Monday, April 27, 2009

emotion and fact

There are times in life when emotions threaten to overwhelm, when we fear what lies ahead, and feel unable to see a way through. This scenario can apply in times of stress or illness; it can also apply in pregnancy.

Sally's baby is due in a couple of weeks' time, and she is planning to give birth vbac (vaginal birth after caesarean) at home. It's her second baby, and she is experiencing an emotional roller coaster ride as that time approaches. Some of the anxiety and fear Sally is experiencing is related to her daughter's birth: a caesarean without labour. At the time Sally accepted that her baby needed to be taken from her, but as she has thought about it more, she has concluded that the caesarean was probably unnecessary. Someone in the 'system', for some reason, chose to give her surgery, and she agreed. She had been told that she had pre-eclampsia - a diagnosis that she now questions. Will it happen again? The fears that are surging, draining her emotionally, are difficult to put a name to; they just are.

Sally has booked at a public hospital near her home, and has also booked me to be her midwife. This means two bookings, as that hospital does not provide a homebirth backup service.

As we talk I am trying to help Sally differentiate between emotion and fact; her fears and her actual decisions.

I think every woman experiences, to some degree, an emotionally rough journey as we approach a birth. I know I did, with each baby. When embracing uncertainty we must try to hold onto instability and change. It's the same with a balloon filled with water, each movement at any point brings corresponding corrections to the whole unit. The birthing continuum has often been likened to physical experiences involving water and buoyancy: body surfing, when we are lifted and carried quickly on top of the wave, and sometimes dumped ingloriously in the turbulence; or a canoe ride down a river, with moments of quiet, as well as the rapids and the whirlpools. The principle we remember is to not panic, to wait until we come to the surface, to take in breath when it's safe to do so, and be ready for the next episode.

When a woman tells me of her emotion, anxiety, and fear, I encourage her to accept it. To own it as part of the awesome journey she has begun. It is not unusual or wrong for Sally to be anxious about the birth of this baby. The feelings she has experienced so far have led her to make certain plans for this birth. She has become well informed, and understands decision making better now than she did a few years ago.

Here are a few facts that Sally has reaffirmed today:
*that she is well, and that her baby is well
*that at present there is no safer or preferred way for her to give birth than naturally
*that natural birth requires spontaneous onset of labour
*that at any time Sally can review her plans, and make choices that she believes are best for herself and her baby

The hospital is able to provide the expert care if and when needed. But at present Sally is happy to wait for spontaneous onset of labour. The doctor who saw her last week said they needed to make a date for repeat caesarean. Sally declined the offer, and reminded the doctor that vbac requires spontaneous onset and progress in labour. The doctor, who was unwilling to accept that degree of uncertainty, attempted to convince her that at least she needed to make a date; that without that magical date she may have an emergency caesarean.

"Yes", Sally replied. Isn't that part of the usual birthing process? A midwife who heard the exchange nodded in approval and said "Yes! Good on you!"

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