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Giving Birth

Kate's Story: When birth doesn't go as planned

Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.

"Giving Birth" features stories about how birth affects breastfeeding. Please send stories that describe the impact of your birth experience on breastfeeding. Articles focused on specific issues relating to birth and lactation are also welcome.

Sometimes, in spite of our intentions or expectations, birth does not go according to plan. Although many of our prior decisions can shape the way that labor and birth unfold, the unexpected can and does happen, and the impact can be far-reaching. In the following story, Kate describes how her hopes for a gentle birth were ended by a potential medical emergency and how it affected her feelings for her baby afterwards.

Kate's Story: When birth doesn't go as planned

With my fourth pregnancy, I planned a home birth. I hoped to have my baby handed to me immediately when she emerged and then to breastfeed her within minutes of the birth, as had happened with my other three babies. I expected to have an easy birth because my last two babies' births had been very short -- indeed one involved only two pushes!

When I was pregnant with Caitlin, I had experienced symphysis pubis displacement, a slight separation of the soft joint between the two pubic bones in the pelvis. This is a common problem in pregnancy. It was painful for me to walk. So, when I experienced dragging pains in my abdomen during the last month of pregnancy and tests showed no clear reason for them, we assumed these were ligament pains. Around my due date, I started to bleed and went by ambulance to hospital with stomach pains. I became exhausted and hysterical, whereas during my previous labors I had remained calm and somehow above the pain. I could not feel Caitlin moving forward in the birth canal.

The appearance of meconium in the amniotic fluid brought a team of pediatricians into the room. When my baby's head crowned but her shoulders could not come out, there was a flurry of activity in which the medical team manipulated my legs into very strange positions to help her out. They did this so forcefully that I was still experiencing back pain 13 months later. We soon saw what the problem was. The cord was wrapped around my baby's neck several times, then around her shoulders, body, and legs. As she engaged, and was then expelled, the cord was tugging on both of us. I had been at risk of an abruption (the placenta tearing away from the wall of the uterus, which can deprive the baby of oxygen and cause heavy bleeding in the mother). Caitlin was grey and floppy with a low Apgar score because of the shock. At that point no one thought of my birth plan. They were preoccupied with giving her oxygen, while I just lay with my eyes closed, feeling relieved that the pain was over and occasionally asking if she was breathing. They showed her to me and then took her away to the NICU, saying that I could see her when I had had a shower and felt better.

When I did see her an hour later, she was clean, dressed in a diaper, and lying in an incubator with a tube down her nose. It didn’t seem like she was my baby at all. I cried because I pitied her for having such a hard time, but I felt no love for her. I believe now that she should have been given to me as soon as her breathing was established, but hospital procedure got in the way. She did not need to be tube fed immediately, but that is what was deemed necessary. I said that I wanted to breastfeed, but the hospital staff kept tube feeding her "to get her blood sugar level up." Although some nurses said, "Of course you can pick her up, she is your baby," one nurse told me not to come during the doctor's rounds as I would be in the way, and kept shooing me away "to rest." The fact that I was tired and alone made me tolerate this for some time, but when my milk came in on day three, I just took her and fed her myself.

They were surprised that her blood sugar level shot up even though I had stopped her tube feedings. If I had not been confident that she needed my milk and needed me we would probably not have started breastfeeding. As for bonding with my daughter, I knew that that would come in time, and I made a special effort to encourage the process by always stroking Caitlin while we breastfed -- her downy head, her little feet, over and over. I can't say exactly when those feelings of displacement and distance went, but now I adore my little girl.

Kate Rayner
Cambridge, GB

How traumatic birth makes us feel

When birth is traumatic, it's not surprising that mothers may feel indifferent or even resentful toward their babies. Mothers may be recovering from unexpected surgery if they had an emergency cesarean section, or perhaps the event was frightening and a mother felt out of control. It is this lack of control that often affects women the most. Sheila Kitzinger, the British birth author and activist, notes that women will perceive their birth experience as a negative one if they are unhappy with the setting in which they gave birth and by the way they were treated. Rules, restrictions, rigid protocols, personal neglect, bossiness, unkindness, shift changes, and the appearance of nameless strangers, are all cited as reasons why women may feel their birth was traumatic (Kitzinger, 2006; 11). And if a new mother feels inherently uncared for, she may not muster up enough energy and enthusiasm to care for her new baby. Indeed, she may even blame the baby for the awful experience. And it is made harder by the fact that everyone is likely to be fussing around the new baby and telling the mother how lucky she is to have such a beautiful child. Somewhere deep inside the mother knows this, but it may take a while for her to feel attached and loving toward her baby. Many mothers describe the early days as simply going through the motions -- acting like a mother, but not really feeling like one. Kitzinger uses the term "robot" to describe the traumatized new mother who is unable to respond in an emotionally positive and spontaneous way (Kitzinger, 2006; 122).

When birth goes well -- and this usually means a gentle, intervention-free birth -- then a mother's body will produce a range of hormones that will make her feel good. As the baby is born she will experience a surge of endorphins that make her feel euphoric. This happy, confident state will make her very receptive to welcoming and nurturing her baby (Robertson, 2004; 44). When a traumatic birth gets in the way of this boost of confidence and euphoria, it's hardly surprising that mothers may not be particularly responsive to their babies immediately after the trials of labor.

The good news is that feelings can and do change, over time. Bonding is a gradual process.

Breastfeeding has the advantage that physical contact is inevitable, and time spent touching and holding the baby can be comforting and will help mother and baby establish their relationship.

Although breastfeeding problems may sometimes seem to exacerbate a mother's struggles after a traumatic birth, managing to breastfeed successfully may be a very healing process as it helps women to feel in control and empowered as they nurture and nourish their babies.

Kathleen Kendall-Tackett, PhD, IBCLC, LLL Leader, encourages mothers to process their traumatic births. "Talking to someone who has shared similar experiences provides validation of your feelings, just as breastfeeding mothers find validation at La Leche League meetings. Sometimes, just talking about your feelings with a good friend can help you sort things out and calm any fears or anxieties."

Kendall-Tackett always encourages mothers to get copies of their medical records. "If possible, talk with your health care provider or someone else who can help you understand the events that occurred during your birth. It is also helpful to read books that might put your birth experience in a broader perspective." See "Making Peace with Your Birth Experience" New Beginnings, issue 5 & 6 2009; 50–55.

By talking about her birth experience and seeking counseling, if necessary, a mother can understand and come to terms with what's happened and then move on. This will help her connect with her baby and give him the love he needs.

References

Kitzinger, S. Birth Crisis, Routledge, 2006.
Robertson, A. The Midwife Companion, third edition, Birth International, 2004.
The Breastfeeding Answer Book, third revised edition, Schaumburg, IL: La Leche League International, 2002.

If you would like to talk with someone about your birth experience, you may find the Birth Crisis Network helpful. See http://www.sheilakitzinger.com/BirthCrisis.htm

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