Week 14: Observation changes things

I am worrying about being observed in labor. I’m worrying about being tampered with. Surely these worries come from what I know about hospital birth – the home births I have seen as a doula have been totally different. But still.

I’m worried that she will want to listen to the fetal heart rate too frequently. I’m worried that she will ask me questions. I’m worried that she will watch me. I’m worried she will tell me something that directly contradicts my body’s intuition. I’m worried that it will come to the moment of birth, and I will realize suddenly with that uncontrollable heaving that I desperately need to be alone in this primal moment, and I either won’t have words to ask her to leave, or worse, that I will ask but she won’t leave.

I recently supported a beautiful, instinctive, unmedicated hospital labor which became, at the moment of crowning, a heavily observed, seriously disturbed birth that resulted in major perineal lacerations. The slightly larger than average size of the baby was blamed but I don’t believe it for a minute. The common rhetoric around perineal tears is one of physics: maternal position, being able to feel pushing vs. epidural, fetal head circumference, supportive maneuvers, etc. But if labor and the process of opening the body and the cervix is a question of physics AND spirit, body AND emotion, how can the moment of birth, with its potential associated traumas (physical and spiritual), be merely a question of physics, geometry and material tensile strength and flexibility?

The midwife can only support and protect from disturbance the process of labor and transition, while the woman is the one who has to do the actual work, and the midwife can only support and protect from disturbance the work that the woman’s mind, body, perineum, fetus, fears and reflexes, etc must do to prevent major tearing. Just as the midwife should be able to acknowledge when her observing presence or touch is hindering the labor process, she should be able to acknowledge when her observation or touch may lead to tension and tearing. It must be a very tricky thing to be able to discern these things, and likewise to discern those rare cases when an intervention would be truly helpful. I feel that it might just be safer for me not to be observed during that critical moment.

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About investigatingbirth

My investigations of birth began in 2009 when I was trained as a doula. I helped women consider the evidence on common interventions, and helped them prepare for the physical and emotional challenge of giving birth. After some time it became clear to me that there was another type of challenge that I was unable to adequately prepare them for, the challenge of the maternity system. But it was only after my own traumatic birth in 2013 that I realized how little I had understood. I began to ask questions that few around me - doulas, nurses, midwives, doctors - were comfortable hearing. Questions like: Under what circumstances, and for what reasons, do doctors not practice informed consent? How do hospitals deal with other patient populations vulnerable to abuse? How does loss of professional autonomy, for obstetricians, and professional authority, for midwives, impact the quality of care they are capable of providing - regardless of their training? This blog will collect noteworthy information that attempts to answer these and other questions. Most of what you see here will be aggregated from other sources and analyzed. You will also see original interviews, and the occasional opinion piece or personal story, as I try to piece together a clear picture of the system in which American women give birth.
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