assuming that she would not only definitely need drugs, but that she would be screaming for them. This does not demonstrate that the teacher had much confidence in Ms Woof’s body to do its job. It’s important to know that when a woman feels safe and supported, the body provides hormones that act as natural pain killers (see Dr Sarah Buckley’s work on this). It also appears that the teacher hasn’t provided Ms Woof or her husband information on how to promote and enhance this hormonal help.
The teacher’s comments also suggest that Ms Woof will not know her own needs in labour. What a disrespectful assumption, and how frightening to know that those around you are being coached to disregard what you say at a time when you are incredibly vulnerable and dependent. Plus, the ‘screaming for drugs’ imagery does not create a positive picture of birth. And would have most likely scared the wits out of Ms Woof. Which it – along with some other scare-mongering – seemed to do, so effectively that it had her booking out of the hospital and booking in for a homebirth.
She says herself that the reason they chose a homebirth was to ‘side-step the evils of hospital altogether’. So she was now making decisions from fear. Understandable, as the hospital had not given her and her husband any reason to not be fearful. But making decisions from fear is a disempowering situation, rather than making decisions based on knowledge.
Continually let down
And then, when she hired a homebirth midwife, she was let down here, too. Ms Woof expressed her concerns about the size of her baby, an understandable worry, especially as she had felt concerned that she was quite small. But rather than being given validation for her concerns and reassured with further information ,she is admonished for not trusting nature. Fact is – why should she trust nature, if the midwife hasn’t given her any information – factual information – that would enable nature to earn that trust? So that worry about the baby’s size, rather than being put to rest, now lies uneasily in the back of Ms Woof’s mind. And, I can imagine, a bigger worry – that she is not being listened to. That her midwife is not taking her seriously. That she cannot ‘be herself’ and ask the questions she needs to ask, and open up to the tiniest of concerns that she may have. If she cannot be herself during the pregnancy with this midwife…what will it be like in birth, when we are required to be the most vulnerable many of us have ever been? Birth needs to be an ‘opening up’, but already, Ms Woof was required to close herself up, and not, as she described it, ‘question the faith’.
This brings more questions to mind. Did this midwife enable Ms Woof and her husband to work through the fears raised by the hospital antenatal education? Was she given the chance to see that birth is not about control, but about surrendering control, once we are in a safe space & have correct information? And did Ms Woof, indeed, feel safe? She dilated beautifully. Her body did an amazing job. And then progress stopped. To me, I can see many reasons why this might have happened. The most obvious may be that perhaps Ms Woof was not in a position to ‘open up’, emotionally and physiologically, when she was being ill-supported. Who would want to open up to a birth carer who pooh-poohs a woman’s fears about birth?
My first baby didn’t slip out either. I laboured for 30 hrs, and also felt like I would crack open. That is horrific to live through. I have so much empathy for Ms Woof, in going through that, and without good support from her carer. How frightening for her husband, too, to find the midwife standing at a loss in the kitchen. Fact is – most babies don’t slip out. My second child slid in and out, in and out, in and out, for 2 hours before she emerged, all 9 pound 7 oz of her. Did Ms Woof’s midwife tell her that this was a possibility? If not, she was misinformed, and misled, to believe that her baby would slide out. I had hoped that mine would…but luckily I had access to a wealth of information and knew that babies often did the ‘in and out thing’. And I did not tear, even though she was so big. I think it was the sliding in and out for so long, and the fact that I felt so safe – I just stretched gently. It is not Ms Woof’s fault that she did not have this information. But her midwife failed her.
I also have experienced the situation of lying in the ward afterwards (after my first birth) in pain, not being able to pick up my baby. It is such a difficult, heart-wrenching situation. I am horrified that Ms Woof was reprimanded by the nurse about not changing the nappy. Where was the kindness, and caring, and nurturing of a new mother? She had not done anything wrong, except perhaps add to the workload of a possibly overloaded nurse. But again – that is not Ms Woof’s fault.
What is ‘natural’ in birth?
I can understand Ms Woof’s wrestle with herself about birth being a natural thing to do. But being unsupported during pregnancy and birth is not natural. It is usual in our society…but not natural. Her body was doing a beautiful job, and then seemed not to continue to progress. Why? Was it that she wasn’t supported emotionally in the journey and her body did not feel safe to open? It would make sense, as this is a protective and normal response of the body if the mother is not feeling safe. Or perhaps less likely, but still a possibility – was there a reason that her body ceased further progression to protect the wellbeing of mother or baby? Either way her body was doing what is designed to do and in no way failing.
And yes, her son had the cord wrapped tightly around his neck. She was told that if he had come out normally, he would have been strangled. And the result of receiving this news makes her feel like a failure for not being in tune with her body. Understandably so…but there are some facts missing. In most cases, babies born with the cord around their necks are completely ok. The midwife usually just unwraps it before the rest of the baby is born. It is very rare for a baby to die from cord entanglement. In a paper presented in Vancouver, at the 15th World Congress on Ultrasound in Obstetrics and Gynecology in 2005, all births between 1988 – 2003 in a tertiary medical centre were studied. The conclusion drawn from the study was that ‘Nuchal cord is not associated with adverse perinatal outcome.’[i]
Of course, hindsight is a great thing, and we don’t know that the baby would have been ok. But they don’t know that he wouldn’t have been ok either.
Evolution and death
And Ms Woof is right – our babies do not have a straight trajectory into the world. And she is also right about evolution dictating that our pelvises become narrow so we could walk upright, and our skulls growing. But evolution also covered that, by giving us a shorter gestational period, so we could birth our babies before they become too large to fit. If evolution had stuffed it up…we wouldn’t be here.
And yes, death has always shadowed birth…but you need to look at it in context. Right now, most women in the western world are big, strong, nutritionally sound and have appropriate shelter, food and safety. If we look at the eras Ms Woof looked at in her paragraph about ‘death and childbirth’: in the 1600’s, the average life expectancy was around 35, and it was, according to the British Library, ‘an era of war, fire, plague and execution’. The 19th Century heralded the industrial revolution and, according to one source, ‘the impact it had on the general health and life expectancy of individuals was shocking’. In the early part of the 19th century the life expectancy in most parts of Britain was that of only 20. There were outbreaks of cholera and typhus, due to the slums, overcrowding, contaminated wells and lack of sewage system etc. No wonder, as Ms Woof notes, women were preparing for death alongside preparing for birth. But our world is vastly different from those time periods, so perhaps we shouldn’t look to these eras to confirm the nature of birth in the 21st century.
In the 21st century the risk to women in birth has reduced as women’s general health and wellbeing has improved. For the minority of women who with good support and care will still have a problematic birth their outcomes have been vastly improved with the use of antibiotics and blood transfusions. And for a small percentage who, regardless of their support and care, require a caesarean section this can be a lifesaving procedure.
Ms Woof acknowledges her gratitude to medical intervention for keeping her children and herself alive. I understand her position. And yes, she was saved from her first experience…but I wonder if she would have even got into the position of needing to be rescued if she had received better education, information and support in the first place – even before she got to the homebirth midwife.
A horrific situation
And on that note, I would like to turn to Ms Woof’s second birth. Rather than looking at the horrific situation she was in, bleeding profusely, without anyone realising, hovering close to death while her husband held their newborn for three hours, without word of her safety, (what a terrible situation – absolutely shocking for them both) I want to go back to the beginning and ask some more questions.
First question – why was she offered a cervical sweep? Why did the obstetrician ‘need’ to stimulate labour? Why did the doctor not trust that Ms Woof’s baby and her body would kickstart labour themselves? They did the first time, no problem. It’s not as if she was overdue – she was on her due date. According to Anne Deans, an obstetrician for Mother and Baby magazine, “Term babies are those who arrive any time between 37 and 42 weeks, not just on one specific date’. So, what is the benefit to Ms Woof and her baby of being induced in this manner? Was there some unmentioned high risk to mother or baby that required her to birth? Or more likely was this presented as an option to Ms Woof without a clear overview of the pros and cons associated?
Of great concern is the obstetrician’s apparent intent to rupture the membranes and her short-lived joy in doing so. Artificially rupturing membranes is a separate procedure to a ‘sweep’ and requires a woman to be given benefits and risks to make an informed decision. It is doubtful that this occurred with Ms Woof.
The beginning of the end
It appears that the whole debacle began when the cervical stretch occurred. As Ms Woof herself says later, she had been haemorrhaging internally since the sweep. But why is nobody questioning the fact that she had the sweep? (not questioning Ms Woof – she would have gone along with the decision in good faith, understandably). She wonders why it happened like that, and questions herself for not choosing an elective caesarean. But was she given the opportunity to question the obstetrician for choosing an invasive procedure such as the sweep and rupture of membranes, in the first place? And an elective caesarean is no guarantee of a good outcome. For more information on the pros and cons of VBAC vs caesarean, see this section of the Cochrane Database, the very database that doctors themselves use.
I can understand the feeling of having let herself down after the first caesarean. I felt that intensely, too, after my own. But wanting to have a normal delivery next baby isn’t a bad thing to want. We are physiologically primed to want to give birth naturally – even if she can’t fully explain why she wanted that natural birth, her body can…it knows that there are hormonal gifts from a natural, supported birth that help with bonding, breastfeeding and wellbeing postnatally, and it wants them.
(And knowing this information could have helped in a caesarean too – these hormones can be replicated postnatally, which can assist in bonding, breastfeeding, and a better emotional outcome. I didn’t know that for my own caesarean either.)
Too high expectations?
I do not believe that Ms Woof ‘set herself up’ to be let down by putting herself under enormous pressure. Why should she not want a better experience than the first time, and why should she not want a natural birth? The problem was not Ms Woof’s desires, but the lack of support for helping her meet her needs in an appropriate way.
It makes complete sense that Ms Woof would need to mourn for the birth she wanted so much. And she was not asking for too much – just to be given appropriate information, and be nurtured and cared-for and supported.
Ms Woof is right – no doctor can predict how a birth will turn out. And it is hard to know how best to prepare…unless you have access to the right education and support. Which I do not believe Ms Woof had.
A woman wronged
And, to conclude, I think that Ms Woof has come to the wrong conclusion.
It was not her expectations of birth that were wrong…it was her experiences of birth. And through no fault of her own.
Why shouldn’t a woman expect to have a positive birth, whether natural birth or not? And why shouldn’t a woman expect to have a natural birth? It is usually the most straightforward and generally safest way to get a baby out. Her expectations were understandable and appropriate. But her information, education, support and care, in both cases, weren’t.
Her birth experiences were wrong. She was treated wrongly, given wrong information, wrong support, wrong management of her labours. It should not have been so. The elements were not in place to afford Ms Woof the realisation of her expectations.
And as I said before…that is not her fault.
This article is about a woman wronged. And for that, I am so sad. I commend Ms Woof on having the courage to speak out. I regret that there are so many questions that arise from her story. And I hope that, like me, with acknowledgment, information and support she can come to a place of peace, no matter how hard won, with her births.
©Melissa Bruijn and Debby Gould, Birthtalk.org 2010
[i] Per Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet. 2006 May;274(2):81-3. Epub 2005 Dec 23.
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