I am in the middle of certifying as a childbirth educator through CAPPA. However, I recently gave birth, and it was an AWFUL experience. No epidural, screaming and thrashing the entire time. This was my first vaginal birth (first was a c-section), and I was completely unprepared for how horrible it would be.
Now I am conflicted. I am still very passionate about educating and informing women and birth. However, I don't think I can coach anyone on pain management or breathing techniques when none of those things made it even remotely bearable for me (even with my amazing doula). It would feel incredibly disingenuous.
Any advice on what I should do?
Maddelyn Anne 10/14/2013
New arrival 4/7/2015
This is an interesting thread. You had a horrible birth experience with no epidural...was there something that kept you from getting an epidural? Do you think you would be more empathic towards women making the choice to have one? Do you truly feel there was a benefit in having the vaginal birth over having the c-section, or do you just intellectually know it without actually feeling it. Do you believe there were things in your vaginal birth that could be managed differently for a different experience?
I'm thinking you have a unique perspective. As you know, I'm sure, women experience birth in a variety of ways, and even when two mothers seem to have really similar births physically, their emotions and their view of the experience can vastly differ. Many women will choose to have an epidural because the pain seems absolutely unmanageable. I've read a number of birth stories, and I've heard so many different experiences: a woman who went in for her OB appt to find she was already 9 cm, and had the baby a little while later, a woman who had a pain-med-free birth with pitocin augmentation, and then a completely unmedicated birth where she didn't believe she was having contractions, a woman who said it was the most painful thing that she'd ever done in her life, and she was crawling out of her skin with the pain. I think the fact that some mothers think it's the most painful thing they've ever done and some don't think it's that bad is more than just how the birth experience went, it's our unique bodies and how we perceive pain. I think some people perceive it much more strongly than others.
I think it depends on what kind of CBE you are (I don't know if CAPPA has any set philosophies), but if you have the knowledge and can present the full range of options along with the data so the mothers can make an informed choice, I think you will be fine. For every mother where breathing or other pain management techniques don't work, there are plenty of cases where they do seem to work, so don't let your experience stop you from sharing. I do think that most women find something at the time that works, and it probably is different from what they expected. I had a friend tell me about her natural birth, and she said she just kept thinking that as soon as the contraction got to its most painful point, it would be getting better again. She would watch the clock and she knew that when she got to 30 seconds, she'd be OK. That kind of thing helped me, but it wouldn't help everyone, especially those who had much longer contractions, or no break between contractions. My doula gave me fine-toothed combs to squeeze in the palms of my hand, and that helped too, although I wouldn't have thought of it, and didn't even ask. Once she offered, I took her right up on it, and I found it helpful.
I had one friend tell me straight out how awful natural childbirth was, and she said she thought we should do it, but the pain is terrible. But she had a breech birth and was transported in an ambulance, and then an OB was able to deliver the breech, so I chose to think her pain was worse because of her situation. And I think it must have been.
I had an experience with an epidural, and that was painful too, but in different ways. At one point I was dry heaving so hard, trying to vomit, and there was nothing there, and I was sure I was going to rupture my esophagus, or something. And I could feel a lot of other things after the birth that hurt, like when he reached in me to pull out some retained placenta, and when the nurse pressed on my abdomen--wowee!
Anyway, the point is I think you can do this job well, knowing that your motivations & experience will not be the same as those of your clients, and that is fine. You are an educator and a facilitator.
I like your perspective.
I was planning to have a natural birth. I was risked out of homebirth because I was very anemic (which turned out to be a good thing). Certain factors contributed to the overwhelming pain--back labor, SPD symptoms, extremely fast labor (9 hrs. from first contraction to birth, went from 2cm to 8cm in less than an hour), large baby (8 lbs. 8 oz.), and a strong perineum that did want to open for baby. I did end up asking for an epidural, but both anesthesiologists at the hospital were busy with emergency births and couldn't get to me. I'm still glad I had a VBAC because I was worried about the health complications that come with multiple cesaereans.
More than anything, I want to help women understand birth and know their options. So I suppose I actually have a better perspective now than I did before.
Maddelyn Anne 10/14/2013
New arrival 4/7/2015
FWIW, my philosophy is avoid interventions you don't need, be an active member of the decision-making team for interventions you do need, and pain meds are one of the interventions where usually the mom knows best when "pain" becomes suffering indicating the epidural intervention is appropriate. I know CAPPA has some official philosophy and I don't think mine conflicts but I also feel like my philosophy is pretty non-offensive and, well, correct! IMHO...
I honestly think your experience of the struggles of what you went through are valuable to future clients. You can be honest with them about how it can be challenging and not always turn out exactly like you wanted. You can empathize with their discomfort, and maybe evaluate what might have made your own experience more tolerable. In the end, you did get your natural childbirth and that in itself is a victory you should be proud of.
Before I became a peds nurse a couple of years ago, I was training to be a doula. I myself had never had a natural childbirth. Due to many personal issues I chose to have an empowered birth with an epidural for pain control. I planned for some trusted people to attend including a wonderful doula. I had attended four births between my own two births (both with epidurals) and three of them were natural childbirths. One at a hospital, two at home. People said I made a wonderfully supportive doula and it did not matter what my own experiences were like: it was about them and their experiences and their wishes and emotional and physical needs. Everyone responds to birth differently and your experiences of both of your childrens' births was no less valid than a childbirth that went off without a hitch.
As a peds nurse I apply those same principles: it is not my job to put myself in the shoes of my patients and their children, to judge what their decisions are. My job is to educate them about what their options are, what to expect, how to deal with the situation at hand, support them emotionally and physically, and be their advocates.
Several years ago I was at a birth where that was the case...followed up with an emergency cesarean!!! I felt so useless and it really rattled my confidence and had me re-evaluating my whole choice to be a doula. It was in the long run the very best thing that could have happened. Up till then I had been so totally focused on helping them all avoid medical intervention that I had lost sight of the ultimate goal - to provide emotional support so that they are far less likely to experience trauma from what-ever comes. I also learned some techniques to help reduce pain...but at the end of the day it is all about walking them through their birth experiences...whatever those are. Compassion and massage...continual encouragement!!! Those are the most precious tools. I agree with other comments...you have a unique experience that can help them. For one, moms are so encouraged to do natural and they take these classes that give them the impression that labor will be hard, but somehow easy. I've stopped telling moms all that...they get it from so many natural birth sources. I focus on giving them practical tips for endurance and confidence. Digging deep and finding the strength to come through that kind of labor pain is amazing and not for everyone. Please don't give up. ;)
Married to a wonderful woman since 2010. Baby boy C arrived in June 2013!
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I definitely agree with the other commentors on your post. While it is unfortunate that your birth was very painful, you did stick with it, and that allows you to offer a different perspective. As an educator, you can offer clients your honest experience, explaining that things may not always work out exactly the way that you want them to. You also can offer them options to make it more likely that their birth experience will go as planned. Things like pre-natal yoga and massage have been shown to help relax the muscles of the pelvic floor. A lot of the pain that is experienced during childbirth comes from the fact that the pelvic floor muscles are so tight that tearing or straining is inevitable if you choose to have a vaginal birth. Preparation beforehand can possibly mitigate some of this tightness.
Having had both a c-section and a natural birth allows you to offer your experiences of both to your clients. I don't think it is disingenuous at all, but actually makes you an even more valuable childbirth educator. I wish you the best of luck with your clients!
I think you can give a unique and honest perspective, without swaying women one way or another. There are pros and cons to natural childbirth and birthing with an epidural.
Our goal as educators and doulas is not necessarily to tell a woman what is best for her-that's something each woman must decide on her own. It is to make women aware of their options in labor (and options are always good), give options of comfort measures and assist them in weighing out pros and cons of each type of medical (and/or non medical) intervention.
Labor isn't easy-if it was, they wouldn't call it labor, and while you may not have been totally satisfied we your own birth experience, that doesn't mean that other women won't look up to you-infact, they may look up to you more for your honesty and strength (I hope you haven't lost sight of how totally amazing and accomplished you are to have given birth naturally-despite how much it may have been an awful experience).
You are a woman who can now draw knowledge not only from classes and books, but from your own life experience-what teacher could be better than that?