"Ask me for strength and I will lend not only my hand, but also my heart."
~ Unknown

Thursday, September 6, 2012

Reflective Practice & The Story of My Daughter's Birth

Dear Readers,

When I certified as a birth doula, I was asked to write a reflective essay on the birth of one of my children.  This is the story of the birth of my first child, my beautiful daughter Sydne, who is the inspiration for my work with families.  You will notice the titles preceding each paragraph.  These are the framework for reflective practice which can be helpful when trying to work through a difficult life experience.  (Please ask me about reflective practice at our prenatals!) This story is raw and emotional.  I hope sharing it will help other mothers to better reflect on their experiences from birth through all aspects of motherhood.  


My Inspiration: The Birth of My Beautiful Daughter

I am a mother of two children. This is the story of my first child’s birth. Shortly after becoming pregnant, my husband and I moved to a larger centre. I found a family physician; a general practitioner who also delivered babies. I remember telling her at one of my prenatal appointments, “I don't want to be a hero. Sign me up for an epidural.” My doctor was supportive and made the note in my chart. I also included it in my simple, one-page birth plan. We also discussed breastfeeding as I planned to nurse my baby.  I did not want a cesarean or instrumental birth.  I wanted to be comfortable and enjoy the birth experience.  These items were also noted in my birth plan.  My wish at the time was for a beautiful comfortable birth experience with the active support of my husband and mother.

My daughter was born on Saturday, May 10, 2003, ten days after my due date of May 1st and after a fourteen hour labor. My mother had arrived from out of the country a week earlier. We walked through several malls, went bowling and I waddled up and down the stairs in our home as much as possible. My doctor stripped my membranes twice and I begged for her to induce me. The night before I was scheduled to be induced, I went into labour on my own.

During one of many nightly trips to the bathroom, I noticed goop on the pad in my underwear. It wasn't my mucus plug as I had lost it a week before and this wasn't pink.  It was a very pale clear yet cloudy grey-green. I called the local 24-hour nurse line. They said it was probably nothing. When I felt a little mini-gush, I knew it was my water leaking at this point. It was around 2:30 AM when I woke first my mother and then, my husband, Mike, and we headed to the hospital.

My contractions started on the way to the hospital, which was 10-15 minutes from our home. They were centered in my lower back. At the hospital, I changed into the hospital gown, peed in a cup, left my pad on a paper towel in the bathroom (per the nurse’s instructions) and was told to lie in the bed in the assessment room. The fetal monitor was strapped around my belly and I lay in a semi-reclined position. I had only been in the bed a few minutes it seemed, when my water broke with a gush. A nurse or doctor confirmed that there was meconium in the water.

They moved me into a labour and delivery room. The contractions were now coming one on top of the other and I had a lot of back labour. I was lying on my left-side and was nauseated. I had been in the hospital for around an hour and was four centimeters dilated. A nurse asked me if I wanted a shot in the hip or the epidural.  I replied that I was ready for the epidural.

According to the staff, the epidural had slowed my labour. So, I was started on IV pitocin to increase the contractions. With each increase made to the dosage of the artificial hormone, the epidural lost some of its numbing effect, so an increase was made to its strength as well. This up and down dance kept up throughout the day.

At some point in the afternoon, I had two young nurses taking care of me. One of the nurses was a student. They checked me and found me to be fully dilated. So, without feeling much of an urge, I started pushing. I pushed for almost four hours and moved the baby down, but my progress had stalled and my doctor arrived. She checked me and basically poked the baby in the eye, finding that she was occiput posterior.
Because I had moved the baby down so far in the birth canal, a cesarean, which my doctor later informed me she would have called for otherwise, was out of the question. So, she called for the obstetrician on-call to come in and assist with the delivery.

The OB mentioned that they would have to try using the vacuum to help the baby out. They tried. It didn't work. So, the doctor brought out the forceps. Finally after an episiotomy and a fourth degree perineal tear, the baby was out. The doctor held her upside down and Mike announced that she was a girl. We cried.

Our daughter, Sydne Mikaela, was whisked over to the other side of the room so the nurses and doctors from the neonatal intensive care unit could give her the once over. They had been called in due to the meconium in the amniotic fluid.

While Sydne was examined, I delivered the placenta. Then, OB oversaw as my doctor stitched up my large tear, which was both interior and through my perineum to the sphincter. I was in a haze.

When I finally held my new baby daughter, I noticed what appeared to be a large blood blister on her forehead. Her face was bruised from the forceps and vacuum and her nose squished from being stuck under my pubic bone. We were moved to the postpartum floor and I tried to breastfeed her, but we were not successful.

That night, the nurses took Sydne to the nursery so I could rest. They fed her bottles of formula.

We continued trying to breastfeed throughout our stay in the hospital. Each time I tried to feed Sydne, the nurses would try to help, but usually ended up shoving her roughly onto my breast. Sydne screamed and pulled away each time. Each nurse had a different idea about why she wouldn't latch on. They said perhaps she was tongue-tied or she couldn't breathe because her nose was squished, or maybe because her chin was recessed. I yelled at the lactation consultant and told her to leave me alone. Finally, my doctor told me just to tell the nurses that I was going to formula feed so they’d release me from the hospital.

The Monday evening after Sydne was born, we went home. I continued trying to breastfeed, but pumped and supplemented with formula as she still refused to take the breast. I cried and she cried at each attempt. The health nurse visited the day following our release from the hospital and I continued to have a nurse visit each day throughout the week, still trying to establish breastfeeding. The day my mother was to return home, I began crying constantly. Then, on my way to the bathroom, I lost control of my bowels.

I saw my doctor a week after Sydne was born to see if she could increase the dosage of the medication I was already taking for depression. At the visit, she suggested we fully make the switch to formula. I agreed. 

In the days leading up to my Sydne’s birth, I really felt as though I would be pregnant forever.  Because my mom had come up from another country for the birth and was only scheduled to stay with us for two weeks, I was concerned that I wouldn’t have the baby while she was still there or early enough for her to spend sufficient time with all of us.  I was so relieved when the hospital called with our induction time.  I actually slept well that night, for the first time in weeks.

While I was very excited about my child’s arrival, I felt very overwhelmed and afraid during her birth.  Just before the epidural was administered, I felt so nauseated.  I was afraid and embarrassed that I may vomit.  I really didn’t want anyone to see me throwing up.  I felt very weak.  I thought I appeared weak to others.  I was young as well, at nearly twenty-four.  I did not feel confident to question the hospital staff.

My mother didn’t say much during the actual birth.  I remember her trying to talk to me when I was experiencing the back labour and nausea.  She was trying to get me to look into her eyes.  As a child, when I would bump my knee or fall, I would cry as though it were the end of the world.  My mother would often say, “They’re going to have to knock you out when you give birth.”  I believed her.  If my own mother said that about me, I felt it had to be true.  I didn’t want to disappoint my mother by showing any fear or by being a “baby” about the pain.  All I felt at the time was the fear that I would let her down and that I wasn’t strong enough.  I wish she had spoken to me more during the birth.  Her appearance was stoic; but, perhaps she was afraid for me.  I can only imagine how I’ll feel when it is Sydne’s turn to become a mother.  Maybe, beneath her strong exterior, there was a tender heart only wishing to spare me pain.

I didn’t want my husband to worry about me.  I don’t remember him being very involved in the birth.  I don’t remember what he said to me or really how he felt.  There was concern in his eyes, but he didn’t really say much of anything, which worried me and made it very difficult for me to feel supported.  He slept after I got the epidural.  I was angry that he wasn’t awake with me.  I wish he had encouraged me more or had perhaps been more involved in researching our options during our pregnancy in order to prepare for the birth. I wish he had protected me.

After Sydne was born, I was in a total haze.  I don’t remember pushing her out.  I didn’t have a feeling of one being becoming two separate individuals.  It wasn’t a spiritual experience as I had hoped it would be.  I just remember feeling like I wasn’t entirely in my body. I wasn’t physically or mentally present.  It was as though I was a hollow vessel and things were being done to me.  I was simply an observer, but not even one that was entirely focused.  It was as though I was watching a movie in a crowded noisy theatre.  I couldn’t pay attention completely, though I knew there was action taking place. 

Not being able to breastfeed my Sydne broke my heart.  I was frustrated that I could not do it myself.  I was angry that she had been hurt by the mechanisms to remove her from my body.  I was angry at the nurses for not noticing she was in an odd position.  I was angry at myself for asking for the epidural, because maybe I could have prevented her getting hurt by the vacuum and forceps. I wish I had learned more about breastfeeding in the early stages after birth. I was angry at my daughter because she wouldn’t take my breast.  Why wouldn’t she take my breast?!

When we arrived home from the hospital, I was in so much pain.  My heart was broken and I had little connection to my daughter.  Every time I tried to feed her at my breast she cried and then I cried.  I planned in my mind to have my husband care for her.  I didn’t feel that she needed me anymore.  The pain of not being able to provide her with the one necessity I should have been able to tore at my heart.  My body also felt ripped apart.  When I lost control of my bowels that was my breaking point.  Here I had just given birth to a helpless baby and I was the one who needed the diaper.  I was helpless, too, and hopeless.

I was relieved when my doctor increased my medication.  I was relieved, too, when she suggested formula feeding.  I couldn’t bring myself to keep trying to breastfeed when, I felt, my daughter was rejecting me.  I also felt like a failure.  I couldn’t fulfill my daughter’s most basic need.  I felt incredibly guilty that I did not breastfeed her.  I knew that my breast milk was made for her and that nothing else would provide the perfect amount of nutrition or immune support.  Every time I prepared a bottle of formula, I felt guilty.  Every time I saw another mother breastfeeding, I felt jealous.  I felt as though I was being judged by breastfeeding mothers for feeding my child an artificial substitute.

I had planned for an epidural and I received one.  I had planned to breastfeed, yet I did not succeed.  It is clear to me now that the choice to receive an epidural impacted my breastfeeding experience.  If I been able to express the type of pain I was experiencing, perhaps the nursing staff would have recognized that Sydne was occiput posterior earlier and suggested a change of position.  I would not have been confined to the bed, so I would have been able to try other things to help her to turn. 

The offer was made to have an injection of morphine.  Had I tried this at that early point in labor, I may have received the relief I was longing for while also giving my body time to metabolize the medication so that I would still have sensation during the second stage.  Also, the epidural had “slowed” my labor.  If I had chosen another pain relief option or no pharmaceuticals at all, I may have had a shorter labor.

The epidural also may have compromised Sydne’s awareness.  Had she been more alert following her birth, perhaps she would have had more of an urge to feed, thus giving us both more motivation to breastfeed.  She also may not have had to have an instrumental delivery and, therefore, would not have had the birth injuries that she experienced.  I also did not know at the time that there were alternatives to bottle feeding.  I could have used finger feeding, cup feeding or tried a supplemental nursing system.  None of these items were offered; but, I also did not ask.

Birthing in this particular hospital was also another choice that I did not realize I had control over.  I knew that there were midwives in our area at that time, however, I was not comfortable with having a homebirth and also, because midwives were not covered by our provincial insurance plan at the time, I did not think I could afford one.  There was a pilot program operating out of a hospital about a half an hour outside of our city with both midwives and doctors on staff, but I was not aware of it at the time.  Perhaps had I known, I could have given birth in a place that gave me the comfort of knowing technology was near if I needed it, but also would have given me more freedom to choose natural alternatives to medical interventions.

The main reason I had chosen my doctor was that she was a woman.  She made me feel quite comfortable in all of our appointments and truly did take time to listen to me; however, her practice was quite busy and she was new to the profession.  Perhaps this may have led her to initially lean more toward the managed style of birthing.  In retrospect, I also must note that I did not really keep an open mind toward everything in my visits with her.  I did not, for example, ask for any information on the risks of epidural anesthesia, nor did I request any information on breastfeeding and breastfeeding support. I could have taken a more active role in my care.

All of the choices I made were motivated out of fear.  I was afraid I couldn’t manage without the epidural.  I was afraid to vomit in front of my family and the hospital staff.  I was afraid that I would not be taken seriously by the staff.  I was afraid that I did not know enough to ask the proper questions of staff and that I didn’t really deserve to have the answers.

As I look back upon the events surrounding Sydne’s birth, I am filled with gratitude.  While much of the experience was truly painful, without it I would not have found a passion for birth and for helping other women and their families.  As much as it hurt, I have been able to learn from the mistakes I made during that period. 

I have learned that I am responsible for my own feelings.  Eleanor Roosevelt once said, “No one can make you feel inferior without your consent.”  While my mother may have relayed her perceptions about my tolerance for pain or my strength, it was I who chose to accept those words as fact.  She could not make me weak, nor could she make me strong.  In repeating her words in my own inner dialog, I had already written the story of my birth experience before it had even begun.  I expected to fail in fulfilling my own perceptions of what a strong birthing woman would or could be, therefore I planned to fail. 

I also realize that I have put a great deal of stock in what others think of me.  I worry about their perceptions of me as an individual.  I often try to please others rather than think of how my decisions affect my life.  As an adult, I place much importance on pleasing my parents and making them proud of me.  I know I need to be proud of myself and concern myself more with the future I have with my husband and children.

I know I must be my own advocate.  I had the opportunity to learn more about my options and make informed decisions, but I allowed myself and my fears keep me from doing so.  The more I learn the greater power I have over my own life. The answers are there for me to find, I only need to look.  Not knowing is not an excuse.  I have found my voice and I must use it. 

I believe that I have a unique role in teaching Sydne about birth and building up her self-esteem.  While I chose to take on my mother’s perceptions as my own in a negative fashion, I also realize that the messages we and others send us have a lasting impact on our lives.  I want to send my daughter positive messages about her body and her capability to birth and mother.  She does not have to repeat my mistakes.  I know she may make her own, but I want her to know that I believe she has the power to accomplish anything she sets her mind to.

Guilt serves no purpose.  It was a waste of my time and energy.  While I did not plan to feed my daughter formula, I did the best that I could under the circumstances.  She was healthy and happy.  I was able to get the help I needed for my mental health without worrying about the substances going through my milk and into my baby’s sensitive system.  I would have loved to have had more support to breastfeed, but I believe that being unable to at the time helped me to value nursing even more.  It has also made me much more understanding when I hear or see another mother’s struggles.

Finally, I have learned that while I may be fearful, I can feel it without letting it take over my decision making.  I cannot and will not give up my power simply because I may not know what lies ahead.  I had been allowing myself to exist, without truly living and allowing myself to use fear as an excuse to keep me from making decisions that may have been in my best interest. I have never been a risk taker.  I do not want to miss out on life anymore.

Reflection has helped me to deal with the negative feelings I have had pertaining to my first birth experience and how such similar feelings and thought processes have been a part of my entire life.  I have also begun to feel empowered to really take control of the decisions I make in my life.  By realizing that my decisions are my own, I see that being fearful would mean not trusting myself. 

I have been able to turn my birth experience into a positive motivator, rather than a negative memory.  I have overcome the challenges of learning to bond after a difficult birth.  I gained the desire to help others learn more about how to have healthier happier births.  I have a renewed passion for breastfeeding.  I know that just because I did not have the ideal experience the first time around, it does not mean that I have not gained valuable knowledge.  I’ve learned to trust my instincts and believe in myself and my abilities.

As a birth professional, I realize I have a unique privilege of helping mothers and their families find their own power, make informed decisions, and begin the journey of parenthood with confidence and joy.  I must strive to live my life as a reflection of these values.  I hope that I can help my clients to feel supported and valued.  Their experiences mean more to me than my personal feelings about their choices.  In the end, the birth experience belongs to the mother and her family.  It should be something they are able to cherish.

I have learned to be more accepting of other’s choices.  I know I may not make the same decisions for myself; but, I also understand that each mother, each birth, and each family is unique.  As a doula, I can be available to provide information to my clients and respect whatever decision they make in the end.  I have felt the pain of my own guilt and perceived judgement of others and I would not wish that on anyone else.

Now that I have realized how my own feelings have shaped my decisions, I believe that I may be able to better assist my clients in reflecting on their own experiences and choices.  I know what it is like to feel powerless.  By using reflective practice with my clients, as well as encouraging them to find the answers to their pregnancy, birth and parenting questions, I hope the women I work with will have a better chance of having a birth experience that is safe and satisfying. 

I am applying what I have learned as a wife and a parent.  I am more open with my husband about my wishes.  We are able to work together when it comes to how to raise our children, researching where to live, and even what vehicle to purchase.  I work hard to help my children realize their own power and potential.  I believe that they can achieve any goal.  I want them to know how loved they are and how valued they are. 

Finally, I am so happy to have been able to communicate with my parents about my feelings.  I am more comfortable relating to them as an adult.  My mother and I have since had many frank discussions about my perceptions of my ability to deal with physical pain.  She expressed to me the anger she felt toward the hospital staff for what she believed to be their neglect in determining my daughter’s position during second stage.  She has also become my biggest supporter in my role as a birth professional.  While I know now that I do not need the approval of others to feel worthy and successful, I am very glad that I’ve had this opportunity to communicate in this way with my mother. 

This paper has been a reflection on my experience giving birth to my first child.  I have discovered that many of the decisions I made were based up on fear and lack of confidence. I used fear as an excuse to keep me from exploring the other choices that were available to me at the time. I realize that by believing in my own abilities, trusting my instincts, and taking the responsibility to make informed decisions in my own life, I will be better able to support my clients in doing so themselves.  Through reflection I have been able to see what I had previously thought of as a negative experience in a positive manner by utilizing it as an opportunity for growth. I have learned to accept the decisions I made that shaped my birth experience.  The birth and early postpartum period taught me to also be non-judgemental and more supportive of my clients’ choices. I hope that the process of writing this paper will give me greater sensitivity when helping my clients as they work through any previous experiences they may have that could hinder them from claiming their own power to birth and mother. I am overjoyed to be able to work toward a better birthing future for the families in my community.