In November I will have my fifth (yes, fifth) cesarean. My husband and I will welcome a girl into our sweet, spirited brood of four boys. You might think I’m bracing for it, anticipating the surgery and recovery as a painful means to a much-desired end. In truth, I want more. I want this baby girl more than I can conjure words to write. But I also want a good birth.
Some people would say my good birth went by the wayside long ago—that a good birth is a “natural” birth, reserved for those who can safely eschew the trappings of modern medicine and find something special, empowering or orgasmic in delivering the way their grandmother did.
I have no doubt births like that can be good, really good. But what about those of us who need or find value in what modern medicine has to offer? Does a surgical birth (or pain medicine, or a boost of synthetic pitocin, or a doctor’s hand) preclude the possibility of a good birth? The short answer is no.
Beyond the four children I’ve delivered and the hundreds of births I’ve attended as an obstetrician, what convinced me of this is a study I led called The Good Birth Project. My research team and I interviewed more than 100 diverse moms. They gave birth in homes, birth centers and hospitals; some delivered vaginally with relative ease while others endured emergency cesareans and episiotomies.
1. Give yourself credit: A good birth is one in which we have a hand in shaping, that is informed by the things we value; it's one in which we feel involved and present. It is not about orchestrating every detail, or delivering in a squatting position with someone catching beneath. Rather, it’s about being acknowledged as the person who is giving birth, the person who has used her body to bring a child into the world. One of the things I love about my obstetrician is that she wouldn’t dream of taking credit for my birth (which, as a fifth cesarean, will take considerable surgical skill) but will give credit where credit is due. She gets it. A mom of two, she knows who delivers babies: women do.
2. Get comfortable: A good birth is one in which we feel safe and secure, in trustworthy hands. Birth is safer these days than it has ever been—but it can be hard to feel safe, deluged as we are with the latest hazards and criticism hurled between advocates of midwifery and medicine. How are we to find that sense of security we all need? Do your research, then figure out what makes you feel safe: ready access to technology or distance from it; a familiar soft pillow or a crisp white one; your partner, your best friend, your mom or sister. And be open. One of my former patients gave me a CD made especially for women approaching cesarean. It's magic for a 43-year-old mom of four who worries too much.
3. Make sure you feel connected: In a good birth we feel meaningfully connected to our loved ones, our care providers, our baby. As I write, I feel plenty connected to my future daughter—she is just starting to make herself known with reassuring taps beneath my skin. As eager as I am to meet her, I know that birth can feel like separation, too. There is no single perfect way to reconnect—and good first moments are as different as the women who describe them: an immediate slippery skin-to-skin union, a swaddled kiss, or something later. Even in an operating room, such moments are well within reach: There have been no sweeter moments in my life than feeling my just-born child’s cheek pressed up against my own.
4. Maintain respect: A good birth is one in which we feel others respect us, our newborn and more broadly birth as a meaningful event in our lives. One of the hard things about my first birth was how everyone was apologizing to me—telling me how sorry they were that I had needed a cesarean. I was expecting—and needed—to hear "congratulations." I'd just had a baby, after all.
Even if it wasn’t the birth you imagined (this is, more often than not, the case), birthing is birthing however you do it. We all need to find the positive and profound in the experiences we have. Birth is, after all, a beginning, chapter one of a story that is—one hopes—a love affair, to boot.
5. Know as much as you can: A good birth is one in which we have enough information before and during the event, that we have a sense of what is happening and why. It also depends on the wisdom we garner by virtue of going through it. I think it wise advice that expectant moms “do their research,” but none of us can know it all. As a doctor and a mom and a researcher of nearly 20 years, I’ve found that there really is nothing like going through it. One of the gifts of birth is the wisdom it imparts.
I’m looking forward to seeing what it is that my daughter has to teach me. I’ll keep you posted.