Culture, shmulture

Recently, “Courtroom Mama” wrote a new post [The Most Important Thing] in response to a comment thread from a previous post [VBAC Doesn’t Make it All Better, by Emjaybee], which are both at The Unnecesarean. If you haven’t read the posts you should, to at least give more context; however, briefly, the VBAC post discusses the grief a woman might feel after having a C-section, and the responses she may get from people may exacerbate her grief and/or pain; and The Most Important Thing takes on the question, “How, exactly, does a C-section ruin your life?” Courtroom Mama says, in part,

This is something that may be difficult for a person who had a necessary surgery, or who is okay with having had an unnecessary surgery, to understand. I’ve tried to explain the fact that the outcome doesn’t erase the pain of the journey, but there really is no metaphor. The closest I have come is this:

Imagine you get in a car to drive and see the person you love most in life. You get into a car accident on the way there, are rushed to the hospital, and the doctors save your life. When you open your eyes, your loved one is there to greet you. Now imagine instead that you get into the car, and on your way there, you’re pulled over for driving too slowly, and then taken to the hospital, where your healthy appendix is removed. When you open your eyes, your loved on is there to greet you.*

Notwithstanding your happiness to eventually get to your goal, you might have some questions—or even anger, sadness, or grief—about what happened to you on the way there. Why were you interrupted just for getting where you were going too slowly? How did that justify unnecessary surgery? Even in the first circumstance, might you not still feel trauma from the terror of fear of dying or never seeing your loved one? Getting to see that loved one might be the most important thing, but it doesn’t diminish the importance of your own physical and mental health. This is something that mothers don’t often get to hear: you are important too!

Dr. Amy left a comment which said something along the lines of, “A C-section isn’t inherently traumatic — it’s only a cultural construct.” [Those aren’t the exact words — her comment came up in Google Reader, and I didn’t respond immediately because I wanted to take some time to think about what, precisely, I might say about that. Not having had a C-section, I don’t know by experience how I might react emotionally, but I thought about being a bit of a smart aleck and point out that surgery — cutting into the body — by definition is a trauma, hence the scars that invariably form — such as the one I have decorating the entire length of my sternum — very necessary, but undoubtedly traumatic. However, by the time I clicked over to respond, a moderator had removed the comment and replaced it with something humorous, so I didn’t respond — nor can I look back to see what exactly what was said.] She left a second comment, which was likewise removed (this time before I saw it, so can only guess at the contents); a third comment from her asked Jill (the moderator and blog owner) to “grow up”; and finally a in a fourth comment, she presented her evidence for her original comment. Citing a 24-year-old study, she says in part,

NCB and all that it implies is restricted by race and class. This is not my idea. It was noted as far back as 1986. Cesarean Birth Outside the Natural Childbirth Culture was published in Research in Nursing and Health in 1986. It highlights the fact that “natural” childbirth is a philosophy that is not universal, but rather the product of a particular subculture. It points out that “natural” childbirth emphasizes process over outcome, and it concludes that C-section itself is not particularly emotionally traumatic, but has the power to be traumatic among women schooled in the rhetoric of “natural” childbirth….

A notable feature of the literature describing the negative psychosocial consequences of cesarean birth is its emphasis on a particular group of women. Specifically, this literature emphasizes the values, expectations, and experiences of women who belong to what can loosely be termed the “natural childbirth culture”. For women interested in natural childbirth, typically from the middle classes, the experience of birth is an end in itself, and cesarean birth is a devastating interference with nature.”

In other words, “natural” childbirth philosophy does not represent universal truths; it is merely a reflection of the cultural pre-occupations of subset of Western, white, middle class women.

The authors are concerned that the values, expectations and reactions of women outside the charmed circle of NCB advocates are simply being ignored. The basis of this study is open ended interviews with 50 women who were medically indigent. In contrast to NCB advocates, the interviewees were predominantly African-American, of limited economic means, and of limited educational achievement….

The full comment was much longer (it’s currently on page 2 of the comments, if you want to easily go there and read the entire comment). Some follow-up comments derided her for choosing a 24 year-old study, while others provided counter-balancing arguments, citing their own or others’ experiences, as women who were not “Western, white, middle class,” yet still found C-sections to be traumatic. They were all interesting and had valid points, but I want to take a different tact. Accepting that this study is valid and still pertinent for today, there are many observations I would have.

First, not every woman who wants and plans a natural childbirth but ends up with a C-section (necessary or not) finds them traumatic. My sister-in-law whom I’ve mentioned before was such — she planned a home birth, took Bradley childbirth classes, the whole nine yards; but ended up with a C-section when not even forceps could help bring the baby down and out. While she found it physically traumatic, and had a lengthy and difficult recovery (compared to vaginal births with or without forceps), I don’t know that she was emotionally traumatized by it — in fact, she was waffling between trying for a VBAC and going in for an elective repeat Cesarean during her second pregnancy, when labor started. She became afraid of a repeat long and hard labor with another C-section, and decided just to “pull the trigger” and go for a C-section to start with. Although I never discussed it with her (and she has since passed away due to colon cancer at a very young age — know the symptoms!), I know that she was in charge of her labor and birth the whole time and ultimately chose the C-section herself, without the doctor giving undue pressure.

Second, while all surgery is physically traumatic, any surgery can be emotionally traumatic, no matter how necessary it might be. Part of that depends on the person undergoing the surgery; and some of it may depend on the type of surgery. There are probably thousands of people today who will be taking Valium or some other similar drug tonight to calm them down so that they can sleep well before their planned surgery tomorrow. That’s just the nature of things! It can be very scary to think about somebody cutting your body open and rummaging around inside; and although the risk of death for most surgeries is fairly low, it is always a possibility, and for some people even that slight possibility can be extremely nerve-wracking.

Third, so what if it is a cultural construct?!? What does that mean — we shouldn’t hope for the best and try for the best, in case the worst happens? Should we just keep our mind on the dirt, focusing on our toes, never looking up to the heavens and imagine that we can fly? I have an analogy (don’t I always? ;-)):

Not everyone wants to be a doctor; some are pretty grossed out by the whole idea of dealing with people’s bodies and bodily functions, or couldn’t make it through med school with cutting up cadavers and all that. A few might like the idea for the money, but other than that would gladly pass on anything to do with medicine. Does the fact that most people wouldn’t want to be doctors if they could, mean that those people who want to be doctors but for some reason can’t (whether they can’t get funding for med school, can’t pass certain courses, etc.) shouldn’t feel badly that they can’t fulfill their lifelong dream of becoming doctors? Is it just a “social construct” or “cultural construct” that some people have the dream of learning how to heal people?

Something about this topic also made me think about those pictures you might see of the orphaned children in Africa — you know the picture — the child with flies all over his face, and he doesn’t even bother to brush them away. Wouldn’t that just drive you nuts, to have flies walking around on your face? Is that just a “social/cultural construct”? In a way, yes — for children like that, there is no real reason to brush away the flies, because they’ll just settle right back down again — there are too many flies to fight. You and I probably can’t imagine that, because we’ve never been in a situation like that, so our social/cultural upbringing leads us to shoo away the flies, not expecting them to land again, while this child’s upbringing leads him to just live with flies on his face. But does that mean that the child is not bothered by flies on his face? — that given the opportunity, he’d as soon choose to have flies as no flies on his face? — that there is no inherent difference between having flies on one’s face and not? Surely no one would say that. Yet he is probably not “traumatized” by the flies — doesn’t have the same reaction that we would have, because he’s become inured to it. I don’t know about you, but it would drive me nuts to have flies on my face all the time. Eventually, I’d probably get used to it, but I wouldn’t like it. I may stop complaining, but that doesn’t mean it’s not bothersome. I may have more pressing needs (such as trying to find food to eat) that would render flies on my face as insignificant, and might even become inured to them myself to a certain extent, but I can’t imagine ever saying that it doesn’t matter whether there are flies on my face or not. Nor do I think that this child would say that, even with his social/cultural construct.

So, yes, I think we can be culturally influenced to expect certain things and to react in certain ways — examples too numerous to be told could be brought up in just a few minutes to support that point. People living in areas with high infant mortality may view their pregnancies and/or infants in a different way from how those of us living in areas of low infant mortality would view it. I remember reading something years ago, in which American infant mortality back in the 1800s or early 1900s was so high (particularly in big cities, which were notoriously filthy and nasty — horse manure in the streets, little or no indoor plumbing, etc.), that mothers were cautioned not to become too attached to their children in the first year of life, not to count the child as really alive until they lived past their first birthday. Surely a similar attitude must exist in other cultures that still have high infant mortality. Yes, it’s a social/cultural construct — a survival mechanism, if you will. But would anyone argue that it’s no big deal whether a mother is attached to her children or not? Sure, in countries where mothers have a pretty good chance of losing an infant, it may be preferable (in one way) for her to remain detached — but wouldn’t it be a better thing to try to reduce infant mortality, than to reduce a mother’s attachment?

Finally, I will close with a comment made on that thread by Patrice, which may shed additional light onto the topic:

I can say that I’ve been deeply affected by the comments on blog post. So affected that I decided to blog about my own first birth experiences. http://mamachildbirtheducator.blogspot.com/2010/04/battle-of-birth.html One thing I remember clearly about it, is my need to forget. My need to not complain. It wasn’t something that was forced upon me. It’s very much culturally ingrained in black women not to talk about trauma’s, not to complain about pain both physical and emotional and in cases not to even recognize it. Culturally we’ve learned to swallow our misery, deny shame, break our backs emotionally. The subject of birth and traditions of birth with black women over the last 50 years only shows how even more marginalized we are, not only by others outside our cultural, but within. We have pain, we have birth trauma. We just need to learn it’s okay to talk about it. We too, have to make our voices heard. We have to realize it’s not just, the way it is. Like everything else this system throws at us.I defy you, Dr. Amy, to try an tell this Black woman, this Black mother, otherwise.

And now, Dr. Amy, since I know you read my blog, feel free to respond — after you’ve read the entire post, of course. I won’t delete your comments unless they get way off track. If any of my readers who have had cesareans think that they may be upset by remarks along the lines previously quoted in this post, please don’t read the comments, just in case.

Vita Mutari

Thanks to Diana, I have come across a new blog that I am sure I will love. In this post, Vita Mutari, which translated from Latin means “life transformation,” she discusses the difficulty that sometimes arises with terms surrounding labor and birth:

So I was asked today again about the pain of childbirth…and again I expressed my frustration that what we feel in labor with our babies is “intense”, “incredibly huge”, etc…but that I don’t believe that there is a word in the English language to express what it feels like, as it’s totally unique to anything else you will ever feel in your life. It demands full attention of your body, your mind, your soul….it is one of the few experiences we have that transcends the physical and is all encompassing, taking everything you have and everything that you are….only to have you emerge on the other side transformed, changed permanently – you will never be the same.  Sometimes you have a really difficult experience and you come out the other side feeling beaten down, feeling weak and dealing with the consequences of the negativity for the rest of your life. Other times you will emerge with an entirely new respect for yourself, your body, your strength…you will suddenly see yourself as the amazing person that you are!

VITA MUTARI

Which (finally) brings me to these two words…my new favorite words.  I think I will start using these words from now on when someone asks about what labor feels like or the pain of giving birth…. VITA MUTARI!!  Labor feels like “mutari”….the contractions will grow and you will feel Vita Mutari …the vita mutari will grow in intensity….as the mutari increases, you may vocalize or call out…

Oh, yes! I like this!! And along those lines, this birth story and this “Sour Grapes” post are fitting.

Updated to add…

This from the Irish Times: Pain relief “doesn’t lead to more satisfying births”:

“Research on women’s satisfaction with labour has found that the one-on-one support they got from the midwife was a much more important part of the actual experience than the experience of pain. Paradoxically, a lot of women talk about a high level satisfaction along with a high level of pain.” – Midwife and professor Denis Walsh

While there are certainly times when labor pain is “pain” and an epidural can “transform what is a miserable experience into one they actually enjoy because they are not suffering the awful pain,” [quote from a doctor in the article], oftentimes a doula or a midwife or some other support person can likewise transform “pain” into “mutari”.

Another good hospital birth story

J’s birth. Enjoy.

Quote of the Day…

One of my friends had this on her facebook status:

“Those who’ve abandoned their dreams will discourage yours. Your job is to not listen.” Bill Baren

Is that not so true? Serendipitously, I had just finished reading an email from a birth-y list in which the topic was “birth circles” and talking about birth; and the woman said that she was at a gathering of moms recently when the topic (of course) turned to birth, and all the mothers were very vocal about their wonderful epidurals and “why would anybody want to go without one”; and this woman felt intimidated from even sharing her experience (which would also answer the question why some women would choose to forgo an epidural). Fortunately, one other woman was also reticent, and when asked about her experience, told her natural-birth story, which opened the door for the first woman also to tell her story.

The above quote reminded me of my sister, who is one of those “planned a natural birth, had a horrendous labor, why didn’t I go with an epidural sooner” moms, and she tends to discourage others from even trying. I understand why; but just because you tried and failed (or rather, the system failed you), it doesn’t mean that others will likewise fail. Nor does it mean that even if they try and fail, that there was no benefit in trying.

But this quote is also illustrated by the “crabs in a bucket” story. Apparently, when catching crabs you can toss ’em into a bucket and don’t even have to put a lid on, because if you get at least two crabs in, then it doesn’t matter how big the bucket is nor how many crabs you put in — if one crab tries to get out, the other crabs will grab it and drag it back down. How many women have abandoned their dreams, and whenever anyone still reaches for that same dream (tries to climb out of the bucket), will actively discourage or pull them back into the place where they are all trapped?

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K’s birth story

Today is my oldest niece’s birthday, and the first grandchild of our family, so I thought I’d give her birth story (from my perspective).

My sister had planned a natural birth — that is, she intended on giving birth without any drugs. She did not take any childbirth classes, read few if any books, didn’t ask about her hospital’s policies or procedures, just assumed that since billions of women for thousands of years have been giving birth without the aid of narcotics, that she’d be able to do it too.

When my sister went into labor, there was a lot of snow on the ground — for us in Mississippi, anyway! We were actually able to build a snowman about as tall as we were, which has happened maybe two or three other times in my life (the other few occasions we had a lot of snow, it didn’t pack together well). So, when it became obvious that the contractions were regular and not going away, my sister and her husband headed to the hospital. There was none of this, “stay at home as long as possible” because not only was there snow on the ground, but also the hospital of their choice was about 90 minutes away in good condition. They wanted to leave in plenty of time because they weren’t sure if the roads were going to be treacherous with the snow, and wanted to make sure they didn’t have to drive fast and end up in a wreck, or hit an icy patch and spin out. (The roads were actually fine, once you got on the highway.) When she got to the hospital, they wouldn’t admit her because she wasn’t 4 cm dilated yet, so she went to her in-laws’ house to wait. And wait. Eventually, she dilated enough, so they admitted her.

Once she was admitted, she was made to be on continuous monitoring (although I don’t think there was a medical reason for it — she hadn’t been given any pain medication, and I don’t think she was given Pitocin until much later). At one point, she had to use the bathroom, but they wouldn’t take the monitor off. Nor did they bring her a bed-pan. Finally, she unstrapped herself and relieved herself, and the nurse came in and chided her for taking off the monitors and getting out of bed, because it meant that she (the nurse) had to leave the nurse’s station and come into my sister’s room to put the straps back on.

Details are a little fuzzy at this point. I know she finally got some Stadol to help with the pain, and she slept for a few hours. Her labor was over 24 hours (but I don’t remember if that included the time before they left for the hospital when she was in early labor, or just the “active” phase), much of that time was spent flat on her back. The baby was born face-up, which means that she was posterior during labor as well, meaning my sister had to deal with back labor much of that time — and perhaps all of that time. Had she been allowed to move during labor, her labor probably would have progressed faster and more smoothly, and the baby would have rotated into a better position. Instead, she followed orders and stayed in bed. Finally she got an epidural, which she said was wonderful. Her experience was so bad that she jokes that when she went into the hospital to give birth the second time, she walked in backwards, so that she could get the epidural that much faster. She pushed for four hours, and my niece was born with the worst cone-head I’ve ever seen. I guess the “good news” is that she avoided a C-section.

During labor, I might have gone into her room once; maybe twice. Our whole family was excited — first grandchild and everything — and they hadn’t found out the baby’s sex by ultrasound, so there was still the anticipation of finding out if the baby was a boy or a girl. We camped out in the waiting area. My mom was obnoxious to get in my sister’s room. I found out much later that my sister had told the nurse to keep my mom out because she didn’t want her in there. I can’t really blame her — my mom is such a “nervous Nellie” when it comes to things like this that had she been there, it probably would have gotten my sister nervous and perhaps made her labor take even longer.

Still, after the baby was born and we all went back into the room, my mom had a legitimate reason to complain. My sister’s mother-in-law — actually her husband’s stepmother, so no blood relation at all — got to the baby first and held her before my mom did. Of course my mom didn’t say anything, but she didn’t like it.

Main lesson I learned from this: if you plan a natural birth in the hospital, you must put forth some effort and do some homework if you actually wish to succeed. My sister might have been able to accomplish giving birth without pain medication under the circumstances related above just be sheer grit and determination; but it wouldn’t have been a pleasant experience, and probably not an empowering one. Had she done some reading and learning beforehand, she would probably have had enough strength to ignore the nurses’ commands to stay in bed, and instead would have labored in a way that was more comfortable to her. But, she was a “good little girl,” and followed orders. Consequently, she had a horrible birth experience, which ultimately was unnecessary.

What does natural birth sound like?

This is probably one of the biggest questions people who have never given birth without pain medications or who have never seen such a birth might have — just in general, as well as particularly if they are planning a natural birth.

Here is a good video that shows a woman vocalizing through her contractions, and as the contractions increase in intensity, her “singing” or moaning also increases in intensity. While many of you may possibly be put off by hearing this (if you’ve never heard something like this before, only watching the medicated births on “The Baby Story” or “Discovery Health” or other similar shows), and may even feel more inhibited now, the reality is that when you’re in labor, the last thing you’ll likely worry about is what other people think of you. After all, if you’re allowing half a dozen people (mostly strangers) to stare at and touch your genitals possibly for hours, then how can vocalizing be any worse?!

One caveat, though, is that since most women have some sort of pain medication — typically an epidural — in the hospital, some nurses may be uncomfortable with how you’re sounding. It’s a typical human response — see somebody in pain and want to help them. Unfortunately, if you’re wanting to give birth without pain drugs, and the only “help” a nurse has available is pain drugs, then she can’t do anything and may feel bad, and may undermine your attempts and desire to give birth unmedicated so that she will feel better. (I’m not talking bad about L&D nurses that do this — I think many of them have the right desire, but just don’t have the right tools to help you; some nurses, though, will not be supportive and will deliberately undermine you just because you’re not fitting into their little mold.) I read a blog recently which is written by a newbie L&D nurse in which she said just this thing — that she feels bad for women in labor and wants to make things better, so she offers them drugs, since that’s the only help she has. I suggested that she take doula training (or at least read some books on what doulas do) so that she has more ways of helping women other than just giving them shots or calling the anesthesiologist.

But enough of the intro: here is the video (which I found by way of Empowering Birth blog)…

This doesn’t mean that every woman is going to vocalize like this. Some women sing, some pray, some chant, some moan softly, some keep it all inside. One woman whose birth story I read said that she felt like she was roaring loudly when she birthed her baby, but when she watched the video, she found that she was absolutely silent — all the “noise” she thought she was making was just inside her own head. I understand that. I felt like I was being loud, but my husband said he didn’t remember me making much or any noise. But this video is an excellent visual and auditory lesson (for anyone attending or giving birth) of what a real birth might sound like. Too many birth videos don’t show this type of thing — only the “sanitized” or “quiet” version. You know the type — where they cut the audio and start playing soft, flowery music. The video only tells half the story; without the audio, you’re missing a hefty dose of reality.

 

This poll allows repeat voters and is multiple choice, so if you have five children but only three birth videos, you can choose “yes” three times and the variations of “no” that fit the other two.

— Update — For some reason the poll associated with this question won’t show up in the post, so if you want to vote, click on “poll questions” in the right-hand sidebar and look for the poll that asks if you have videos of when your child(ren) were born. Also, just in general, if you choose “other” on any poll question, there should be a little box to clarify what the “other” is, and I always burn with curiosity when I see that somebody would do some “other” thing, and I don’t know what it is! (Yeah, I’m curious that way.) 🙂

Wonderful list of birth videos

Go over to Wonderfully Made Bellies and Babies for a long list of birth videos on YouTube. I know I’ve seen several of them, but many more names look unfamiliar to me. It looks like I’ll have a fun night tonight on YouTube! 🙂