|
A
reflection on one of my experiences of birth
(This essay was written before I had my last
two children, which where born at home, in water with the aid of
a midwife, a doula, my husband and my children)
I have given birth to
three children and I must say that I have had very different
experiences of labour. My first child was born in Holland and
the other two in Ireland. My experiences of giving birth have
varied from being in absolute panic to feeling totally in
control. Also, from a natural birth without medical
interventions to a pain free labour with an epidural. For the
purpose of this essay I will focus on the one that had the most
impact on me, which was the birth of my first child. I will
analyse a range of situations and procedures that I have
experienced, but that also many other women may go through
during their labour. I will point out some areas, which by
teaching those issues in classes can make a difference to
someone’s experience of labour.
During my first pregnancy
I was living in Holland, a country with whose maternity services
I was not familiar. I attended the local Public Health prenatal
classes. Looking back now, I don’t think I learned anything
there that helped me for my labour, but I do remember being
terrified looking at a labour video that was shown to us.
I have never been strong
dealing with pain and was very scared of not being able to cope
with it. Holland is known to have one of the highest natural
childbirth rates in Europe with 60% of births being home births.
It surprised me how little I was taught about relaxation,
alternative pain relief and comforts for labour. All I had got
from those classes was some information on the anatomy of labour
and we practiced some very complicated breathing exercises. I
didn’t feel prepared for labour at all. This made me feel very
anxious and nervous, which made me decide I was going to have an
epidural.
Being born and raised in
Brazil, my ideas of childbirth were influenced by my mother and
friends’ experiences. Midwifery is a profession that has not
developed yet in Brazil and all women have their babies in
hospital with the aid of an obstetrician. Giving birth is seen
as a medical event in which women have very little say. Shaving
the pubic area, enemas, epidurals and episiotomies are all
standard procedures. Culture plays an important role in how
childbirth is viewed (Nichols & Humenick, 1988). In my culture
it is seen more as an abnormal event than something which is
just part of life: something that your body has been designed to
do. Taking this into consideration, it is understandable that I
didn’t want to give birth with a midwife, so I decided to look
for an obstetrician. Maybe if a midwife had provided my
antenatal care, she would have prepared me better to cope with
labour.
When the big day arrived,
I didn’t feel scared; just very excited. It was finally going to
happen. Women experience different emotions during the first
stage of labour. The first one, which marks early labour is of
excitement (McCutcheon Rosseg, 1984). I was told to go to
hospital when the contractions were 5 minutes apart. However,
the time between contractions is irrelevant for assessing
progress of labour, as there are many variations. A more
reliable guide is the length and strength of the contractions
themselves. (Robertson, 2000) I arrived at the hospital still
at a very early stage of labour.
My husband was going to
be my birthing partner, even though he had not attended any
prenatal classes and didn’t have a clue about what was going to
happen to me. Labour supporters often don’t fully realise what
the role involves. First-time fathers may just be expected to be
there with little thought of what this might involve (Robertson,
2000). But I was just so glad that he was going to be there. I
needed his support, whatever that was.
When we arrived at the
hospital, the contractions slowed down. Environment and the
woman’s emotional state have great influence on the progress
of labour (Sweet, 1997). If I had stayed longer at home I would
have been in a familiar environment and labour would have
progressed quicker. At my classes, when I am a teacher, I hope
to be able to raise awareness of the advantages of staying at
home for as long as possible.
I was then brought in to
a large room. There wasn’t much in there, just a bed and a
chair. Labour rooms should be furnished with a variety of props
(chair, floor mattress, beanbags, bed ledges etc.), so as to
offer women freedom of movement during labour (MIDIRS, 1999).
The nurse on duty sat me on a chair and put a monitor around my
tummy to see the intensity and regularity of the contractions.
Because I didn’t have m a midwife, I had an unfamiliar nurse
monitoring my labour, which made me feel rather uncomfortable.
There I was left for
about 30 min. The nurse left my husband and I on our own. Few
partners want to be or should be the only person in the room.
The presence of additional support in the form of an experienced
woman (far from diminishing the role of the partner), can reduce
his anxiety freeing him to offer more personal support (MIDIRS,
1999). I was able to do the breathing I was told to do and was
very proud of myself for coping with the pain. After all, labour
wasn’t so bad, I thought.
At this point we realized
that my husband had forgotten my bags in the car and he went out
to get them. I was left alone for about 20 minutes, which
seemed more like 2 hours. I lost control of my breathing and
felt very anxious. I didn’t want to be alone and I needed
someone to reassure me. Every woman in labour should receive
support, reassurance and encouragement (MIDIRS, 1999).
After a while the nurse
came in again. She said she was going to carry out an internal
examination to see how much I had dilated. I was 2 cm dilated
and I must say that I was quite disappointed. I wish I was told
during antenatal classes the amount of work the cervix has to do
before even starting to dilate, I would then have looked at 2 cm
with a lot more enthusiasm. Cervical effacement may occur late
in pregnancy or may not take place until labour begins. In first
labours the cervix will not dilate until effacement is complete
which takes time (Bennett, 1999).
For the examination I was
asked to lie on the bed and I think, for convenience, I just
stayed there. Also, the bed was the most attractive and tempting
part of the room. Once there, I stayed there. Most women being
cared for in a hospital will stay in bed during labour (Page,
2000). The choice of position is often made on the basis of the
freedom the woman feels in her birth environment, as well as the
encouragement she receives from her birth companion (Nichols &
Humenick, 1988). Without a supporting midwife or doula and with
a husband that had no idea a woman could labour in positions
other than lying on a bed, it doesn’t surprise me that I stayed
in bed for the entire labour.
Later on the nurse came
in with an extra bed for my husband. I still don’t know the
reason why she did that. I know supporters also have needs that
have to be looked after, but bringing an extra bed seemed to
suggest that my husband should get some sleep. I was once more
alone, without a midwife or doula and with a sleeping
husband, having to deal with the contractions on my own. Often
partners may be unable to give effective support because they
don’t understand what is happening or are themselves too anxious
to give support (MIDIRS, 1999).
My husband did not attend
any of the prenatal classes because men were not allowed
to attend. He had no idea what it was like for a woman in labour
and even less what their needs are. He also felt there wasn’t
much he could do, since I was the one who was going to give
birth. I hope, during my classes, to prepare partners to give
support during labour and also to make them feel that they have
an important role.
For a while, I was able
to doze off in between contractions but when they got stronger
and closer together, I found it quite difficult to cope. I
wasn’t exited anymore, I was getting tired and scared of what
was ahead of me. As labour progresses, so does the woman’s
emotions, which are now ones of concentration and seriousness
(McCutcheon Rosseg, 1984).
I think the fact that I
had no support to get me through each contraction, and lying on
a bed for so long, made labour seem endless. It was then that I
started to beg for an epidural. When the nurse came in for
another internal examination I was told she was going to get the
epidural organized. I was then about 4 or 5 cm dilated so at
least I was progressing. The internal examinations were very
uncomfortable and I used to dread every time the nurse came in
for one. I felt that once I was in their care I had to do what I
was told.
At this stage I wasn’t
coping well at all with the contractions. I had lost control of
my breathing and started to panic and shout for the epidural
that had been promised to me. My husband then was with me after
being woken up by the noise. Instead of the epidural, I was
given morphine without an explanation of what I was being given
and any possible side effects, if any, on the baby or me.
Every woman should be given information on the drugs available
and be allowed the time to decide (Priest, 1996). I just felt my
carers knew best and never even thought of questioning any
procedure that was being done. Once a teacher, I will teach in
my classes how to be assertive without being aggressive, and how
this may help my clients. Morphine didn’t make any difference to
the pain, but it made me relax in between contractions.
When the contractions got
so close together that I didn’t have any time to relax in
between them and since the morphine didn’t help with the pain, I
got out of control. In fact the morphine had interfered with my
ability to concentrate on the contractions, and made me
hallucinate. I had vision of dieing.
My out of control state
had made the nurse come in. I had reached my limit and felt I
could give it all up and go home. That is the emotional sign
that the woman is in transition. Self doubt; when she thinks she
can’t do it anymore. She should be praised and reassured that
she is nearly there (McCutcheon Rosseg, 1984). Another internal
examination determined that I was almost 10 centimetres dilated.
I was then transferred to the labour ward, where I was actually
going to give birth.
When we got there I was
told I could start pushing. By then, I was exhausted and my
pushing wasn’t very effective. I was also terrified to tear and
didn’t want to push very hard. After about 30 minutes of
ineffective pushing, I realized that I did not have a choice but
to push very hard. I was able to follow the doctor’s
instructions for when to stop pushing and luckily I didn’t tear.
Some doctor's are particularly skilful in assisting birth in a
way that minimizes perineal trauma (Enkin et al., 2000). At 3
a.m., after 8 hours in hospital, Julian was finally born. He was
immediately brought to my chest.
I had expected this
moment to be very emotional and special with an immediate bond,
but all I could feel was relief that it was all over. Birth
experience has an impact on maternal instinct (Nichols &
Humenick, 1988). I then fell into a deep sleep, probably from
exhaustion and from the remains of morphine.
It took me a whole day to
come out of the state of shock I was in and to be able to enjoy
Julian. Because of the side effects of morphine on the baby,
Julian never breastfed in hospital, which made me feel rejected
by my baby. Luckily, I was able to breastfeed Julian with some
help and support after the side effects of the morphine had worn
off.
I had a normal and
natural birth (with the exception of morphine) without a tear
and with a healthy baby. Maybe a dream for a lot of women, but
for me it seemed more like a nightmare. From this experience I
can say that it doesn’t matter if it’s normal, natural, assisted
or a caesarean birth. As long as the woman feels supported
physically and emotionally and is treated as a participant
rather than a subject, only positive feelings can emerge.
Daniela Vasconcellos
(2000)
References:
Bennet V. & Brown L.
(1999) Myles Textbook for Midwives. London: Churchill
Livingstone
Enkin M., Keirse M.,
Neilson J. et al (2000) A guide to effective care in pregnancy
and childbirth. Oxford: Oxford University Press
McCutcheon Rosseg S.
(1984) Natural Childbirth the Bradley Way. New York: E.P.Dutton
MIDDIRS (1999) Informed
choice for professionals: Positions in labour and delivery.
MIDDIRS (1999) Informed
choice for professionals: Support in labour
Nichols F. & Humenick S.
(1988) Childbirth Education: practice, research and theory.
London: Sounders Company
Page L. (2000) The New
Midwifery: science and sensitivity in practice. Churchill
London: Livingstone
Priest J. (1990) Drugs in
conception, pregnancy & childbirth. London: Pandora
Robertson A. (2000) The
Midwife companion: the art of support during birth. Australia:
ACE Graphics
Sweet B. (1997) Mayes’
Midwifery: a textbook for midwives. London: Balliere Tindall
|
