Kristin Prentiss Ott, M.D.

The One Thing Doctors, Doulas, Moms, & Midwives All Want

As a feminist, a lover of birth, and a physician, I struggle every time I read people’s stories of birth trauma. Improving Birth’s “Break the Silence” photo project has generated pictures like this one:

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This man’s words are true. And while I’ll never know for sure, I suspect on the day his partner delivered, there was a stretched-to-the-limit charge nurse trying to get laboring patients out of the waiting room and into beds.

I have no desire to med-splain (doctor version of “mansplain”) away wrongs. Mainstream medicine has a reprehensible history when it comes to maternal health. It wasn’t that long ago that hospitals shut out family members from the delivery room, gave unnecessary enemas, shaved escutcheons, and knocked women unconscious for delivery. It was deplorable and that is why we must remember it.

In many regards, the medical establishment has recognized what naturalists/feminists have been promoting for years. Hospitals welcome family members into birthing rooms and unmedicated births are routine. Modern medicine has recognized the benefit of moving during labor and knows that squatting is an excellent birthing position. Healthcare professionals know they are supposed to support a woman’s right to make choices about her body and her delivery.

So if everything I’m saying is true – why do so many women end up supine and immobile with unwanted interventions? Why did improvingbirth.org get so many submissions like this one?

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Well the answer lies in the impersonal black and white reality of numbers, stats and probability – and also the very personal and exclusive world of experience.

Experienced providers know that statistics represent real people who will be crushed by real grief and undoubtedly always wonder, “what if?” Despite its small size, “if” is a very big word.

IF your child has a permanent brachial plexus injury resulting in arm weakness, will you be proud you said no to a c-section?

IF your baby spends weeks in a NICU seizing, getting brain cooling, and has permanent disabilities, will you be glad you chose the process over the outcome?

Right or wrong, providers presume your answers to these questions like these will be, “No.” This is why, if a provider really believes a baby is at risk, it’s nearly impossible to say, “Well, have it your way.”

Physicians are not averse to natural birth, they are averse to poor outcomes. I have a physician friend who delivered at The Farm (Ina May Gaskin’s famous midwifery center in Tennessee). It was her third child and she’d had 2 prior vaginal deliveries without complications. As a physician, she had a genuine grasp of the risks – and knew hers were remarkably low. She delivered a healthy baby and has a great birth story to go with it.

About birth, Gaskin has said:

“When you are going with it, it’s a ride, an exciting adventure, and you can watch it in a woman’s eyes when they go ‘wow!’…and sometimes they’ll actually go ‘This is fun!’ People seek adventure by skiing, hang gliding, all kinds of things that are way more dangerous than birth and they have no idea that pregnancy and birth offer a great adventure of exploration that turns out to be extremely enriching.”

Her statistics are a little inaccurate as birth carries a much higher mortality rate than most adventure sports:

mortality

 

 

 

 

 

 

 

 

 

 

 

 

 

But this is a fantastic comparison. Birth IS (and should be) exhilarating. We should approach it just like an adventure. If we want to go skydiving, most of us would pick a reputable outfitter with good reviews rather than some rag-tag operation. And most of us would trust the advice of someone who has jumped hundreds (or thousands) of times. A little bit of fear helps us stay safe – even while savoring the exhilaration of jumping out of a plane.

Imagine being an experienced skydiving instructor and having a student who’s positively fearless – so much so – you wonder if the person even realizes it can be dangerous. They refuse gauges and additional precautions. You jump with this person. Free-falling is amazing! (Cue Tom Petty.) But then this person doesn’t open their chute. You signal danger and they seem to blow it off. The ground is closing in…

Would you feel desperate?

Would you get mad?

Would you try to forcefully intervene to save a life?

Yes. Yes. Yes.

Recently, a group of tens of thousands of physicians was riveted to the blog of a soon-to-be first time mom, Maura. Her unborn daughter, Lila, was breech and she and her husband moved to Bali at the end of her pregnancy to have a magical outdoor water birth in a petal strewn pool surrounded by tropical beauty – which sounds more like the set of a hibiscus-scented shampoo commercial than the plan for a high-risk birth.

Without a doubt, women’s bodies are capable of delivering breech babies. But the impersonal world of stats and probability makes it clear vaginal breech deliveries carry additional risk. About the risks, Maura wrote:

“Lila has chosen to be born this way and we know that there are dangers involved and that there is a chance we might lose her during this, her first rite of passage…What we do not ask for are horror stories, dead baby stories, or advice about why we should make a different decision than the one we have already carefully made.”

Reading her words for the first time I felt like a sky-diving instructor watching her hurtle towards disaster. She writes with the bravado of someone who’s never actually seen a seizing neonate with an anoxic brain injury. She writes like someone who likes the drama of her words without understanding the flesh and blood meaning of them.

And there lies the disconnect between providers and patients in so many birth stories.

  • Providers think – if you KNEW what I KNOW – you would make a different choice.
  • And patient’s think – if you KNEW ME – you’d know how much this means to me – that I’m not stupid and I care about my baby.

And so providers end up feeling frustrated and women end up feeling disrespected, coerced and disempowered.

One of the biggest complaints I hear from women after birth is that their doctors tried to scare them. That providers used threats like, “your baby is going to die if you don’t have a c-section,” to manipulate them. I know all of these claims are true.

Maura (Bali breech blogger) wrote:

“When I first showed resistance to having a 38-week scheduled c-section just because our baby was breech, I got the line ‘how you birth doesn’t really matter, having a healthy baby in the end is all that really matters.’…Statements like this are used to push cesarean on mothers with very insidious bits of guilt, shame, and an illusion of control…You face a consensus trance of rabid control freaks who will whip and shame you if choose to trust your body and the cycles of nature instead of trying to control the outcome. But you can’t control the outcome.”

Maura is correct that there are no guarantees, but we absolutely can (and do) control our choices. Risk, probability and experience should guide our choices because these consequences do not live in the land of birth theory but in the flesh & blood world of soul-wrenching reality.

Ultimately the consequences of Maura & Andrew’s failed plans were mild. She labored for 16 hours before they walked to a road and got a ride to the hospital where she had an emergency c-section. She had surgery in a country where she didn’t speak the language and her husband wasn’t present for the delivery. Although Lila reportedly didn’t cry for 5 minutes, she is alive!  And because there is a happy ending – they have a good story.

In her post-birth blog, Maura extols her powers of intuition and proclaims her total peace with the possible death of her child, but she does concede one point. She writes:

“After my experience, I say that yes, the most important thing is having a healthy baby at the end. Believe me, I look at little Lila and I feel so much love and gratitude for her that I would agree to have a thousand incisions all over every part of my body in exchange for having her alive.”

Maura’s thoughts on delivery changed after experiencing just one birth. Imagine the added wisdom (and even intuition) that comes from experiencing hundreds (or even thousands). Birth should be mother-centered – but the other people present have a stake in the outcome too (including the baby). If a mother is allowed to make choices experienced birth providers would never make for themselves and the outcome is poor, guilt will haunt that provider forever. Poor preventable outcomes keep professionals awake at night. Providers are not indifferent observers. They care.

So when I read people’s birth trauma stories…

  • Behind reports of threats, roughness, and bullying  – I see a provider’s desperation.
  • Behind a mother’s hurt and disappointment – I see providers who were trying their best to ensure a happy ending. Because if you get the story you’ve always wanted, right up until the very end, and then deliver an infant with a preventable outcome – the beginning and the middle parts lose their beauty.

Birth is an adventure and it should be exhilarating. But if you are enjoying the rush of crashing through class V rapids, and hear fear in the shouts of your rafting guide, you’d trust it’s real and listen closely to his paddle calls. Experience has taught providers that birth statistics represent real people, real tears. So if you see your nurse and doctor give each other a look – if your midwife seems tense – believe the risk is real.

In the quiet moments after birth, if a bad outcome is averted, it’s easy to question whether interventions were really necessary. If there is a chasm between birth dreams and the medical record, negative feelings can nag at the corners of joy and gratitude. And for that I am sorry. I am sorry for the tethering of such great joy to disappointment. I am sorry for anything that tugs at someone’s memory of such a momentous occasion with an internal tension between gratitude and anger – joy and hurt.

A #breakthesilence mom put up this post:

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Although I don’t know this mom’s birth story, I’m betting the foundation is that she sacrificed herself and suffered to meet the little boy who’d been kicking her in the ribs for months. And that is a story worth telling.

Parenting is a self-sacrificial journey that begins with the birth process. Maura made the hard choice to let go of Plan A for Plan B. She swapped a warm pool for a cold operating suite for the love of a daughter she hadn’t met yet. One of the bravest things a woman can do is face the gap between her dreams and her provider’s urging and make the jump. Ina May Gaskin, Maura, doulas and midwives, doctors and nurses, family members, you, me and your neighbor down the street: we all want one thing. We all want a happy ending.

Everyone wants a happy ending.

#everybirthisamiracle

 

PS – I am hesitant to link to Maura’s blog because it contains a great deal of inaccurate (or blatently false) medical information. With this precaution, however, if you would like to read it – you can read it here. For a good article on vaginal breech delivery, click here. And for people interested in where I got my mortality numbers, sources are linked here: Maternal death from birthSkiing, White water kayaking, Hang gliding & skydiving

Photo credit: Helen Pickens Murphy

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Kristin Prentiss Ott, M.D.

Author of the viral post: 10 Things to Know Before Your Next Visit to the Emergency Department. Board certified emergency medicine physician, wife, mother, aspiring novelist.
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9 Comments

  1. anne k

    thanks for this!!! i am posting on my practice’s Facebook page.
    love,
    a grateful obstetrician

  2. padrooga

    Everyone wants a happy ending, yes… but everyone also wants a hashtag and a reason to whine about their 1st world problems indeed, as your stats show. Anyone with enough disposable income to complain about the frame or setting of their healthy child’s birth not being perfect has completely lost touch with reality.
    I can’t fathom the degree of narcissism it takes to have a “birth plan”.

    You know these are the same women that over planned every detail of their freaking wedding, with nary a thought to the marriage.

    Process over outcome, don’t you know.

    Pity the poor child they will be raising.

    Planning a social media worthy birth takes narcissism to level expert, but it is also a sad tale about our distracted millenials. And I do believe that now that more and more people aspire to be the stars of their own documentary being constantly updated on facebook, that social media is driving one ups-manship to dizzying heights.

    The miracle of birth is not quite enough to hold their attention, and they must have it orchestrated with a thousand appropriate accoutrements or it just isn’t special and unique enough. And we know how all the little snowflakes have had it drummed into their heads their entire lives, just how special and unique they are indeed.
    Just look at how they are naming their babies…They are sometimes, completely outlandish, off the wall, ironically symbolic private jokes for the parents. We used to only see this among the Hollywood crowd,and one would expect that degree of self centered behavior from actors and actresses. Everything they did was about drawing attention to themselves rather than thinking about how a wacky name might affect the baby.
    Now the general population has the same level of it and it is showing in selfie culture everywhere.

    On the flip side, others follow the fashion and at the same time they think they are being different.

    aiden
    ayden
    baylynn
    bayden
    brooklynn
    kayden
    caden
    cayton
    peyton
    zayden
    dayton,
    kayla
    kyla
    keela
    kasey
    kelsey
    kaitlin
    and on and on…
    Like all the 60’s hippies that swore they were expressing their individuality by wearing pretty much the same tie-dyed hippie poncho as everyone else.

    It fits the template of everything else now. We no longer merely have a child or buy a product, we expect, nay demand, to have an artisanally designed, hand crafted, cruelty free, fair not free trade, organic, gluten free, product. Extrapolate this to the “birth experience” and you see what I mean.

    They demand and insist that things like a “magical outdoor water birth in a petal strewn pool” are an important part of their identity

    What we are seeing is the result of children who raised to believe they are the center of the universe and that every waking moment has to be social media worthy. We see this, because their parents abandoned their responsibilities to bring responsible adults into the world, and instead, raised them to think that every freaking moment had to be elevated to a magical moment as well.

    Ain’t nobody got time for that!

  3. padrooga

    You really are a Tom Petty fan!!!! hehe Inside joke.

    1. Kristin Ott

      To be honest, although I love music, I would be posing to imply that I know a lot about it! But frequently over the course of the day, someone will say a word/phrase that cues a song in my head (which I then sometimes sing outloud horribly off-key). So when I write, the same thing happens and I just put it in. Why should I be the only one with that song stuck in my head? Sharing is caring;)

      1. padrooga

        Thanks for sharing! Cuz now I’m free- Fallin’!

  4. Molly Lancaster

    I had an emergency C section with my first and a repeat c section with my 2nd only after seeing 4 different OB’s and my midwife who all recommend the repeat c section they knew my wishes were for a VBAC but the most important results were a healthy mom and baby. I wouldn’t change a thing about my son’s birth stories. I was invited to be part of a C-section committee meeting at the hospital and was able to talk about my experience and any suggestions for improvement. Frommy experience I think the staff at Spectrum health Gerber in fremont are doing an incredible job listening to their patients.

    1. Kristin Prentiss Ott, M.D. (Post author)

      I am so happy to hear this!

      1. Molly

        I love your blog 🙂 wish I was able to read through it all. Rory keeps trying to convince me to go to nursing school to work in the OB because I very much enjoy it all but I have seen how hard the nursing program is and I can’t even imagine how difficult med school was for you to balance. Well your depression article summed it up well . I definitely know that feeling.

  5. Smitty

    Powerful ! “The truth, the whole truth, and nothing but the truth.”

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