Birth of a new ope­ness

From pod­casts to TV pro­grammes and fo­rums, mums are break­ing with tra­di­tion and freely talk­ing about the tri­als of labour. But is this al­ways a good thing, asks Sharon Ní Chonchúir

Irish Examiner - Feelgood - - Cover Story -

ÚNA O’Sul­li­van, a new mum to sixweek-old Don­nacha, thought she was pre­pared for labour.“My three sis­ters had ba­bies be­fore me and I’d heard about nat­u­ral births, C-sec­tions and stitches but my labour was noth­ing like what I thought it would be,” says the 30-year-old from Din­gle. “It was much worse.” She at­tended an­te­na­tal classes in Cork Uni­ver­sity Ma­ter­nity Hos­pi­tal. “They gave lots of tips, from breath­ing tech­niques to dif­fer­ent birthing ball po­si­tions,” she says.

“But they also said that what we were do­ing was like learn­ing to drive with­out a car.”

Due on Au­gust 20, Don­nacha still hadn’t ar­rived by Au­gust 30. “I was in­duced and as soon as they hooked me up to the mon­i­tor, they said it should be an easy case as I was al­ready con­tract­ing,” she says.

Some 26 hours later, her con­trac­tions were ex­treme but she was only 3cm di­lated. “The con­trac­tions were vi­ciously painful and with ev­ery one, I’d fall to the floor or bury my head in the pil­low,” she says.

“The baby’s heart­beat would drop or even stop. I was up­set and fright­ened be­cause I didn’t know what was hap­pen­ing or why things were go­ing so wrong.”

She even­tu­ally had a Csec­tion and her 7lb 6oz baby boy was born at 8.21pm on Au­gust 31, 27 hours af­ter her labour be­gan.

Un­til re­cently, only moth­ers and med­i­cal staff knew what hap­pened be­hind the doors of the de­liv­ery room. Now, thanks to on­line fo­rums such as Mum­, blogs like bad­, pod­casts in­clud­ing The Mother of Pod, and the likes of The Ro­tunda se­ries on RTÉ, even peo­ple who have never set foot in a ma­ter­nity ward can get up close and per­sonal with the messy busi­ness of labour.

On The Mother of Pod, Jen O’Dwyer and So­phie White dis­cuss their birthing ex­pe­ri­ences in graphic de­tail and with bawdy hu­mour. For ex­am­ple, White makes fre­quent ref­er­ences to what she calls ‘vadge-maged­don’ — when her epi­siotomy scar be­came in­fected af­ter the birth of her sec­ond baby.

Some ar­gue that hear­ing sto­ries such as White’s or O’Sul­li­van’s gives preg­nant women a more re­al­is­tic view of the chal­lenges that lie ahead.

But do they share the in­for­ma­tion they need to meet those chal­lenges or do they risk adding to the anx­i­ety of first-time moth­ers?

A 2014 study of young Cana­dian stu­dents sug­gests the lat­ter. Those who re­ported that the me­dia had shaped their at­ti­tudes to­wards preg­nancy and birth were more fear­ful than oth­ers and more likely to opt for epidu­rals and caesar- eans.

Krysia Lynch is chair­woman of the As­so­ci­a­tion for Im­prove­ment in Ma­ter­nity Ser­vices (AIMS), a group that pro­vides in­for­ma­tion and sup­port to cou­ples dur­ing and af­ter the birth of their baby. She is happy that women are fi­nally speak­ing out about their birth ex­pe­ri­ences. “His­tor­i­cally, ev­ery­thing to do with the vagina was a taboo topic,” she says.

“Sub­jects like men­stru­a­tion and birth sim­ply weren’t dis­cussed.”

There was also the un­spo­ken im­pli­ca­tion that women should be grate­ful their baby was born alive and healthy. “If you had a baby to hold in your arms, you couldn’t com­plain,” says Lynch. “You just got on with it.”

A lot has changed, ac­cord­ing to Pro­fes­sor Ce­cily Be­g­ley, chair of Nurs­ing and Mid­wifery at Trin­ity Col­lege Dublin, who says that so­cial me­dia has played its part. “In this age where peo­ple share what they ate for break­fast, it’s not sur­pris­ing women are talk­ing about what’s in­volved in hav­ing ba­bies,” she says. How­ever, she is con­cerned that some voices are heard more than oth­ers.

“Women who have had trau­matic ex­pe­ri­ences may be louder and their sto­ries could frighten oth­ers,” says Be­g­ley. “We need to hear more from women who have had man­age­able births that in­volved pain and hard work but were also worth­while.”

One of the best places to pre­pare women for bloody and painful labour is an an­te­na­tal class. “This is where dif­fer­ent sto­ries should be heard so that women are given a clearer idea of what’s ahead of them,” says Lynch. “These sto­ries should also demon­strate that as long as they have prac­ti­cal knowl­edge and cop­ing strate­gies, they will be able to get through it.”

Be­g­ley be­lieves that most women aren’t pre­pared for this, which leads to a high rate of labour in­ter­ven­tions.

“Take the ex­am­ple of a woman left with her part­ner while labour pro­gresses,” she says. “She is fright­ened so her oxy­tocin (the hor­mone re­spon­si­ble for sig­nalling con­trac­tions of the womb dur­ing labour) level drops, caus­ing her con­trac­tions to weaken. She is put on a drip to en­cour­age the con­trac­tions again but they be­come too painful so she needs an epidu­ral. Then the baby’s heart­beat be­comes er­ratic and a C-sec­tion is re­quired.

“If this woman had been taught to help her­self, she could have had a nap or got up and walked around and it might have started her con­trac­tions again.”

Ni­amh Healy, an an­te­na­tal ed­u­ca­tor with Cuidiú, the Ir­ish Child­care Trust, and au­thor of Bump2Babe, agrees. “Pain is not the en­emy in labour — fear is,” she says. “And an­te­na­tal classes should teach women and their part­ners how to keep it at bay.”

Ju­lianne Booth, 33 and from Par­teen in Clare, is an­other woman who doesn’t be­lieve in keep­ing mum about labour. She saw a doula be­fore the birth of her

son Alex, who is now two years old, and thinks this helped her to feel con­fi­dent dur­ing labour.

Her labour lasted two days and she fol­lowed her doula’s tips through­out. She took lots of walks out­side the hos­pi­tal and re­peated af­fir­ma­tions and vi­su­al­i­sa­tions.

“Dur­ing my con­trac­tions, I told my­self I could do any­thing for two min­utes,” she says. “I also kept the im­age of my 3D scan in my mind.”

Booth did have mo­ments of doubt. “There were times I thought I was dy­ing be­cause of the pain,” she says. “But I did take pethi­dine at one point and that helped. I needed an epi­siotomy and Alex re­quired a suc­tion cap but when he was born at 3am, it was sud­denly all worth it.”

A sig­nif­i­cant pro­por­tion of Ir­ish moth­ers have com­pli­cated birth sto­ries to tell. The World Health Or­gan­i­sa­tion main­tains that only 10%-15% of births re­quire a cae­sarean sec­tion but in Ire­land, more than 30% of births are cae­sare­ans.

Be­g­ley sug­gests this may be be­cause our ma­ter­nity sys­tem is led by ob­ste­tri­cians. “This means it’s safe but it’s very med­i­calised and there is more in­ter­ven­tion than there would be in a sys­tem that was led by mid­wives,” she says.

Up to 36% of first-time moth­ers re­quire the use of for­ceps or a suc­tion cap to de­liver their baby. In­duc­tion rates are even higher. Last year, CUMH recorded the high­est in­duc­tion rates in the coun­try with 44.6% of new moth­ers in­duced last year.

In­duc­tions are as­so­ci­ated with stronger con­trac­tions and faster labours and the in­duc­tion rate for NHS hos­pi­tals in Eng­land last year was a com­par­a­tively low 29.4%.

“Be­cause these in­ter­ven­tions are so com­mon, on pa­per it can look as if a woman had a rel­a­tively nor­mal birth,” says Healy. “Yet she might feel as if it was any­thing but.”

A trau­matic birth can lead to psy­cho­log­i­cal trauma rang­ing from post­na­tal de­pres­sion to post-trau­matic stress dis­or­der. Ap­prox­i­mately 15% of new moth­ers in Ire­land suf­fer from post­na­tal de­pres­sion and PTSD is thought to af­fect 4% of new moth­ers in­ter­na­tion­ally.

To­co­pho­bia is even more se­vere. Only recog­nised in 2000, this dis­abling fear of child­birth is es­ti­mated to af­fect 10% of women.

Pro­fes­sor Ca­tri­ona Jones is an ex­pert in peri­na­tal care at the Uni­ver­sity of Hull. One of her stud­ies pub­lished in 2014 found that speak­ing out and shar­ing birth sto­ries can im­prove women’s men­tal health.

She re­cently caused con­tro­versy when she spoke at the Bri­tish Sci­ence Fes­ti­val in Hull and called on women to be care­ful when and where they share their birthing hor­ror sto­ries.

“If you go on­line, there are women say­ing that their ex­pe­ri­ences were ter­ri­ble and that it was a blood­bath,” she tells Feel­good.

“We need a bal­ance where we meet the needs of women who have had ba­bies and who find it cathar­tic to share their sto­ries as well as the needs of women who are about to have ba­bies and might be­come fear­ful if they heard those sto­ries.”

This is where im­proved ma­ter­nity ser­vices can help. “Women who feel heard through­out labour will re­port more sat­is­fac­tion with their ex­pe­ri­ence than a woman who had the same ex­pe­ri­ence but didn’t feel in­volved in the de­ci­sion mak­ing,” says Healy.

This might ex­plain why Booth felt pos­i­tive about her birth. “Even though I had an epi­siotomy and Alex needed a suc­tion cap, I felt part of it all,” she says. “The mid­wives helped me to have the ex­pe­ri­ence I wanted and my mother, who was my birth part­ner, stood by me. I felt lis­tened to and sup­ported.”

Af­ter birth, most moth­ers will need to talk about the ex­pe­ri­ence. “Of­ten, even a trau­ma­tised woman will feel bet­ter if she can ask ques­tions and hear the rea­sons for the in­ter­ven­tions,” says Be­g­ley.

This was true for O’Sul­li­van. “I felt like I had been through hell on earth and had so many ques­tions,” she says. “My hus­band ran into the sur­geon who car­ried out the C-sec­tion and asked her to come to see me. She ex­plained why ev­ery­thing hap­pened as it did and at least now I know... why I couldn’t de­liver him no mat­ter how hard I pushed or how painful the con­trac­tions.”

Laura Ersk­ine, head of com­mu­nity for Mum­, is ex­pect­ing her third child and is look­ing for­ward to the labour, hav­ing pre­vi­ously had what she calls “two very pos­i­tive birth ex­pe­ri­ences”.

She is sure that moth­ers ben­e­fit from hear­ing other birth sto­ries. “The C4 se­ries One Born

Ev­ery Minute had just started when I was preg­nant with my first and was prob­a­bly the best ed­u­ca­tion I could have had,” she says.

“It showed real mums en­gag­ing in dif­fer­ent tech­niques to re­lieve pain and progress labour. The new Ir­ish se­ries, The Ro­tunda, gives mums a real-life look at the Ir­ish ma­ter­nity sys­tem in the same way.”

There is great in­ter­est in birth sto­ries on Mum­ “They re­ceive huge en­gage­ment so we know they strike a chord with other mums,” says Ersk­ine.

“That’s why we launched a mum blog­ging plat­form called Mum­myPages Voices and the Mum­sTruths pod­cast. Both al­low women to share preg­nancy, birth, and par­ent­ing sto­ries in or­der to em­power other women to be more pre­pared and con­fi­dent on their jour­ney.”

Úna O’Sul­li­van, Ju­lianne Booth and many of to­day’s moth­ers are break­ing the si­lence of the past by speak­ing out about their birth ex­pe­ri­ences. Shar­ing their sto­ries al­lows them to process the many com­pli­cated feel­ings that sur­round birth and may also help other women be bet­ter pre­pared for the chal­lenges of their own labours.

“In­for­ma­tion is power and the more in­for­ma­tion you have, the bet­ter placed you are to make de­ci­sions and ask for things,” says Lynch. “Women can learn what they want and need by hear­ing other women’s birth sto­ries.”

Pic­ture: Ea­mon Ward

Ju­lianne Booth and her son Alex from Par­teen, Co Clare.

Pic­ture: Domnick Walsh

Úna O’Sul­li­van, mum to six-week-old Don­nacha, at her home in west Kerry.

Laura Ersk­ine: Com­mu­nity head at Mum­

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