How to Have an Empowered Birth

 Shared with permission from the family, with joy.

(please note- the first birth described in this post could potentially be triggering for someone with a previously difficult or traumatic birth experience, or someone with significant fear around birth.)

 

I wanted to write a blog post about the importance of being engaged in the decision making process for one’s birth. Most of my posts are written in a more informational style. But this one came out as a story. That’s just the best way I could share with you about the value of an engaged, Empowered Birth.

First- a NOT empowered birth

Sarah had a very difficult first birth. Her doctor had insisted on an induction at 41 weeks. She had labored for days, she had been sick and exhausted and wandered through the haze of strong labor where time and details are fuzzy for so long. She and her partner were a bit confused in telling me their story. But parts of it stood out clearly—strong words from their doc about needing to make progress. “We’re going to break your water now.” Sarah didn’t know she could decline. She didn’t know what other options were out there or even what questions to ask.

The nurse started pitocin while she snoozed with the epidural- but didn’t tell them. They discovered this later. At one point, the staff came in and quickly ordered her on to her side—Sarah was in a daze—what was happening? Oxygen mask on- “Oh just a bit of a dip in the heart rate.” Long hours of slow progress, but finally on to pushing. After two hours, the doc examined her and said, “if we don’t see progress in the next 30 minutes we’re going to need to do a C-section”. And then- “this baby isn’t come out we’re going to have to do a C-Section.”

This was terrible – frightening, out of control—not what we planned! There were people rushing about and looking very serious—they kept asking if she had questions—but she didn’t know what to ask and was too exhausted and scared to say much. Then she lay there feeling helpless and failed. Her precious, longed for baby was taken to the NICU for observation. “She had a bit of a rough start.” Sarah barely saw her and could not reach out to touch her.

Sarah and John shared their story with me with tears and sadness. They had hired me to helped them have a better birth with their second child. I love helping families like this! I see so much opportunity for having a more enjoyable experience. I listened to their story with empathy and understanding and noted so many places where there was space for a more empowered experience. Their first birth felt out of control—this next one they planned to ask questions and make decisions rather than feel that it was all happening TO them.

 

An Empowered Birth

This time, when an intervention, such as induction, breaking water or starting pitocin was brought up, Sarah and John were ready. They read up on the value of these procedures (Pregnancy, Childbirth and the Newborn is an excellent, comprehensive source of information), knew about the risks and alternatives and were going to be ready for Informed Decision Making around the management of labor.

By being actively engaged in the management of her labor, Sarah was set to feel less out of control. We couldn’t necessarily change the need for similar interventions, but we could change how the experience felt. Sarah and John choose a thoughtful care provider who listened to their concerns during pregnancy and was aware of the traumatic feel of their first birth. As the time for labor neared, they became increasingly worried about the myriad of ways labor could get complicated and dangerous though. Fear was looming despite good preparation. And for John too, although he did his best to support Sarah in her wishes, he was also scared for her and their new baby.

A few days before her due date, at her regular office visit, Sarah was showing signs of pre-eclampsia—swelling, protein in her urine and a much higher blood pressure. She and John discussed their options with the doctor and decided it was safest, and best to get checked in to the hospital. There, they discussed several options- induce with a foley catheter, break her water and hope labor started, start pitocin or have a repeat C-Section.

 

Here are some good questions to ask in this situation:

  • -What is the problem we are trying to fix?
  • -How likely will the solution work?
  • -What are the risks to this intervention?
  • -How likely are those things to happen?
  • -What alternatives are there?
  • -What will happen if we choose to do nothing?
  • -How fast does this decision need to be made?
  • -What feels like the right choice?

 

Sarah and John were scared to have another induction. It didn’t feel right, despite this meaning they would then need to have a C- Section. Although Sarah had been planning for many months to have a VBAC- when that meant having an induced labor again—it just didn’t feel right. John was having strong memories of their first labor and the out of control feel of interventions cascading over days. After much discussion and soul searching, Sarah and John lovingly decided that a C-section was the best course of action. It wasn’t what they expected, but it felt right. As their doula, I was sad to see the VBAC slip away for this family—but I was thrilled to see them feeling connected to the process, and feeling engaged and respected in the decision making.

They had a chance to ask all their questions- and this time they knew what to ask because they had prepared. They knew what to expect as the staff prepared for surgery and Sarah requested a chance to cuddle and snuggle with her baby in the OR, with an arm free so she could touch her new son. She walked to the OR and felt better by having everyone introduce themselves before putting on the masks. She understood what was happening, and was able to ask to have the drape lowered a bit so she could see as her son was born.

This was an Empowered Birth. They were able to make the best decisions they could for their family, with the circumstances that presented themselves. This birth, even with it’s unexpected turn, was a chance to heal. I am grateful and honored that I was asked to be a part of their journey.


Want to read more stories of Empowered Births? Take a look at the Empowered Births Website.

(note: Sarah and John’s story is mostly fictitious. I’ve worked with a number of families whose story is partial woven in to this blog post. For the family whose story this most closely matches, I have been given permission to share, although all identifying details have been omitted or adjusted to protect their privacy).