We already knew each other, Denise and I. Four years ago I had also visited her for a lactation consultation. Now she phoned me again, because she had given birth a week ago. The childbed nurse had just left; she had pain while breastfeeding and struggled with cracked nipples. We made an appointment and I went to see her. She opened the door, her four-year-old daughter in tow, shyly hiding behind her. Her son was sleeping in the playpen, but once picked up he was eager to feed. After I had done an oral exam, in which I found nothing special, mom put her son to breast. I made some suggestions and with a few adjustments breastfeeding was painless.
During a consultation, the way the mother experienced the birthing process is always discussed. Denise indicated that she had had a great delivery and that she looked back on it with a good feeling. She had gone to the hospital because, just like last time, the dilation was not progressing. She had started in the birth pool at home, according to how she wanted it. When, after a while of working through her contractions, she got stuck at three centimetres dilation, she was asked what she wanted. She could stay home a little longer or go to the hospital for pain relief. She chose the latter, with which her dream birth disappeared from view.
She went to the hospital, was given pain relief via a pump and then an IV with contraction inducers, because the strength of the contractions had subsided after the move from home to hospital. Once she was fully dilated, she pushed for another seven minutes until her son was born. She looked back on it well, she said; it had gone fine. The only problem now was the pain during breastfeeding and a feeling that things were not really going well yet. That was why she had called me: to help resolve what looked like a breastfeeding problem by means of a consultation. I had listened intently and all sorts of things came to my mind. I considered how I should continue the conversation with her.
After she told her story, I asked how she would have preferred her delivery. She was very clear about that: she had wanted to give birth in the birth pool at home, with her daughter there. They had discussed it extensively in advance that she could be there, and if mom had to go to the hospital, grandma would pick her up. When Denise had been in labour for a while at home, her daughter had woken up and come downstairs; she had been pleasantly present. If mom had a contraction, the girl was asked not to disturb mom for a while, but otherwise it felt very nice for Denise to have her daughter there.
When they called the midwife after a while, she was asked if she had any objections to an intern coming along. Denise had not minded. When they arrived, an internal examination had been done and it had been found that she was three centimetres dilated. Because it was a second child, the assumption was that it could go quickly. That is why the maternity care was immediately called as well. In an earlier phase, during the intake, Denise had indicated that a childbed nurse intern was no problem. During the delivery, she was not asked if she still agreed, so two more people joined. The situation thus looked like this. In a not so large house, with a not so large living room, the coffee table had to make way for the birth pool. Two large steps away from the tub was the kitchen table where the midwife, the maternity nurse and the two trainees were talking to each other. The maternity care intern was quite present and talked both a lot and loudly.
Giving birth is an intimate event, a life event that deserves safe, sacred space. The process has the best chance of a smooth and desired course if the birthing woman is not disturbed too much, if she is surrounded by people with whom she feels comfortable. You can compare it to sex: if you are observed having sex, an orgasm is highly unlikely for most people. If, on the other hand, you can find your own shape with your partner undisturbed and let everything go as it feels appropriate for you at the time, then an orgasm is much more obvious and will usually come easily.
During childbirth, the same basic principles apply in terms of privacy and a sense of security. If you are in an environment that feels safe for you with people you trust and who trust you, your body can relax and birthing your baby will go smoothly. Disruptions, such as people around you conversing loudly, detract from that safe environment and cause the process to stagnate. In this case, it happened the first time, probably because of the turmoil around Denise, which led to the birth not progressing. In the hospital, the process stagnated again because the new environment and the interventions contributed to the fact that the contractions stayed away.
Such a course also affects the self-confidence of the mother. Something lingers in the subconscious: “It has now happened twice, so I keep in mind that it may go the same way next time. Giving birth at home is not for me. I cannot do this; my body is letting me down. I’m not good enough for such a task… and possibly not for other tasks either…” That is very unfortunate and very sad for all kinds of reasons, because how your mother felt during pregnancy and childbirth, the way you came into the world has a major influence on how she begins her motherhood. Her experience has an influence on your mutual bond and therefore on the rest of life. Does your life begin in an atmosphere of peace and trust or does your mother feel a sense of failure because she (again) failed to give birth to you as she would have liked? How much grief does she carry with her?
And a deeper question: how come it was difficult for her and her partner to guard the ‘sacred space’ of the birthing place like lions, regardless of the opinion of the midwife or maternity care about it? What made it difficult for the expectant parents to stand up for their own needs? There are many more questions thinkable that deserve attention. For example, what made the childbed nurse trainee no longer aware of her place in the whole, of the importance of being silent and humble? What prevented both the midwife and the childbed nurse from pointing out to the intern that her loud talking was disrupting the situation? How come the care providers did not know in advance that the living conditions did not lend themselves to the presence of so many people?
With a trauma-sensitive view, it becomes clear that a more coordinated approach would have been possible at all levels. When we as a society have more knowledge about the effects of this kind of action on the beginning of a human life, we can all contribute to ensuring that that start is optimal, so that we do not stimulate ‘adverse’ but ‘awesome childhood experiences’!