Empowerment Through Birth

The culture around pregnancy, birth and the postpartum period is very diverse and constantly evolving, with many different moving pieces all playing a part. Doctors. Midwives. Doulas. Childbirth Educators. Anesthesiologists. Nurses. Moms. Dads. Siblings. Friends. Family. Community. All of these people have an opinion about how birth should be, based on an intricate web of individual factors - experience, education, guidelines, perspective, background - and these different, and often somewhat conflicting opinions are what shapes a woman’s set of expectations going into her birth and level of satisfaction in the days, months (and years) following her birth. 

I’ve been a midwife in two different practices in the same community for seven years. When I was a new midwife, I had a particular set of ideas (or perhaps ideals), and I strived to create a birth for my clients that met the expectations of all of the players, which I ultimately discovered was not only impossible, but also not the most important piece of the birth puzzle. Those of us who provide primary care for pregnant women and their families are motivated by safety, and we all work really hard to create what we feel is the safest environment for any given patient. In fact, I would venture a guess that having a healthy mom and a healthy baby at the end of the day is what is most important to all of us, but it’s not the only important thing. 

As a midwife, I believe that home birth is a safe option for low risk women, when there is a skilled birth attendant, trained in managing emergencies including postpartum hemorrhages and neonatal resuscitation, present. I also believe that many of the interventions that have become so routine - including inductions, epidurals and cesarean sections - can increase risk so I promote natural, low intervention birth because it’s what I believe results in the best outcomes for mom and baby. That being said, the whole point of providing prenatal care and monitoring both mom and baby during pregnancy and labour, is weeding out those individuals who are at higher risk of having an adverse outcome. Every single one of these interventions that I may not think should be offered to all woman in labour, should most definitely be offered and even recommended to some women. As a result, women in my care occasionally end up with some (or even all) of the interventions that they worked so hard to avoid, and definitely didn’t include in their birth plan. Sometimes, my recommendations for a hospital birth, or a consult with an obstetrician, or an IV in labour, are met with resistance during and disappointment after labour. 

Now, it’s not that important to me that women are happy with every aspect of their labour and birth - that would be unrealistic, and truthfully, sometimes the situation necessitates an intervention that is disappointing for all of us. It is, however, very important to me that women feel empowered throughout their pregnancy, labour, and even as they are getting into the groove of becoming a new parent, and I’ve discovered that it is absolutely possible to create an environment where empowerment can occur through birth, regardless of whether or not all of the “wants” on the mother’s list get checked off. Empowerment occurs when the care is centered on the patient(s), and they are involved in every step. It also occurs when they trust and respect their care provider, and when they feel respected in return. Sometimes, in a true emergency, there isn’t the opportunity to have a comprehensive discussion around the pros and cons of a recommended intervention, so I have discovered that the time to discuss those interventions are in the office, during their prenatal visits. When there is an understanding around what the different potential interventions are, when they might be recommended, and there is a trusting relationship between patient and provider, women will feel more empowered during and after their births than if they went into labour holding their birth plan, and just trusting that things will work out. 

The bottom line is that no one has complete control over how a birth goes; there are so many variables that we can’t always anticipate. Empowerment, however, can still occur in the most surprising of circumstances. It all comes down to education, perception, and most importantly, trust. Trust in birth, trust in the body, and trust in the providers and the fact that ultimately we all have the same goal - a healthy mom, and a healthy baby. 

Be an active participant in your health, and in your pregnancy.