Things I Wish I Knew Before I Had My First Baby.

My first birth experience was very traumatizing. I had no idea what my rights were, or that I even had any. "Hospital policy" was quoted at me left, right and center whenever I asked "why?" or "I want my baby back.". I often felt like I was being patted on the head. So I gritted my teeth and counted the hours until I had my freedom back. My second birth I knew my rights,as I had a wonderful midwife who answered all my informed choice questions as well as a supportive doula that I shared my fears with. I had a better breastfeeding education than my nurses. My baby slept skin to skin with my arms propped up with pillows. My son was latched on all night. I was able to doze for 8 hours. Much longer than with my first baby, who can sleep when their baby is screaming across the hall and the nurses won't bring him/her to you? When the nurse noticed that I was only writing down which side I breastfed on last not the length of time, she chided me. "That's to make sure your baby is getting enough to drink," at which point I told her that "there is no current research that supports that the duration of time on the breast can determine the amount of breastmilk ingested. In fact, the timing of feedings is considered to be counter-productive to breastfeeding success according to the World Health Organization. But it is a wonderful tool to help me remember which breast I fed with last. " She answered "It won't hurt to just write it down." Then left in a huff. When I knew my rights and was able to firmly assert them, my hospital stay was almost pleasant, except that they let my meds wear off and I had to walk to my car 3 days post c-sect with no pain meds in my system. Also, I was able to have my mother stay in the hospital with me, so there was never a reason for them to "help" with the baby, or take it away for a long period of time. Thanks mom. So here is a list of the things I wish I knew before having my first baby.

1.That hospital policy does not override a mother's legal right to informed choice.
Mother: "I don't want an iv" nurse "well it's hospital policy, just in case there's an emergency."
You still have a right to refuse. According to Canadian Medical Association's code of ethics and the Canadian Nursing Association's code of ethics. A patient has the right to refuse any medical test/procedures without further pressure from the health-care provider. In fact, a nurse who is just following the doctors orders and carries out a procedure after the patient has refused said procedure, is just as legally liable as the doctor who gave the order despite the patient's refusal.

2. Cesarean sections are not the "easy way out". They are risky, painful for weeks (sometimes years) afterward and leave you helpless to do simple but necessary motherly tasks.

3. According to the WHO hospitals with c-section rates higher than 15% actually have higher maternal mortality rates and higher incidences of re-hospitalization. In other words, this
life saving procedure when done in excess is a life-endangering procedure. The average c-sect rate in Canada is 25%. So feel free to ask questions when a cesarean is suggested. Your life may depend on it. There are many hospitals in Europe that have less than 15% c-section rate and much lower maternal and infant mortality rates than Canada.

4. It is not a requirement to have a formal breastfeeding education to be a L&D nurse or a doctor, though, the health-care providers who do not have a formal education (18 hours is the minimum recommended by the World Health Organization) will still offer advise. Nurse "Oh well, the baby's not getting enough liquid because your 'real milk' hasn't come in yet." or "write down each feeding and the length to show your baby's getting enough milk" Scientific research has debunked both of these misconceptions, but I still heard them coming out of healthcare providers mouths.

5. The Doctors responsible for creating the policies for formula supplementation usually have no formal breastfeeding education. So, if it is suggested that your baby be supplemented with formula, ask that a healthcare professional with at least an 18 hour breastfeeding education be consulted first. If possible, ask to speak with an International Board Certified Lactation Consultant, they are the gold standard in breastfeeding information and current breastfeeding research. Once again, you have the right to make an informed choice for your baby. It is not considered an informed choice if the caregiver does not have accurate or up to date information. You wouldn't consult Orthopedic Surgeon for advise on treating glaucoma, you'd see an eye specialist. It should not be any different for breastfeeding.

6. When I got home I would need a lot of breastfeeding support. I had no idea how much patience and confidence I would need to learn to breastfeed, and in turn, my baby to learn as well. Thank goodness for midwives, postpartum doulas and public health nurse Lactation Consultants. Find yourself at least one of these to help with the first 3 weeks of breastfeeding.

7. A new baby will want to eat between once every three hours to once an hour. This is not a sign that the baby isn't getting enough. This is very important to the production of breastmilk.

8. Breastfeeding, though very rewarding, is exhausting.

9. Sometimes babies just cry and all you can do is comfort them the best you can, they are adapting to a whole new world. Don't take it personally.

I think we should go to the hospital. NOW.

As doulas we are expected to continue our childbirth education. It is important for us to understand medical terms, tests and procedures. To understand possible complications in labour and delivery. But we are NOT to offer medical advise or do any clinical tasks that would be preformed by a healthcare provider (though, out of pure motherly instinct, I have checked a client's forehead when she said she felt like she had the chills). We do observe our clients, take notes (bathroom breaks, what snacks they've eatin, length of contractions and space between them.) But when we observe signs of possible complications (including a very fast labour ) and we are with our clients pre-caregiver, how should we approach this? We don't want to alarm our clients, we don't want to "make" them go to the hospital. It's a bit easier, I find, when my clients have a midwife. Any time a concern arises, for example: slightly heavier than usual bleeding. Clients ask: "Is this normal?" I say:
"Every labour is different, but this does seem a bit unusual, so you may want to give your midwife a call." Easy, midwife asks questions/answers questions and may/may not come over/suggest they meet at the hospital. But when the caregiver is a Dr. and it is not office hours, something that is just a little unusual, needs to be checked out at the hospital. Just in case. Though, I find myself, feeling the need to "cover my butt" sometimes. There have been times that I admit, after a client has told me she doesn't want to go to the hospital to get something checked out, that I reiterate what her Dr. has told her about when to go to the hospital (if it applies) or retold them that what I was observing was not typical of labour, but if she wants to stay at home, I will support her wherever she wants me to. I'm sure this felt like pressure from me to her and her partner. There has been times though, where I've ushered clients out the door, carrying their labour bags. Is this beyond my scope? probably. If I were in the same position would I do it again? Yes. It's a hard line to walk, I want to support her in all her informed choices...but I don't want to have to give baby catching instructions to dad via a 911 call either. Sometimes when mom's suddenly 2 minutes apart and 60 seconds long, squatting saying she doesn't want to go; you just got to step in and say: "I think we should go to the hospital. NOW."

I will never have the birth I want...healing words?

With my first pregnancy I was coerced into a c-section. My baby was breech, and apparently no one in the area would deliver Frank Breech babies vaginally. What they didn't tell me was that they cannot force me into having a c-section and that if were to refuse, who ever was on call would have to, by law, deliver (I prefer the term catch) my baby vaginally, unless I changed my mind and consented during labour. The surgery was cold and unfeeling, my questions were answered with statements like "all you have to do is sign this consent form and then the doctor will answer your questions." and then: "you ask a lot of questions." It was a horrible and scary experience. I had complications, uterine infection and an allergy to the antibiotics. I wanted to be a good mother, but I felt helpless and tired.

The second time around. I WAS NOT GOING TO HAVE ANOTHER CESAREAN. This pregnancy my midwife had hospital privileges (in case I had to go to the hospital I was planning an HBAC), I got a doula and an Aquadoula (heated birth tub). I got an education, I became a doula in the time since my first birth and had attended births by that time. I went to counselling for my first traumatic birth experience, I got massage therapy and I joined an ICAN yahoo group to read VBAC stories. I was ready and nothing short of my baby's distress was going to make me agree to another c-section.

Well, there were signs of distress and abnormal bleeding. So, as planned, I told the obgyn to give me a tubal ligation with the cesarean, because I never wanted another c-sect again, I didn't think my body could handle it. This surgical birth was better than the last, there was a genuine excitement in the air. The doctor talked about the baby while he performed the c-sect, my questions were answered with respect. Not what I wanted, but not so horrible either. Of course there were complications with this c-sect as well, though not life threatening.

So why did I feel so sad? Because never in my life have I not gotten exactly what I wanted if I put my mind to it. NEVER. My body had betrayed me, it ignored the plan. It went and let itself tear along the inside of my uterus, just one layer though, not enough to cause an emergency, just enough to cause concern. Concern+Meconium+heart Decels=My informed choice to a Cesarean.
I knew I made the right decision for myself. But it was my body's fault, I looked at it angrily when I caught sight of it naked in the mirror. I read VBAC success stories incessantly, punishing it; see that's what you should have done. Until one night after reading Women's Bodies, Women's Wisdom, I wrote myself a letter. It went a little like this:

I will never have the birth I want
I will die not knowing what it is like to push a baby out of my vagina
I will never give birth in a tub surrounded by candles
This is not my body's fault.
My body is strong, I love my body for growing my babies.
I believed with all my heart I could do it and I couldn't,
This does not make me weak or foolish.
I am a strong woman and a good mother.
I will never have the birth I want.
I forgive myself
I forgive my body.

I cried writing it. But felt immensely lighter after doing so. So my fellow cesarean mothers; please write yourselves a letter, paint yourselves a picture, or sing yourselves a song. Then get out there and help others avoid/heal from cesareans.