Why does the Choice-based childbirth trend fail so many expectant families? There are both simple and complex reasons. In order to fully comprehend why this way of thinking does not produce real change in childbirth, we have to look at pregnancy and birth from the woman’s viewpoint, the father (of course there are many single moms, women in lesbian partnerships or women who will have a friend or family member participate), the staff (whether midwifery or obstetrical nurses) and care provider (whether obstetrician, GP or midwife) and of course … the baby.
Any integrated system that works well should have a positive impact on all involved.
Everyone, not just the woman, becomes involved in the choices women make about The Birth. Let’s drill down and see why ‘choice’ alone does not achieve change in childbirth.
WOMEN:
There is no way to know what a birth will be like. That is a fact. No matter how much planning, hoping, life style living, religion or even health status there is no A=B in regards to birth. On top of that pregnant women are always connected to their baby and there is no correlation that indicates mother= baby. This means we are dealing with two people so closely interwoven that sometimes what impacts one will impact the other and sometimes not.
The mother might have issues that impact her baby but those are always only a statistical percentage. If it happens to you or your baby then it can be 100% happening or partially happening or perhaps it doesn’t happen at all. Variables within statistics support ‘there is no way to know what your birth will be like’ and ‘choices’ do not always negate those variables. Gosh this all sounds so general yet there are millions of women out there who understand this. There are women who try desperately to mitigate issues if they are known, yet sometimes issues are unknown until they present themselves. Other women do nothing or very little and although they may statistically be headed in a certain direction, that doesn’t mean it will happen.
It is this disconnect between ‘choices’ and either ‘outcome’ or ‘process’ that frustrates so many in regards to childbirth. Remember there are two parts to The Birth … the outcome (whether the mother or baby come through that experience as two healthy individuals) and the process (how the woman copes with giving birth). Even those two things are not A=B. Good outcome does not mean good experience and unfortunate outcome does not mean uncomfortable process.
Here’s an example of how passionate people are about believing that ‘choices’ result in both good outcomes and processes.
At one conference as our New Zealand charitable Trust presented the concept to grow a skilled birthing population and discussed how the Choice-based trend is failing too many women. A pregnant woman (who also worked as a birth professional) stood up outraged. She honestly believed if a woman ate well, exercised, researched her choices, prepared everything just so, chose a birth professional with complementary believes and lived a healthy life style of thinking positive thoughts and only listening to positive birth stories then her birth would unfold positively and naturally.
When we told her there was no correlation between those things (only statistical probabilities) she and many at the conference were incensed. In fact, the conference became an attack on the concept for a skills-based approach and the organizer had to step in and try to calm the audience down. Many people share a belief that if women ‘choose’ the right things then their birth will go well. Of course, if a woman has a great birth after making those choices then she suspects they are the reason for her success. Yet if a woman does all those things and has a terrible birth then what is she left with? This particular woman did not have a good ‘process’ … moving from home birth to hostile that included lots of interventions she did not want and the ‘outcome’ was less favorable than she or anyone would have wished. She have a vaginal birth yet took a 4th degree tear because she was so ‘fit’ her vagina was incredibly tight. She was sown up yet developed scar tissue that caused pain during intimacy. She eventually had to have reconstructive surgery. She felt depressed, had trouble nursing and it took several years for her to come right. Her baby was born with a major clef palette that couldn’t be fixed right away, causing the nursing difficulty and resulting in an unsettled baby for months. Eventually she had surgery and is a beautiful little girl.
None of us would have wanted these things to happen to her. Although her story is just one story, it’s not uncommon. Choices do not always produce the outcome or process women desire and we can understand why this frustrates so many. Women don’t like to feel out of control. If we don’t have choices then we have no control. This woman had to deal with the loss of expectations that all her wonderful choices had not produced either the outcome or process she wanted to control.
Here are general statements about ‘choice’:
- Women who have lots of choices, those choices unfold as she wants and she has the birth experience she desires. What percent of women experience this? Fewer than we’d like to imagine. Often these woman have trouble understanding how choice does not equal outcome or process.
- Women who have lots of choices, those choices unfold as wanted but there is a poor outcome to her birth. This is not a big group but is part of the larger group that too often feels shame, blame, guilt and disappointment.
- Women who have lots of choices, those choices unfold as she wants yet she finds the experience terrible and ends up with feeling traumatized for months or years. This is a much larger group and too often find themselves feeling negative about their birth experience.
- Women who have choices yet the unexpected happens and the birth is profoundly different than she had hoped. She might resent her experience, accept it or be glad for how the birth unfolded.
- Women who lack any choice and have a wonderful birth experience and good outcome. This is a larger group than many people would like.
- Women who lack any choice but want something different and resent how their birth unfolds yet others around them thought the birth was great. This is a large group.
- Women who lack any choice but want something different yet work with what happens to her and feels pretty good about her experience and outcome. Not a large group.
- Women who lack choices and are delighted that she doesn’t have to make any. Large group
- And the list can go on and on and on.
Do you begin to understand why ‘choice’ is not the solution to changes in childbirth? The Choice-based childbirth trend just does not embrace enough women. There is so much variability based on so many factors that having choices does not guarantee the perceived or real success hoped for by making those choices. And when choices are lacking it doesn’t mean women feel terrible about how their birth unfolded. The Choice-based childbirth trend has always been slanted toward achieving more natural birth and certainly does not reflect the majority of pregnant/birthing women in modern society. While The Choice-based trend implies that all ‘choices’ are respected you just need to go online and read how individual and groups are discussing choices.
This lopsided view of our Choice-based childbirth trend means that the present childbirth conversation really does not honor all births. Women pay lip service to doing so but that’s not what really has happened during this Choice-based childbirth trend. This is why there is such a rift in childbirth today. If all of us are not included and every birth is not honored then the system is failing.
What’s become apparent is that women have become mean to other women when it comes to birth. Men would never do to each other what women do to each other (‘I had a better birth than you did’) and from our Trust’s viewpoint this has to stop. That’s why we advocate so strongly for a Skills-based childbirth trend. No matter what category you fall into from the above list … or one not mentioned … you can prepare your pregnant body to become a birthing body and you (and partner/other) can learn a shared set of birth and coaching skills to use throughout your baby’s birth journey.
Many choices or lack of has still left too many women incapable of planning the birth they want or having the birth they hope for, or are resigned to having or feel pressured to have or accidentally have. However, every single birthing woman can use positive breathing patterns and learn to soften inside her pelvis. This is NOT rocket science. A Skills-based approach covers everyone without exception. As humans we thrive on being skilled. Shouldn’t we want this for ourselves and each other? We should want our baby’s birth to be a true highlight no matter how it unfolds. When the majority of women are skilled birthing women we will see a shift in childbirth.
Can a Choice-based and Skills-based trend exist side-by-side … ideally. However, we need to still understand that choices do not directly lead to either a positive outcome or process. Skills also do not directly lead to a positive outcome yet are more likely to lead to a positive process and sometimes it is the process (feeling in control) that is so vital for women as they move from ‘becoming’ a mother through the Gateway of Birth to ‘being’ a mother.
NEXT POST: Why the Choice-based childbirth trend fails fathers-to-be.