What is a ‘good’ birth?

I am one of the very lucky people in Toronto who gets to work out of the Centre for Social Innovation. This shared workspace is teeming with brilliant, engaged minds belonging to individuals who all want to make the world a better place. Every day I am surrounded by people working in social justice, the environment, food politics, public spaces and other important fields. With such a committed group of people come a lot of shared values and the interest that is fostered between members here is really motivating; everyone truly seems to care about each others’ projects, even when they seem to have very little in common with one’s own. As the only (I think!) doula in the space, people know when they see me packing up and rushing out the door mid-day, or when they don’t see me at all for a couple of days, that I am more than likely supporting a woman in labour. Upon my return I am often warmly greeted with questions like, “Were you at a birth?”, “Did somebody have a baby?”, and sometimes the hardest to answer, “Was it good?”.

Often, I get to respond to that last question with a simple, “It was amazing.” This is almost always my reply when a birth turns out exactly as my client had hoped and wished it would, or at least nearly so. All of the births that I have attended so far have been “good” in the sense that a healthy baby was born and got to go home with a healthy mom. As anyone who reads this blog knows though, I truly believe that there is a lot more to birth than simply a healthy baby and a healthy mom. Obviously, without question, that is the fundamental, most essential thing, but I know from my research, from my experience working with birthing women and from deep within myself, that as a society and as individuals we are capable of much much more. Birth is an extremely complex phenomenon that cannot be limited to questions of physiology alone.

I recently attended the birth of a woman who went into labour extremely well-informed, with clear ideas of what she wanted (and what she didn’t want) and having negotiated in clear terms with her healthcare providers what she would and would not be permitted to do throughout her labour once in hospital. Throughout her labour this mom was a champ. She laboured for a very long time and coped with some very intense stuff, both physically and psychologically. She had to make a lot of difficult choices, wade through conflicting recommendations and negotiate and renegotiate with doctors and nurses many times over, all while coping with strong contractions and the usual ups and downs of labour. In the end though, the outcome was not what she had hoped it to be, despite her best efforts and the best efforts of those around her to provide support and the freedom to make decisions without pressure or fear. Baby was born healthy and mom was healthy too.

So, was it a good birth? If your only concern is the health and safety of mom and baby, then yes, unquestionably so. If though, you also think that there is importance in women achieving the goals that they set for themselves, then it’s a little more complex. To me, what matters is that women feel empowered by their birth experiences, regardless of their specific practical goals and wishes beforehand. It may seem difficult to understand how it can be possible to have an empowering birth experience when the actual outcome is contrary to pre-established goals of the birthing woman. This is why this case in particular,  stands out to me as a complex, but ultimately “good” birth experience.

Did she achieve her practical goals? No, unfortunately, she did not. However, because this mom was committed to being informed and involved in the decision-making process and because she had the support necessary to ensure that that was possible, even when she was deep in labour, she is now able to look back on this experience with a sense of pride and accomplishment (as she well should). She knows that she did absolutely everything possible to try and achieve her ideal birth. She also knows that the steps that were taken that gradually led her to a different birth experience were necessary and, ultimately, inevitable. She feels that she was knowledgeable and emotionally prepared going in, that she was given useful information throughout (though some of it, at times, was contradictory when the same questions were asked of different practitioners), that she was given the space she needed to make decisions clearly and confidently and that it was ultimately her decision to have the birth experience that she had. She may feel disappointed in the outcome (and rightly so, the loss of a hoped-for birth is a significant loss for many women), but she does not feel disappointed in herself. From my perspective as her doula, that is what makes this truly “a good birth”.

If you are planning your own upcoming birth, consider your goals carefully. Are they all centred around the practical aspects of the experience (e.g. who will be there, where you’ll be, what medications or interventions you want or don’t want, etc.) or are you also considering more complex or emotional goals? For instance, is it important to you that you feel involved and informed in all decision-making? How important is a sense of control to you, both in your normal daily life and in thinking about your birth? Have you spoken to your healthcare practitioner about these aspects of your birth? Similarly, have you sincerely acknowledged the possibility that the outcome may not be exactly as you hope it will be? I believe that for women to have truly empowering birth experiences, they need to know what they want (and don’t want), but they also need to accept that what they want may not be possible and think about what it will mean to them after the fact if it is not. Thinking about how you will feel if things don’t go as planned and how you will cope with those feelings is the first step towards coping with an unwanted birth outcome. Being optimistic that you won’t ever need to rely on that type of preparation is wonderful and I would encourage it, but denying the fact that you might could set you up for a fall.

A doula can help you to explore your feelings prenatally, so that you are able to identify and deal with any anxieties or fears ahead of time.  A doula can also talk with you about the “don’t wants” or absences in your birth plan and help you to acknowledge the ways in which these may be implying submerged fears. By doing this, you not only prepare yourself emotionally for coping with a less-than-ideal outcome should it arise, but you also could be helping yourself to reach the ideals themselves by ensuring that fear and stress are not hindering your labour progress.

A “good birth” means different things to different people – thinking in advance about what it means to you can be the key to making sure that you have one, no matter what the practical nature of your birth is in the end.

~~~

[P.S. So that you all are aware, I asked my client’s permission prior to writing this post, given that its content may identify her, if only to herself. I also took steps while writing it to make it as vague as possible in terms of identifying features. I take the confidentiality of client information very seriously and wanted to make sure that everyone out there knows that!]

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