By Louise Rachel
Issue 140 January/February 2007
Our society in general, and the Mothering community in particular, has a problem: How can we advocate for birthing and parenting practices that have proven benefits without making parents who have not achieved them feel denigrated? How, for example, do we discuss the overuse of cesarean delivery without making the one-fifth to one-quarter of us who've had one feel bad, or promote extended breastfeeding without seeming to blame women who haven't been able to do it?
I suggest that the answer lies in achieving a certain perspective. This perspective starts from the premise that each of us does the best she can—given the particulars of our knowledge base, resources, support system, and the circumstances in which we find ourselves (and which we often cannot fully control). No one should ever allow herself to feel judged inadequate for doing the best she could, or the best she knew at the time of choosing. But we must also note that because our knowledge base is one of the keys in our decision-making process, it is absolutely appropriate that every effort be made to disseminate good information as widely as possible—never to blame people for past choices or idiosyncratic situations, but to get good facts out to whoever needs and can use them.
Furthermore, and crucially, those who promote such information must recognize that while such choices as excellent prenatal nutrition, natural birthing, extended breastfeeding, avoiding circumcision, cosleeping, and so on are documentably ideal for most families most of the time, there sometimes really are exceptions, limits on information, and limits on what is possible. A simple example: I teach the Bradley Method of natural childbirth, which is based on the principles and practices of Denver obstetrician Robert Bradley—who did not deliver 100 percent of his patients naturally. He had a 3 percent cesarean rate, and another 3 to 5 percent of his patients required some obstetrical assistance short of surgery. It's a fact: In a small minority of birthing situations, only obstetrical intervention can get everyone through alive and well; and in another few percent of cases, it's not perfectly clear whether or not obstetrical intervention will be required.
It can be a shock when one of these cases is someone who all along has planned a natural birth, as I did. An hour into second-stage labor, my baby was halfway down the birth canal when her heart rate began to fluctuate wildly. My midwife called the backup obstetrician, who managed to quickly explain to me that a baby whose heart did that might be fine, or might be getting into such difficulty that another hour of labor could cause permanent damage. He recommended a forceps delivery, just in case it was the latter situation, and of course that's what we did. Although I appreciated the doctor's frankness, and his including me in the decision-making, I was deeply disappointed. But knowing I had tried to make the best choice for my family in the circumstances presented to me, I refused to second-guess myself—even though the baby, once born, proved that it had been a false alarm.
There are exceptions to every general principle. I teach prenatal nutrition, and most of my students do improve their eating habits once they start to think about it. But one student developed such severe food allergies during pregnancy that entire categories of food gave her hives. She had to do the best she could with her prenatal vitamins and the few things she could eat—and her baby was born OK.
The issue of cesarean section similarly reveals complications beyond the basic awareness that there are simply too many of them being performed. One student who took my classes wanted a vaginal birth after cesarean (VBAC), and had found a doctor and a hospital willing to support her in having one. She began labor, got right through the first stage, but when she tried to push in second stage she realized that something felt wrong. During the resulting cesarean, her second, the obstetrician had quite a bit of trouble freeing the baby from the scar tissue resulting from the first cesarean. I congratulated her on everything she'd done right: waiting for her labor to start on its own, laboring for many hours without medication, being able to recognize a problem, and acting to get herself and her baby through safely.
On the other hand, I met a woman at a La Leche League meeting who was grieving the fact that she'd had a primary cesarean and still did not understand why it had been necessary. When she told me the details, I thought it sounded less like an emergency than her obstetrician's failure to be patient or to take into account the mother's feelings. This mother had not realized that she might need to be prepared for such a possibility. All I could do was to validate her unhappiness, encourage her to work through the hurt, and to seek a VBAC for any subsequent pregnancy. Plans for labor can go awry even without a cesarean. The active labor of a friend (she is also a student and doula client) began with her waters breaking and significant hemorrhaging. At the hospital, this resulted in a complete change of birth plan: instead of being on her feet and in the shower, my friend was now confined to bed with continual fetal heart monitoring (the baby's heart rate was just barely OK). Her older child, instead of being allowed to be present at the birth, was exiled by the doctor to the waiting room in case the partial placental separation that he had (correctly) diagnosed might suddenly worsen and require immediate surgery. These were real physical dangers that we had to make the best of. We did, and the baby's condition stabilized enough for a normal birth and immediate nursing.
Breastfeeding, too, is sometimes not simply a matter of putting the baby to the breast. One of my students nearly gave up on breastfeeding in the first weeks postpartum due to agonizingly sore nipples. A La Leche League leader spent an entire afternoon with her, helping her learn better positioning. This did the trick—but what if she had lived in a more rural area, where a lactation consultant was not so readily available?
Early parenting is a time of a variety of choices and possibilities. I teach about the nonexistence of medical reasons for circumcision and the concerns about performing the procedure, as well as about the controversies over vaccinations. But given the force of societal norms, I also teach about topical anesthesia if circumcision is chosen, and the safest way to manage vaccinations if some or all will be used. Being Jewish, I would have had a son circumcised—but, to my enormous relief, my baby was a girl. She did get all her baby shots, because at the time I was unaware of any reason not to. But by the time she was in sixth grade, I knew more, and did not authorize a measles booster when there was a measles outbreak in our city.
While I now teach about the advantages of cosleeping, 27 years ago I thought that giving a baby the privacy of her own room was the right thing to do, and worried that a two-bedroom apartment had not yet come available by the time my daughter was born. We moved furniture and installed a roll-up screen to divide our single bedroom into two spaces—we were cosleeping, if not actually sharing a bed, for her first few months. But having to sit up in the rocker for night nursings, I surely got less sleep than I would have with a sidecar. This experience informs my teaching on the subject, as does the fact that when we did move into two bedrooms, I kept both doors open and could still hear my baby in my sleep.
My experiences have thus taught me that some of my choices could have been better, and that in some cases there is more than one reasonable possibility. How could I have learned this except by making some less-than-ideal choices and experiencing their consequences? For that matter, teaching birth classes and then sending my students forth to give birth in their own ways has taught me not to judge others' choices.
Many students take my class for the first time only with their second pregnancy; they're trying to arrange a birth that will be better than—or at least different from—their first. Most of my students and clients do have natural births and good early parenting experiences. But these samples of unexpected wrinkles show, I think, how much messier real life is than our ideals would make it. They also show how people can respond with courage, resilience, and purpose in navigating the shoals they may find themselves in, even though they had reasonably hoped and planned to be sailing in deep, open waters. Stuff happens, people do the best they can, and very often they learn and grow thereby.
Listen to our podcast interview of Louise Rachel
Louise Rachel is the mother and stepmother of grown daughters, and lives in Shorewood, Wisconsin, with her husband and cats. She has been a childbirth educator for 20 years.
Illustration by Alison Stephen.