When a woman first discovers she’s pregnant, the birth can seem distant, an event that happens at the very end of pregnancy. There are nine months to get through first. She knows the birth will be something big, but it’s still a somewhat abstract idea—and maybe even a little scary. She can prepare by taking childbirth education classes or by asking her maternity care provider questions, but the real truth is that every birth is unique—and unpredictable.
Juliana Fehr, author and midwife, often teaches mothers and care providers about the three Ps of childbirth: passenger, pelvis, and powers. The first, passenger, refers to the baby: its position, its size, its vital signs, its presentation. The pelvis refers to the passage through which the baby travels—the mother’s pelvic type and the birth canal, including the cervix. And, finally, powers, refers to the condition of the uterus, such as uterine contractions and other physical indications of active labor. Looking at birth from a systems perspective, it’s clear just how variable each birth experience can really be.
After giving birth many women speak of the power of the birth process or of feeling empowered and more confident after learning just what their bodies are capable of accomplishing. Natural birth advocates often discuss unnecessary interventions as potential disrupters of a powerful birth experience. Unnecessary interventions, like an epidural, can interfere with a woman’s ability to feel and accurately discuss her contractions and some interventions can interfere with beneficial hormones that are released in a natural birth. Unnecessary interventions can invite more complications and more interventions—a cascade effect.
But what if something goes wrong with the three Ps of labor? What if the baby is in distress or has a difficult presentation? What if the passageway is obstructed in some way, or the powers are working not with, but against mom or baby? What if intervention is necessary? Can a mother still feel empowered/powerful/confident? What does having a powerful birth experience really mean?
The Oxford English dictionary defines empowerment as the process of becoming stronger and more confident, especially in controlling one’s life and claiming one’s rights.
It’s easy to see why a woman’s birth experience can both empower and, potentially, disempower her. Some women who go through a disappointing or complicated birth report the birth experience as traumatic. Researchers are only just now recognizing postpartum PTSD as its own classification. Previously women experiencing postpartum PTSD were misdiagnosed with postpartum depression, an equally serious condition requiring treatment. But, like soldiers returning from war with PTSD, women who are traumatized by their birth experiences, experience flashbacks, triggers, and live in a perpetual fight-or-flight state. In 2015, the Atlantic Magazine ran a story on postpartum PTSD, pointing out that up to 17% of new mothers might experience some form of postpartum PTSD. A woman’s birth experience is something she never forgets.
Women can prepare themselves for birth by carefully examining their expectations. The more fixed the expectations, the more room for disappointment, and in rare cases, even trauma. For instance, if a woman is fixed in her desire to birth in her home, but ends up with a complication that requires a transfer, she may have a hard time accepting that she delivered the baby in a hospital with obstetrical assistance. Or, conversely, if a woman is determined to have a hospital birth with an epidural and an obstetrician to catch the baby, but the labor moves too fast to make it to the hospital, she may not achieve either.
There is a beautiful communication between the baby and woman’s body during labor. Most often that communication informs the labor and moves it along smoothly. And sometimes the communication can highlight when something is wrong. For instance, intense back pain in early labor might mean the baby is posterior; persistent back pain when pushing might mean the cord is pulled tight and the placenta is pulling too early from the uterine wall with each push. The most important preparation a woman can make is to remain open to the wisdom of her body, of the baby, and of her trained birth attendants.
A conscious fluidity on the part of the woman in labor can help her to relax and more easily ride the contractions, and it benefits the mother when something unexpected happens.
Flexibility on the part of the family and birth attendants is also important. If a birth moves too fast to make it into a birth tub filled and waiting with warm water, the birth partner and the birth team may need to scrap the idea of a water birth and simply follow the mother wherever she needs to go with the labor. Or the nurse who likes the orderliness and predictability of an epidural and continuous monitoring should remain flexible to the approach each mom most needs and wants for her birth.
Power in birth can take many forms. For some it may mean accomplishing that natural birth, but for many others it may mean something entirely different. The operative words in the Oxford English Dictionary’s definition are “controlling one’s life and claiming one’s rights.” A cesarean birth can be just as powerful as a natural birth. If the woman feels in control of the decision and that her rights and her baby’s rights are equally respected, her birth will be powerful. A slippery slope occurs when birth attendants (midwives, nurses, physicians) don’t fully involve the woman in decisions or when the woman feels coerced or forced to consent to an intervention or change in plans. Another slippery slope occurs when one intervention is recommended, but the woman is not fully briefed on the other interventions that will likely be necessary because of the first intervention (like an induction.) Many hospitals have adjusted rules and regulations so that even if the mother delivers her child by cesarean, the father can be there or the baby can be placed on the mother’s chest immediately after delivery. The mother and her birth team can effectively communicate with the medical personnel to be sure that the mother’s needs are met.
Childbirth is a big event in a woman’s life. It marks the beginning of motherhood and it has far-reaching effects on the mother-baby bond and the woman’s self-confidence. Whether a cesarean birth, a medicated birth, or a natural birth in the hospital, the birth center, or in the home, can all be powerful. And if a mother has experienced a traumatic birth, she can find power in overcoming the trauma. She can recognize the power in her body’s ability to communicate just how painful the birth really was for her. She can find power in, as the Oxford English Dictionary defines in empowerment, the process of becoming stronger and more confident through even the most negative of experiences.
Looking back at the definition of empowerment, it’s clear that when a woman experiences RESPECT, a powerful birth experience will happen, regardless of the mechanics or final outcomes. With respect, a woman can face any birth experience and find power in her ability to embrace the way in which she becomes a mother. Respect, however esoteric the idea may be in the realm of physiological labor, is by far the most important ingredient to a powerful birth experience. Respect is what each laboring woman deserves. It’s with respect that her birth will feel powerful, allowing her to feel confident as she moves into her new role as mother to her new baby.