Traumatic Birth Leads to Creation of Birth Networks in India
by Ruth Malik
© 2008 Midwifery Today, Inc. All rights reserved.
[Editor’s note: This article first appeared in Midwifery Today Issue 87, Autumn 2008.]
I had always been fascinated by birth. I considered pain a small sacrifice for a job well done and the reward—a baby. I found comfort in birth as an experience that bonded me with women, my child and as a family—not something I wanted to avoid—but a powerful experience that I just had to have! I intuitively knew there must be benefits in nature, for both me and the baby. (I personally am wary of medications and medical interventions and their ability to cause harm and thus chose to avoid a medical birth.) The lack of open discussion and information made the journey confusing and fearsome, yet still appealing.
I spent a lot of time preparing myself with yoga, swimming walking and a good diet of organic food. I had expectations of being supported and of having a compassionate doctor; I assumed that the natural process would be the first port of call.
Well, things don’t always work out in the way we imagine. Two children later my life, like that of countless women globally, had been shattered by the experience of birth.
My son was born by c-section, without labor, under general anesthetic. Then he was kept from me for 24 hours in the nursery—not for a medical reason, but because it was hospital policy. I spent the night pressing the buzzer and asking for my baby. I felt as if I had been knocked over the head and had something ripped from me. When I first saw my son I looked at him and fell back in the bed thinking, “I need to go home and come back and do this again.”
His birth was an out-of-body experience; my brain couldn’t relate the baby to the event. My response to my child shocked me. I thought, “What kind of mother are you?” I dragged myself up, with a huge painful gash across my abdomen, and began a struggle of bonding and mothering under the exhaustion of an awful depression and post-operative recovery. This mood clung to me for three years.
My process of healing has been a need to understand the truth and starting to ask questions. I now know that what was presented to me as an emergency was not a true emergency. My doctor had asked me to go for sonography when I was three days past my due date. Today I know that being overdue is not an indication for sonography—gestation is 38 to 42 weeks. I was in a perfectly normal state.
During the sonography, I was told that a tight cord was around the baby’s neck. The doctor described it as a noose. I now know that as many as 50% of babies are born with the cord around the neck and rarely does it result in a problem. A cord around the neck is not an indication of an emergency, when the fetus is experiencing no evident distress. The risk of cord complication is minimal because the cord stretches and no one knows how it will respond in labor and, in any event, the sonography really can’t tell.
The decision should have been to allow natural onset of labor, with intermittent monitoring for fetal heart distress. I could have safely gone home and waited for labor. My doctor made me feel terrified; I was told that my baby would die as I slept that night. My husband supported her and I had nowhere else to turn. I was confused by conflicting information and horror stories and I was fed up—a feeling experienced by many women at term. This time is the most vulnerable in our lives; and after nine months of feeling heavy and uncomfortable we are really ready to be over with the pregnancy. As a result, we may be easily manipulated.
I submitted and was taken directly for surgery.
For my second child, I again tried for a natural birth, this time a vaginal birth after cesarean (VBAC). My doctor supported me in this decision. Considering the increased medical complications for women who have multiple abdominal surgeries—or cesareans—VBAC is highly recommended. The success rate for VBAC is around 75% and can be even higher. The success rate is directly affected by the commitment of the birth attendants. VBAC has to be a gentle, supported birth.
On my due date my doctor waved her hand over my body and declared that I had a lazy uterus and that my prior c-section scar was paper thin. She said that since the head had not yet engaged, I should come the following morning. Again I was facing a questionable diagnosis. Firstly, the head rarely engages in a second pregnancy until the onset of labor and is not even worth mentioning on the due date. Secondly, simply looking at the scar is not a diagnosis—no doctor is capable of determining the ability of the scar to endure labor without a trial of labor. The real issue was that it was simply my due date. I decided to stay away from my doctor and let labor come when it was ready. (My mother was ten days overdue with all her three children, and all were born perfectly normally and naturally!)
My doctor started sending text messages to my husband and to me informing us that I had to come into the hospital immediately. She said that the blood supply to the baby and the uterine fluid levels were diminished, and as the baby gets bigger so does the head, which would make birth more difficult. This does happen, but after 42 weeks and it is gradual and not so marked as to cause alarm on the due date.
Interestingly, the doctor wasn’t presenting any evidence of these problems occurring or asking to examine me to determine this. I was under so much stress and was confused by conflicting information. In the space of five days I had two nonstress tests to check the baby’s heart rate and two more sonograms to check umbilical cord blood supply and uterine fluid. (I had already had three in this pregnancy; this would make a total of five.) All was well; fluid and blood supply were perfectly normal and baby was happily waiting for when she was ready to be born.
On my seventh day overdue, I finally went to meet my doctor. I was asked to lie flat on my back for a fetal heart rate test of the baby—alarm bells went off on the machine. I was prepped and rushed to surgery within 10 minutes. No one spoke to me or even touched me. Cold antiseptic was rubbed over my back and went into my bum and stung terribly. A urine catheter was inserted (removal of the catheter about two days later would be the most painful thing I personally have ever had to endure). Then the painful epidural needle was inserted into my spinal cord and I felt the flush of chemicals through my body; then I went numb. I was aware of about eight people in the room and of the fact that I was now completely naked with my legs spread apart in the most humiliating fashion. I closed my eyes and said, “I’m going to vomit.”
I felt more medication surge through me to stop the vomiting. I kept asking, “Is the baby all right? What’s happened?”
I was told that I was overdue and thus needed a c-section, which didn’t make sense to me.
However, because I was given an epidural, I heard my baby cry at birth and saw her immediately. She roomed in with me and we started breastfeeding after an hour (for best initiation of feeding and bonding baby should go to breast immediately—before the bath or cord cut). This helped a lot.
I now know that again I was not in a true emergency state. The test was performed incorrectly: A woman made to lie flat on her back at term goes into tachycardia due to pressure on the vena cava vessel at the base of the spine. When I was lying flat on my back I felt as if I were dying. Some women vomit or faint when made to do this. When I sat up or laid on my side I felt perfectly fine. (ECG tests should always be done with the woman reclining—never flat on her back—as it will give a false reading. As for the alarm bells, they are a guide not diagnostic, in fact all report cards of ECGs note this.)
The ECG had shown that my baby’s heart rate had fluctuated, but it then recovered. The situation was actually perfectly normal for an anxious woman who was probably dehydrated and on the verge of labor. No effort was made to determine the cause or to rectify the situation by other means. What a simple diagnosis: MACHINERY = ALARM BELLS = SURGERY!
My births were about the doctor’s needs and not mine. She misused medical equipment and used the language of fear to convince me to do what suited her. I had no idea that so many sharks and dinosaurs were in the birth business. We so want to believe we are in the right hands.
The birth of my children felt like violence.
Birth has been an experience of great loss, the intensity of which I will always feel from time to time. The fact that I didn’t get to experience any of it—the labor, the birth—makes it is very hard for me. Isn’t that what I was born to do, what makes me uniquely woman?
Pregnant women say to me, “Why would anyone do anything medical to me if it wasn’t necessary?”
We only need to see the statistics. The World Health Organization (WHO) states that no community should have a cesarean rate higher than 10%. In India, preliminary studies show it at 50% and possibly as high as 80% in some private hospitals.
Women still don’t feel comfortable or capable of voicing their concerns or complaints, thinking it is impossible, too hard or not within their rights to challenge or question a doctor or any other staff members. Additionally, many women feel and are told that as long as the baby is healthy then the way they were treated is justified.
In trying to unravel the truth behind my birth story I discovered that many people around the world, including in the WHO, are trying to educate the public and trying to promote natural childbirth.
I am taking the second doctor to the consumer courts for lack of due care and abrupt decisionmaking in carrying out childbirth that led to emergency c-section instead of a VBAC, for which I was a suitable candidate. My complaint also addresses the important medical issue of the rampant use of cesarean surgeries by doctors all over India, to the detriment of the health of the mother and newborn child.
In talking with women in Mumbai, a few of us decided to establish Birth India. We met to discuss our birth stories; some shared traumatic experiences and others beautiful ones. However we were mostly concerned with the alarming numbers of cesareans occurring around us and the effects on mothers, babies and families.
Since then, we have seen a positive response through networking and momentum is growing. We have members across India with networks in Mumbai, Delhi, Chennai, Bangalore, Shimla and Goa. The national and international response has been overwhelming. We are from varying backgrounds including medical practitioners, health workers and researchers, nutritionists, psychiatrists and therapists, chiropractors, midwives, doulas, birth teachers, breastfeeding specialists, various alternative therapists, concerned citizens, mothers and fathers.
Our aim is to promote the benefits, both physical and psychological, of natural childbirth and the best practices to achieve normal birth. We recognise the evidence that mothers and babies fare better in natural birth. We emphasize that birth choices are a women’s rights issue.
Babies born by cesarean surgery or medicated vaginal birth are at risk of many physical and psychological disorders.
Our goals are to:
- Improve Maternity Services
- Provide Options/Educate
- Inform/Rediscover the Wellness in Nature
We’ve had film nights across the country where we showed the documentary The Business of Being Born, (www.thebusinessofbeingborn.com), which was recently released internationally and is sending shock waves around the world. We’ve had an international conference in Mumbai that was attended by people from all over India and internationally.
We’re presently in the process of introducing doula training (doulas provide labor support for women in hospitals) and hypnobirthing training. Through our education and some simple tools we have empowered many women to achieve natural birth within the hospital environment and we have also linked them with practitioners to assist in their birthing goals. Our dream is to open a birth center in Mumbai and introduce direct entry midwifery education, well woman care and the midwife model of care, as well as start monthly natural birth information sessions. Considering we are only a year old, what we have achieved is overwhelming.
Mumbai’s women are ready to become empowered to feel their birth completely and to give themselves and their babies all the benefits of the natural process, in particular the essential hormones which are only released in natural birth.
Birth India believes that how a woman is treated in birth is important to her and her baby, because how she feels directly impacts her ability to mother well.
For more information see www.birthindia.org.
Ruth Malik, BA, is an Australian who has been married for 12 years to Indra Malik, an Indian. She is mother to son, Jai, six years old, and daughter, Sophia, two years old. Ruth came to Delhi, India, when working for Australian Education in promotion and student recruitment. She was in business with her husband for five years, then worked in Bollywood in Mumbai. She has spent the last six years in intense mothering and will be taking hypnobirthing and doula training this year.
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