Let me start by saying that I love midwifery care. I love doulas. I appreciate the life saving care ob/gyns can provide. These healthcare providers are all skilled, compassionate and hard working. They deserve respect and appreciation. However, they are also human, and being human, they have bad days.
Can't read minds.
Don't remember every personal detail.
They are there to provide for your health and physical well being. While midwives often offer mental and emotional support in addition to providing for physical wellbeing - support that a laboring woman should't go without - you need to go into your birth prepared to advocate for yourself, regardless of who your care provider is.
Going into my first birth, I armed myself with a midwife and doula who I thought would help me achieve the best birth possible. I was scared and overwhelmed by all my options. I thought that having these two amazing women would take away that fear. I thought that because I had naturally minded care providers I wouldn't need to speak up for what I wanted during my birth.
I was so wrong. Labor started, and to paraphrase Helmuth von Moltke the Elder, "No plan survives contact with the enemy.”
It started with the little things. I happily rocked on a birth ball while I began to let family and close friends know that the big day was here. I enjoyed calling my family and sharing my excitement, but my doula rushed me through it and told me to “put that away”. I felt abashed. What was the big deal with a few calls? If I wanted to be on the phone, why shouldn’t I be? I should have asserted myself. It was my labor.
But I didn't ask questions, and she didn't explain.
I knew beforehand that I’d be hooked up to fetal monitoring for about 30 minutes on arrival at the hospital. As time passed and the nurse kept me hooked up, I kept expecting that I’d be “let off”. Sure, my water had broken and had meconium staining but my daughter showed no other signs of distress. I wanted to get up and move around, but I was restricted. If she wasn’t in distress, why did they need to monitor me? If that was their general policy, did they not make exceptions when there was no apparent reason to continue? Or did they have a reason that they didn’t share? I still don’t have any good answers on this subject today. I should have asserted myself. It was my labor.
But I didn't ask questions, and they didn't explain.
The one thing I set my heart on for my labor was that I get to relax in the tub at some point. I inquired about it soon after arrival and was told that I would have to wait for the midwife on call (not the midwife I had seen for my prenatal care) to arrive and make that call. When she came, I quickly asked about laboring in the water, and she put me off. I kept asking and being put off. They didn’t want me to do it while I was being monitored, that much was clear, but no one seemed to want to tell me that the monitor wasn’t coming off.
I kept my calm despite those things, but I started to want to be away from the nurses, the beeping machines, and my horribly unsupportive doula. I figured out that the monitor cords wouldn’t reach all the way to the toilet, and that everyone except my husband, the one person I actually wanted at that point, left me alone when I used it, so the bathroom became my refuge. Enthroned on the toilet with the lights dim and the doors tightly closed, I felt much more relaxed, even if undignified. Eventually the nurse figured out what I was doing and began to come with me into the bathroom and hold the monitor on my belly. At that point, the bathroom lost its allure.
Why did they have to monitor a perfectly healthy baby (their words), showing no signs of distress, throughout the entire labor? Why were my wishes, made clear at the start of the labor, so totally disregarded? Did they know something that I didn’t? Why didn't they explain what was going on? I will never learn the answers to these questions. I should have spoken up. I should have asserted myself. It was my labor.
But I didn't ask questions, and they didn't explain.
I made it through transition like a breeze. I know that may sound trite, but when I think about transition, I remember it as a bed of roses compared to what followed shortly. I remember my midwife telling me I was 8-9cm and asking her, "that's the peak of pain, right?" She nodded and I started to cry. I felt so relieved and amazed. I had practically done it! The worst was over! I was about to have the all natural birth I so wanted!
And then the biggest, most heartbreaking disaster set in: back labor.
Only, I didn’t know what it was, and no one bothered to put a name to my pain. All I knew was that what started as pressure in my lower back turned into agony that made my transition contractions seem like child’s play. I plopped down on the toilet and had my husband give me counter pressure. I moved from the toilet to the bed so that my doula could help Jon’s tiring arms. I remember that I kept gasping at them to push harder. My doula responded with, “we can’t push any harder” in an unsupportive tone.
I asked for a warm blanket to press on my back. It was heavenly. I asked for another one when it got cold...and then another. After a few blankets, my doula told me that I "couldn’t use all the warm blankets".
I was furious. I was in acute pain and doing everything I possibly could, but she wasn’t guiding me through what to do. She wasn’t pulling any tricks out of her bag like I thought she would (wasn't that her job?). No tennis balls. No warm water bottles or rice bags. No massage. No trying to get me to utilize helpful positions or exercises. Nothing..
Looking back, I know that I should have asked her to help me. I should have asked for her to suggest something. Instead, I trusted her. I assumed that if she wasn't specifically addressing the excruciating pain in my back and seemed to be dismissing my suffering as almost inconsequential, that it was a normal part of labor and would soon pass.
I don’t know where my midwife was in the midst of all this. Since my doula wasn’t stepping up, why didn’t she try to help me cope? Why didn’t I ask her for help? Could they not see that I was desperately in need of support and guidance and seeking help? Yet more unanswered questions piling up. I didn’t advocate for myself. And I will never know the answers or what could have been.
I didn’t ask questions, and they didn’t explain.
And so it was that I ended up pushing flat on my back with an epidural. I was so exhausted and so beat by that point that I hardly cared I was on my back. I remember thinking that I should have asked to not be on my back, but I was too defeated to care. I assumed I would be directed to change positions if it became necessary.
I pushed and pushed and pushed. I pushed for almost two hours and wasn’t making progress. At that point, with no warning, my midwife announced that she didn’t think I’d be able to get baby out on my own. No explanation why. Baby was just "stuck". She thought we needed to call in her back-up ob/gyn to help. It was my husband who asked about trying some alternatives first. He asked if we could sit me up in bed and have me push from there.
We tried, but at that point I think I was too physically and emotionally exhausted to do much. But why? Why hadn’t someone other than my untrained husband suggested that I change positions early on? I know that having an epidural can make a lot of positions hard but I could have at least been put on my side to help open up my pelvis. But I wasn’t and I ended up with a doctor vacuuming my baby out. She ended up with a nasty bruise on her head and I ended up with a 4th degree tear. Why? Why? Why?
I didn’t ask questions.
The moral of my story is not that birth professionals are bad, or lazy, or the “enemy”, but that advocacy is necessary during your birth no matter who your care providers are. The few occasions I asserted myself, I got results. Of the very few times I spoke up for what I wanted, they accommodated me (other than letting me get in the water). When I didn’t, they followed their own routines and preferences.
But your healthcare providers aren’t the enemy. The enemy is silence. You can’t know what is going to happen during your birth. All you can do is prepare, and, when the time comes, speak up for yourself and your preferences. Don’t be silent because you trust your providers. Don’t assume they know what you want. Don’t live with unanswered questions. Advocate, and demand the best birth you can have.