A fulfilling birth experience: what does it take? by Penny Simkin
In one month, I was privileged to attend two births that were vastly different from one another, and I was once again reminded of the true essentials of satisfaction in childbirth.
I attended the birth of Sam, the third child of dear friends. Sam was born after four hours of intense back labor which was relieved by the “double hip squeeze,” cold packs, and immersion in a hot tub. Secure and confident, the mother vocalized and moved, and directed her support team in specific ways to help her. She gave birth in the water, surrounded by her husband, son, daughter, midwife, doula and friends, and the moon was full. A perfect scenario; the “ideal” birth, a memory to be treasured.
Cedar, the first child of a lovely couple who took my childbirth class, was born at 3:00 on the morning of my birthday at 43 weeks’ gestation. After four days of on-again, off-again labor and augmentation by rupture of the membranes and Pitocin, Cedar was born by cesarean section. Cedar’s parents were accompanied throughout labor by a favorite aunt, a close friend, two midwives, and me, their doula. After hours of painful, “inadequate” back labor contractions, after numerous frustrating and futile attempts to determine whether the monitoring equipment was failing to detect contractions, after an epidural block and increases in Pitocin, after increasingly deep variable decelerations with no further progress, the mother initiated the discussion of a cesarean, which by then appeared to be the best choice. The entire support team was welcomed into the delivery room, although two of the six chose to stay outside. Cedar’s birth was documented on videotape. The doctor explained “for the camera” and for the parents’ later reference what he was doing. Cedar was immediately alert, hungry, and responsive to her father’s voice. It turned out that her mother’s uterus had contained several fibroid tumors and a Bandl’s ring, which helped explain the incongruity between the seemingly low contraction intensity and her high level of pain.
Throughout the entire labor and cesarean, Cedar’s mother impressed us all with her patience, her ability to adjust to necessary changes in plans, her good questions, good decisions, and her sense of humor. She never gave up and was ever willing to continue, despite a tiring and discouraging labor pattern.
On the surface you might think of Sam’s birth as “fulfilling” and positive, and Cedar’s as depressing and negative. Almost nothing went as Cedar’s parents had desired or expected.
And yet, the essential ingredients for a sense of satisfaction and fulfillment were there—as much during Cedar’s birth as during Sam’s. In both cases, the parents were prepared. They were treated respectfully, patiently, and kindly by their caregivers. People whom they loved and who loved them accompanied them. They also had a doula. And the mothers were the central figures, making decisions, “calling the shots” with the help and support of their professional caregivers. The birth experience belonged to the mothers: in one case with very little need or use of medical technology and expertise; in the other, heavy utilization of medical resources. Both had good outcomes for mother and baby. Also importantly, both sets of parents had the opportunity to talk about the birth, together and individually, to reflect on their experiences. The love, care, and respect both the mothers received, the opportunity to discover their strength, the safety and security of their surroundings, and the fact that they were the central figures in the drama will positively influence their memories. The complexity of Cedar’s birth took more time to process, but because the essential ingredients were there, Cedar’s mother was empowered just as Sam’s mother was. In fact, two years later, Cedar’s mother had a smooth normal labor and the vaginal birth of a son. Satisfaction and fulfillment in birth do not depend on an absence of medical intervention; they do depend, however, on the degree to which these other essential but intangible ingredients—human values—are present.
