Birth is no time for war stories
"Birth is different for everyone. My experience doesn't define your experience, and vice versa" ... Tara Moss.
"I died, but it was fine," a woman at a barbecue told me when I was nine months' pregnant. She was a stranger, her story unsolicited. As I nodded and nervously sipped a glass of water, she explained how she'd suffered from pre-eclampsia, "died" on the obstetrician's table and had been brought back to life.
Hers was only one of numerous unsolicited stories that would have been enough to act as excellent birth control, had that ship not already sailed.
In today's confessional culture, extreme stories are always retold with greater frequency than what is more common and positive
"I had two C-sections. I still can't sit up," a waitress announced on seeing my burgeoning belly.
"You'll never be able to have decent sex again," lamented one.
"Just say yes to the epidural," warned another.
Funny how our own personal experiences become The Big Truth.
There is a dominant philosophy in the Western world that says birth is something women survive, not something they actively take part in or, heaven forbid, enjoy. As fewer women experience natural birth, with caesarean section rates more than doubling in the past 15 years (now 31 percent, more than 40 percent in private hospitals), fewer Australian mothers will have a different tale to tell.
Those who chose natural births, particularly outside hospital, are commonly dismissed as hippies, insane or worse, so it can be easy to forget that the 'survive it, don't expect to enjoy it' philosophy isn't held by everyone who has given birth, let alone women in countries where natural birth is more popular. In Nordic countries the caesarean rate is less than half ours at 14 percent; in the Netherlands, 30 percent of mothers experience planned home births in the presence of midwives.
There's no doubt that interventions save the lives of mothers and babies every day. In Africa, for instance, where the caesarean rate is only about 9 percent, greater intervention would prevent a significant number of deaths. But the World Health Organization, which estimates the "ideal" rate of caesarean births to be about 15 percent, says there are concerns that go beyond the financial.
The WHO says women undergoing caesareans that aren't medically necessary are more likely to die or be admitted into intensive care units, require blood transfusions or encounter complications that lead to hysterectomies.
The perspectives of maternity caregivers vary dramatically. One mother I interviewed said, "I chose an elective [caesarean] because as a doctor ... I saw all the worst cases that women have to go through."
Dr Hannah Dahlen, associate professor of midwifery at the University of Western Sydney, had a different outlook. "The amazing thing for me is [that] after 24 years of working mainly in hospitals and seeing so much fear, I now hardly ever see it when women birth at home ... Women get to climb their own Everest in birth and we rip them off so often by not putting into place systems of care and birth environments that will enable them to get there."
I was one of the "just survive it" mentality, which may be unsurprising after so many dramatic stories reinforced my every fear. Then I attended a course called Calm Birth (no, I am not being paid to spruik it), recommended by my obstetrician, who saw that it regularly helped reduce birth trauma and medical intervention in her patients. In the end I was able not only to survive the birth of my daughter, but enjoy it. And none of the horrors I'd been set up to expect came to pass.
On one level, the "just survive it" mentality and rising fear of childbirth is paradoxical, as perinatal morbidity and mortality for mum and baby have become very rare - particularly in countries like Australia, where birth outcomes are excellent, with only about eight women per 100,000 dying due to pregnancy, birth or postnatal issues. Low-risk women have only about a one in 1000 chance of losing their baby in labour.
Yet I was not alone in my fears. According to experts, "tocophobia" - or fear of childbirth - is on the rise. A report preported 80 percent of women express common childbirth anxieties (Saisto and Halmesmaki, 2003) and up to 10 percent of women report "pathological levels of fear".
In today's confessional culture, extreme stories are always retold with greater frequency than what is more common and positive. The "I died but it was fine" mum had been telling her war story to unsuspecting pregnant women for two decades.
But perhaps the oft-repeated war stories about birth aren't as harmless as some believe. In otherwise healthy and normal births, fear can lead to low levels of oxytocin, a hormone involved in lovemaking, breastfeeding and in the normal stages of labour. Fear is also known to lead to lower levels of pain-relieving endorphins and higher levels of adrenaline, which can lead to panic, increased pain and foetal distress. Recent research shows that it also makes labour last for longer.
As obstetric physiotherapist Juju Sundin points out, "The fear each woman has as she enters childbirth will have a direct relationship to the progress of labour."
Birth is different for everyone. My experience doesn't define your experience, and vice versa. There's no right or wrong way to approach birth – whether that means a planned caesarean or a medically supervised home birth – as long as we make informed choices based on evidence-based advice. More than ever, women need to consider what is right for them and their babies. And forget the war stories.