Trusting Birth Even More
by Carla Hartley

[Editor's note: This article first appeared in Midwifery Today Issue 81, Spring 2007.]

I hear lots of birth stories, most of which are wonderful. Today a friend e-mailed a very tragic story of loss and despair. A mom going in for her second cesarean suffered a massive rupture and lost her baby and her ability to have another. It shook my friend to the core and I certainly understand why. I have been in similar situations and know how desperately everyone involved wants answers. I wish I had them.

Sometimes when tragedy strikes we have no answers. I do not know whether this situation was attributable to induction or Pitocin and I know nothing about the previous cesarean. Even if this mom had been just walking down the street when catastrophe struck, I still have faith in the intrinsic safety of birth. I am terribly sad for everyone involved, but I still believe that birth is safe.

Living is synonymous with risk: We can't escape that fact. Everything that we do carries some risk and we have many reminders of the fragility of life. Some years ago a young friend of mine died just moments after she had given a presentation at a summer church camp where she was a counselor. I had known her for more than seven years. She was a beautiful, vivacious girl. The autopsy report could not tell her parents why their child died. At 16, she just sat down on a bench and her heart stopped beating.

Just this last week I learned that four people I know died recently. One was an apparent SIDS death of a six-month-old baby. A few months ago a family friend, who was only 18, ran a stop sign and was killed. So many people in my life have been killed in car wrecks that I am convinced that driving is considerably riskier than anything else we do on a regular basis. That is why I made my daughter Jessie take her driving course twice.

Many things are much riskier than birth. I am positive that unhindered, unmanaged birth is extremely safe—as safe as breathing. In 1975 I did not believe birth was as safe as I do today. I wasn't scared of birth as far as I knew, but I thought I needed an authority and an expert or something bad might happen. The birth I experienced then, and everything that has happened concerning birth in my life since, taught me that a bad outcome is more likely to be due to interference with birth, rather than with a flaw with the design or a deficiency in the process.

I preach to all who will listen that the best way to serve a woman during her pregnancy is to help her realize that she is her own authority and that a midwife or doctor or doula is only a paid consultant. A consultant may be an expert about birth, but I believe that a woman is her own best expert for her birth and that her body knows exactly what to do if given the chance.

Some of you know about the June 12 birth of my granddaughter and namesake, Carla Rae. I attended as Baba only. I toted water to the tub as the hose was too short to reach the kiddie pool. I also handed the mom the honey spoon from time to time. I said almost nothing. I did not do anything "midwifery."

The mother had had a c-section three years prior almost to the day. She knew nothing about birth then, but afterwards was sure that she wanted something different. She wanted a homebirth. She had watched What Babies Want at my house and it "opened the curtain." From that point on, my daughter-in-law read and watched everything she could. Her favorite book was Pleasurable Childbirth. She loved hearing my birth stories and especially about my "did not push, just let my body do it" birth. And Marcela did just that with the birth of Carla Rae.

If I had been her midwife I would have suggested that she do some things differently. As her mother-in-law, I suggested nothing, did nothing. I just loved her and did what she asked. If I had been her midwife I most assuredly would have said something when another contraction took soooooo long after the head was out. As the mother-in-law, I said nothing. After what seemed an eternity to the midwife in me, her powerful uterus rose up and I observed that baby come out in one contraction, with no assistance from the mother. Truly, as many of you have heard me preach, the body that managed conception and grew a healthy baby with little assistance or direction, did not forget what to do at the end. In fact, it was quite efficient in ejecting that baby.

Last Monday, I observed this amazing phenomenon again as I was with my first home-born baby while she gave birth to her second child. Heather's first birth was a lovely midwife-attended waterbirth. While excruciatingly painful for my daughter, it was a beautiful birth, nonetheless. This time, she prepared the same way in terms of nutrition, labor prep and daily chlorophyll, with a few additions. She did a lot more kegels this time. She went to the chiropractor regularly because of a pelvis that was uneven due to scoliosis. She took arnica in the last three weeks to help with the hip pain. The difference that made the difference, in my humble opinion, was that she knew she could do it with or without the midwife this time. Heather adores her midwife and was very happy with how she assisted in the first birth. This time, though, her greatest desire was to "do it herself." She read everything she could find about unassisted birth and she read Sarah Buckley's Gentle Birth; Gentle Mothering repeatedly. She read it so often that she could quote long passages of Sarah's take on the wisdom of the body.

In spite of the fact that Heather had almost no sleep in the last month and was totally exhausted, once real labor started, it lasted just under two hours. She had a lot of back labor and she and her husband were alone almost all of those two hours while I ran errands for them. I got back less than a half hour before the birth.

Once again I spent most of that time toting water, but this time because the pool was just not filling fast enough. Heather stood up out of the birthing tub and leaned on me while her husband continued to try to get more air into the blow-up pool. During her last waterbirth, the sides had been underinflated and a considerable amount of water had spilled. Her husband is somewhat of an efficiency expert and did not want a repeat of that. This is funny to us now. He just would not fit into his head that the birth was imminent. I can assure you though, that at the time it was very irritating to Heather. The speed at which this labor progressed was a shock to both of them. In fact when she stood up and felt the baby move down dramatically, she asked in disbelief how it could be happening so soon, as she had not had time to dilate. Although she had had no exams, she was comparing it to her 21-hour labor the first time!

The water broke just before the baby was born. Much to my surprise, I heard a gurgly inspiration and cry immediately after that. I had never heard a baby cry before the head was out. Heather had just asked me to confirm that indeed the baby's head was emerging between her legs so I could tell her husband that now was the time for him to get in position! After I heard the cry, the midwife in me wanted that baby to be born pretty quickly, but Heather's body, being much wiser than I, waited a bit. And that was a good thing in the end as it gave her husband time to turn off the air compressor, put down the air hose, get into the tub and get behind her to catch his baby. While supporting her front-to-front I was able to literally feel her amazingly powerful uterus bring her baby into the world. It was incredible to feel my daughter's body doing its job for her. Heather did not push, even once. She had three or four contractions from the time she stood up until the baby was born. She told me later that once she realized her body was doing it, she literally could not have pushed if she had wanted to. She had given her body permission to do its job with no interference from her and there was no going back.

Heather is convinced that not pushing was beneficial in other ways. She had no trauma to her perineum or vagina whatsoever. No swelling, tears or skidmarks. Honestly, she did not look like she had had a baby—ever. She bled very little and her lochia are almost completely gone at six days. She feels great. She is in a perpetual state of awe when she talks about her birth. In spite of the pain, she would love to do it again today. I can completely identify with the feeling.

After Jessie was born I had the incredible desire to put her back in and do it again. The feeling was the most amazing sensation I can imagine. For Heather, the sensual, powerful feeling of allowing her body to do what it was designed to do has changed her life as well. She has always been a committed believer in the safety of birth, but now she has experienced a whole new level of trusting her own body to give birth, as well.

My wish for every woman would be to experience the power of unhindered birth as I have and as Marcela and Heather and many others I know have experienced. We are so conditioned to believe that we have to work hard to push babies out, when more likely, most would come out better if we just allowed our bodies to do their job.

So, once again, I find myself trusting birth more than I did last week!

Carla Hartley created the first distance education program for midwives—Apprentice Academics—in 1981. In 1994 the name was changed to Ancient Art Midwifery Institute. She is the author of Helping Hands, The Apprentice Workbook, and several educational publications relating to birth. She has spent close to thirty years in birth work of one kind or another: childbirth educator, midwife, author, speaker, and midwifery educator, and she is the mother of four children and Baba to six. Carla is the founder and director of the Trust Birth Initiative whose primary work is telling the truth: Birth is Safe; Interference is Risky. www.trustbirth.com and www.ancientartmidwifery.com.


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