Birthing rights
August 2008
By Ruth Malik
One mother describes the traumatic experiences that drove her to found Birth India, an organisation supporting natural birth
I was always fascinated by birth. I considered pain a small sacrifice for a job well done and the reward – a baby. I found comfort in birth as an experience that bonded me with women, my child and family. Birth was a powerful experience that I just had to have! I intuitively knew there must be benefits in nature, for both the baby and myself. I am personally wary of medications, medical interventions, and their ability to cause harm. Thus, it was my choice to avoid a ‘medical’ birth. The lack of open discussion and information made the journey confusing and fearful. I had expectations of support. I hoped that the doctor would be compassionate. I assumed that the natural process would be the first port of call. Things do not always work out the way we imagine. Two children later, the experience of birth shattered my life, like that of countless women globally. My son was born without the onset of labour, by Caesarean section under general anaesthesia and he was away from me for 24 hours in the nursery. Not because it was necessary, only because it was the hospital policy. I spent the night pressing the buzzer and asking for my baby. I felt as if I had been knocked over the head and something ripped from me. When I first saw my son, I looked at him and fell back in the bed. His birth was an out-of-body experience. I simply had no feelings for him. My response to my child shocked me. Despite the huge painful gash across my abdomen, and the exhaustion of an awful depression, I struggled to bond and mother. This mood clung to me for three years. The process of healing for me has been a need to understand the truth, and I started to ask questions. I now know that what was presented to me as an emergency was not a true emergency. My doctor had asked me to go for a sonography when I was three days past the due date. Today, I know that being overdue is not an indication for the need of sonography. Gestation is 38 to 42 weeks. I was perfectly normal.
During the sonography, I was told that there was a tight cord around the baby’s neck. The doctor described it as a noose. I knew that as many as 50 per cent of babies are born so, and rarely does it result in problems. A cord around the neck is not an indication of an emergency when there is no evident foetal distress. The risk of cord complication is minimal. Firstly, because the cord stretches, and no one knows how it will respond during labour. Secondly, sonography really cannot tell. Natural onset of labour and intermittent monitoring for foetal heart distress should have been the decision. I could have safely gone home and waited for labour. My doctor made me feel terrified. I was told that my baby would die as I slept that night. My husband supported her, and I had no one else to turn to. I was confused by all the conflicting information and horror stories. I was fed up, a feeling shared by most women before delivery. It is the most vulnerable time of our lives. After nine months of discomfort, we want birth to end the pregnancy. As a result, we are easily manipulated. I submitted, and they took me for surgery. For my second child, I tried for a form of natural birth known as VBAC – Vaginal Birth After Caesarean. My doctor supported me in this decision. Considering the increased medical complications of multiple abdominal surgeries or Caesareans, VBAC is highly recommended. The success rate for VBAC is around 75 per cent and can be higher. The success rate depends on the commitment of the birth attendants. VBAC has to be a gentle supported birth.
On my due date, my doctor waved her hand over my body, declared that I had a lazy uterus, and that my prior Caesarean section scar was paper-thin. Since the head had not yet engaged, I should come the following morning. Again, I was facing a questionable diagnosis. Firstly, the head rarely engages in a second pregnancy until the onset of labour, and is not even worth mentioning on the due date. Secondly, simply looking at the scar is not a diagnosis. No doctor is capable of determining the ability of the scar to endure labour without a trial of labour. It was simply my due date. I decided to stay away from my doctor and let labour come when it was ready. My mother was ten days overdue with all her three children. All were born perfectly normally and naturally! My doctor started sending text messages to my husband and to me informing us that I had to come into the hospital immediately because the blood supply to the baby and the uterine fluid levels were diminished, and as the baby got bigger so would the head, making birth more difficult. This does happen after 42 weeks but it is gradual and not so marked as to cause alarm on the due date. The doctor had no evidence that these problems would occur, nor did she ask to examine me to determine this. The conflicting information confused me, and put me under severe stress. In the space of five days, I had two non-stress tests to check the heart rate of the baby, and two more sonographies to check umbilical cord blood supply and uterine fluid (I already had three in the pregnancy – now five). All was well, fluid and blood supply perfectly normal, baby happily waiting for when she was ready to be born. On the seventh day after the due date, I finally went to meet my doctor. I was asked to lie flat on my back for a foetal heart rate test of the baby– alarm bells went off on the machine. I was prepared and rushed for surgery within 10 minutes. No one spoke to me or even touched me. Then the painful epidural needle was inserted into my spinal cord. I felt the flush of chemicals through my body, and then I went numb. I was aware of about eight people in the room, and that I was now completely naked with my legs spread apart in the most humiliating fashion, far more than any birth position. I closed my eyes and said that I was going to vomit. I felt more medication surge through me to stop the nausea. I kept asking, if the baby was all right, and what had happened. I was told that I was overdue, thus I need a Caesarean section. This did not make sense to me. However, because I was given an epidural, I heard my baby cry at birth. I saw her immediately, and she was in the room with me. I started breast-feeding after one hour (however for best initiation of feeding and bonding, baby should go to the breast immediately, before the bath or after the cord is cut). This helped a lot. I now know that again I was not in a true emergency state. A woman made to lie flat on her back at term goes into tachycardia, as the vena cava vessel at the base of the spine is pressed. The test was performed incorrectly. When lying flat on my back, I felt as if I was dying. Women often vomit or faint when made to do this. When I sat up or lay on my side I felt perfectly fine. A non-stress test (NST) should always be done with the woman reclining, not flat on her back, as it will give a false reading. As for the alarm bells, they are a guide, and not a diagnosis. In fact, all report cards of NSTs state this. When reviewing the ECG report, my baby’s heart rate had fluctuated but it then recovered. It was actually a perfectly normal situation for an anxious woman who was probably dehydrated, and on the verge of labour. There was no effort made to determine the cause or to rectify the situation by other means. Diagnosis has become simple. Alarm bells means surgery!
My surgeries were about the doctor’s needs, and not mine. Medical equipment was misused and a language of fear used to convince me to do what suited my doctor. The births of my children felt like violence.I still have a sense of great loss at not getting to experience labour, and have a natural birth. Is it not what I was born to do? Pregnant women say to me, “Why would anyone do anything to you if it wasn’t necessary?” We only need to see the statistics. The WHO states that no community should have a Caesarean rate higher than 10 per cent. In India, preliminary studies show it at 50 per cent and possibly as high as 80 per cent in some private hospitals.
Women still do not feel comfortable or capable of voicing their concerns or complaints. They think that it is impossible, too hard, or not within their rights to challenge or question a doctor or any other member of the staff. Additionally, many women feel and are told that if their baby is healthy, then the way they were treated is justified. In trying to unravel the truth behind my birth stories, I discovered that many people around the world, including the World Health Organisation, are trying to educate the public, and to promote natural childbirth. While talking with women in Mumbai, a few of us decided to establish Birth India. We met to discuss our birth stories; some shared traumatic experiences and others, beautiful ones. However, we were mostly concerned with the alarming number of Caesareans occurring around us, and the effect this was having on mothers, babies and families.
Since then, through networking, the response has been extremely positive. There are members across India with networks in Mumbai, Delhi, Chennai, Bangalore, Shimla, and Goa. We are from varied backgrounds, but all of us are concerned citizens, mothers and fathers. Our aim is to promote the benefits of natural childbirth, both physical and psychological, and the best practices to achieve normal birth. We recognise the evidence that mothers and babies fare better in natural birth. We emphasise that birth choices are a woman’s right. Babies born by Caesarean surgery or medicated vaginal birth are at risk of many physical and psychological disorders.Our goals are to improve maternity services, provide options, educate and inform. In the last one year, our activities have included showing the documentary The Business of Being Born (http://www.thebusinessofbeingborn.com), which was released internationally recently, and is sending shock waves around the world. We had an international conference in Mumbai, which was attended by people from all over India and the world. We are presently in the process of introducing doula training (doulas are labour support for women in hospitals) and hypno-birth training. Through our education, and some simple tools, we have empowered many women to achieve natural birth within the hospital environment. We have also linked them with practitioners to assist in their goals. It is our dream to open a birth centre in Mumbai, and to start monthly natural birth information sessions.
Birth India believes that how a woman is treated while giving birth is important to her and her baby, as it directly impacts her ability to mother well. India’s women are ready to be empowered, and give themselves and their babies all the benefits of natural birth, in particular the essential hormones that are released only during natural birth.
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Ruth Malik is the co-founder of Birth India.She has two children and lives in Mumbai.
For more information, see www.birthindia.org