What happens when a doula has a cesarean birth? How do we as doulas support these women? Are we doing enough?
Often these mothers report feeling like outcasts of the natural birth community once their planned unmedicated birth or homebirth turns into a HBC (the name given to a planned out of hospital birth that ends in a transfer and cesarean).
DTI is committed to making sure these moms feel like they still have a place in the natural birth community. We want to start a dialogue here about what some of these mothers have experienced and how as doulas we may be sure that these women continue to feel a part of our community. How as doulas (or other birth professionals) may we better help them process their births, honor their birth stories, and improve our role during cesarean birth.
We asked a friend and doula colleague, Becky Alford, to share with us her experience of re-entering the natural birth communities after not one, but two, homebirth cesareans. Her heartfelt story is here:
Some girls grow up dreaming of their perfect fairy tale wedding. The colors, the flowers, the hand stitched pearls… every detail is thought through and planned out and imagined and re-imagined. Dreamed about and obsessed over.
As a girl and young adult, I dreamed about giving birth. I pored over articles and pictures and movies about birth, imagined pulling my wet baby up my body into my arms. In college I became a doula and for the next 10 years I helped other women experience that blissful moment when they transform into a mother while getting lost in their newborn’s eyes. At home, at a birth center, or in the hospital, we used all the tricks in the book to get the baby out healthy and safely and to keep the mother’s experience one of empowerment and joy. In those 10 years I had just 2 clients who needed a c-section to birth their babies safely. I was not allowed to be there for the surgery, but stayed at the hospital to help initiate breastfeeding and bonding.
“Trust birth”
When I became pregnant with my first child, I had no doubt that homebirth was the path for us. We hired an incredible midwife, went to homebirth prep classes, ordered our tub and figured out how to get our wonky sink faucet to connect to a lead-free hose and how to then siphon out the birth water. 9 months of yoga and meditation and acupuncture and massage and birth tub trial runs and that dream continuously on a loop of my slimy baby sliding up my chest. I had never wanted anything so badly, and had never believed in myself more. Even as my baby went 2 weeks late and grew much larger than average, I had no doubt I would birth him in his home surrounded by love and Reiki charged candles. I didn’t pack a hospital bag, wondering if it would put the idea out to the universe that I needed one. I vaguely knew my back-up plan was St. Vincent’s with a homebirth friendly OB, but never honestly considered what that would be like.
“Your body is not a lemon”
What choice is left, after 70 hours of labor at home, every movement and position imaginable, acupuncture and body work and mental work, relaxing in the tub, hypnobirthing, walking and squatting and belly lifts and birth balls, affirmations and mantras, doula and midwife and partner cheering you on, 15 hours of involuntary pushing and a stuck stuck stuck baby? Despite the unimaginable pain of a baby pushing down into your bones while your uterus pushes in overpowering cascading waves and every cell in your body bears down to get this baby out while baby’s head tries to split your pelvis in two… despite all that, I sobbed and wailed at the injustice of needing to transfer.
My body was a lemon. It was shutting down. I was going into other worlds of consciousness from the pain and bone crunching and yet I could not accept that this would not happen at home. I had never imagined a transfer and all I could see was my dream was OVER and ALL WAS LOST.
My baby wouldn’t even know I was his mother and who knows if he’d ever breastfeed and what was that quote about there being no more love in the world because of surgical births and if I couldn’t smell him I wouldn’t know he was mine and his poor damaged gut flora and early cord clamping will make his iron stores too low and surely I’d get PPD without his placenta to encapsulate. My mind raced and panicked.
I told my body to shut down labor and it did. I went from contractions every 2 minutes to a few an hour until my c-section. And somewhere in there, I tried to remember, that this was My. Baby’s. Birth. And I would never get to do it again. Remember to push aside the feelings of failure and dreams crashing down and meet my little boy, if not with open arms, with an open heart.
“Your body won’t grow a baby it can’t push out.”
But, it did. All 9 lbs 4 oz of him. I was thoroughly unprepared for my new role as “the exception” or for the arm chair analyzing of my birth from the natural childbirth community. What did she do wrong? And how can I make sure that doesn’t happen to me? Why didn’t she try x, y, z before “giving up”?
I attended a birthing event a few months later with my sweet little (big) newborn in my arms. After a seemingly lovely doula smiled and asked more and more questions about my birth, she ended our conversation with, “If you want to avoid what happened last time at your next birth, give me a call and I will teach you how” and walked away. Her words were a punch to my scarred and still sore gut. The arrogance and disrespect of my experience and ownership of my own birth story in that moment has haunted me and angered me ever since.
The attitude proved to be more prevalent than I ever would have guessed. My birth story should be hidden away, because pregnant women should only hear “positive” birth stories. The language of the natural childbirth community infuriated me. Having a baby is not the same as having a bowel movement, thank you. My body may have been designed to birth babies, but it couldn’t, so what exactly should I have done?
I sacrificed my dreams in order to bring my child into the world safely. But few people acknowledge that sacrifice, your strength, or your broken heart. You don’t fit in the mainstream birthing world, because you KNOW what you missed, and you miss it with all your heart, and they view you as a reason homebirth is unsafe. You don’t fit in the natural childbirth community anymore, your baby can’t wear the “Born at Home” onesie that came in your birth kit. No one calls you a Birth Goddess or Warrior. In a community that you once found your friends, your livelihood, and your passion, you are lost.
“But at least you can still VBAC!”
Unless you can’t. 3 years later, history repeated itself with a late, 9 lb 4.5 oz big stuck baby girl. HBAC dreams went down the drain. When your incredible homebirth midwife, with her ridiculously low transfer rate, tells you it’s time to go, it’s time to go. Do I need to say again that everything natural was tried to get this baby out? Yes, I do, because there could be those that assume that the right mindset, or trick, or patience, is all that would have been needed. So instead of just your own dream shattered and your own disappointment in yourself, you hear those “inspirational birth quotes” again and again mocking you and your birth you apparently didn’t trust or want enough.
“Mothering the Mother”
It doesn’t need to be this way. Birth professionals can learn about the Homebirth Cesarean Community, can really, honestly listen to our stories, and truly prepare themselves for how they would help a mother process her feelings should she require a transfer. Ask themselves how they can help her achieve a family centered empowered birth, even if it is in the OR, and see it as their role as birth workers to advocate for this. They can view c-section transfers not as the enemy to be avoided at all costs, but as part of a continuum of healthy birth outcomes.
They can vow to themselves that they will no longer read every c-section birth story through the lens of questioning and criticism, spoken or not. Because we feel it, we hear it, even if it isn’t said. They can know that the line between “necessary” and “unnecessary” c-sections is a gray one and the only one who knows where she lives on that line is the mother herself. Refrain from commenting on other’s birth stories online unless you are there to say, “Wow, you are incredible.” Because we are.
Natural childbirth community members can rally together to embrace mothers who so desperately wanted to be full fledged members in their club, but now feel pushed to the perimeters. And everyone can ask themselves whether the language they use to “inspire” pregnant and birthing mothers, as well-meaning as it is intended, could end up causing pain to others, or to that very mother should her birth go to Plan C.
And if a little girl spent her life dreaming of her picture perfect wedding, and up until the very last minute saw it coming to fruition, and then her wedding was abruptly canceled, the decorations torn down, the cake spoiled, the dress in tatters… would anyone tell her to suck it up and be happy with her city hall certificate? At least she’s married, right? Would anyone question her and ask her to defend her every move that led to her wedding being destroyed? Why, then, do we do this to birthing women? Why do we not give them ownership over their own bodies and stories?
4 years later, I am at peace with my births and my body and my children’s need for medical assistance. But other mothers will follow in my footsteps, and experience a birth that is vastly different from what they planned. My hope is that in their darkest moments, when they are plagued with thoughts of not being good enough and all the what-ifs, a new generation of birth workers will support them and love them and welcome them back.
“You are incredible” is what every new mom wants to hear.
“I was there and I saw how much love you put into this birth. Your baby is so lucky to have you. You may not realize it right now, but I do and I’ll tell you as many times as you need to hear it over the next few years until you believe me.”
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Becky Alford certified with DONA in 2000 and worked as a doula until her son’s birth. She is also a kindergarten teacher in NYC, currently home on leave with her son and daughter.