What makes a good birth?

Unmedicated? Homebirth? Freebirth? Nah, it's none of that.

Photo by freestocks on Unsplash

My last post was a somewhat feisty one, written essentially in response to a New York Times op-ed¹ that I did not like very much. A conversation in the comment section (of my post) had me thinking of an old blog post I wrote, which actually sort of mirrors the larger point of the op-ed: that a mother’s experience matters. (Ah, it turns out reality is complex. Who knew!) Anyway, that blog post is no longer on the Internet as I accidentally lost that entire blog, but because a helpful computer guy went in and recovered all the posts and sent them to me in PDF form, I still have it and am re-publishing here.

I wrote this in April of 2021, pregnant with baby number 3. I’ve had three very different births, and I share about the first and second here.

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Because I’m a researcher at heart, when I was pregnant with my first baby I took in a lot of information. I felt like I knew nothing, and I wanted to be informed and intentional, especially around my birth experience. I watched The Business of Being Born (highly recommend) and read quite a few books. I also learned about a thing called a “birth plan.”

Birth plans get flack sometimes, like “lol, as if you can plan for birth.” But to me the term “birth plan” is sort of a misnomer. It’s really a birth “wishlist”—a way to document the efforts a woman has made when she takes the time to learn about birth and think about her preferences. I don’t think mothers with birth plans think that because they wrote some things down on a piece of paper that it’s all going to go just like that. (At least, I hope they don’t.) Birth wishlists are not about control; they’re about intentionality. Making one is about thinking through what you ideally want and (respectfully and kindly) communicating that with your providers, who are there to serve you.

I’ve birthed two babies, and I definitely created birth wishlists for both of my labors that represented the type of birth I desired: one that trusts what my body was made to do. Here’s what happened: neither one went very smoothly and the wishlists ended up being largely irrelevant. The interesting thing is that although neither one went all that well—neither was that oxytocin-filled, intervention-free birth I desired—I still define one birth as a good birth (the other, not so much).

What makes a good birth, then, if not things going according to a desired plan? Let me tell you about my first two experiences with birth.²

Alice’s birth, 2016

My first birth didn’t go optimally at all.

It was long and it was hard (about 20 hours, with no sleep) and I ended up with several interventions, including a late epidural and a vacuum extraction. However, I still came away feeling great about it. I considered it a good birth.

Why? Because I felt respected and supported throughout the process. I had an amazing doula, a great team of midwives, a beautiful, beautiful man who gave me an epidural when I needed it, and a thoughtful (if a bit arrogant³) obstetrician who oversaw things at the end. My providers carefully navigated each step of the way, talking with us at every turn about options and preferences and all of it.

The birth was challenging and didn’t go according to my wishlist, but I felt a sense of agency, of involvement and relative control, throughout the whole thing. I came away feeling empowered and proud of what I’d done.

Clare’s birth, 2018

Clare’s birth is still hard for me to talk about. Though it gets better each year, each of her birthdays (‘cuz birthdays are birth/days, ya know) I’ve felt uneasy as the date approaches. One time I was back in the hospital where she was born, and as I walked down a specific hallway, my heart started beating faster and my breath grew rapid.

With this birth, I wasn’t able to have a midwife like I did with Alice, because we had recently relocated to a small town with no practicing midwives. I was nervous about this (I believe midwives should oversee healthy pregnancies) but was able to get in with a doctor with a private practice and a great reputation, and we had many respectful conversations about birth and my preferences.

I was 40 weeks and 5 days. I came in for a regular check-up at 1pm on a Wednesday, leaving Alice with my grandmother and telling her, “I’m just going to the doctor so he can check on the baby; I’ll be back soon.” By 2pm I had my baby in my arms.

(You can listen to me talk about her birth on the Healing Birth podcast, right here.)

Tears almost always come when I talk about it for more than 30 seconds, so I know the trauma is still in my body. The short of it is this: I had an emergency c-section because my doctor wasn’t happy with the heart rate. I wasn’t in labor at all, and there was very little dialogue or patience. After 10 minutes or less of monitoring, I was instructed that we were going to the OR, now. (His office is connected to the hospital.) In shock, I was made to gather my things and hurry in the direction they were telling me. When I apparently wasn’t moving fast enough, they got me a wheelchair and pushed me, as I fumbled for my phone to try to tell my husband and family what was happening.

It was totally surreal and genuinely felt like a living nightmare.

There is more to unpack (and I do unpack it a bit more in the podcast linked above), but in sum, I felt totally robbed of agency in this birth, and disrespected, to boot. I remember the nurses chatting with my doctor while he stitched me up, laughing as they went about their day and even mentioning who I was in relation to my brother (who is a PA at the hospital), saying “I didn’t know he had a sister!” All as I laid awake behind the curtain, having just had my baby surgically removed from my body in an “emergency” situation.

Birth prepares us, emotionally and spiritually, to welcome a new human being into our lives. It’s a meaningful experience that I believe is meant to inform women of their power and strength so they are ready to mother. Because my birth went the way it did, my bond with Clare was affected and I experienced awful postpartum anxiety (and probably some depression, too). The months after her birth were dark and difficult, especially because we had other family stressors happening at the same time. Our marriage was struggling (mostly due to the demands of new parenthood), and we had just moved and were trying to settle into a new life in a new state, find a home, etc. It was a hard time, and I easily cry thinking of not only the birth but the year or so afterward.

One thing that made Clare’s birth experience worse was the constant invalidation of my feelings afterward. I was extremely traumatized, yet all was fine with Clare, so I heard over and over “a healthy baby is all that matters.” Of course a healthy baby matters, so much, and I’m grateful all was well in that regard.

But a healthy baby is not all that matters. That statement erases and invalidates the mother and her experience during the birth. That actually matters, too.

Before I became a mother, and even a few years in, I thought a good birth was one where you were intentional and made all the healthiest choices. I used to spend time considering the merits of this decision versus that one. Epidural or no? Induction or no? What’s the evidence? What’s the rationale? What’s the best way? I’m not saying those things aren’t important; they are. It’s so, so good to educate yourself about birth.

What I see now is that this is what matters more than any certain way birth goes: the woman’s experience.

(It seems so basic, doesn’t it, that in a birth the birthing woman would be thought of as the one whose feelings and thoughts matter most? Alas this is not the way it so often is.)

With Alice’s birth, I felt strong the entire time, despite it being long and difficult and requiring several interventions. I felt truly proud and powerful afterward, even though it didn’t go how I would have preferred it to go. With Clare’s, I felt the opposite. It felt like decisions were made without me and procedures done to me. I felt small. Invisible. Dehumanized, dismissed, even violated, and then after, like my experience didn’t matter and that all I should feel is gratitude.

So what makes a “good” birth?

Here’s the litmus test for a good birth in my book.

Did the mother feel centered and respected? Did she feel like she could use her voice and make thoughtful decisions about her body and her baby? Did the involved professionals hold space for the the sacredness of what they were overseeing?

If the answer to those questions is yes, then that’s all we need. At the end of the day, a good birth isn’t about Cesarean or vaginal, epidural or not—or really any of the things on a birth wishlist. Ultimately, a good birth is about the felt agency of the birthing woman, no matter how things went down.

What did you connect with here? Do you agree, disagree? What has birth been like for you? I’d love to hear your thoughts and experiences on all things birth, and if you have any questions for me, let ‘em fly (or send a DM). Thanks for reading.

P.S. I think I’d go so far as to argue that even in births when things go really wrong—and maybe there’s a difficult outcome—the mother’s experience is still central. As in life, things in birth can go awry and good results are not guaranteed. There’s a film that I think illustrates this beautifully called Pieces of a Woman. I disagreed with the Internet outrage over the film in the birth community, and I wrote about it. You can find that post here.

P.P.S.

Serena Sigillito

wrote an excellent piece on birth recently, how the state of hospital birth is pushing women to homebirth and freebirth, and that that’s maybe not ideal. “But after I got pregnant again, as I sat in my amazing new midwives’ office, I started to cry. I cried with fear that I hadn’t realized I felt. I wasn’t afraid of labor, which I had loved, in spite of the pain. I was afraid of having to fight so hard again, of having to stand up for myself and my baby that way again, of being at the mercy of people I didn’t trust again… I was afraid of giving birth in the hospital again.” Find it here.

1. The op-ed was incredibly biased toward a certain perspective/worldview. It painted a picture of people who advocate for undisturbed birth, breastfeeding, co-sleeping, and other things along those lines as judgy, dumb, and anti-science (and Christian, the worst of all offenses apparently).

2. I’ve since had a third, who was born at home, a decision my husband and I made with great care and spiritual discernment. It was an extremely meaningful and redemptive experience and I wrote about it in this post.

3. She was certain Alice was having a hard time coming because she was OP (sunny side up). “You can always tell by the ears,” she told the room. Alice was not born sunny side up.