Sunday, November 15, 2009


Okay. I'm ready. I have been mulling and processing the SOGCs change in breech birth policy since it came out months and months ago, but I have not felt ready to post about it until now. I have actually sat down and STARTED to post about it, and stopped or deleted the posts because I wasn't ready. But recently a blogger I follow posted about birth and asked a poignant question: Is birth the most defining moment of mothering, or is it just a door that opens, and all that follows is the defining moment of mothering? How important is the birth itself, really?
This post gave rise to other posts on other blogs, and I got caught up in them. First of all, the original article that inspired this topic was found in Midwifery Today and reads as follows (please keep in mind that in the USA midwife attended birth is almost synonymous with homebirth, but this is not the case in Canada);

This is what I want to say to every young woman in the world: your birth is the most important event in shaping your life as a mother. It is imperative that you be properly cared for, nurtured and, in this culture, educated. You need a loving midwife, because the effects of the birth year—positive or negative—will affect your whole life, your baby’s whole life, and indeed society, as your decisions reverberate through herstory. Even with good midwifery care, prenatal self-care is essential—this is what you do between your visits with your midwife.

If you think you cannot afford the midwife of your choice, because maybe insurance doesn’t cover her or maybe you have no insurance, please think again. Even as an out-of-pocket expense, it is nothing compared to a traumatic birth year. As I sit at my desk and read the many birth stories that women submit to us, I read of the trauma and pain they have endured and realize that loving midwifery care may be the single most important thing we can do as a society. Many of the stories we receive are of a horrendous first birth, after which the mother goes on to have a miraculous second birth with a midwife. The cost of a midwife’s care is the best insurance in the world, at any price.

If you must go to the hospital be sure to get yourself a doula, because in almost every hospital birth you need an advocate and a protector. It is a sad testament to what is going on this world, but it is true.

Jan Tritten,
Midwifery Today

In response, Sweet and Salty Kate wrote this post, in which she is adamant that Jan Tritton is wrong. Birth is not the most important moment in a woman's life, nor the defining moment of motherhood. She says,

"Birth cannot be controlled. Or promised. Or unfailingly protected, or made reliably miraculous and beautiful. It can be nudged, and sheparded, and prepared-for, and supported, and informed. But sometimes, birth is just a gong show. When that happens, it is imperative that we do our best to shrug at the mechanics and hope for better luck next time.

Because I can’t carry any more guilt. I don’t need birth idealists piling themselves upon my thoroughly buggered psyche like a well-intentioned rugby team, calling me or any other woman a warrior for delivering one way as opposed to another.

They’ve got the best of intentions, but the wildly overstated significance some people heap onto birth in order to steer more women towards labouring self-actualization is just too heavy a weight. This weight doesn’t make everyone feel empowered and guttural. It makes some people feel anxious and pressured and damaged and unfulfilled."

I particularly like one of her edits, which says

"Birth is one of countless important events and encounters that all mash up together to shape your perception of your life as a mother.

Birth is one day in a life that will give you all kinds of chances to become much more than a birther. It can heal and inspire and give cause for delight and awe. It can be medicalized or marginalized. What determines one or the other is not your skill, nor the divinity of your preparation, nor your stamina, but random fortune or misfortune. In the case of the latter you’ll have to let it go and find your pride again, and trust that your kid won’t remember it. Because she won’t. Or if she does, she’ll only remember it in an unconscious kind of way such that her innermost self, which is more worldly and less delicate than we all know, says Yikes! That was a friggin’ startle. Hmph. (kid’s innermost self shrugs)"

It is true, this birthing thing is important, and how we do it is important, but it is taken too far if we give it the power of defining us as mothers. What if we don't birth perfectly, or well, or vaginally, or at home in the water attended by nymphs; are we doomed to become damaged goods? Absolutely not. I can say this with authority because I have had all kinds of births, and because I believe in redemption. I believe in healing and growing and the rich learning that happens along the way, and if ONE MOMENT defines my motherhood it leaves no room for redemption, growth, healing, and learning along the way. Life isn't structured so that we can choose to do things perfectly every time. We are born ignorant and we learn by trial and error, which means much of the time blundering things or making mistakes or giving birth under less than ideal circumstances. But I would like to state here that I believe that humans are flexible and forgiving by nature, in order to compensate for the fact that we are born so ignorant and have only one life to live, so the lessons we learn cannot be retroactively applied.

Some bloggers agreed with my line of thinking, though I didn't wholeheartedly agree with Sweet and Salty Kate. Birth wasn't the defining moment of Me as a Mother, but it wasn't just another day, either. It was not simply a portal to a child, for me.

Rixa's blog is one of my favourites, and she wrote this post in response to Sweet and Salty Kate. She and I agree that birth is neither the defining moment nor just another day. I like what she has to say about choices we make as pregnant women and how that impacts the outcome. She also says,

"I was wondering: how would I say that my children's birth ranks in importance in my life? It's hard to quantify. My own journey wasn't just about "the birth," but the entire process of thinking and researching and planning--not just for the tangible, physical birth itself, but also for the spiritual process of becoming a mother. I deeply treasure the memories of my children's births. I love that my labors were experiences predominantly of love, peace, and calm. I love that I was able to meet and overcome the challenges of labor and birth and find strength in other areas of my life, knowing that if I could give birth to a baby I could certainly do ___ (run a half marathon, finish my dissertation, etc).

Making a woman's birth as positive and empowering and enriching as possible is important. Why not strive to make every birth as good as it can be? "

Women can be deeply impacted by their birth experiences, for many years, so birth isn't just another day for those women. I guess we are as varied as we look, and for some, the experience ranks high and for the others it is a portal of little significance. But I do still believe we should strive to make birth as positive and safe as possible for all women, which is why I so vociferously advocate for better obstetrical practices, lower cesarean rates, more VBAC advocacy and support, universal access to midwifery care, and etc. I actually advocate cesarean doulas, which is my own brain child that no one seems to think necessary unless she herself has had a cesarean and felt disappointed by it....but that is a side topic and one for another post.

Another blogger, Jill, responded with her middle ground as far as birth as defining moment versus just another day here. I think my opinion falls closest to hers. In particular, she states that

"I think the problem with these two lines of thinking is that they both seem to believe that only a "good", i.e. natural/drug-free/vaginal/home/water/etc. birth is capable of being a life-changing event. The former cling to this gold standard, and the latter reject, nay, outright abhor it, but vilifying something is still giving it power.

I believe that EVERY birth has the potential to transform a woman and offer her many lessons she can apply throughout her life, instead of just being one day of empowerment and awesomeness (or trauma and suckitude). Take for instance the births of my two children. They could hardly be more different. One, a Cesarean after a long hospital labor with "the works." The other, a VBAC waterbirth at home. Both have taught me countless things that have shaped who I am, not only as a mother, but as a woman and a human being."

Yes, yes, and yes. The three births of my children were significant and holy, and taught me, and shaped me, and I don't regret them or their rogue or peaceful paths. Ayden was a scheduled cesarean for a persistent breech position. Matthew was an airport birth that produced a standoffish toddler of 15 months and an unconventional path to love. Riley was a drug free hospital vaginal birth, supported and celebrated and redemptive in all ways.
The society of Obstetricians and Gynecologists of Canada has this year revised their recommendation for breech births based on more definitive research and now urges physicians to offer women whose babies present breech a vaginal birth, and to retrain themselves and train physicians now in medical school on how to assist breech babies on their journey to the outside world. In light of this, it would appear that my cesarean section with Ayden was based on faulty evidence and was unnecessary. I'm sorry, but unnecessary surgery is not okay with me. Surgery is not routine. It is a big deal. It carries risks. It usurps my power and my bodily integrity.
But I don't regret it. I made the best decision I knew how to make at the time, as we all do. So did my surgeon. So did my doctor. And that surgery made me grow. Man oh man did it make me grow. On the operating table in the middle of surgery, I was determined that next time would be different. I learned how to give up control while still maintaining my dignity. I learned how to be weak but still maintain my essential identity. I learned how to cope with the more difficult things in life, the rocky potholes in the road that we just never expect to come across. I wasn't always graceful in my coping, but I fumbled around and learned a lot. And I have empathy in spades. I know what it is like to lie on the operating table and have your baby pulled from you and feel that all your guts are being pulled out as well. I know how disappointing it is to build up for a vaginal birth and have your plans go sideways, and how empowering it can be to recover from it afterwards. I know what it is like to limp around for weeks, and to breastfeed a baby who kicks your incision site, and to throw up while holding your baby and not drop him because you ate too soon after surgery because you were starving and no one was LISTENING THAT YOU WERE STARVING because you just had a freaking BABY dammit, and were not allowed to eat all day in preparation for surgery. I had the spinal headache that lasts for weeks, and vertigo that lasts for months as a result of the spinal headache, which is a rare complication of spinal anasthesia. I have the scar. I wanted the natural birth and didn't get it (the first time). I know.

Which gives my voice power. When I advocate for VBACs, or lower cesarean rates, or doulas for cesarean births, it is because I know what it is like to have a surgical birth.

Would I make a different decision if I knew then what I know today? Yes. I would have gotten my ass to Children's and asked for a physician with skills and willingness to deliver my breech baby vaginally. Do I regret that I had a cesarean? No. It is my history, it is a part of me and who I am, it is the true portal through which Ayden entered the world, it taught me many valuable lessons, and it lends my voice power. So no, I do not regret it.
I am glad for how all my babies entered the world, and I learned SO MUCH from each portal, which made me who I am, and is a true and beautiful beginning for all my children.

I am glad the SOGC reversed their position on breech births, and I hope it leads to culture shifts in obstetrics across Canada and inspires change in the USA. I read in this Globe and Mail article that 11,000 to 14,000 women PER YEAR in Canada had had surgery for breech presentation. That's a lot of unnecessary cesareans. If you add to those the subsequent cesareans that many women had, I'm sure, because VBACs are not encouraged and because the old "Once a cesarean, always a cesarean" belief is really persistent, there are a lot MORE unnecessary cesareans that happened after those first unnecessary cesareans. It saddens me that the culture shifted away from vaginal delivery of breech babies, because it indicates a strong cultural belief in birth as dangerous and something women are often incapable of.
But Ayden's birth was still holy. And positive. And beautiful. It had a powerful impact upon me as a person and as a mother, but it did not define me as a mother.
Matthew's birth (second birth, since he had of course already been born, vaginally, in a hospital in Samut Prakan, Thailand) was holy, and beautiful, and we all cried. That airport moment had a powerful impact upon me, but it did not define me.
Riley's birth was also holy. And beautiful. And redemptive, because I finally had my vaginal birth, empowering and liberating, and one of my most cherished memories. It changed me, it really did, and it was very important to me that I have that experience and take back my bodily integrity and my own power over the birth. It was wonderful. But it did not define me, and it is not the most important moment in my life nor in my journey as a parent. It was a beautiful, significant portal. But a portal nonetheless, because time moves forward and the birth stays behind in the past, and because Riley and me and the rest of our family are more than the sum of our most significant moments.

I'm so glad we have birth, in all its various forms, because it is significant and beautiful, and it teaches us so much. And I don't regret my cesarean.


Louise and Gary Chapman said...

Mel, I really appreciate this post. I feel like my C-section with Kai humbled me and made me more understanding. This is a wonderful thing for prideful, think-I-know- everything me.
Their births were def. not the most important/defining/amazing days of my life. I keep thinking that each day that passes, as I know them more and more and deeper and deeper, that day is a wonderful, fabulous day and I look forward to many more to come.
Good job momma!

amy frances said...

This was empowering and encouraging and uplifting and humbling and sweet. I'm as with you as I can be. Thanks.

Caryn Ouwehand said...

Wow. Thanks so much for this post. It means so much to me to hear that someone who has had both a C-section and a vaginal delivery state that they can now look back on their C-section have have some fond memories even though they have a vaginal delivery to compare it to. Even if I one day have a vaginal delivery, I never want to look back on Silas' birth day as a negetive day just because of the incision he had to come through. Thanks Mel.

Rachel Clear said...

Amen, sister.

I followed this same line of posts when they came out, starting with the midwifery post, going to Sweet n' Salty's and ending with Rixa's, and I agree with you whole-heartedly.

And a serious and glorious yay for you for realizing what you wanted to be different, for taking control of your birth and for going at it in the way you felt was best. Seriously.

Asheya said...

Thanks for sharing these thoughts, Melissa. God is so gracious that the negative or less than perfect moments in our lives can be redeemed, and used to teach us so many important things. I haven't had an overally traumatic birth, which I am thankful for, but I have had other traumatic events in my life, which I have worked through and which I think have contributed to my growth and empathy.