If you’re reading this, it’s because I care about you, and I want you to rock your birth. I believe you deserve the best. If “rocking your birth” sounds like something other people do and you just want to “get through it” with a healthy baby — girl, raise your expectations. You’re both too valuable to whiff on this one. If this is your first baby, it’s even more important, because it will set the tone for your future births and may determine your options for the rest of your life.
Please don’t feel judged that I’m sending this to you or like I’m trying to tell you how to do things. In fact, I don’t care how you give birth — that’s your business. But because I care about you and this incredible journey you are on, you have to know you’re facing a system where great maternity care is a gamble for most women. Nine in ten women lose that gamble.
I’m not trying to scare you — I’m trying to power you up. I want you to learn from my experience and from what I’ve picked up from other women who have gone through this — good, bad, and ugly. I don’t ever ever want you to say, “If only I’d known….!” about your pregnancy and birth.
I’m going to lay it out for you here, so get ready.
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#1 You Are in Charge
Now is not the time to “wing it” or let anyone else take over, including your care provider. This is Step #1 to becoming a mother, when you will be making all kinds of decisions and will be asked to do all kinds of things that are outside your comfort zone and that you may feel completely unprepared or unqualified for. That’s okay. Put on your Game Face, because this is one of life’s all-time best learning and growing opportunities.
When I switched care providers at 41 weeks, 6 days pregnant, I believe that’s when I became a mother. Until then, I’d been floating along, doing my best to advocate for myself while also getting along with my care provider, who I actually really liked. When I decided to switch from her to someone else, I was choosing my baby over everyone else: over that provider, who had been so sweet and nice to me; over my family, who would surely call me “high maintenance” behind my back; and over my friends, who already thought I was crazy for wanting a natural birth. But I didn’t feel 100% safe with her, and I knew that’s what my baby and I deserved.
I can’t say this enough: this is your show. It’s your body. It’s your baby. You are responsible for the decisions you make, and you will bear the consequences – good or bad – for any decisions made about your care. There are a few ways this can go: it can be traumatic and life-changing in a bad way; you can “get through it” just to get to the other side with some minor complications; or you can grab the bull by the horns and do everything possible to make it the safest, most positive, most life-affirming experience you’ve ever had, and something that will make you love and respect your own body in a profound new way.
Childbirth is unpredictable, but that is all the more reason to prepare for it and embrace it. You will never have another chance to give birth to this child.
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“Unlearning” about birth is almost as important as learning about it. There’s so much inaccurate, outdated information and so many negative messages out there, you kind of have to start from scratch. Accept that a lot of what you think you know is simply not true. We live in a country where 1 out of 3 births is by surgery, and many of those surgeries are “emergency,” even though optimal care says that the majority of women could give birth safely without medical interventions and without complications. We create a lot of emergencies in the U.S. (How many of your friends have had unplanned c-sections?)
Do not waste your time on What to Expect and general pregnancy websites. Most are full of outdated and conflicting information. Don’t even think about taking the “childbirth class” at the hospital.
Do start with Birth Book by Steve and Sarah Blight. It’s easy to read and high quality.
Do get over and watch The Business of Being Born. Today. Right now. (It’s on Netflix, too.)
Finally, get in a good, reputable childbirth class outside of a hospital. This is an amazing process and the more you know, the less there is to fear. Education is power.
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#3 The Thing About Routine Birth
I’m going to skip you ahead a few steps here. When you start researching and really learning how awesome birth can be–and not some emergency horror show like you see in the movies–and when you start formulating a plan for how to make birth the safest it can be, you’re going to find that what most places provide for care doesn’t match up to what your research shows as most beneficial and least risky for you and your baby.
Here’s a (really long) example:
> Evidence-based care for you means freedom of movement, freedom to eat and drink as you like, intermittent auscultation to monitor your baby’s heart rate during labor, one-to-one continuous support by someone who is educated in childbirth, water immersion for pain management, privacy so you can focus, no vaginal exams during labor unless there is a specific reason for it or you want to know your dilation, and freedom to push in whatever position feels comfortable to you. It includes interventions when medically necessary and not before, and, if medical interventions are recommended, full and accurate information on their risks, benefits, and alternatives, and support of whatever decision you make. It also means that labor and pushing go as long as you feel comfortable and you and baby are doing fine.
> BUT Routine hospital care usually looks more like: strapped into bed with belts for continuous monitoring of your baby (this kind of monitoring has an over 99% false positive rate), no food or drink allowed (they might give you ice chips), no one-to-one support, maybe a tub for water immersion, but you can’t get in if you’re on monitoring belts, an automatic IV into your hand that hurts and makes it hard to move, lots of interruptions by people wanting to give you vaginal exams (that usually serve absolutely no medical purpose, but increase your odds of infection down there), and constant pressure to “hurry things along” with medication or “give you a break” with an epidural. It’s unlikely that anyone will tell you the significant risks of medications that speed things up (Pitocin causes fetal distress, which is a #2 cause of C-sections) or the downsides of an epidural (primarily, that you won’t be able to move around to get baby positioned better, which makes it much harder for him or her to descend through the birth canal and can result in a need for episiotomy/forceps or vacuum or even surgery!).
You are free to choose any of these things! There is no judgment here. The thing is that most women don’t choose these things–they’re just done to them–or they “consent” without all the information about what’s being done. I don’t want that to happen to you.
So what’s a girl to do?
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#4 Get a Damn Doula
Have you ever cut your hair yourself? It might turn out okay, but then you get it done at the salon with the hypnotizing head massage and the mysterious, magical products and the blow-out-you-can-never-replicate and you realize, yeah, that was better with professionals. That’s kind of what doulas are to birth.
Doulas are trained to support women in continuous, one-to-one support throughout pregnancy and childbirth, and their use is strongly supported by science, including new guidelines from the nation’s obstetricians that call doulas “one of the most effective tools to improve labor and delivery outcomes.” They will answer your questions if you’re having heartburn at 28 weeks or refer you to a great chiropractor if your hips hurt, and help you create a birth plan; during labor, they will gently help you get in different positions, encourage you, inform you about what is going on, bring you snacks, and let your partner have bathroom breaks so s/he can stay comfortably by your side when you want her/him. If you or your partner is wondering what a doula does, read this.
But they are so much more than just a luxury. They really, truly, are a safety measure. Look at these stats! Look at the decrease in the risk of C-section!
Doulas can also help you with #5 “Best Provider Ever” because they work together with many different providers and see how they practice! They know if Dr. A tends to be more patient with first-time moms, or Dr. B’s bedside manner sucks during birth even after being so laid-back during pregnancy, or that the nurses at Hospital C are exceptional. Hospital cultures are VERY different, and doulas can help you figure out where you’ll have the best shot at the safest, best birth possible.
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#5 Best Provider Ever
Every provider is different, and research shows that the #1 determinant of whether or not you end up with a C-section isn’t you–it’s your provider! That’s saying something.
Know that your options include obstetricians, family doctors, and midwives. This is significant, because the U.S. is unusual in that we send low-risk, uncomplicated pregnancies to surgeons rather than normal childbirth experts: midwives. Midwives specialize in preventing complications, including surgery. Speaking of, don’t be shy about vetting your provider. What is his or her rate for Cesarean section? What about episiotomy and other common but usually unnecessary interventions? This is your vagina we’re talking about. You have a right to know.
Know that whomever you pick owes you the best. If you’ve done your research, you have an idea of what to look for. If you hear things like, “You’re not allowed” or “We can’t let you,” — if you are getting any of these “red flags” — please, take your business elsewhere, to someone who will treat you like a competent adult.
(Remember that your local birth professionals are a GREAT resource for insider info on how providers practice!)
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#6 You don’t have to go to a hospital
If you’re a healthy, low-risk woman, birth centers are a stellar option: comfortable, high-quality, family-centered care with a Cesarean rate of approximately 6% and a less-than-2% urgent transfer rate (for either mother or baby) with no adverse health consequences compared to hospitals. More here.
Home birth is another option that more and more women are taking advantage of, as they recognize the benefits of truly supportive one-to-one, individualized care and avoiding the routine risks of a hospital. The acceptance of home birth as a legitimate health choice makes it more safe in some places than others. If you’re open to this possibility, do some homework and see if it’s a fit!
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#7 Know Your Rights
Most women are totally unaware about what their rights are or why they’d ever need to know them. Pregnant women have the same rights as everyone else, but women are very often treated as if they’re in a special category because they’re pregnant. Legally, you are entitled to informed consent and refusal: a full discussion with your care provider about the risks and potential benefits of anything they are suggesting, and about your alternatives, with the right to say “no” to anything. You’ve got to know your rights if you’re going to use them!
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Birth doesn’t have to suck. Keep your expectations high and do the work to have those expectations met. Don’t let anybody convince you that you need to step aside for your baby. You need to step up for your baby.
I’m rooting for you in this once-in-a-lifetime process. I know you can rock this thing.
Author Cristen Pascucci is the former Vice President of ImprovingBirth and is the founder of Birth Monopoly, co-creator of the Exposing the Silence Project, and executive producer of Mother May I?, a documentary film on birth trauma and obstetric violence. She is dedicated to promoting the rights of women in childbirth.
Want more must-know info like this from Cristen Pascucci? Check outor any parent planning a hospital birth–