This article was originally published in Midwifery Today Issue #80 Winter 2006

Over the last decade I have worked with hundreds of childbearing families, attending over 300 births in various roles. I have attended waterbirths, medicated and un-medicated births and cesarean births. I have taught childbirth classes to over 100 people. One thing I have noticed repeatedly is how women make choices about their own births based on stories they have heard from others. I have learned to listen closely to the stories women tell. Women tell not only their own birth stories but those of their friends, relatives, co-workers and acquaintances.

  Women have told birth stories since the beginning of time. These stories express celebration, validation and power, and even assist with the healing process. Women need to reflect on their childbirth experiences so that they may understand their personal impact. Processing their stories into categories of positive and negative is vital. Each birth will surely hold feelings of both for most women: for example, pain and pride.

  In Birthing from Within, Pam England says that “The day you give birth 300,000 women around the world will be giving birth too.”(England 1998) Each of these babies will be born to a woman with a unique birth experience. She will leave her birth with a more developed opinion of what she believes to be true about birth. She will develop a story and over time she will repeat portions of this story again and again. This story will affect other women, possibly influencing other birth outcomes.

  Just a few generations ago women trusted their bodies to give birth. Medications, surgeries and interventions were not even choices at the time. Women supported each other through birth by telling of their own births, guiding each other down a path of trust and essentially carrying each other through the process. Birth was considered a communal affair in which women joined together and shared their knowledge and honored the deep connection and experience of the power of birth.

The Medical Way of Birth

Today, with inductions women can choose their babies’ birthdays, they can choose pain medications or they can even choose to give birth surgically to avoid labor altogether. A number of people believe that with these options women now have ultimate control of the birth experience. The truth is that “for millions of years the birthing female was the most important member of the obstetrical team, but today her knowledge about her body is often suppressed and managed.”(Davis-Floyd 2003) Birth no longer is controlled by the woman, but by the medical system.

  Every time a woman gives birth she is creating a new story to be told to generations of people. Unfortunately, women in the US today commonly tell negative birth stories. 

Self-Fulfilling Prophesy

    I believe that hearing about predominantly negative outcomes in birth can affect a woman’s decision-making process, leading to a bad outcome in birth. I also believe that negative birth stories breed fear, causing women to make uninformed choices about common birth interventions without even considering the risks to their birth memory, themselves and/or their babies.

  Negative birth stories have a much greater impact on our culture than most people believe. As a childbirth educator I start each of my classes with a communication check-in. I ask the women to share what their mothers and friends tell them about birth. Each time I do this exercise I am surprised to hear the stories. I have heard: she had to have an induction; she had to get an epidural; she had to have a cesarean; the baby almost didn't make it. .I then find myself defusing my students’ cultural beliefs about the medicalization of birth: malpractice, medications, complications, cesarean sections.

  Ina May Gaskin says that “So many horror stories circulate about birth—especially in the United States—that it can be difficult for women to believe that labor and birth can be a beneficial experience.”(Gaskin 2003) Not only do these women not see birth as a beneficial experience—but entire generations are missing out on the normal and natural biological process that women have gone through since the beginning of time. Women do not see or experience birth as a positive and joyous event, but something that must be done to have a baby.

  By choosing the current medical model of childbirth, women are decreasing their ability to experience the benefits of pregnancy and birth ritual, as naturally designed. “In the United States, in 1900, less than 5% delivered in hospitals. Today the figure is 98%.”(Davis-Floyd 1997) The majority of present births are attended by obstetricians. Women aren't aware of the risks of choosing the medical model of care; instead they often believe that doctors are heroes who can save them and their babies from a bad outcome. However, research shows that the incidence of complications is high when the natural progression of labor is disturbed. Women often come out of their birth experience feeling traumatized. 

The Dutch Model

The Dutch model of childbirth calls for attendance by midwives through labor and birth for most women. The Dutch maternal and perinatal outcomes are equal to or better than those of other industrialized countries and their cesarean rate is nine percent, compared to the US rate of 29.1 percent.

  The Dutch government will pay only for midwifery care unless a woman is high-risk and needs more interventive care. Women who desire obstetrical care without cause must pay out-of-pocket. This model proves to be superior to the US medical model, which has a higher mortality rate than most other industrialized countries. “US babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway.”(Green 2006) These figures should cause women to learn about all of their options for birth before choosing the medical model. Using such information to choose prenatal and birth care while minimizing risk can be a key in the development of a birth story. 

The Fear Factor

While researching birth stories I was amazed at the number of birth stories on the Internet. This is another example of how birth stories travel through time, affecting more than just the birthing woman. These stories are certain to influence birth choices. Do pregnant women seek “the full story” or are they satisfied with the stories told by their family, friends or even strangers in cyberspace? If a woman tells her friend that labor was hard so she had to have an epidural, her friend may become scared of her own impending birth experience. “More women experience tokophobia, the intense anxiety or fear of death [in childbirth], that leads to dreading childbirth despite wanting a baby.”(Lemay 2003)This newly coined term is used by the medical profession to describe why women are having elective cesarean births. I believe that tokophobia is a side effect of the traumatic births that are occurring and being discussed amongst the women in our culture. 

Increase in Interventions

As interventions such as induction, vacuum extraction and cesarean increase the fear that is passed from woman to woman; their effects traumatize women, leaving them with post-traumatic stress. “Four elements of post-traumatic stress following childbirth appear to be physical pain (physiological), not being heard (sociological and psychological), feelings of betrayal (sociological and psychological) and powerlessness or loss of control (psychological).”(White undated) It's no wonder that women are telling birth stories that are so negative and fear-inducing.

  Recent statistics from the Centers for Disease Control (CDC) show a significant increase in surgical births over the last few years. “The rate of cesarean delivery increased by six percent for 2003-2004 to 29 percent of all births in 2004, the highest rate ever reported in the US. The primary cesarean rate rose eight percent during that period, from 19.1 to 20.6. The rate of vaginal birth after cesarean (VBAC) dropped 13 percent, down to 9.2 percent in 2004 from 10.6 in 2003.”(Martin 2005)

  Some women undoubtedly do need surgical delivery in more complex situations. However, in today's system, determining which surgical births are emergent and which are for convenience can be difficult. This confusion can lead to birth stories tinged with fear and sadness, as women often do not know the truth about why they were rushed through the birthing process and can’t understand the series of events that they went through. They also may not realize that by telling their stories they inspire fear in others, even though they are looking only for validation of their experience.

  Women have a hard time understanding why their friends are having complications and surgical births and believe that birth is dangerous and scary because of this. I also find the increasing interventions in birth confusing. Previously, the American Academy of Obstetricians and Gynecologist (ACOG) suggested that surgical birth may have been better for women because it will protect their pelvic floor (muscles of the perineum) and prevent incontinence (leaky bladder) in later life and that it will also ensure better outcomes for babies. More recently ACOG office of Communication published a news release Patient-Requested Cesarean Update in which Dr. D’Alton stated “While some data show an association between both vaginal and cesarean delivery with pelvic floor problems and incontinence later, the data are not definitive."(ACOG 2006)

  The American College of Nurse Midwives (ACNM) has as a different view: "The list of reasons women must not think surgical birth is as safe as a vaginal birth is long and ranges from increased incidence of drug-resistant infections to the potential for life-threatening complications from blood transfusions. Women risk permanent damage to abdominal and urinary tract organs, longer recovery times, little to no chance for a subsequent vaginal birth and a premature end to their ability to safely bear children.”(Sagady 2004)

  "ACOG continues to review all of the issues surrounding maternal-request cesarean, but at this time our position is that cesareans should be performed for medical reasons," says Dr. Zinberg. 

Popular Culture

Our birth culture is also affected by the view of birth espoused by popular culture. Few people in the US are probably unaware that singer Britney Spears chose a scheduled c-section. According to a report on CNN, Spears said "My mom said giving birth was the most excruciating thing she's ever gone through in her life. So if a caesarean doesn't happen, I'll be like, 'Epidural, please.”(CNN 2005)

  Television sitcoms offer another look at storytelling. Sitcoms often portray birth as a horrifying and painful experience that terrifies women. Often women are portrayed as angry and bitter during birth, saying things like “you did this to me” or screaming and thrashing about. Although these situations may be portrayed with humor, they still contribute to a negative view of birth.

  The negative messages that a woman receives during her pregnancy can be counterproductive to the mental state in which she needs to enter into labor and birth. I believe that entering into a birth experience with worries caused by horror stories may lead to longer labor and/or complications

  Positive Stories and Empowerment

  I believe that sharing positive and empowering birth experiences and outcomes with pregnant women will lead to more positive birth stories. Some women are seeking these stories in order to be positively inspired. According to Ina May Gaskin, “The best way I know to counter the effects of frightening stories is to hear or read empowering ones."(Gaskin 2003)

  I recall speaking to a woman in the clinic I used to work at telling me she wouldn’t let her sister talk to her about her birth or even let her attend her birth because her sister had such negative memories of her own birth experience. The woman I spoke to chose to pave her own path to her own destiny, by empowering herself and defining who she will be as a birthing woman and a mother and protecting herself and her birthing space from this negativity.

  Sheri Menelli, a childbirth educator from San Diego, wrote a book in 2005 called Journey into Motherhood: Inspirational Stories of Natural Birth. The title of Sheri's book says a lot. Women need inspiration as they journey into motherhood. Each story in the book is written by a different woman but they all have in common powerful words describing their positive birth experiences (e.g., amazing, accomplishment, excited, transforming, peaceful, conscious, understanding, beautiful, and wonderful). At the end of each chapter Sheri adds a short paragraph or so called “A Mother's Guidance.” In these short entries she writes what the women in the birth story did to create a more positive experience.

  When a woman feels empowered during pregnancy with education, understanding and compassion, she is more likely to trust her body to normally and naturally birth, as well as to take an active role in the decision-making process. If her birth takes a different course than what she may have planned she will be able to make decisions based on what she knows to be right and true.

  The birth stories told by women who felt empowered by the birth are very different from the stories of the women who express fear and loss of control. An empowered birth story comes from the depths of a woman’s soul. She speaks carefully yet powerfully about the change that happened to her mind, body and entire being through the birth. A transformation occurs. “In her birthing she is all woman, she is a Goddess, she embodies creation in the core of her being and houses it within her as divinity in humanity, spirit in Matter, energy in form. She is balance. There is no strength so powerful, no beauty so expansive as a birthing woman. She is the Mother.”(Karll 2003) 

Support

Support is another key element in the birthing process. In the US today women give birth in hospitals, birth centers and at home. They choose a variety of care providers and often do not consider what type of birth support may be needed. The common hospital birth attended by a physician is typically supported by nursing staff. Unfortunately, hospital protocols and nursing staff requirements often do not permit the nurse to offer full and complete support to women throughout labor and birth. A woman's partner may be her main support; she also may include her mother, sisters or friends to help. Other women may choose to hire a doula to ensure the best support possible.

  A homebirth with a midwife can be a whole different experience. The stories told by women who have given birth at home are very different than those of women who give birth in the hospital. In homebirth, mothers accept responsibility for their birth process by making informed choices and receive education throughout their pregnancy to ensure the best outcome in birth. Midwives typically provide longer prenatal appointments, often spending an hour or more per visit with clients. They are prepared for birth as a natural and normal experience. Midwives spend time building a relationship with the mother, the family and the yet-to-be born baby. Development of a strong and committed relationship between the birthing mother and the midwife is essential to trusting the birth process. Homebirth enables the mother to experience intuitive birth, which gives her the ability to listen within and use her internal knowledge to monitor the outcome. The relationship between mother and midwife is one that honors the mother's inner knowledge about her birthing process.

  While midwives monitor the mother and baby's well-being during labor and birth, the majority of the birthing process is handed over to the woman. This gives her the ability to empower herself through birth. Carolyn Eustis writes in her essay A Matter of Faith, “It is not that faith creates the reality of birth; it is the reality of birth that creates faith.”(Eustis 1991) The faithful birth creates the positive birth, and the positive story creates hope and trust in a tradition that goes back to the beginning of time.

Patricia M. Couch lives in Eugene, Oregon, and has been providing a variety of care to the childbearing community in Lane County since 1996. She gave birth to two sons: her first son was delivered in 1995 in the hospital with an obstetrician, and her second son was born in 1999 at home. She also helps to raise her three stepchildren. To learn more about Patricia and the birthing services she offers to families in Lane County, Oregon, visit www.PattyCakeBirthingServices.com

References

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