What They Should Tell You
There’s labor, and baby’s health, and there’s also the health and experience of the mother.
“What’s the rate of emergency C-sections here?” I ask.
The midwife at our antenatal class flops her hands back and forth. “About fifty-fifty. A coin toss.” Seeing the wide eyes of the couples around the room (only one of which raised a tentative hand when asked if anyone was considering an elective C-section), she amends: “Well, that’s how many births are C-sections. Actually, we don’t have a separate statistic for elective versus emergency; they’re combined.”
We’ve just watched videos of two different couples’ birth days: a 30-ish hour vaginal birth (say it with a long i here in the UK, emphasis on the middle syllable — vagiiinal, but avoid saying “natural” to avoid stigmatizing interventions), and an “abdominal” or caesarean birth: hungry momma fasting before surgery, infant being lifted straight out of the cut-open cavity, mother being wheeled to a room while her partner does skin-to-skin with the newborn to encourage bonding but not infect the surgery patient.
They’re both disturbing in different ways. It still blows my mind that this (and pregnancy) are the processes that produce all humans; only Octavia Butler comes anywhere close, in fiction, to imaginings as strange as fact.
But the important part, according to the literature and our doula, is that the mother feels empowered in decision-making and supported through the birth process, regardless of the method. Not just for the soft, obvious reasons; birth, recovery, and breastfeeding all have better outcomes if birth trauma can be avoided. So that’s why I’m raising my hand, my only question in the whole two-hour session.
It is disheartening indeed to learn that emergency C-sections are not measured separately. I know that the United States is world-leading in birth and labor interventions, and that I’d like to have as little of that as possible.
The UK seems in general to encourage this approach: if you choose homebirth, the NHS sends a midwife team to your house. If you’re low-risk, you’re encouraged to labor in a midwife-led unit if not at home; birthing pools are de rigeur. You can absolutely opt for C-section, epidural, inductions, but you’d have to ask for them.
“The intervention rate, unfortunately, is rising a lot here, though,” my doula informs me. She’s fully and explicitly supportive of any birth method I want to pursue, but she knows I’m excited to keep it as non-medical as possible.
I’m still thinking about the lumping of the “emergency” versus “elective” C-section statistics. At first blush, this feels like a massive oversight. But where exactly should you draw the line? At any point in the labor process, a mother is allowed to switch to a C-section. But “choice” is a complicated thing, medically. Consent is required; even if a doctor recommends C-section, technically, the birth-giver has to choose the operation. Is that elective?
I’ve heard horror stories, the weaponization of the “dead baby” card: it’s so easy for a medical professional to say, at any point, “if you don’t do this, your baby could die.” Notice the phrasing: this is always a possibility. This statement includes no statistical odds. But as someone who has worked hard to become a mother, has carried a pregnancy to or close to term, whose community is invested in the outcome and tiny human — how vulnerable you are. How easy it could be for a doctor to push you into choices, make you responsible, carve your path.
This is why we’ve hired a doula. She’s meant to stand with us: on-the-spot statistics, massage, interference with pushy doctors. Whatever actually happens, we should feel like our choices are ours.
There’s labor, and baby’s health, and there’s also the health and experience of the mother. Pregnancy has some inherent challenges, but most of my own frustration with the process comes from bad information. Here’s an example:
Parents.com informs me (in the same page) that baby is about the size of a high chair tray, or a napa cabbage. Sure. At 32 weeks, it says, common symptoms are hemorrhoids (piles, in the UK), low back discomfort, and prenatal depression.
You’ll see these “common symptoms” lists everywhere: your gums might bleed. Your feet might swell. You might start peeing yourself. It’s true, all of these things are common. But if the site gives any advice, it tends to be vague and basic: don’t sit too long, but also elevate your feet as much as possible. Eat well and drink lots of water. Somehow, we have this collective consensus that because a thing is “common” or “normal,” it’s okay. But I’d like to see these symptom lists re-divided. For each week, there should be headings:
• Seek medical attention if you are experiencing any of these
• These symptoms are common and you just have to put up with them
• These symptoms are common but you can do something about it
“Oh, good work, you don’t have pregnancy gingivitis,” my dental hygienist informed me in June. I’ve seen bleeding gums on the symptoms lists, and I figured I was just lucky. But no, she tells me, you probably won’t get it if you already brush and floss well.
Same with gestational diabetes: I was under the impression that it’s mostly random, with strong genetic determination. But my physical therapist assures me that actually it means I’ve probably been active and eating well through my pregnancy so far. I’m sure it’s both; no shade to the moms with GD. They’ve also changed the threshold for that diagnosis (and it varies by country) — so the same measurement that now yields a positive result might have given negative a few years ago.
Back in May, in Alaska, I struggled to put on my rainpants and Xtratuf boots. I would stand by the wall and try to get my left leg to lift, and it wouldn’t come. In July, in Hamburg, walking was sufficiently painful that I rented those app e-scooters because I couldn’t keep up with my sister’s pace for more than a couple of blocks. In London, rolling in bed was painful, and getting out of it was not guaranteed.
But pain of this type is pretty common, in pregnancy. That’s what our private insurer told me over the phone.
I sighed. I had debated mentioning that I was pregnant when asking for coverage (the games Americans learn to play).
“Right. But can I see a physical therapist?”
There was some hemming and hawing, a week of delay while they had me do some stretches (trust me, I’d tried that). And finally, I got a referral for PT. Within two sessions, I was significantly more mobile, my extremely normal but fixable symptoms relieved.
This is stupid. Pregnancy doesn’t have to suck — or at least, it can be a lot better than the “common” experience. I could follow the advice to not to lift anything over 20 pounds while pregnant. Or I could engage my core, use proper form, and do squats, rows, and deadlifts with ten-kilo (~22lbs) weights in each hand. Of the two, only the latter has improved my life experience, increased my ability to carry a growing belly, and strengthened my posterior chain.
If you’ve been reading along, you know that for a while, my abs were splitting. Maybe they still are, but I don’t feel it anymore. I’ve been working my transverse abdominals and pelvic floor, and though the fetus is objectively bigger, it feels lighter.
You might start to pee yourself before and after birth, but you have other options: you can get help learning how to do kegels properly, how to fully relax. Pelvic floor therapy is a common postnatal prescription in France, and French mommas typically don’t keep this issue.
Tearing is common in vaginal childbirth, but if you use the birthing pool to soften tissue and commit to regular perineal massage in the weeks leading up, you can be stretchy instead. You have options, if you know about them.
We’re still two months out from birth. We’ve done basically no baby-stuff shopping, no apartment preparation. But it’s feeling close: baby makes visible belly waves. It wants out, I think.
I’m not fussed about the onesies we haven’t bought; at this point, I’m prepping for me. Eight weeks is a training-plan length, and I’ll be a much better mother if I’m strong and healthy for birth and after.
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