Tuesday 25 November 2014

The not-so-perfect, perfect birth

There is a lot of pressure on expectant mothers to have the perfect birth. They are encouraged to write detailed birthing plans, from pain relief options down to aromatherapy and whale music; as though to make your experience as close to a spa day as humanly possible. After suffering from post traumatic stress after my first birth, I have struggled with the thought of giving birth again; the thought of going through what I did the first time around seemed unthinkable to me. Throughout this pregnancy I have felt very low, wondering if I could cope with a newborn again, let alone the pain of childbirth. Opting for an elective cesarean this time around was something that was not an easy decision, but seemed right for me and my family. Now I should know, of all people, that births rarely go to plan but I somehow thought I was exempt from that by having an elective cesarean. 

A week before my planned cesarean, and two weeks before my due date, I started to get a lot of pain. I felt I was unlikely to go into labour early as I was two days over with my first so I figured the pain was just Braxton hicks. At my last appointment with the midwife I asked her about the pain I was in - extreme lower back pain and bad nerve-type pain when I walked and contractions seemed to be happening often but weren't regular. The midwife told me that the pains sounded like 'head fitting pain' – the pain of the baby's head getting lower into my pelvis. Despite my previous irregular contractions with my first labour I still opted to trust a professional over my own instincts. It probably sounds silly to you but I have no idea how to take my own pain seriously. I have learnt to deal with pain - both physically and emotionally - by trying to squash it, as though it was some kind of weakness. I walked the mile long walk home with my 3 year old, stopping every few minutes to deal with the pain.

The day went on and the pain got worse, but the contractions did not seem to follow any pattern. The pain also felt a very different pain compared to my first born's - much lower down and pelvic, as opposed to higher, more period-like pain. I rang the hospital triage about it to see if I could be examined and they told me it sounded like head-fitting pain too. Two professionals, who was I to doubt them? 

So I battled on through the night, taking cocodamol and using breathing techniques to cope with the pain. What the hell is this 'head fitting pain'? And how come no one told me about it before?! I didn't get much sleep but once I was up the pain eased a little and I felt relieved that I would probably be able to have my elective cesarean as planned. But things soon heated up again. I tried to time these so called contractions but got frustrated and gave up because they were all over the place - roughly every five minutes but didn't seem to be getting longer or closer together. The pain was so intense though and I was mentally feeling like I couldn't take much more - how long was this going to go on for? No one seemed to be able to tell me. I rang another midwife for advice. Yep, head fitting pain. They all must have some sort of handbook on head fitting pain and who was I to doubt them? 

By the second evening I was close to tears and exhausted at the thought of another sleepless night. I tried ringing the labour police again (aka. triage) but no reply. I decided that I was going into hospital no matter what, they'd at least be able to refer me to page twenty four in the head fitting pain handbook, telling me when the appropriate times to question symptoms and waste hospital time were. 

On arrival I was directed into a waiting room and told do a urine sample. There's something about medical surroundings that make my body react; my contractions slowed right down again and I couldn't even pee in a pot. What pregnant lady can't pee in a pot?! I may as well have had hyperchondriac stamped on my forehead. I looked down at my belly and convinced myself that, yes, I was in fact pregnant, and quite possibly in labour. Once I'd been taken to be examined the little monitoring machine showed a graph which measured my contractions. And there it was on a bit of paper: Science. I felt like taking it and framing it on my bathroom wall for the next time I considered avoiding going to the doctors. Science says I should trust my body. 

It turns out I was 7cm dilated. Ring any bells? Yes, the exact same thing as with my first born. Each medic I saw questioned my decision for a cesarean - "do you not want to try for a natural delivery now?" As though 30 hours of labour had really sold it to me again. No, thank you. I somehow knew I would not be able to deliver naturally. But as each person asked I grew slightly weaker. I've come this far, maybe I should continue? Maybe going into labour naturally was a sign I should deliver naturally too? Neil started to speak for me, knowing I would be deluded with thoughts of what I should be doing instead of what's right for me. I started to feel anxious, wondering how long the pain would last and whether there'd even be time for a cesarean. And that's when something amazing happened for me; a word of encouragement at just the right time. 

During my appointments with my psychologist, she gave me a number of exercises in order to help me to deal with post traumatic stress from my first birth. She gave me cognitive behavioural therapy techniques and meditation exercises in order to deal with stressful situations more effectively. One of these exercises was to develop my 'compassionate self' - in other words, to learn to be kind to myself and override the critical thoughts that I have about myself. She told me I needed to imagine a compassionate figure in these meditations and to record what positive words of affirmation the figure had. I opted for an angel: a muscular, tall, protective angel. I felt a little stupid imagining this figure standing there and listening to what he said, but it helped to have an image to refer to that would calm me in times of anxiety. 

One time the angel showed me a picture in my head of a huge storm at sea. I felt quite scared by this image as the waves crashed and did nothing to ease my anxiety. Then he took me to the eye of the storm - a place where I was still surrounded by chaos but almost encased in a room of glass, looking out and protected. The angel told me that I was not exempt from pain but that I could be protected within it, that I somehow did not have to carry the weight of it - that was not my responsibility. 

So in the midst of labour, when I was laid in pain and wondering how long this was going to go on for, I received a message from a friend. Not knowing anything of my 'imaginary angel,' she sent me a message after finding out I was in labour and it gave me a sort of inner strength at just the right moment. She said "I'm praying you know peace in the middle of all that's happening. It's like you're in the eye of a storm." I immediately felt calm, as though there was a tangible presence next to me. Who knows if there was really an angel, or if I was high on drugs, but something changed after that.

So, thanks to the help of a friend, an angel, and a shot of diamorphine, I felt all the tension go and an excitement that I have not felt in a long time. I was close to meeting my baby – the baby I very nearly didn't have due to my fears. I was wheeled to theatre, my heart's desire – though in reality I had no heart for any of it, just a baby at the end. Neil was asked to leave theatre until they were ready to operate. It felt strange to be given a spinal when I was not delirious with pain like my first birth –  It all felt very sane, 'normal' in fact. Neil was invited back in as though we were in fact there for a tv show, under the bright lights the stage was set. Neil held my hand. 

There seemed to be a lot more tugging and pulling than last time - I think my memories of the first cesarean are distorted by the fact that being out of pain was all I cared about at the time. Now all I cared about was the whole thing being over as quickly as possible. I tried to overhear what the surgeons were uttering. Was the baby ok? Was my anatomy in order? Would they be kind enough to give me a nip and tuck while they were at it? 

I remember the moment my firstborn was delivered: the deepest tug from the pit of my womb and an unforgettable cry. This time there was lots of tugging about, feeling my whole body vibrate with each tussle, as though they were in some sort of tug of war with the baby. It turns out they were because fourceps had to be used to remove him as he was stuck deep in my womb. I now know that having a cesarean was a very good decision indeed - this labour would not have progressed and would have resulted in a cesarean anyway. 

Eventually feint gargled cries could be heard. They took him for checks and I waited while they told me it would take about thirty minutes to stitch me back up. Eventually Neil brought him to me and I strained my head to get a look at him. I could just about make out his tiny little face: his beautiful, beautiful face. And he was talking to me; making little noises at me. It's quite an incredible thing to meet your baby for the first time.

My birth was not pain free; I felt misunderstood; I felt overwhelmed at times. But, to quote the Kung Fu Panda, I felt an 'inner peace' throughout it all. My birth was far from perfect, but the things I've learnt from it have been invaluable. The name we had already chosen for our baby was Freddie; his name means "Rules with peace." He is a lesson to me to choose peace over anxiety - to let it 'rule' over me despite my circumstances. 

Monday 3 November 2014

I'm not posh but I'm not pushing

cesarean, csection, not posh but not pushing, childbirth, birth, parenting, pregnancy, birth plan, mother diaries
"Too posh to push"

I'm not sure who invented that phrase or why class has anything to do with giving birth. It assumes that, if you're privileged, birth can become something on a par with getting your bikini line waxed. The nitty-gritty births – the 'natural' kind – are for the hardcore, working class mothers who are prepared for a bit of hard graft; popping out their babies in time to make meat and potato pie for tea. And along with the people who consider c-sections something for snobs, there are also the mothers who rave about giving birth naturally. You hear their stories of how wonderful it was to have a four hour water birth on nothing but half a paracetamol. "I did it!" They say. It's no wonder that when my first birth resulted in an emergency c-section that I felt like a failure.

I always thought that if I were ever to give birth again (and maybe because I thought I never would), that I would give birth naturally, as though to prove something to the world. I'd actually got pretty good at blocking out all things birth and babies and when I found out I was pregnant again, four years later, the memories of a difficult birth were all too raw. I was referred for help to deal with post traumatic stress but despite my obvious anxiety this did not stop the consultant recommending that I try for a natural birth 'because it's best.'

Best. People are very good at telling mothers what is best, and at no other point in a woman's life is she told more about what is 'best' for her than when she decides to have children. Best for what? Statistics? Finances? Respectability? If you are considering my medical health then my mind comes into that equation too. Usually the people who seem to be most forthcoming with advice about what is best are the people who have never been through what you have.

Now don't get me wrong, I am not one to shy away from a bit of pain. After having experienced a burst appendix during my current pregnancy I can safely say that was the most intense pain I've ever been in. It was, however, a lot less traumatic than my first birth, and despite a mere 32 hours of labour I still wondered whether to try for a natural birth again. After all, c-sections are by no means an 'easy' option; they involve intensive surgery, pain and weeks of prolonged recovery. They involve scaring, body disfigurement, self-injecting and wearing rather fetching embolism stockings for about a week. People who have never experienced one say to me "Oh, just opt for a c-section," as though it really is on a par with getting your bikini line waxed. The truth is, there is no easy way to give birth and no right way at that. What is best for one woman will be entirely different for another.

What has struck me about being given an option this time around is how much pressure there is on women to have the perfect birth experience. There are many women who have had positive experiences, but a lot of these women do not have grace for those who do not – it's as though they can take credit for their genetics and circumstances; as though birth is purely about mind over matter and determination. This attitude makes the rest of us feel penalised if we have complications; looked down upon if we opt for more medicalised ways to deal with childbirth.

The thing is, I need to have grace too. Grace to accept that some women do find childbirth wonderful and that I was just one of the unfortunate ones. I need to learn to listen to their stories and accept them as encouraging experiences. I need to know that a difficult birth experience does not necessarily equate to another, it just might. But every women is different, and one woman's motive for having a natural birth will be entirely different to another's. I have come to realise that, for me, giving birth naturally had become more about identity and self-worth than about actually doing what is best for me or my family. It's not like I didn't give it a good go the first time round – my problem, if anything, is that I push myself too much. Refusing pain relief at 8cm dilated is just damn-right stupid. I could do that again; display my working class roots to the full, but what that would do for my mental health is another thing entirely. At what point would I be kind to myself and say I needed pain relief? At what point would I accept things not going to plan? At what point would I be proud of myself? What would it take to say "I did it!"? You see, I did it the first time around. I don't need your applause for that; I don't get a medal. No one looks on my child any differently because of the way I birthed him.

So, this time I am having an elective c-section and you have no idea how hard it has been for me to make that choice. It is not, as some may think, an easy way out for me or a means of avoidance – it is about giving myself the birth I really want. It is about choosing a birth where I can be more prepared for the pain and the healing and know roughly what that involves. It is about being in a good place mentally when my baby arrives. It is about giving myself a birth that fits my preference for planning and knowing roughly what's around the corner. It is about choosing a birth that means I can prepare my son for the impending arrival of his sibling and make sure he is cared for. It is about accepting that long labours and big babies run in my family of small-framed women. And yes, it is about having a better night's sleep before the chaos starts. Above all, it is about being kind to myself. Call me posh all you like, but I, along with all women, deserve to have a good birth. I'm not posh, but I'm not pushing.