How To Be A Good Friend To A New Mother

(Trigger Warning: pregnancy, birth details, breastfeeding, hospital stays)

Spring is the time of new life, and I've been thinking about babies. Partly this is because I'm finally going off the antidepressants after a bad go of postnatal depression, and partly it's because spring is springing and I'm at the age where many of my friends are having children. Well, children are part of a community, and part of being a good friend, sibling, cousin or community member is being nice to people who are having them. But for those of us who haven't had children, or haven't had them yet, it can be tricky to know how best to do that. So, as the mother of a one-year-old, here are some of my tips:

Before the birth

- If you're going to spend time with with the new mum, plan social events around the limitations of pregnancy. By the third trimester a woman will be easily tired, heavy on her feet and in frequent need of the toilet. (Women have smaller bladders than men to begin with, and a baby sitting on them is no joke.) Hence, a four-hour hike up a hill is probably not the best event for her. Likewise, a drunken night out is not really on the cards. On the other hand, fun with friends is much needed, so hang out in places with chairs and bathrooms.

- Do not give her any pieties about birth. She's probably scared, and this is not unreasonable. There's a lot of low-grade shaming goes on when it comes to mothers who needed pain relief during birth, and she needs people on her side. There are certain particular things not to say...

- Don't say 'It's just one day out of your life.' Would you say that to someone who was going to be tortured, or have a tooth pulled without anaesthetic, or ... well, anything painful that didn't involve the sacred notion of motherhood? Don't say it.

Among other things, it's not true. Labour lasts less than a day only for some women, the lucky ones. For other women, it can last as much as a week. Even when it's over, it's not over: she'll almost certainly have a torn perineum, which is extremely painful, and feel bruised from the pregnancy, and learning to breastfeed is often painful in various ways too. And that's assuming she didn't need a Caesarean, which takes months to heal properly. And then there's baby blues, and postnatal PTSD and postnatal depression; the latter can last a lifetime. It's possible it'll just be one day out of her life and she won't tear and have no problems breastfeeding, but if that's the case, Ripley's museum would probably like to hear from her. Labour takes a long time, and it also takes a long time to recover from.

- Don't say 'It'll all be worth it when you hold your baby.' For starters, it's not your place to tell her what her pain and discomfort are 'worth', and it's certainly not your place to coach her on being a loving enough mother. These are things she needs to work out for herself. For another thing, it's just not that simple. Women who've had traumatic births often take longer to bond with their babies; they get there, but they don't experience an epiphany of 'It was all worth it!' as soon as they're handed the child, and being told that they will just makes them feel guilty when they don't. And on another score, when it comes to birth there are definite haves and have-nots. My mother bore me in about three hours with no painkillers needed; I had an induced labour that lasted forty hours, got codeine, gas and air and finally an epidural, and I still wound up with PTSD and then depression. Now, I'm perfectly prepared to concede that my son is a better child than I was - nobody's child is as awesome as mine - but my mother is of the opinion that he and I were about equally cute babies. So is my forty-hour ordeal the price I had to pay for my child's loveliness while she owed the universe only three hours? Doesn't that mean that she deserved less suffering than I did? Or, to put it less abstractly: the suffering of the birth is not proportional to the charm of the child, and talking as if the one bought the other is just wrong. What it basically boils down to is a way of saying 'I don't want to know about the painful side of it.' Well, she doesn't either, but she's going to have to, and telling her to shut up about it is not supportive.

- Don't tell a heavily pregnant woman to enjoy her freedom while she still has it. She's hardly in a condition to go sky-diving; she's probably very uncomfortable, and not feeling very free.

- Do offer her your seat, offer to carry stuff, fetch stuff, and - particularly - pick stuff up for her. (Bending over with the permanent heartburn pregnancy often produces is no fun.)


Visiting in the hospital

If a new mother has to stay in hospital for more than a day, it's probably because there's a medical question mark over either her wellbeing or the baby's. Perhaps she's had a Caesarean and isn't ready to be discharged; perhaps the hospital's concerned the baby might have an infection and is giving a course of antibiotics just in case; perhaps the baby was premature and needs hospital care; for whatever reason, a new mother staying in hospital for long enough to make visits an option is almost certainly worried, and absolutely definitely tired. Hospitals allow very little privacy, and sleep is not easy to come by. Here are the best things you can do:

- Assuming hospital policy allows it, bring food. Never mind flowers; in a hospital, they're just one more thing to find room for on your tiny bedside cabinet, and there probably won't be a vase for them anyway. Never mind gifts for the baby for the same reason: unless she's there long-haul and has specifically asked you to bring something, a gift is something she'll have to find storage space for, and that's just another thing to worry about. Food, on the other hand, is a good gift. Hospitals provide meals, but hospital food is ... well, it's hospital food. It's reasonably nutritious and it's usually palatable, but it's institutional and not very inspiring. More to the point, it's served on the hospital's schedule based on the hospital's menu: the patient has very little control over it, and at a time when she's probably feeling rather disempowered anyway, a snack she can eat on her own time can feel like an important little piece of independence. Food has a lot of emotional and social associations, and food brought in from outside by her real friends and family is a connection to her real life. Bring something that doesn't need refrigeration and isn't too messy, and that suits her tastes (plus, of course, avoiding any allergies she might have and being suitable for breastfeeding); bring healthy grapes if you know that's what she likes, but if you know she'd like some cookies better, it's not the time to stand on health protocols: she's already stuck in hospital for the sake of health, and she doesn't need you joining the act.

- If she's asleep, don't wake her. Really don't; it's unforgiveable. If she's on a shared ward, she'll have been woken all night by other patients, their crying babies, and hospital staff rattling to and fro - not to mention her own baby. On a postnatal ward, you sleep when you can, and she's probably not going to have an unbroken night for at least the next year. Let her be; leave a note if you have to.

- Try not to be too noisy. She's sharing the hospital space with other exhausted women whose privacy is pretty much gone, and while the mum you're visiting may enjoy your uproarious laughter, her neighbours won't: for them, it's just rubbing in that at a vulnerable time they have no control over who they have to share a room with. Be considerate; she doesn't need you making enemies for her.

- Ask if she needs you to get her anything. She can't leave, and an errand can make the difference between helpless frustration and a manageable experience.

- Ask how she is as well as cooing over the baby. Do coo - if you don't, you'll hurt her feelings - but don't forget that she's in a pretty rough place too. Hospital staff have to focus on whoever needs the most care, and often that's the baby: she needs to know that people haven't stopped caring about her welfare now she's a mother.


Visiting at home

- Be guided by the parents as to when would be convenient to stop by. It could be that they're desperate to see their old pals, but it could equally be that they're exhausted and already overwhelmed with visitors, and what they really want is a bit of time to themselves to keep learning all the new skills that are suddenly vital. Be keen to see them, but clear that if what they need most is some time alone, you're ready to provide that.

- Call the day before or the morning you leave, and ask if there's anything you can pick up for them and bring along. Running errands can be difficult when mother and baby are still adjusting to the new situation, and being stuck at home without an essential thing can be a nightmare. If you can swing by the pharmacy or the grocery on your way there, you could be doing them a big favour.

- Be sensitive as to how they feel about having the baby held. Some mothers are quite happy to pass the baby over for a cuddle and take a break themselves; other mothers can't bear to relinquish their beloved little bundle. Either is fine and should be respected. More noisily, some babies are happy enough to be cuddled by strangers and some panic when separated from their mothers. The parents will know their baby's feelings on this point - babies are not known for their stoicism - so ask them what would be better. To a non-parent, the baby will probably seem like a squirmy little blob with mystifying reactions, but the parents will already be quite clear on their child's personality and preferences, and will let you know if you ask.

- If you're squeamish about nappies, spit-up and so on, fine, but try to cut the parents some slack if they mention it - or at least don't make a big production about how gross you find it all. Squeamishness is a luxury parents can no longer afford, and you won't endear yourself by flaunting yours; you'll come across like an aristocrat exclaiming in delicate horror that the peasants have to do their own dirty dishes. It's not good manners for a parent to give you an in-depth description if you don't want it, but caring for a baby is non-stop and they may need to give each other the odd piece of information about a subject you'd rather not think about. Don't grimace at them; they're trying to manage a complicated process, the baby's bodily functions are an important guide to his or her state of health, and they need to keep up to speed on them. Acting like they can't talk about things they need to talk about in front of you sends the message that parenting is a second-class-citizen business that shouldn't be done in decent society. Try to be tolerant; after all, you don't have to do the actual nappy changing!

- Once again, food makes a better gift than flowers. Alcohol is out if the mother is breastfeeding, so a bottle of wine probably won't go down well, and even if she's not, parents of a new baby really can't afford to get drunk. What they'll almost certainly be missing is home cooking - take-aways and ready meals will probably be the order of the day - so if you can cook something you know she can eat, a pot of something nice will go down very well. (One of the best visits we had was from some friends who'd had a baby themselves in the last year. They turned up with a pot of pumpkin curry, a pot of cooked rice and a pot of cauliflower cheese, then took my son in their expert arms and told me firmly to relax and enjoy my lunch that they'd just provided. That was nearly a year and a half ago, and the gratitude is still fresh.)

- If she breastfeeds in front of you, treat it as normal. The baby can't wait even a minute when it's hungry. She may need to take it upstairs and feed it in bed - some babies only really nurse properly when they're lying down - or she may need to do it sitting in front of you. After a couple of weeks, nursing boobs feel much less private than they did pre-nursing, so the modesty rules are different - obviously don't gawp at them, but if she doesn't mind doing it, don't worry. Just talk to her face and carry on.

- If you're bringing a gift for the baby - which is good manners - bring something practical. It'll be many months before the baby cares a hiccup about toys; what new parents need is machine washable clothes and muslins ... but very few people give these as gifts because they don't seem very exciting. The basic necessities of dressing a baby are short-sleeved vests with poppers between the legs and full-body sleeper suits with poppers down both legs; some parents like to dress up their kids more than others, but these are always useful. Stretchy fabrics are good; denim and thick fabrics can be a nuisance with small floppy kids. Get a size or two larger than the age of the kid, as babies grow extremely fast, many are bigger than their 'size' to begin with, and it's better to have clothes the child swims in than clothes that don't fit. If you really want to be helpful, and if the parents aren't too hung up on gender roles, get unisex: that way they can put them aside for any subsequent children.

- If there are older siblings about, they'll need affirmation. If you're bringing any kind of gift for the baby, bring something fun for the older sibs; pay attention to them as well as cooing over the baby. Don't for goodness sake tell them what they should be feeling - 'Aren't you lucky to have such a nice baby brother/sister?', or 'I bet you're proud!'; children don't like this any more than adults do. Just act like baby is not the only interesting child in the family.

- If the mother has had a difficult birth, for the love of humanity don't say 'But the baby's doing great, and that's what matters.' Seriously: do not tell someone who's had a traumatic experience that it doesn't matter. The fact that she's too traumatised or too polite to punch you for saying it does not mean you wouldn't deserve it.

- If you can do it with any degree of sincerity, tell the mother she's looking good. Pregnancy wreaks merry havoc with your body and most new mums are feeling fat, dowdy and mumsy; a compliment is a very nice thing to get.


New parenthood is a pretty extreme state, and friendship is a big deal. In the end, though, it's not that complicated: don't lecture her on how she should feel and make allowances for the changes in her life, and you'll probably do fine.

--Kit Whitfield

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The Slacktiverse is a community blog. Content reflects the individual opinions of the contributors. We welcome disagreement in the comment threads, and invite anyone who wishes to present an alternative interpretation of a situation to write and submit a post.

Comments

[Emily Cartier]

Something else for the don't list... Don't share horror stories.

Trigger warning: Details of difficult birth/labour

My mom had a 72 hour non-progressive labor with me (for no apparent reason), followed by an emergency Caesarean section after I started having heart trouble. She had pre-eclampsia. She had diabetes. I passed miconium before I was born, "breathed" it in, and nearly died again as a result. I tend to wish pregnant ladies an easier experience than mom and I had rather than sharing the gory details of exactly how we both are medical miracles. Or if they already have a kid, I hope it will be easier than the last one.

If someone does have a rough time, I will happily point out that I survived a really awful birth (leaving out details unless they're relevant), and so did my mom. I also ask if they want to talk to mom, because it can help to talk with someone who has had similar experiences. I'm also all in favor of pointing out the joys of good painkillers and doctors who will do c-sections when called for. Natural birth is good, but sometimes you need medical miracles... and they usually don't feel terribly miraculous when you need 'em! And it doesn't mean you failed, even if there's no obvious "reason" why you needed surgery or painkillers or whatever. I'm a perfectly serviceable adult, and as near as they can tell nothing that's wrong with me is caused by my birth being so excessively exciting.

I'm also the oldest of 3, so obviously the horror of having me didn't put mom off the whole idea forever after. I do think that's ok to bring up... even a really hideous experience won't always feel hideous, especially if it's ok to talk about it. Part of what helped mom was her doctors understood that the experience was hideous, and no one pushed her to have vaginal births for my sibs. They were both born via C-section too, and (unlike me) the births were planned to be pleasant for mom.

Good thing too. I was 9bs (about 4kg), and my sister was 10.5lbs (almost 5kg). I was small enough that a vaginal birth was possible for many women. But my sister was large enough that she could have killed a lot of women as a first vaginal birth. And yes, I know the doctors checked my head size... that wasn't the issue.

The other thing I do is I willingly volunteer to play with toddlers, because I *like* them. I know a lot of people act like kids are space aliens. I am not very good with babies, but if there's an older kid, I can play with them happily so the parents can at least pretend they just have one kid for a few hours. This includes changing diapers and convincing your toddler to not play on the train tracks.

[The Board Administration Team]

@Emily: We added a trigger warning to your post because a number of our readers find any descriptions of difficult births to be disturbing.

You point, of course, stands.

[Lonespark]

Quite a lovely post.

I cannot sing loudly enough the praises of clothes with snaps on the legs.

[Z]

As usual, Kit, excellent work. I like your emphasis on bringing food as a gift. Giving birth is as demanding as a triathlon!
I'm baffled about the mention of 'shaming' around requiring pain meds. Maybe that's a European thing... can other North Americans chime in?
Also, "that's assuming she didn't need a Caesarean, which takes months to heal properly"? I'm not sure what you mean about heal properly, so I'm giving you some wiggle room, but that seems a little off the cuff. I had an emergency c-section and I felt great after 2 days. I was back to my normal self after a week, a full month before the other women in my birth group. Yes, there are horror stories out there, but that's true for natural childborth as well.

[Jenny Islander]

Up late with nonsleeper, breaking blog fast, such is life.

Here's a nice thing to ask a new mom who is breastfeeding: "Would you like a glass of water?" IME thirst sneaks up on us.

It's also thoughtful, albeit potentially a source of argument, to do little things that new parents are just too brain-blown to think of right now. If you use their bathroom and the toilet paper is low, change the roll. If the couch is disheveled, straighten it yourself before you sit on it. Take your own dirty glass to the kitchen and while you're in there, gee, there are six dirty glasses and a sponge, and there's the dish soap, and suddenly they have clean drinking glasses again. Some new parents may bristle if you do this kind of thing. Others may cry tears of gratitude.

Gifts: To onesies and feetie pajamas I would add towels-with-a-hood, soft baby socks, and receiving blankets, the very thin kind that are basically just pieces of cotton sheeting cut and hemmed to baby size. Receiving blankets are a multi-purpose tool for new parents. For girls, avoid the shiny, cute satin dress-and-diaper-cover combo. They are extremely slippery.

Never EVER tell somebody that at least they have a healthy baby. And even if you were raised to believe that a good baby is quiet all night and likes to be passed around, do NOT talk about good babies. Especially if theirs isn't what you would call good.

[Kirala]

If my last two comments got through, sorry for the double-post; if not, Typepad is up to its usual shenanigans. *grumble*

[The Board Administration Team]

@Kirala: You aren't even in the spam trap -- if you email the comment(s) to TBAT we can put them up for you if you like.

[Kirala]

Comment emailed; sorry for the fuss!

[Kirala]

Oh, sure, it allows me REALLY SHORT comments...

[Mmy]

@Z: Also, "that's assuming she didn't need a Caesarean, which takes months to heal properly"? I'm not sure what you mean about heal properly, so I'm giving you some wiggle room, but that seems a little off the cuff. I had an emergency c-section and I felt great after 2 days.

This is very much YMMV

Trigger warning: discussion of c-sections/surgery

Can't speak for Kit about this but I do know that: it takes around 6-weeks for the incision to heal properly; you shouldn't drive for the first 2 weeks of that period; you are told not to lift anything heavier than the child for that same period of time (2 weeks); you are told to limit going up and down stairs for at least that period of time; and there can be problems with pain that extend beyond the 6 weeks period. That is leaving aside many of the other problems that often arise (bleeding, urination issues and so on.)

Women who are breastfeeding have an additional set of challenges since the positions easiest for the feeding are sometime the positions most painful to the mother. Women who are breastfeeding can also be limited in terms of the pain medications/treatments available to them.

[Kirala]

@Z: No, pain-med shaming is also a North American thing. And I imagine it could be really rough on someone who needs pain meds - I have a friend whose loud praises of natural birth are always accompanied by an "of course meds are good when needed" that I find a bit unconvincing.

Re: gifts: I'd want to add a modifier that if at all possible, you want to find out what the family needs. My best friend has a six-month-old who has not worn the same outfit twice and still has not worn all the appropriately-sized clothes available because approximately everyone in a fifty-mile radius dumped every hand-me-down possible upon her head. She has approximately twelve large garbage bags full of clothes. (The first statement is hyperbole; the second is not.) Not to say that clothes aren't still the best default when exhausted, overwhelmed parents can't be asked ahead of time, but if you can... ask.

[kisekileia]

Trigger warning: description of problems during birth and their effects on women.

I haven't given birth, but I have friends who are into the whole natural birth/parenting thing. And I have to say, I HATE to see women feeling like failures because they needed an epidural or C-section, or worry that their baby will suffer because of problems in the birthing process that they couldn't control (e.g. not being able to hold the baby right away). I have no doubt that things like having all the medical staff coo over your baby when you haven't even seen her yet (this just happened to a longtime online friend of mine) are horrible, but I hate that women are made to feel like their baby will always be worse off, or like they failed by either needing medical intervention or not being assertive enough about how they wanted the birth to go, because of the stupid "natural birth" ideal.

Natural birth is for the privileged: women who CAN give birth naturally without major problems. People who insist that women's bodies know how to give birth and medical intervention is generally a bad thing are showing remarkable historical illiteracy--in years past, millions of women and babies died during childbirth because we did not have the medical interventions we have now. The idea that women should have ownership of the birthing process should not be used to shame women who don't get to have everything go according to plan.

[hapax]

Pain-shaming is alive and well in North America, including among medical personnel. Horror stories are very much NOT the point of this thread, but suffice it to say that I sent flowers to the staff of the hospital where I had my first child; the staff at the hospital where I had my second are darn lucky they didn't get sued.

The most lovely gift I received as a new mother was TIME ON MY OWN. I was all alone in a new town, and spouse had a new job and was swamped; his boss offered to sit with the baby for "an hour or so." I still remember it; I went out and bought underwear and socks and didn't have a ten-pound wriggling weight strapped to my chest. It was one of the loveliest afternoons of my life.

Although the "no alcohol as gifts" made me laugh about how times have changed. When I was breastfeeding, the doctor prescribed a pint of Guinness every day, to boost my iron and "help the milk come". (It took me FOREVER to lose the baby weight, for some reason)

[Mmy]

As hapax said sometimes time to be on one's own is the most precious thing one can give a person. When my mother was in palliative care one of the greatest struggles we had was just to get the laundry done.

Also (re the changing attitude toward alcohol) when my sister was an infant and teething the doctors advised our parents to a) rub bourbon on my sister's gums and b) if that didn't work give the baby a tablespoon worth of the drink.

[Nick Kiddle]

The med thing is interesting. I wanted to make do with gas-and-air because I thought it would work best for me. One of my friends was incredibly dismissive about that idea, telling me that of COURSE I would need an epidural and the only reason I wasn't keen was because I didn't know what it was all about. Seems like it's not so much the specific choice you make as other people's need to own the decision for you.

//Be guided by the parents as to when would be convenient to stop by.//

This is so important. I read a parenting book that said you should tell all your friends to stay away so that you can bond with the baby in peace, but I was horribly insecure and wanted as many people around me as possible to help me feel I didn't have to cope completely alone. And reading that I ought to be bonding quietly by myself ... you can probably imagine how it made me feel. So letting the parents say what they need is very important advice.

[Jenny Islander]

TRIGGER WARNING FOR GROSS AND DISTURBING MEDICAL DETAILS.

@kisekileia: The problem isn't medical intervention but unnecessary medical intervention. In a nutshell, "bad becoming normal" has infected the modern medical outlook on labor and birth. Examples: Drugged moms must be manually checked to make sure the cervix has dilated sufficiently for the doctor to help the baby out without injuring the mother. Okay, but then all moms have to have painful and possibly labor-slowing manual exams even if they are alert; the pushing urge is disregarded. Moms who have received pain relief via spinal anesthesia may not feel a pushing urge or experience involuntary contractions, therefore they are often coached to push. Okay, but then every mom in the hospital is commanded to push on schedule whether or not pushing is actually a good idea. Forceps births require episiotomies, but then all births require episiotomies. Etc. I just saw a blog post about a woman who was told that she couldn't have her breech baby born by C-section at term because C-sections are too dangerous for full-term babies, therefore she had to have the C-section when the baby was slightly premature. Note that the rate of slight prematurity has risen steeply in recent years due to induction due to misreading the size of the baby or treating induction as just an ordinary thing for the convenience of the mother . . . doctors are beginning to accept the problems of slight prematurity as normal and see a normal full-term baby as wrong! And on and on it goes. No malice is required for any of this; it's just bad becoming normal.

The problem underlying this problem is that in the early modern period, if you didn't see a midwife, you saw a family doctor who usually came to your house. You went to the hospital under the care of an obstetrician if things went wrong. GPs thought of themselves as baby catchers for people who were having babies and OBs thought of themselves as rescuers balancing the dangers of invasive procedures against the dangers of doing nothing. Most OBs still do. But most laboring people and near-birth fetuses are not in need of an OB. So the OB is left attempting to do a midwife's job with an emergency surgeon's tools and outlook. And moms and babies are left with the side effects. ("At least you have a healthy baby!" Yes, and a spinal headache, a surgical wound, nightmares . . . not to mention the bills.)

On a personal note, every single dire prediction the OBs at my practice made about my labors and births was false. Why? Because they thought of birth as a terribly dangerous thing that only young (but not too young) athletic mothers with the correct BMI could endure without intervention, and I was a fat thirty-something white-collar worker. Actually it's a hard job of work that is potentially dangerous, hence the use of a midwife or GP as a spotter with emergency services on speed dial.

[Nick Kiddle]

//Also (re the changing attitude toward alcohol) when my sister was an infant and teething the doctors advised our parents to a) rub bourbon on my sister's gums and b) if that didn't work give the baby a tablespoon worth of the drink.//

I used to deal with colic by drinking a mug of brandy-laced tea before breastfeeding.

Actually, the amount of alcohol that finds its way into the milk is pretty negligable, so all it was really doing was helping me to calm down ... which does often have a slight calming effect on baby.

[Ross]

... Grumble. Typepad, kindly auto-fornicate.

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@Z: I don't know about shaming, but I do know that there's a broad cultural perception that EVER needing pain meds means you're one step shy of being a street junkie out looking for a quick fix. (This may be just my personal neurosis and not a cultural thing, but it feels to me very much like one of the strains of american puritanism is "If you are in pain, you deserve it, and using medicine to get out of the pain is cheating"). When we took the childbirth class, the instructor asked how many of the expecting mothers planned to go without painkillers, and every single hand shot up, including the hand of the one woman in the corner who was literalyl quaking with terror every time pain was mentioned. They all, my wife included, had a VERY strong preconception that any kind of pain medication meant that they were personal failures, and a substantial amount of time in the class was spent on the lesson "No, really, even if you get an epidural, you are still 100% a mother and a good person and have not robbed yourself and yor baby of the One True Birth Experience".

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@Nick: I'd add though that first time parents probably won't know _themselves_. Just as you describe, we went through a lot of "I want people around me" (Particularly because I went back to work after my wife got out of the hospital since we only get a finite amount of leave and I wanted to have it for when it was needed after those first weeks when we were being swarmed by family.), but at the same time, putting up with guests is stressful for a couple of introverts, and there was a lot of "Oh god please I just want some time to myself to enjoy the company of my baby". Those first two weeks were spent hosting a pair of proud grandmothers, one of whom was domineering (No, you are NOT supposed to put a baby face-down to sleep, stop turning him), and the other of whom was sort of counterproductive (Thanks for making us dinner, but next time could you try cooking the meat all the way through?)

[jnc]

Kit - thank you for the trigger warning about breastfeeding. It allowed me to avoid reading a post I may have found disturbing.

[Nenya]

The points about pain and management of same are very salient even to me, as someone who has never given birth. Because one of the reasons I don't want to have children is that it would hurt so damn much, and since I don't otherwise have a burning need to reproduce, "But you'll love the baby once it's born!" is less than useless. I've always felt a bit of a failure for not wanting to put myself through the pain, but as Kit says, if it were any other topic than motherhood, would that even be an issue? So I have great sympathy for people who *are* pregnant and coming up against the "it's going to really hurt" part.

[Jenny Islander]

The thing that honks me off about the pain narrative is that most mothers didn't have to experience labor as the most pain they had ever had. I blew out my knee once; that was a little hell. Sprained my ankle so badly that the doc told me I had essentially done the most damage a person could do without tearing a blood vessel or breaking a bone, then had to get myself and my ankle up a cliff, up a steep hill on top of the cliff, around a house, and up a set of stairs, completely alone. That was a larger hell. Hip problems associated with pregnancy sucked. Labor? I went uuuugh and ooooof and uuuuuuuurgh and OW OW OW and then I had a baby. But I had been well prepared beforehand. My birth attendant had clearly explained the stages of labor, the working pains thereof, and the signs that something was actually wrong. I had been assigned stretching exercises. I had been taking multivitamins recommended by my attendant for maximum absorbability and eating the most nutrient-dense foods I could keep down. I was well hydrated. I had a menu of movements and positions for ease of labor and the freedom to try them. I had a slow cooker full of hot compresses (hot compresses are love, hot compresses are better than beer). I had a big pile of pillows. I had an advocate standing by for the times during labor when all circuits would be busy in my brain. So, yes, labor was not fun, and the last part of it was very unpleasant, and when it was over I was glad it was over . . . but damn it, I was not injured and I was not sick, and I knew I had a job to do that was going to be onerous, and even though I didn't end up taking any painkillers the pain monster did not come and get me. Not the way it did that time at the bottom of the cliff, that's for sure.

I don't take credit for this. I was very lucky to have an expert in prepared childbirth, well-positioned babies all three times, and no pre-existing injuries or illnesses. But my story should not be that unusual.

[kisekileia]

Trigger warning: difficult childbirth, mother blaming

Jenny, the "birth is over-medicalized" thing is one of those ideas that seems to be very popular, particularly in the "natural" community, but that nobody ever seems to actually present any solid evidence for. So I'm a tad suspicious of it. Do you have any scholarly studies to link to on the subject?

The other reason I'm wary of that particular attitude towards birth is that so often, women end up feeling like failures because their birth isn't completely "natural". The underlying assumption that goes along with "birth is a natural process and fewer interventions are usually better" seems to be "if my birth wasn't completely "natural", then I failed, my doctors behaved wrongly, and my baby will be worse off." I have an online frien going through this now and it's awful to watch. This woman had a 22" waist when she got married, and she labored two days (one without an epidural, one with) before her C- section, and her baby was poorly positioned. A woman in her shoes should have NO shame about having a C-section, and she quite responsibly agreed to one before it could become an emergency because she knew that was best for the baby. But the hospital staff didn't let her hold the baby right away, and she feels awful because bonding with your baby in the first 2 minutes after birth is supposed to be really important and she'll never get those two minutes back.

She has EVERY right to be upset at the staff about how showing her her own baby was seemingly an afterthought, and at the staff repeatedly taking her baby away and lying about how long it would last. What's wrong is that from what I can tell, SHE feels like a failure for not saying no to the medical staff or making sure she had the perfect birth. And I HATE that the "natural birth" movement has pushed women to have such unreasonable expectations of themselves. As far as I'm concerned, it's just another way to make women feel like crap about themselves for not living up to a completely unrealistic ideal of femininity.

When I have kids, I'm going to give birth in a hospital, have an epidural at least the first time when I don't know what's coming, respect that doctors know more than doulas with no medical training do about what is and isn't safe, and be damned proud of it.

[Mmy]

Trigger warning: difficult labour

@Jenny Islander: The thing that honks me off about the pain narrative is that most mothers didn't have to experience labor as the most pain they had ever had.

This strikes me as you telling other people what they have felt and what they should have felt. You don't know what "most mothers" have had to face and it really doesn't matter to the individual mother to whom you are speaking whether her experience(s) are/were typical.

Leave aside the fact that not all people can be well prepared it is simply not true that adequate preparation would prevent virtually all of the pain women in labour experience.

I come from a family of women who have easy childbirths--all the same one of them, after a number of really easy labours, almost died from the next one. She did nothing different nor did anyone else. I also know quite a few women who prepared just as you did and had difficult / painful deliveries.

Really, lots of people do get taken by the pain monster and lots of women who have experienced other horrific things have told me that childbirth hurt more than anything else they had gone through.

[kisekileia]

Crap. I'm on my phone and couldn't fix this before posting because I don't know how to move the cursor. TBAT, please add trigger warnings to that comment for difficult birth, and maybe for shaming of women around birth and motherhood, and for whatever else you think is necessary.

[Jenny Islander]

@Mmy: I'm sorry if I came across that way. There are pain alleviation techniques that all laboring people should receive as a matter of course that I only got because I was having a baby with a crunchy-granola midwife who didn't have anybody else on the schedule that night. Freedom to move, compresses, advance preparation, lots and lots of pillows and somebody to arrange them as needed, etc. It still hurt, but my worst pain? Not even close.

[Jenny Islander]

@kisekileia: ASAP I will dig out the statistical study on C-section rates in similar populations laboring in hospital vs. with midwife. IIRC it was 26 percent vs. 2 percent--again, with similar mother-fetus pairs. But I have to go look it up.

[Nenya]

On the topic of being prepared, I will say that reading Our Bodies, Ourselves for the first time this year (I'm 32 years old), especially the chapter on childbirth where it went slowly and calmly through the steps and the kinds of things one was likely to experience and what they meant, and advised you to sit down and think beforehand whether you thought you would want more or less of various kinds of interventions...well, that was the first time since I became aware of childbirth about 25 years ago that I was less than terrified of the whole concept. I feel now like if I ever had to do it, probably I could. I still don't want to, but it was really reassuring to feel for the first time like yes, my body was made to do this as much as it was made to do a lot of other things. (I know very well that that doesn't mean things would be easy--other body systems I have have gone quite blooey at times, and my mom's six deliveries ranged from "fairly easy" to "forceps and way too much trauma.")

Still pretty damn sure I'd go for pain relief, though, as much as I could possibly talk the docs into. And having had a calm, sane person there to hold my hand in other medical situations, I think I'd want a midwife as well--or at least someone I trusted to be there for *me*. That would be more important than how "natural" the childbirth was, and I imagine that's true for most women: that you are listened to and supported and have information and comfort available are more important than the specific forms those take (as what is comforting or supportive to you may not be to someone else).

[Mmy]

@Jenny Islander: It still hurt, but my worst pain? Not even close. The thing to remember is that it may not have been your worse pain but that doesn't mean that it wouldn't be someone else's -- especially since there is no form of pain alleviation that gets rid of all pain, in all types of birthing conditions for everyone.

Trigger warning: discussion of painful childbirth

We have a wonderful range in our family--from a relative who gave birth at home (we have pictures!!!) and someone who didn't even realize she was in labour until the nurse checked and realized that the baby was crowning. The same women/family/circumstances that produced those easy births also led to births that were bloody, painful, near-death experiences.

Modern medicine cannot guarantee a pain-free (or pain reduced) birthing experience. What goes on in the labour room is partially the result of factors that no one has yet figured out how to control. You can do everything you can and you can prepare as much as you like but giving birth is still fraught with complications one cannot predict.

[Amaryllis]

But the hospital staff didn't let her hold the baby right away, and she feels awful because bonding with your baby in the first 2 minutes after birth is supposed to be really important and she'll never get those two minutes back.

That, pardon me, is crap.

Okay, to rephrase, no she can't get those minutes back, but those two minutes, or two hours, or two days for that matter, are nothing special. You bond, to accept the term, with the baby over all the minutes and hours and days that you hold her and care for her, whenever that time begins.

I'm sorry for your friend, but I'm pissed at the people who fed her the her the idea that two particular minutes are all-important.

As for recovery from Cesareans, I'll just say that my experience was much more like the standard described by Mmy than like Z, who felt great after two days. I'm happy for you, Z, but I don't think you're typical.

Also, my very favorite doctor's order after the surgery? "Don't use the vacuum cleaner." (I hate that chore.)

[kisekileia]

I have another friend who didn't realize she was in labour because she'd been told it was worse than menstrual cramps, but her cramps were just as bad. And because her cramps had been so under-treated, she'd learned to tough it out in extreme pain, and was putting on makeup during a rather advanced stage of labour.

Out of curiosity, since I do want kids in the next few years, how does the pain typically compare to a broken bone? I'm thinking of a small foot bone here, since that's the only one I've broken. It was unpleasant, but I took Advil and Tylenol 1, put ice on it, and went back to sleep for a few hours to wait for hospital X-ray machines available. I find abdominal pain very unpleasant though.

@Jenny, the logical corollary of "labour pain doesn't have to be that bad if you're well prepared" is "if your pain was that bad, you weren't well prepared enough, which means that either you did something wrong or someone else involved in your birth did". That's exactly the kind of rhetoric that makes women feel bad about themselves and mistrust their doctors, like I described earlier. Painting an ideal of the perfect birth as achievable for all women, or even "most" women or "normal" women, is ultimately destructive and oppressive to the many women who, through no fault of anyone's, have "imperfect" birth. For all the nice-sounding rhetoric about it being empowering for women to control their own births, ultimately that control is available only to (in that respect) privileged women. There's nothing feminist about making women feel like failures at living up to an ideal of feminine perfection, even under the guise of that ideal being "empowering".

[kisekileia]

@Jenny, they'd have really had to work hard to make the groups similar. Unless women were assigned blindly to either an OB or a midwife, with decisions about who was too high-risk to stay in the study also made by people who were blind to the OB vs. midwife assignment, it would be hard to avoid a tendency to keep the highest-risk patients with the OBs. It'd be interesting to see the study, but it would have to be very carefully done to be persuasive. This is a really difficult situation to study in a way that is ethical and safe while still obtaining valid results.

[kisekileia]

I'd also be interested in developmental outcomes of hospital vs. midwife babies and effects on the mothers' long-term health. Fewer C-sections is only a good thing if it actually led to better outcomes (with easier recovery as one but not the only factor) for moms and babies.

[Glendanowakowsk]

I just wanted to mention that a new mother who has had a C-section may not be able to eat solid food for a day or two, until her digestive system is working again. When I had mine, I had to eat a clear liquid diet for a day or so (broth, popsicles, gelatin, tea.)

So if you take food to the hospital, make sure that it is something that can keep until she is able to eat it.

[Helen Louise]

(TW for difficult birth)
Really wish I'd read this post before my niblings were born - excellent and really helpful advice. I particularly like the advice about 'difficult' births... One of my nephews was born after a difficult birth and I had no idea how to react or how to help. And having been assured that mothers forget the pain pretty soon after, I didn't realise until afterwards how much it had hurt my sister. It was all pretty scary even as just his aunty, often wish I could turn back the clock and do more to help :(

[Lonespark]

bonding with your baby in the first 2 minutes after birth is supposed to be really important

What?
Seriously, WTF?
What about adoptive parents? People who are sick or tired or a million other things and need to bond with the baby at a time that's good for them?

It doesn't seem to me that this is necessarily traditionally done...mother and baby both need care...Bah, I say.

[Emily Cartier]

Thanks to the mods for adding the trigger warning :)

I am fairly sure I wasn't handed to mom within the first two minutes (I can call the doc who did the delivery to see for sure, but while he's a really super neonatologist, I don't think he's amazing enough to have done everything needed in less than 2 minutes). This is good, because well... see previous. I'm VERY sure my mother wanted me alive most of all.

Yes, it's important for moms and babies to bond. It's also important for dads and babies to bond, and aunts and uncles and and and. Bonding is slow, and gradual. I am much fonder of my nephew now that he's 3 than I was when he was a month old. Same for my sister and brother when they were born, and the various neighbor kids I did big sister duty for. Relationships take time to develop, and until you've put in the time... things feel weird. Including sometimes thinking the baby you just got handed feels rather like a lump of jello, while she chews on your hair.

[Mmy]

Trigger Warning: Discussion of pain, torture, mother blaming and cancer.

Two things occur to me reading this discussion:

1) the degree to which "being a mother" has become loaded with expectations and judgments. One can trace the history of the recent mom-blaming and see its roots in modern psychotherapy among other things.

2) the degree to which we (as a society) are willing to assess/ judge the pain of others [see the gobsmackingly disturbing discussion not that long ago wherein people in authority wanted to define "anything that doesn't cause permanent organ damage" as not really torture and other wanted to argue that "if the organ damage didn't lead to death it doesn't count."]

Pain is an internal experience. No one can measure your pain and, unfortunately, it is difficult to prove to anyone else that you are experiencing it. Sometimes one can begin to demonstrate it--as was the case when I was hooked up to a TENS like machine that was sending electric current through my body and was allowed to "ramp it up" until it was stronger than the pain I was feeling. The tech was stunned at how much current I had to run through my body to equal the pain we were attempting to measure.

But that doesn't really "measure" it either does it? Pain can exhaust one. Pain can make it impossible to function in one's normal job. Pain can undermine one's normal relationships with others. Pain can make the very idea of going on another day overwhelming. Pain can inhabit you so that it suffuses every moment of one life or pain can be something you inhabit so that you cannot remember a life without pain.

Pain management is still in its infancy and is, one gathers, limited in the United States by the fear of "drug addiction." I was reading today about the gruesome and painful end of ovarian cancer. As the writer described the pain of having ones' bowels shut down due to adhesions. TRIGGER WARNING: Really disturbing descriptions of the symptoms of bowel adhesions -- I was thinking -- that is what happened to MY mother and yet she did not go through the convulsions and pain the writer is describing. It took about a week for the wonderful palliative care nurses and doctors to work it out but Mom was on complex regime of different drugs including muscle relaxants and anxiety relief drugs as well as the classic pain treatments. It required some combination of the drugs every 2 hours (there were semi-permanent drug ports so they didn't have to "stick" her constantly.) It also required that the medical staff trust Mom's family. Mom couldn't talk (was perhaps unaware of her environment) for the last 4 weeks of her life but she had a family who knew her body language well. If I told a nurse that my reading of Mom's body language was that she was in pain then they gave her additional shots.

Mom was being treated by people who specialized in helping end-stage patients with painful conditions and the one thing they stressed to everyone was that there is no "standard" or "normal" amount of pain in response to anything. Every one of us is unique in our reactions. Their job was to find out how to ease the pain not to argue with us about whether it existed.

[Amaryllis]

Continued Trigger Warning for difficult childbirth details:

@kisikileia: I've been lucky, never broken a bone, so I can't compare.

I can say that I had an induced labor. And the first day was not bad at all: the comparison to ordinary (not excruciating) menstrual cramps was pretty accurate. The second day, they turned up the Pitocin level, and, as the old comic strips used to put it, !#$*@$!%*

It was bad. And then I had to have the C-section anyway. I only wish I'd known 24 hours earlier, or that my doctor had gone the "unnecessary surgery" route, because it turned out to be necessary. At least I never had to doubt that it was necessary. I've got plenty to blame myself for, as a mother, but I never worried for one minute about that.

As for ordinary, unmedicated, nonsurgical labor: from everything I've ever heard, it varies too much to make any definite pronouncements. So it's kind of a dilemma. On the one hand, you don't want to scare pregnant women with horror stories when their own experience may not be so bad. And it's true that fear of pain can contribute to pain, and that good preparation and good support can help the pain be manageable for many women.

But not for all of them. And women who get told that if you just prepare in the right way, or that it's all natural and your body can handle it, well, they really feel tricked or shamed when it doesn't go that way.

So, all I can say is to educate yourself beforehand on the different things that can happen. Hope for the best, but know that you can't predict how your own experience will go.

And when you're talking to a mother, let her tell you about how it went for her-- most of us are all too ready to talk about every detail-- and just sympathize.

[Amaryllis]

Also, I meant to say, it's hard to make those kinds of comparisons because individual perceptions of pain vary so much.

I had a (non-obstetric) medical procedure once. When I asked if it would hurt, the doctor said it would be like a dentist appointment. And I was thinking, shallow cavity with good Novocain, I'll hardly feel a thing. And maybe he was thinking, lightly-medicated root canal, because he really seemed surprised when I was surprised that it hurt.

[MercuryBlue]

Pain management is still in its infancy and is, one gathers, limited in the United States by the fear of "drug addiction."

Yep. I know somebody whose metabolism goes through pain meds at warp factor nine. Chronic pain patient. Her rants on the subject are highly entertaining for everyone but her. Also she swears she wouldn't need any of the meds if she could just smoke a joint every few hours, but her wife's career advancement depends on said wife passing the lie-detector test in which they ask if anyone in the household has used marijuana recently.

I think it's a combination of "pain is weakness leaving the body" and "pain is punishment for character flaws", personally. Like whozit's rules of attraction (it is simultaneously inconceivable and intolerable for women to feel desire; it is simultaneously inconceivable and intolerable for men to be desired), neither is true, but lots of people act as though they're true.

[Izzy]

I am...pretty skeptical of any claim that X is natural and therefore X is good/not that bad/an experience you should have.

Bubonic plague is natural. Abscessed teeth are natural. Those creepy wasps that eat caterpillars alive are natural.*

Do what works for you. But realize that other things might work better for other people, and that "natural" does not always mean "better."

*Sometimes I think half the insect world exists as a comeback to the fluffybunnier types of pagan. Scary little motherfuckers all around.

[Raj]

@Izzy:

I wish I had a dollar for every time I've refuted the "X is good because it's natural" or the "Y is bad because it's unnatural" argument.

[Ross]

From talking with someone who's got a family member going through chronic pain, my understanding is that one of the big issues is that opiates work so well on short-term pain that there isn't a lot of drive to develop good painkillers that are well suited for chronic pain

[MercuryBlue]

opiates work so well on short-term pain that there isn't a lot of drive to develop good painkillers that are well suited for chronic pain

Buh? 'Cause I can assure you there are plenty of people who'd pay real good money to have drugs that deal with their pain on a longer-term basis and don't screw with them the way opiates do.

[Ross]

By the way:

The basic necessities of dressing a baby are short-sleeved vests with poppers between the legs

On my side of the pond, we call these "onesies". It's only from context I had any idea at all what that any of those words meant in that configuration (A vest is a sleeveless button-down piece of outerwear and poppers are a fried cheese-stuffed jalepeno. The image in my mind was head-scratching).

There is, and we didn't know about these until after delivery, an alternate form of newborn clothing consisting of a sort of kimono, essentially a long undershirt that opens at the front with a single snap. These are fantastic for newborns since they don't have to be pulled over the baby's head (Seriously, we couldn't find a way to clothe babies that doesn't require forcing their enormous heads through the tiny little neck holes of things all the time?)

[Ross]

Oh, also this:

If you want to hold the baby, and the mother asks you to wash your hands first, just go wash your damned hands. It is not the time for you to (a) explain at length how you are a generally clean person and haven't been fondling anything infectious recently, or (2) launch into a lengthy speech about how "parents these days" are over-protective and how "kids these days" develop allergies and asthema and other disorders all because our sterile evironments don't allow their immune systems to develop naturally by exposing them to every germ in the neighborhood. Mom wasn't insulting your hygene. Your hands might well be clean enough for most considerations, but there's a good chance the baby is going to stick your fingers in its mouth. Anyway, you should be washing your hands more often anyway, they're filthy.

----

Btw: the post mentioned cauliflower. Point of order: cauliflower is one of those foods that breastfeeding moms may need to eat with caution, since it can give the baby gas. (Found that one out the hard way)

[Mmy]

@Ross: Actually what the OP mentioned was "cauliflower cheese" which is a quintessential British dish. The cauliflower is very well cooked before it gets to the table--which might make a difference for some.

The "check with the mom" thing works no matter what the dish is. Cauliflower cheese is usually made with wheat flour (which I can't eat, nor can my father, two of my aunts and at least seven of my cousins), milk, butter, and cheddar cheese (which no one who is lactose intolerant or on a severely cholesterol restricted diet can eat.)

In my own circle of friends and family I personally have never run into anyone who had a gas problem with cauliflower but then I also didn't "get" all the "beans cause gas" jokes that float around in North American culture until I left home.

Bottom line -- it is far easier to bring food to people you know well enough to be aware of cultural, religious and medical food restrictions.

[sarah]

My cousin's wife just had a baby (they now have three boys!) and a good friend of mine just had a baby, so thanks for the advice, Kit. I'm at that age where a lot of my friends are starting to have kids.

[Anonyregular]

Horror stories are very much NOT the point of this thread, but suffice it to say that I sent flowers to the staff of the hospital where I had my first child; the staff at the hospital where I had my second are darn lucky they didn't get sued.

@hapax - I'm actually very curious and would like to hear more details about your two experiences at different hospitals, if you're up for sharing. Being pregnant right now myself, I like to know what I might be in for depending on my doctor. I don't mind horror stories at this stage in the game.

[cjmr, who can't remember her Typepad login]

Trigger Warning: Birth details

Anonyregular--

The first thing you need to realize about a hospital birth is: there is absolutely no guarantee that the doctor you have established a rapport with throughout your pregnancy will be able to be at the hospital when you are in labor. And you can have the most detailed birth plan in the world, but chances are you will not be able to follow it.

I was EXTREMELY lucky with my first that my OB returned from vacation the day I went into labor and got to the hospital in time to take over from the forceps/cesarean-happy resident who had been checking me all day. (He was unhappy with my progress, ordered an induction 'to speed things up', and wanted to do a C-section if JJ wasn't born by 12 hours after my water broke. She walked in, turned off the pitocin, and he was born by the first doc's deadline, no forceps necessary, three hours later.)

----

Re: worst pain

I think the only reason that labor and birth wasn't the worst pain for me is because I have had relatively short 'active' labor with all three kids. I go 3-5 days in the slightly worse than menstrual cramps stage, but only 3-5 hours of 'please make this pain STOP!'. Also, I get to compare it with lovely things like irritable bowel syndrome, migraines, GERD, and sciatica, all of which are much worse on the 'constant and long-lasting' scale, IMO.

I really wish there was a good non-opiate, non-aspirin, non-acetiminophen pain-killer, because having multiple drug sensitivities sucks big time.

-----

Re: time and bonding

I think I bonded much better with ES (who was born in the car, but after the ER doc handed her to the nurse after I cut the cord I didn't see her again for over an hour) than with JJ and SG (who were both placed on me within seconds of birth).

[Jenny Islander]

Turns out that the study I want is cited in Ina May Gaskin's written works, not online, where I thought it was, unless my Google-Fu is fooped again. I'm getting the book through ILL.

While the title of the blog makes their advocacy obvious, there is useful data at The Unnecesarean dot com re the tendency of C-section rates to vary by hospital regardless of population served.

The takeaway for people considering giving birth: Know your doctor,* know the other doctors you may be getting on rotation, look for a childbirth class that is not focused on hospital protocols and read up about childbirth if you can't find a class, read birth stories,** and most importantly, have an advocate in the room who is there purely to remind others of your wishes, and your non-emergency-patient status,*** while you are busy having the baby.

*I have been told that physicians can now be reviewed online. So Google your OB!
**TV shows about giving birth generally leave out things that don't make good shots. It's best to read birth stories instead.
***Presuming that you are in fact a non-emergency patient. Let's all be glad that we do have obstetricians in this day and age for the occasions when we do need someone to practice obstetrics.

[kisekileia]

cjmr, how did the pain compare to IBS pain for you? That's something I've experienced as well, so it would be a useful basis of comparison for me.

[cjmr, who will probably figure out her typepad logon eventually]

TW: Frank discussion of pain

I would say the pain was about the same on the pain scale, but because it came in waves of predictable frequency and duration, it was easier (for me) to manage than a 2 a.m. IBS attack. With 1st child and 2nd child I spent a lot of time watching the tracing on the external fetal monitor going, "Okay, here comes another one! Try to relax! Don't panic!" 3rd child was an 'abrupt labor'--I only had clock to watch.

[kisekileia]

Interesting! That's really good to know. Thank you.

[Mmy]

TW: Discussion of pain, descriptions of difficult / dangerous labour

I can't compare the two types of pain (intense intestinal pain and extremely painful labour) having experienced only the first type...but to me there is a difference between the two types of pain.

Bowel / intestinal pain -- wow it is way worse than most people can imagine. I have had bouts when I could not remember what it felt like to not be in pain but:

a) I knew intellectually that I had survived other bouts of pain and that none of them had lasted longer than X number of hours. I remember working out the longest possible period time I would have to endure this and then counting backward in time.

b) I knew intellectually that no matter how great the pain it wasn't "killing me." Yes, there are long term consequences to auto-immune gut disorders but the pain that one is feeling is a relatively "short term" symptom of the underlying and more subtle long term damage. It might feel like my bowels were twisting and ripping themselves apart but in two days I would be bruised internally and rather sore but I would be basically sound.

c) labour pains can be open ended--if the child is not delivered the mother can be in labour for weeks. In modern medicine they are usually ended by doctors intervening when they fear either / both the mother or child will be seriously damaged. In the past (and in many countries of the world today) women actually died during labour from the cumulative effects of the pain and the exhaustion. So mothers don't have the psychological comfort of being able to count down to a time when they will be okay.

d) Childbirth can have immediate and devastating consequences on the mother's body -- which can be ripped and damaged in so many ways that it is stomach turning to even consider them. Additional trigger warning. Descriptions of obstetric fistuals One can read about some of these consequences (and donate to an organization that works to help women who have endured these consequences) at Aid for Africa's The Fistula Foundation.

[Jenny Islander]

@Mmy: Maybe I just had an overly optimistic birth attendant, but she told me from my very first appointment that for the overwhelming majority of women, childbirth is not and should not be a long-term injury or source of debilitating pain. She compared giving birth to climbing a mountain. It's painful, but in generally predictable ways, so it isn't like the pain of injury or sudden illness; it can lead to injury, but if the climber is well trained and well equipped and working with a team, the chance of injury is so rare that it isn't worth worrying about until it happens. This assumes, of course, that the person in labor is not underaged and/or malnourished (IIRC these are the underlying causes of most obstetric fistulas), that the fetus is well positioned for birth (women who died of exhaustion often had intractable malposition without the ability to get a C-section IIRC), etc. Extensive pre-birth monitoring and assistance was a standard feature of her practice, to catch and hopefully repair isses that might complicate labor and identify clients who should be referred to an OB.

In her opinion--an opinion I came to share--it isn't natural vs. unnatural, it's the difference between attempting to direct the course of an uncomplicated birth as if it were a complicated birth, and providing support to the person in labor while letting the uncomplicated birth proceed without interference. So she was a big proponent of, for example, gas and air. Not that we could get gas and air here. At the time I was having babies, she wasn't aware of any hospital in the U.S. that even offered gas and air. But taking gas and air does not require a epidural or even an ordinary IV, which means that the person in labor is free to move around, which generally speeds the course of labor.

Basically she opposed worst-first thinking as a waste of energy at best and a cause of iatrogenic complications at worst.

[Mmy]

TW: discussion of birth trauma

@Jenny Islander: I feel that we are talking right past each other. I am not saying (nor is anyone else I know of in this thread) that giving birth was not overly medicalized in the the last century and that sometimes that over-medicalization can have massively negative effects.

But...and I have a lot of buts.

And I am speaking as someone from a family of women who tend to have incredibly easy births. My sister gave birth in her bedroom. Of course she had an OB/GYN in attendance and was 5 minutes away from some of the best hospitals in Canada. My mother didn't even know she was in labour the first time--she thought she was having stomach cramps from the massive number of green apples she had had sneaked into the hospital. My grandmother got up, cooked breakfast, sent the men off to work and then called the midwife and gave birth by noon.

I picked those three examples because they occurred across a century and very different medical treatment. What they had in common was that they were well-fed, healthy and lucky. It wasn't due to any particularly wonderful preparation.

So, was in answer to your statement: Maybe I just had an overly optimistic birth attendant, but she told me from my very first appointment that for the overwhelming majority of women, childbirth is not and should not be a long-term injury or source of debilitating pain. She compared giving birth to climbing a mountain.

I would say:

a) yup, I think she is overly optimistic

b) she is anything but an disinterested observer (thus I want statistics, thank you, for anyone who makes claims about medical treatments whether they are about childbirth or curing arthritis.

c) you know, even if 70% of women really do experience childbirth as she describes it that leaves 30% of women who don't. (Pick whatever figure you like-it makes no difference to the argument.) That is 10s of thousands of women whose pain and suffering cannot be alleviated with all the stuff you are talking about (much of which seems to fall into the placebo category). Those are women who are being made to feel responsible for the very real pain they felt and the very real damage done to their bodies.

And yes, fistulas are uncommon in England or the US or Canada now, but there are a hell of a lot of other things that can happen wrong and one of the reasons why the very worst of things tend not to happen here, now, is because there are medical interventions.

Pregnancy is bad for a woman's overall health (that is why it is fiscally advantageous for health insurance companies to provide free/low cost birth control.) And, even if you only look at the death of mother per live birth (per capita) rate in the US it is actually not that good compared to other "industrialized" countries-- double that in the UK, about 2.5 times that in Canada and way, way more than that in Italy.

In serious research studies I can find there is a real concern about unnecessary cesareans BUT there is very little conclusive evidence that other differences of treatment by midwives including compresses, massages and "just leaving them alone" show outcome differences that are statistically significant when it comes to physical trauma to the vaginal area.

But to loop back to an earlier point -- it doesn't make any difference if you can line up ninety-nine women who found birth sweet, fine and hunky dory -- the pain and suffering of the hundredth woman was real and not her fault. And statistical analyzes indicate that usually the hundredth woman enjoyed the same increased hygienic standards, better food and exercise and preparation as the ninety-nine who have no problems.

[hapax]

@Jenny Islander –

Look, I understand what you and your birth attendant are trying to say. Overmedicalization of birth is a problem. Women being afraid of childbirth is a problem. I get that.

But what you are actually saying is really painful to me, personally.

Sorry, this is going to be pretty long. ROT13 for medical details, severe birth trauma:

Arvgure bs zl certanapvrf “jrag jryy”. V jnf frevbhfyl vyy sebz nobhg guerr jrrxf va hagvy rvtug zbaguf. V npghnyyl ybfg jrvtug qhevat obgu certanapvrf. V gevrq nyy bs gur srj zrqvpny vagreiragvbaf nccebirq sbe certanag jbzra. Rira gubhtu V nz na rkgerzr fxrcgvp nobhg nygreangvir zrqvpvar, V gevrq ureony zrqvpvar, nphcerffher, ubzrbcngul. Gb ab ninvy -- V unq gb or ubfcvgnyvmrq naq cynprq ba na VI. Abarguryrff, zl qbpgbef obgu gvzrf nffherq zr gung gur onovrf jbhyq or svar, puvyqovegu jbhyq or nofbyhgryl abezny.

Fgvyy, V xrcg srryvat nakvbhf. V jnfa’g “rngvat evtug”. (V jnf uneqyl rngvat ng nyy). V jnfa’g rkrepvfvat. V nggraqrq gur cer-angny pynffrf, ohg V nyernql xarj nyy gur ovbybtl naq nangbzl, naq gur oernguvat grpuavdhrf rgp. frrzrq cnyr vzvgngvbaf bs gur zrqvgngvba genvavat V’q nyernql unq.

V ernyyl jnagrq aba-zrqvpngrq, “angheny” puvyqovegu gur svefg gvzr. (Gur frpbaq gvzr, abg fb zhpu, sbe ernfbaf gung jvyy orpbzr boivbhf.)

Ng gur ortvaavat, rirelguvat jnf svar. Ynobe jnf cnvashy, ohg ab jbefr guna ernyyl onq penzcf. (Vg orpnzr n snzvyl wbxr gung V jrag gbfrr zl BO gb nfx vs vg jnf bxnl gb gnxr n pbhcyr bs Glyraby, fb V pbhyq tb gb jbex; ur fnvq, “Ab, lbh pna’g tb gb jbex, lbh’er tbvat gb gur ubfcvgny.”)

Fb sbe gur svefg srj ubhef, V qvq zl cnva znantrzrag rkrepvfrf. V jnyxrq nf zhpu nf V pbhyq. V jnf senaxyl xvaq bs oberq. Gur ahefrf gbyq zl uhfonaq vg jnf bxnl gb tb gb jbex sbe n pbhcyr bs ubhef, orpnhfr “abguvat zhpu jbhyq or unccravat.”

Naq gura, nsgre ur pnzr onpx – fhqqrayl, gur zbfg rkpehpvngvat cnva V unir rire rkcrevraprq va zl yvsr (hc gb gung gvzr). Yvxr fbzrobql fyvpvat zr bcra jvgu n tvnag xavsr sebz gur vafvqr. V’z gbyq V jnf fpernzvat, ohg V qba’g erzrzore vg. Nccneragyl cneg bs gur preivk unq orpbzr “sbyqrq bire”, naq abj gur onol jnf chfuvat ba vg. Zl qbpgbe unq n pubvpr – gb yrg vg grne, phg vg, be gel gb ernpu va jvgu sbeprcf naq “hafgvpx” vg.

Ur bcgrq sbe gur ynggre, naq sbeghangryl vg jbexrq. Ohg vs gur svefg cnva jnf rkpehpvngvat, gung jnf vaqrfpevonoyr. V pna fbegn xvaqn erzrzore vg, ohg V xabj V’z oybpxvat zbfg bs gur zrzbel.

Naq fubegyl gurernsgre, qnhtugre jnf obea, urnygul naq ornhgvshy naq cresrpg. Naq V fgnegrq oyrrqvat. Naq V qvqa’g fgbc.

V tbg gb ubyq qnhtugre sbe znlor n zvahgr, orsber gurl gbbx ure njnl naq gur qbpgbef tbg ohfl. V erzrzore urnevat n urnegorng zbavgbe fybj qbja, whfg yvxr ba gryrivfvba. V erzrzore fcbhfr ubyqvat zl unaq, naq fnlvat, “Ubarl, vg’f tbvat gb or bxnl.”

Naq gura V qvrq.

Abg sbe ybat. V qba’g erzrzore. Gjb zvahgrf? Guerr? Vg gbbx gb trg zl urneg orngvat ntnva. Ohg gurl pbhyqa’g yrnir zr hazbavgberq. V qvqa’g trg gb frr zl qnhtugre ntnva gung qnl. (Naq gura gur ubfcvgny “ybfg” ure, ohg gung’f n jubyr ‘abgure fgbel.) V qvqa’g fgbc oyrrqvat sbe n zbagu.

Fb jvgu zl frpbaq certanapl, V jnf tbvat gb or CERCNERQ. Rira gubhtu rirelbar nffherq zr vg jnfa’g zl snhyg, V nyjnlf sryg gung vs V unqa’g unq gubfr tynffrf bs jvar orsber V xarj V jnf certanag, vs V unq orra noyr gb pubxr qbja gubfr cerangny ivgnzvaf gung znqr zr fb anhfrngrq, vs V unq rngra orggre, rkrepvfrq, tbar guebhtu nyy gur evtug cercnengvbaf, jungrire jrag jebat jbhyq’ir tbar evtug. Whfg yvxr gur “birejuryzvat znwbevgl bs jbzra” lbhe nggraqnag fcbxr bs.

Naq orfvqrf, rirel qbpgbe fnvq “rirel certanapl vf qvssrerag.” Vg fheryl pbhyqa’g nyy unccra ntnva, evtug?

Fb rira gubhtu V jnf whfg nf fvpx – fvpxre, ernyyl – jvgu gur frpbaq certanapl, V sbeprq qbja gur ivgnzvaf, gur sbbq, gur jngre gung pnzr evtug onpx hc ntnva. V xrcg jnyxvat na ubhe rirel qnl, rira jura V unq gb gehaqyr gur riraghny VI nebhaq naq nebhaq gur ubhfr. Naq V gubebhtuyl qvfphffrq zl “ovegu cyna” jvgu zl BO – V’z fher fur jnf qernqshyyl gverq bs vg – guvf gvzr V jnagrq srgny zbavgbevat, guvf gvzr V jnagrq cnva zrqf ernql, guvf gvzr V jnagrq fhetvpny vagreiragvba ng gur fyvtugrfg uvag bs n ceboyrz.

Fb, ynobe fgnegrq, ntnva vg jnfa’g n cnva V pbhyqa’g fgnaq. Trg gb gur ubfcvgny, naq svaq bhg va guvf fgngr (n qvssrerag bar sebz jurer qnhtugre jnf obea) gung snguref ner xrcg sebz jbzra va ynobe hagvy gur ynfg ubhe be fb. N fgenatr qbpgbe pbzrf va gb purpx zr bire – vg’f abg zl erthyne BO’f fuvsg, svar – ohg ur unf ab vagrerfg va zl ovegu cyna. Ur unf gur ahefr ubbx zr hc gb na VI qevc (V gubhtug va cercnengvba sbe cnva zrq, vs V erdhrfgrq gurz), fdhvegf fbzrguvat va, naq yrnirf. Bayl nsgrejneqf qb V svaq bhg ur unq nqzvavfgrerq Cvgbpva – gb negvsvpvnyyl fcrrq hc ynobe – jvgubhg gryyvat zr be tvivat nal ernfba. Yngre V svaq bhg gung ur jnagrq nyy oveguf fgnegrq juvyr ur jnf ba fuvsg svavfurq orsber gur fuvsg punatr.

Cvgbpva – juvpu V unq nfxrq abg gb erprvir rkprcg nsgre n cebybatrq ynobe – terngyl vapernfrf gur cnva naq vagrafvgl bs pbagenpgvbaf. Abj, engure guna onq penzcf, V sryg yvxr V jnf orvat ercrngrqyl fdhvfurq guebhtu n gbbgucnfgr vafvqr bhg. V evat gur oryy naq nfx sbe cnva zrqf. V nz vtaberq.

Fcbhfr pbzrf va, nfxf sbe cnva zrqf sbe zr. Ahefr cercnerf n flevatr, naq yrnirf vg ba gur pbhagre. Fur tvirf zr n qbfr bs fbzrguvat ryfr – zber Cvgbpva, V svaq bhg. “Gurer ner fbzr fvtaf bs srgny qvfgerff, jr unir gb uheel guvf ynobe hc,” fur fnlf. Fur yrnirf. Gur cnva vf ntbavmvat. V pnyy ure onpx va, nfx sbe zber cnva zrqf. Fur ybbxf ng gur flevatr fgvyy ba gur pbhagre, “Bbcf, fbeel, V sbetbg. Jryy, gbb yngr abj!”

Fba vf obea – V qba’g erzrzore nalguvat zber bs vg ohg cnva, cnva, cnva. Ohg ur vf urnygul naq ornhgvshy naq cresrpg, naq gung vf nyy gung znggref, evtug?

Rkprcg bayl nsgrejneqf qb V svaq bhg nobhg gur rcvfvbgbzl. Naq gur snvyher gb fgvgpu vg pbeerpgyl. Naq gur qbpgbe sbetrggvat gb cerfpevor cnva zrqvpngvbaf sbe nsgrejneqf. Naq gur ahefrf ershfvat gb nafjre gur ohmmre, fb gung n cnffvat ivfvgbe unq gb erfphr zl fba sebz zl nezf, nf V fgbbq gurer pebhpurq bire gur orq, gbb zhpu va cnva gb svavfu cvpxvat uvz hc, gb zhpu va cnva gb chg uvz qbja.

Fb lrnu, V’z tynq gung lbh unq jbaqreshy ovegu rkcrevraprf. V gehyl nz. Naq V nz tynq sbe gur “birejuryzvat znwbevgl” bs jbzra sbe jubz guvatf jbex bhg terng. Naq V ybir zl puvyqera, naq jbhyq unir tbar guebhtu sne jbefr, qvrq va cnva n uhaqerq gvzrf bire, sbe gur cevivyrtr bs trggvat gb xabj gurz.

But please, stop saying that good preparation and good health and a good team and a good attitude are all you need for a good birth. Because sometimes these things aren’t available to everyone who wants them. And sometimes they aren’t enough. And I don’t need to keep hearing that it’s all my fault.

[Mmy]

@hapax: um--that is nightmare fuel. And what makes it worse (more nightmare-y) is that it is just an example of what really happens--it takes no supernatural intervention. Just life. Cruel life.

BTW, although nothing like that ever happened to me (never had a child) I did not find out that I was allergic to morphine until after they were giving it to me by IV for post-surgical pain. My sister didn't find out how sick various pain-killers could make her until she was having dental surgery.

Some pain killers make me nauseous and others "just" wipe out my immune system and so whenever I am in the hospital for procedures I grab everyone who walks into the room and tell them loudly "don't inject me with anything without my permission." That "not telling the patient" thing and the "whoops, forgot to give you the painkiller" thing happen far, far too often.

[Froborr]

@hapax: That was terrifying and heartrending. Hugs if you want them?

[kisekileia]

*hugs for hapax*

Thank you for making it clear that no, the best preparation does not always result in a good birth. I know natural birth advocates would use the story of your second birth to argue that women should give birth at home, but that obviously wasn't possible given what happened with your first birth. I think there's a LOT of room for insisting that hospitals should get women's consent before procedures without also insisting that OMG HOSPITALS BAD, and I wish it happened more.

[cjmr, who will probably figure out her typepad logon eventually]

I think the biggest lesson I've learned from my births/reading about the births of others is how important it is for a laboring woman to have a person who can act as a patient advocate--who can say no for her to specific medications/anesthesia methods/procedures that will be harmful to her for some KNOWN reason when she is too exhausted to and can ask questions like, "Is drug X related to drug Y? She can't tolerate drug Y."

[kisekileia]

cjmr, that's the sense I've gotten as well, that having an effective advocate for the woman is the most important thing.