Welcome to a brand-new book series and a brand new website! I’d like to tell you a little about the new direction I’ve taken—well, same direction and intent, really, but a slightly different path—and why.
For the past few years, I have been the person behind Childbirth U. As “Childbirth U” suggests, my model was education about the issues of childbirth via a lecture series.
I’ve come to realize, though, that I want a more intimate relationship. Rather than teaching from the front of the room, I want to sit down at the kitchen table with you, mug of tea in hand, and work with you to help you figure out what’s right for you and how to get it.
I still offer the hard-to-get-your-hands-on piece of the puzzle: data-driven information on the advantages and disadvantages of all your options and practical advice based on what choices you make. The difference is that I want to be a resource, not a guide, and instead of lead, I want to have your back. In place of offering instruction in what constitutes optimal care and how to obtain it, I want to help you take charge of your birth.
The best way for me to illustrate that shift is to share with you my personal journey to where I am today and more details about what I hope I can do for you. I lay these out in the preface to Labor Pain: What’s Your Best Strategy?, the first book in my new “Take Charge of Your Birth Series.” You can listen to me read the preface in this excerpt from the audiobook version of my book, or you can read the transcript below. The rest of the audiobook, I should add, is narrated by my daughter, who, as it happens—proud mama here—is a professional audiobook narrator with over 200 books to her credit.
Before we sit down together, I thought you might like to know a little more about me and why I’ve written this book. You can, of course, get my qualifications for writing it from my bio, but I mean something a bit more personal.
My passion and my life’s work have been providing pregnant women what they need to make decisions about their care: complete and accurate information, presented neutrally, on the pros and cons of all their options.
My passion arose from my experience of my first two births. Both were medically uneventful vaginal births to a healthy baby. At both births, my caregivers were competent and everyone was nice to me. Nonetheless, I emerged from the first birth feeling distressed, defeated, and diminished, lacking confidence in myself and my body. In contrast, after my second birth, I felt exhilarated, proud, and strong. What, then, was the difference?
At the first birth in 1974, I assumed my caregivers knew better than I what was right for me and everything they did had to be for the best. I was persuaded to have an opioid injection for pain even though my Lamaze techniques were working for me and I wasn’t feeling the need for pain meds. All I got from it was a losing battle to surface from my drugged haze to try to cope with contractions. I remember trying to push lying flat on my back and pleading that if I could just sit up more, I could push more forcefully. I was ignored. After pushing awhile longer to little effect, I ended up with a large episiotomy—cutting the vaginal opening to enlarge it for birth—and a forceps delivery. I desperately wanted to be with my baby, but after just a few minutes to hold him, he was taken away for a routine twelve hours of observation in the nursery. Because he was born at noon, he wasn’t brought to me again until the next morning. At that point, hurting from the episiotomy and the forceps delivery, feeling exhausted and overwhelmed, the best I could work up was that I thought he was cute. It took weeks to heal from the delivery, and sadly, I went on feeling no more emotion for my son than a sense of duty toward him for months after his birth.
I put my difficulties down to my inadequacies. That’s where things stood until my next pregnancy two years later when I started considering what I wanted and didn’t want for this next birth. As I began reading and exploring, I found that none of the practices and policies that had caused me such physical and emotional pain had been necessary in my case. All had been avoidable. If only I had known . . .
This time, I sought out a care provider who saw me as an active contributor: someone with concerns, insights, and judgments to be respected as much as his own. As a result, my second birth experience couldn’t have been more different, although it was the more difficult labor. My daughter was in occiput posterior position, a situation where the baby is facing the mother’s belly instead of her back. Babies may not be able to descend through the pelvis until they turn into the more favorable occiput anterior position, and sometimes the malposition causes the mother excruciating back pain, which it did in my case.
In this birth, though, I was supported and encouraged in my desire for an unmedicated birth. When I got to pushing, my doctor recommended that I push on my hands and knees so that gravity could assist the baby in turning to face my back. As I did so, he used his hand to gently help bring her head around. Once she swiveled into the anterior position, I easily pushed her out in a very few contractions with no episiotomy, despite her weighing one and a half pounds more than her brother. Once she was born, she came immediately to my arms and was in my arms or my husband’s arms for the first couple of hours after her birth except for a brief examination. I felt on top of the world, thrilled with myself, and instantly in love with my baby.
Here’s what those two births taught me: when it comes to how you feel afterward, it’s far less about how easy or difficult the labor and birth were or whether everything went according to your preferences or how you imagined it would; it’s far more about whether you participated in the decisions, you made the ultimate calls, and your caregivers listened to and respected you. And yes, I subsequently found research that agrees with that.
By the time my daughter was a few months old, I realized I wanted to share with other women what I had learned about the importance of having agency in the decisions that are made during labor and birth. I joined a group that was opening a birth-resources center and founding a community-owned and -operated freestanding birth center. I began working as a doula (there were no formal training programs for doulas yet) at the birth center and trained as a Lamaze teacher, all in the interest of wanting women to know that they have choices and the right to make them, and that having their autonomy respected matters to how they feel about themselves, their babies, and their partners.
Eventually, I realized there are many excellent birth educators and doulas, and I could fill a niche that was less crowded and had the potential to reach more people: I could read, analyze, and synthesize the obstetric research. It’s not that difficult, really. All it requires is having college-level reading skills, acquiring the specialized vocabulary, understanding statistical concepts, and being able to think critically. Very few people, then or today, though, were engaged in that task. So I shifted gears, and that’s what I’ve been doing for the last thirty-five years and counting. This book is my latest project.
Enough about me. Let’s turn to you, now, and how I think I can be of help.
Why This Book?
This book, as does all my work over the years, has one purpose: I want you to learn the easy way what I learned the hard way. I don’t want you to find yourself thinking later: “I never knew that was an option. If I had, I would have gone for it,” or “If I had known that could happen, I would have made a different choice.” The book’s subtitle—Get the data. Make a Plan. Take Charge of Your Birth.—sums up my ideas on how best to accomplish that goal. Let me take you through the sequence step by step.
To begin with, if you’re going to make a choice, you need to get the data—meaning, as I said above, complete, accurate, fact-based information on the pros and cons of all your options. Getting data, as opposed to opinions, can be difficult. Whether they practice standard obstetric management or favor refraining from medical intervention whenever possible, many of the birth professionals you would expect to be your source for data are convinced they know what you should choose. Consequently, they may consciously or unconsciously tell you only as much as they think you need to know to persuade you to do what they think is best. Friends, relatives, and media sources have opinions, and while other people’s thoughts, feelings, and experiences can be valuable, they aren’t data either.
This is where I hope to help. This book will present the research evidence in a digestible format so that you can decide for yourself. And while that will involve interpretation on my part, which introduces my judgment, I will compensate for that by playing my cards face up. I will always tell you why I think what I think about the evidence. I also promise to stick to reasoned analysis and avoid loaded language that evokes strong feelings that may override your thought processes.
Once you’ve taken in the data, the next step is to make a plan, that is, to decide what’s right for you and what you can do to maximize your chances of getting it. More than a few birth professionals, though, find birth plans problematic. They think making a plan leads women to think they can control an uncontrollable process, a mindset likely to end in frustration, disappointment, and even feelings of failure when they find out they can’t. Best not to make choices, they say, and just go with the flow.
They are right if you think of a plan as a shopping list or blueprint. However, that’s a narrow conception of what a plan can be. Planning for a birth is more like planning a vacation or a career. It’s the same process of using heart (values, inner knowing) and head (information gathering, practical considerations) to figure out what you want and what best promotes getting it. Certainly, obstacles may crop up, but if they do, knowing what’s important to you, where you’re headed, and the route you’re taking will help you navigate, adapt, and modify. And, should things really go sideways, you ’ll be prepared to take a different direction while salvaging what can be salvaged of your plan.
A plan is a crucial element of having agency, and having agency, as I said, matters profoundly. Feeling strong and capable (or the reverse) as you encounter the challenges of new motherhood affects not just you but also your baby and other members of your family. A malleable plan will serve you far better than drifting with the tide and letting others decide what’s best for you. I can help you with your plan as well. In addition to providing the data, I can give you ideas and suggestions for bringing your plan to fruition and avoiding common pitfalls.
Finally, having a plan based on the data enables you to take charge of your birth. Notice I didn’t say “control.” You can’t control the birth—or, really, anything in life. You can, though, take charge by knowing what you want and why, then planning how best to achieve it. Having said all that, I want to add that you can, of course, decide to leave a decision up to your care provider or simply follow their recommendation. I just want you to make that decision consciously and not because you didn’t think you could do anything different. Also, by knowing what you want, you’ll be able to choose care providers who are in alignment with you and whose judgment you can trust.
So let’s set out on your journey together. I’m here as a resource to help you find your own path. If something I tell you resonates with you, great! If something doesn’t feel right for you, that’s OK too. Figuring out what you don’t want is as useful as figuring out what you do want. Take what works for you in this book and leave the rest behind. Trust yourself. You have what you need to decide what’s best for you, and I’ve got your back.