2003
 Nine years after the glorious birth of Gabriella, and 14 after the trauma of Brenton's, i felt incredibly well prepared for the birth of my third child. I was older, wiser, experienced—and i knew that I would be “in control” when it came to expressing my preferences and communicating my needs to my care providers. Midwives were not readily available in the geographic area i was now living in, but I had little doubt that in 2003, with all of the new support for “natural parenting” and the public acceptance of things like breastfeeding, and the wide availability of ground-breaking research results, that doctors, nurses, and the hospital would all be “on the same page” as I was.

I wrote up my birth plan with great care and presented it, along with my concerns to my care provider. He said "yeah sure,” That should have been a warning bell for me, but in our culture we are taught to trust people in authority and rely on their expertise. Additionally, i thought his flippant attitude about it reflected the fact that my requests were common-place and "standard procedure" not even worth writing up in a birth plan. Well, I should have remembered that I hired him to perform a service for me! He worked for me!

If i was having my deck built and I handed a contractor a detailed plan for how i wanted my new deck to look...what materials i wanted it to be built with...how i planned on using it...i would welcome his expert advice, but the finished project had better be what i paid for! I expect that the contractor would know better than i what the best wood to use for my particular climate or budget...but i would not expect him to flat out refuse to use a wood that at the very least could be stained or painted to look similar to what i wanted. I wouldn't pay him if he built a deck that was not what i had asked for. And i would shop around with other contractors to find one who was more compatible with the needs of my family. But in medical care, patients often feel that they are trapped by a lack of choices in their care. In our area it is particularly difficult. You can choose Male Dr. A or Male Dr. B to “deliver” your baby. (By the way, you give birth to your baby...it is not delivered to you. That terminology is another way that women, even today, are still treated like vessels who carry around a baby until a qualified professional delivers it to us).

But i did not heed my own warnings and i continued care with this health provider. The childbirth classes at the local hospital were a bit more reassuring, but still less progressive than I expected. First, the good stuff--the Labor and Delivery (theres that term again) nurses proudly showed off the state-of-the-art birthing rooms and convertible birthing beds which would allow a mother to 'deliver' her baby in several different positions. This was good news for me since Sara, my midwife for Gabriella, had explained that my tendency towards larger babies made birthing difficult in traditional positions, like lying down on my back with my legs in stirrups. Having the freedom to listen to my body while birthing my baby—squatting, standing, etc...would ensure that my larger babies made it into the world without invasive surgery.

The strange thing about these classes was their lack of emphasis on how to cope with labor. The labor nurse who taught the class explained that “everyone just gets an epidural, now.” So they stopped teaching breathing, relaxation or coping techniques because so many clients complained that it had wasted their time to learn those things! I was shocked and very angry that the level of care in 2003 was still so skewed towards medical intervention. I am not necessarily an all-out advocate for drug-free childbirth...if a mother needs something to cope with labor, then it is nice to know there is that option. But eliminating the chance to give labor techniques a try is robbing mothers of the chance to feel proud of their accomplishments. Coping with labor is difficult, but some women have reported pain free labors, or have even “enjoyed” the sensations that intense uterine contractions can bring on. Or what if a mother has to wait, or cannot have an epidural because of a slow labor, very fast labor or other complication? How will she get through labor with no practice at coping techniques? Needless to say, I was horrified at this policy decision, but was still encouraged by the nurses enthusiasm for the possibilities of the birthing beds, birthing balls, in-room showers and other gentle birthing options.

What the nurses failed to tell me though, was that these were all options for the bed—things that the bed was capable of doing or helping a mother to do during labor...but that the doctors had no intention of giving up their “seats of power” at the end of the bed, with mother's legs in stirrups while flat on their backs!

Now, finally at the birth of my daughter, 14 hours after labor began, both my husband and I knew what we wanted, and we even protested as my legs were strapped into the stirrups. The nurses even looked sympathetic. But they simply responded “This is how the doctor has to deliver your baby so he has access to everything.” Then, because of the awful position, the pushing was difficult and painful and long. The doctor prepared me for an episiotomy, which i had clearly stated i didn't want. Both my husband and I said, right there,”Do not preform an epsiotomy!” And the doctor gave us a confused look in response, pretended he had forgotten how to understand English and proceeded to prepare the area with painful injections in anticipation of an episiotomy...he did this while i was screaming at him to stop and struggling to kick him away. In between pushes, i struggled against the stirrups and the nurses and demanded to be let up so that i could push in a squatting position, however, the nurses simply held me down tighter. The doctor gave me a very painful epsiotomy against my wishes. I could not feel her crowning or help my body guide her out gently since i had no feeling in my entire perineum. My daughter, who was only 9 pounds (compared with my second daughter) was born with a painfully broken collarbone-- according to my OB was caused by “narrow pelvic bones”. What? I gave birth to a baby who was nearly a whole pound larger with NO tearing, ripping or episiotomy-- a baby who did not come into the world with a broken collar bone! Why did this doctor insist on hurting me and my baby? So that he could have a better view of the birth canal? If i had been allowed to be in a position that felt natural to me, i would have been spared the pain of a healing episiotomy (which took almost a year to heal and still gives me grief at least a few times a month), and my daughter could have been spared a broken bone! It is common knowledge that the pelvic opening becomes wider in a squatting or standing position, and narrower in a supine (laying down) position! My doctors convenience was more important than my comfort or wishes? And i had to pay him for this service???

Again, i felt robbed of what should have been my easiest birth of all! My husband and i both felt powerless against a system that didn't seem to listen to us, or to be on our side. Again, all of my complaints were met with the same phrase “The most import thing is having a healthy baby.” Yes, and the second most important thing is having a healthy mother who feels ready- emotionally and physically - to take on the challenges of parenthood. I don't understand why those goals seem to be mutually exclusive for the typical OB/Gyn. My midwife and doula managed both...why can't the traditional medical establishment?

This is what led me to become a doula. I want to be able to help other mothers and families from making the same mistakes that I have. Assumptions, fears, social norms, misinformation, and inaccurate expectations can all contribute to a birth experience that leaves parents angry, confused, and disappointed. A doula's purpose is to keep you “in control” and to make sure that you feel like you are making the best choices for you—your choices. Following a doctors recommendations are the best thing to do, but you should fully understand what impact the choice will have for you and be fully informed and fully active in the process. It is easy to “hand over” our care to our doctors, but being an informed, educated and empowered patient sends a clear message to care providers about the level of service they should be providing. Changing the way that care providers view and treat birthing women can only begin when women and families demand the services and the types of care that they require in order to feel satisfied with their birth experience. If you are not getting that from your care provider, tell them that you will take your business elsewhere. And then take it somewhere else...start early in your pregnancy and keep looking until someone can provide answers to you that make you comfortable and that make you feel like you are an equal partner in the decision making process. Things CAN and DO go wrong and families do need to be flexible, but there should be a plan in place for handling the things that CAN and DO go wrong. A doula can help you practice those scenerios and help you to communicate effectivly with your care-provider.