Preventing PPD 1: Setting yourself up for a Good birth

You're reading this and waiting to hear my judgement (and how judgemental will I be?) about what constitutes a Good birth. Well, here it is:

A Good birth is one in which you're respected as a person.

You can have an easy birth or a hard birth, a long labor or a short scheduled c-section, a birth that involves many specialists and lots of modern technology or one that's just you pushing out your baby in your bathroom, the "perfect" induced epidural vaginal birth or an emergency c-section, but as long you're treated with respect and as the most important person in the room, it's a good birth.

A note: I'm assuming that you end up with a live, healthy baby. A birth that doesn't end up with a live baby isn't a Bad birth--it's a tragedy. So saying that any birth in which you end up with a live baby is a Good birth misses the point that of course you should have a live baby. The descriptors Good and Bad aren't large enough to describe the loss of a child during birth.

Labor is unpredictable, and you have no way of knowing or controlling what happens. Some people use that fact as an excuse to just give up and pick a provider randomly, or because a friend used him/her, or because s/he was recommended by their RE, or because the provider was the first person listed on their insurance website. But I'll argue that chance favors the prepared mind, so you need to pick someone you can trust when things get hairy. Find someone that shares your same ideas about what birth should look like and feel like, and what should happen if things don't go the way you hope they will. If the provider you're with now isn't on the same page you are, switch. (I, personally, wouldn't feel comfortable switching after 34-35 weeks, but I know someone who switched at 38 weeks and was happy about it.)

If you're surrounded by people who you trust personally and professionally, you don't have to be afraid of how things are going to go. Yes, you have the best chance of having the birth you want, but even if things go south you'll still be around people you can trust who will make the best decisions possible with you.

I strongly encourage people to get a doula if you don't have a partner or friend or relative who can fully step up to that role. Even if you're planning on using the drugs (What if the epidural slows down your labor? A doula can help you fight for more time to dilate before they want to do a c-section.). Even if you're having a scheduled c-section (She'll stay with you while your partner goes with the baby.). It's just another person on your side who can get you ice chips when things are easy but help advocate for you if things get difficult.

These people will also help you weigh everything and make the best choice if you know ahead of time that your options are limited. Maybe you always dreamed of an unmedicated vaginal birth, but you have complete placenta previa. You can't have a vaginal birth, but with the right provider and support people, you can make choices that make it a Good birth for you. Or maybe you and your partner have had to compromise on the birth location, or you can't use certain medications because of bad reactions, or you have to be heavily monitored because of previous complications, etc. Picking someone who is thrilled to work with you as you are is essential.

Having gone through labor and delivery twice now, I just can't overemphasize how important it is to trust your providers. And I don't mean that you just decide to trust them even if you have misgivings. I mean that you snoop and ask around to find the people who most line up with your views. Hunt them down on the internet if you have to. And, above all, trust your gut when you meet with them. If a doctor or midwife is dismissive of something you're concerned about, or even if s/he just seems to be focusing on completely different concerns than you have, you should look around some more. Even if you just had all your medical records sent over to that office, or even if you've been using that doctor as a gyn for years (or used that doctor for your first baby), or even if your RE released you to that doctor because they're friends. This is only going to happen once with this baby, but it's going to be long and tough and painful (coming or going), and it's going to set up what happens to you for the next few weeks or months, so you need to be sure of the people who are going to be controlling things.

Why am I so adamant about putting yourself in the best situation possible going into a birth? Because I believe strongly that what happens to you during the birth process sets up how you feel about yourself and your ability to parent a baby for the first few weeks, if not months, of the baby's life.

There are basically two ways labor and delivery can go. They both usually involve your dealing with pain, fear, and enduring a long physical process that you wouldn't want to repeat often. But in one scenario, you know what's going on, the people around you are kind and funny, if things start to get a little strange you're told what's happening, and the decisions about which of the available courses of action to take are up to you (with input from your provider and support people). In the other scenario, you aren't told what's happening or you have to fight for that information, the people around you never talk to your actual head, and things are just done to you without much explanation because you signed the blanket consent form when you came in. One makes you feel like you really did something. The other makes you feel like something was really done to you.

If you feel like you really weathered the birthing experience (gracefully or not!), you'll feel like you have the ability to do whatever your baby needs. You feel powerful. Sore and bruised, but powerful. You can stand up for yourself and your baby in recovery, and settle into a routine when you get home. When things start to pile up with the nursing and the hormone rush and the days and nights mixed up, you can look back and know that you made it through the delivery, even when things weren't perfect. That will give you the confidence to make it through one more day.

If you feel like you weren't even integral to your child's birth experience, that everyone else was controlling what happened and you were just a vessel for the baby, you're not going to feel like you're the best person to care for your child. You won't feel like you have the right to tell the nurse you'd rather have the exam done in your room while you hold the baby. You won't feel like you can ask repeatedly for a breast pump or to see a lactation consultant. If you don't have any confidence in how the birth went, you'll feel like everyone else knows more about taking care of your baby than you do, even when you get home.

So in that way, surrounding yourself with people during the birth that know who you are and value you as a person (not just a baby-making machine) and are on the same page about priorities (with a live healthy baby being a given) is the first step in making sure the hours and days and weeks after you give birth are manageable or not. The learning curve on mothering is so very very steep, but having had a birth experience that makes you feel like you can do it is going to give you the mental energy and emotional reserves to become The Mother.

Comments? I'm guessing there are plenty of you out there who either had very "normal" births that left you feeling incompetent or scary extreme births that left you feeling empowered. Do you think how your birth went (not the details on paper, but how you experienced that birth) informed how you felt about mothering at the beginning?