Guest post by Andrea Laurel Merg
During my first attempt at graduate school, I became pregnant with identical twins. I was in a PhD program in clinical psychology with an emphasis on violence prevention. I took a leave of absence after I had my daughters. I tried to go back and felt I could not do both: be a grad student and be a mother as well as I wanted to simultaneously.
The irony that words from my violence prevention program applied so easily and appropriately to my experience of pre-natal care and birth was not lost on me. Coercion, lies, manipulation, bullying, intimidation, threats, anger, submission, compliance… I knew someday I wanted to go back to graduate school. I also knew that I was still deeply interested in violence prevention while becoming increasingly interested in the role birth experiences play in shaping families.
After essentially re-doing my master’s level coursework (non-terminal master’s degree in the beginning of PhD school, could only use so many transfer credits, blah, blah, blah…don’t get me started), I submitted a proposal. I was granted the privilege of interviewing 11 women who had homebirths after previous hospital births. My aim was to capture the essence of their collected comparisons reflecting the midwifery model against the hospital model. Hospital births were classified as hospital model regardless of who attended the births. The midwives who attended a couple of the hospital births still had to operate under the policies of those institutions. The midwifery model included only homebirths.
I analyzed the data consisting of verbatim transcriptions of the 1 to 2 hour taped interviews using Moustakas’ method. The major themes that emerged across all participants were: a) respect/autonomy vs. disrespect/coercion, b) trust vs. distrust, c) accomplishment vs. failure, d) empowerment vs. power struggle/powerless, e) allies vs. adversaries, and f) satisfaction vs. dissatisfaction. Additional major themes, which were reported by four or more participants, in addition to myself, were: a) avoiding probable interventions, and b) healing vs. broken.
Respect/Autonomy vs. Disrespect/Coercion
Every participant felt they had the freedom to act and make decisions of their own volition during their homebirths. Only three women did not specifically feel disrespected or coerced by the hospitals, the doctors, or other staff at the birth of their first children in the hospital. Athena subsequently felt disrespected and coerced by the postpartum nurses, particularly as it pertained to the handling of her newborn baby. Demeter and Artemis went on to have second hospital births filled with disrespect and coercion from hospital staff, and in Artemis’ case, the doctor.
Allies vs. Adversaries
Without exception, each participant relayed feeling that her homebirth care providers wanted for her what she wanted for herself. Five of the twelve of us felt the hospital staff and doctors were our adversaries, showing little if any regard for our wishes and preferences, and working against us when our wishes and preferences interfered with their agendas.
Avoiding Probable Interventions
Fifty percent of us experienced specific circumstances at home, which we feel would likely have resulted in unwanted and unnecessary interventions at a hospital. Those included position changes to handle shoulder dystocias. Gaia also said of her second homebirth, “I would have been sectioned several times over.” She explained she had an intact amniotic sac and was 8 centimeters dilated for 12 hours. She did not have any temperature problems, or anything else that indicated trouble, but she feels a hospital would not have waited.
I had a VBAC and believe I would have had a real fight on my hands to prevent most hospitals from trying to give me a repeat cesarean, or interfere in any number of other ways.
Healing vs. Broken
Five of us experienced psychological healing as a result of our homebirths. Artemis went through tremendous physical trauma, with a urethral tear during the birth of her second child. Her doctor bullied her into pushing her baby out “as hard as she could.” Artemis was only in the labor and delivery room 1 hour and 44 minutes when her daughter was born. Her doctor was only there when Artemis began to push.
Artemis came to view her daughter as “intense…needy…and crying all the time.” She felt she did not get to fully experience her daughter as an infant. At times, she feels she is still making up for that. Speaking about her homebirth, Artemis said, “[The baby] launched me into a wonderful place. Actually she…her birth was very consoling for me.”
Following the hospital birth of her first child, Aphrodite was left with a great deal of residual physical and emotional trauma. Aphrodite explained that her homebirth was a way of “solidifying” the mother she was already becoming. Aphrodite said, “I think it was a really healing experience. I felt like it really helped heal all the pain that was left from the last time.” Describing her body helping to push her second baby out: “…just experiencing that moment sort of washed it all away.”
Arianrhod described being changed by her hospital birth. She said, “I thought I was strong, I thought I was brave, and after that I wasn’t anymore…I walked into the hospital elated and I walked out…broken…” despite leaving the hospital with a “healthy baby.” Arianrhod described that near the end of her homebirth she started making a noise. She said she was unaware of her ability to make such a sound. She said, “It was this song…it came from deep inside me…And there was no way that I could have released that song without being free…And from that moment, I’ve been free.”
Hemera initially had difficulty emotionally connecting with her daughter. She attributes that to the trauma they shared during birth and postpartum. For her second hospital birth she labored at home and was actually at the hospital only nine minutes before she delivered. The postpartum experience for her second hospital birth was still not nurturing. She left with frustration, anger, and resentment.
Hemera described her homebirth as a spiritual experience. She said that though her second hospital birth helped her heal from the first, her homebirth did more still.
When I became pregnant with my twins, it did not occur to me that I would be treated like a medical disaster waiting to happen. I felt healthy. Blood tests and ultrasounds confirmed that we were all healthy. I carried the girls for 38 ½ weeks.
I progressed, effaced, and dilated to seven centimeters before all the interventions arrested my labor. I ended up with a cesarean section and, with a lovely smile on my face I deeply hated everyone there except my doula and my husband. I cried and smiled and told people not to feel sorry for me.
I felt broken. Every challenge of being a new mother to infant twins felt like further confirmation that I was not equipped. I decided I could not handle my PhD program and be a good mother. Leaving the program did not make me feel any better about my mothering ability. It just made me feel more a failure.
For my second pregnancy, I found a midwife to whom I will forever be grateful. She supported me, and I came out of that birth a relatively whole person. If she had fears, she never showed them to me. She showed me trust and respect. She gave me information, and I made decisions.
I believe my study demonstrates understanding of the ways the midwifery model of care contributed to and even restored well-being in the women studied. In future, I hope to see research further examine whether women who have been cared for under the midwifery model of care have fewer difficulties adjusting to their role as mothers.
In seeking publication for this study, I have presented it to an interdisciplinary journal. It is one thing for advocates to stand around agreeing with each other. My hope is to get people who may have never thought much about maternity care to consider the effects. Whatever happens, I am trying to do my part to influence the way women, their support systems, the community, and society at large view and approach prenatal care and childbirth.