From Surviving to Thriving: Rethinking Standards of Maternal Care

 

It doesn’t matter how you give birth as long as the baby’s healthy.

This is the mantra I would tell myself whenever the more unpleasant memories of my daughter’s delivery would surface, all those tiny decisions that others made for me (or over me) that settled into my gut and would frequently whisper—it shouldn’t have been like that.

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My first birth was not traumatic by any means. I was a week past my due date when my water broke and I did not go into labor. I had been seeing a practice of midwives connected to the birthing center at a hospital in central Manhattan. I wanted a natural birth, and the hospital birth center promised a family-centered birthing experience (as long as I met a long list of eligibility requirements and had textbook labor progression).

But there I was, a week past my due date, waiting for contractions to start after my water broke at 5:30AM. By 10PM I still hadn’t gone into labor, so my husband and I packed our bags and headed to the hospital to check my progress. The midwife on duty monitored my erratic contractions and told us we could start induction or wait to induce at 6AM the next morning if I hadn’t given birth yet.

We induced, which led to numerous monitors and IVs and confinement to a bed, which led to an epidural, which led to a night of laboring, which led to meconium, which led to “the baby will need to immediately be seen by a pediatrician,” which led to twenty minutes of pushing, an episiotomy, my baby being born, cord immediately cut, and us separated for forty-five minutes while the staff did their newborn checklist that I was told would not happen until after an hour of skin-to-skin.

“I wanted a natural birth, and the hospital birth center promised a family-centered birthing experience…”

That is the story I would tell family and friends about my daughter’s birth, glossing over the more unpleasant aspects to highlight the joys. But nestled in that story are the many ways my care was not as promised. It’s the bit about being denied any food after induction despite the fact I hadn’t eaten in over twelve hours and needed nourishment to labor. It’s the bit about being given an episiotomy “because I was tearing anyway” instead of being asked or told about the recovery complications.

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It’s the bit about the dated hospital policy that partners cannot stay overnight. It’s the bit about not getting to hold my newborn for almost an hour after her birth despite her being healthy. It’s the bit that—because I needed interventions—I no longer got to have a say.

It doesn’t matter how you give birth, as long as the baby’s healthy.

So often this mantra is used as a silencing mechanism whenever we want to talk about our discomfort or trauma related to childbirth. So often “healthy” just means “alive” (there’s also the issue that sometimes babies are not born healthy and they aren’t any less wonderful or beautiful nor the birth any more a failure on the mother’s part). Despite numerous studies confirming that the birth experience shapes a mother’s confidence in her parenting, her bond with her child, and her emotional health postpartum, options for truly holistic maternal care are limited and/or inaccessible to most pregnant women.

“So often ‘healthy’ just means ‘alive’…”

I’m now 32. The care I have received this pregnancy has been night and day from my first. I knew I wanted a different birth experience from my first pregnancy, and I was lucky to find an incredible midwife and birth center only half an hour from where I live. My first appointment felt more like a conversation. I was asked about my first pregnancy, why I was interested in the birth center, and I answered questions about my family health history. This was not to determine if I was too much of a risk, but rather so they could create a care plan to best support me during pregnancy.

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For example, I had bloodwork done in the first trimester that revealed I have a homozygous MTHFR gene mutation, which makes it difficult for me to process folate. My midwife referred me to a nutritionist who provided me with a supplement to help my body process the nutrients it needs. Half of each visit is spent measuring the baby and listening to its heartbeat; the other half is spent getting to know me as a person and talking about my health. They listen, they learn, they give me control.

The medicalization of birth has largely stripped the event of its psychological, emotional, and socio-cultural components. For many medical and maternal professionals, birth has become all about efficient fetus extraction. Often times, the mother is viewed as a problem to be solved, and any endured trauma is justifiable in the name of baby’s “safety”.

Technological advancements have made life-saving miracles possible, but it’s also greatly reduced our trust in women’s bodies, in women’s instincts. The result of these trends is an overwhelming abundance of maternal care providers who view birth in a tunnel and leave new mothers disappointed at best and in life-threatening situations at worst.

“The medicalization of birth has largely stripped the event of its psychological, emotional, and socio-cultural components.”

I want to be clear: this isn’t an issue of OB/GYN versus midwife, hospital versus birth center. This is about family-centered, mother-empowered, supported care that treats birth as a major life event.

How we experience birth matters. How we are supported through birth matters. How we are cared for after birth matters. So, having been around the proverbial block a couple times now, here are my must-haves for maternal care providers:

1. They treat birth as a major life event with biological, social, emotional, and psychological components that all need to be equally valued when providing care. This means taking your wishes for your birth experience seriously and solemnly. This means centering the birth on family and providing ample time and space for infant-parent bonding, both during prenatal care and postpartum.

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2. They ask for informed consent before any procedure, no matter how big or small. I can’t tell you how many times I was poked and prodded during my first pregnancy without ever being told why. With my current midwife, I am always given extensive information on any procedure, I am given time to review the information, and am never pressured to offer or refuse consent. If I get blood drawn, I know exactly what tests it’s for and why. This creates a positive relationship between provider and patient. This way, the provider is able to share professional knowledge while the patient is still able to maintain autonomy.

3. If interventions are necessary, you still maintain agency. So often we share our birth plans with our care providers and then when something doesn’t go according to plan (which it never fully does—birth is messy and unpredictable) the care provider completely takes over and the mother is no longer consulted or considered a major participant in the birth experience. Intervention should not be treated as a failure of the mother but rather as a shift in the birth process that the provider and mother navigate together.

It’s time to raise our standards from surviving birth to thriving through birth. We must refuse to be treated as problems and instead demand to be treated as participants. Fellow mothers: We deserve to receive nurturing, thoughtful care. Who’s with me?★

 

Rachel KercherRachel Kercher is a photographer, writer, and stay-at-home mom. Before delving full-time into child-rearing, she directed an after-school program in NYC and taught special education in Georgia. She currently lives in Los Angeles with her husband and toddler daughter.

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