Birth in America: Reflections on power and social media

Meredith's Story

"Amy, can you meet us at the hospital in an hour?" my doula client asks. "We are trying to decide what to do."

"Of course. I'll be there soon Meredith." I hang up my phone and take a deep breath.

Meredith is a first-time mom hoping for a natural birth. As her doula, my job certainly isn't to make decisions for her. Rather, I am trained to offer loving support as she sorts through the choices at hand. Whatever happens, I vow to give her my best energies as she welcomes her little one into this world.

Meredith is 40 weeks and 5 days along. Her OB practice is known for its high cesarean rate and the nine doctors constituting the practice don't "allow" women to go over 41 weeks gestation. This stands in contrast to other care providers in the area who support waiting the full 42 weeks, as long as mother and baby are healthy. Meredith chose to stay with the practice because she admires the one doctor in the group who supports natural birth.

I walk down the hospital corridor and reflect upon her situation. Meredith and her husband checked into the hospital the previous evening. Under pressure to deliver before 41 weeks, she agreed reluctantly to be induced even though this statistically increases the risk of cesarean delivery. She received a vaginal suppository full of labor inducing hormones. Despite this, her cervix remains closed and shows no signs of the changes characteristic of labor.

As I enter the hospital room, the doctor-on-call addresses the couple. "We will start an IV drip of Pitocin and then give you 12 hours," she explains. "If you haven't delivered the baby by then, we will prep you for surgery."

I look at Meredith's expressionless face frozen in thought. Her body is hooked up to an external fetal monitor that beeps methodically in the silence. She tucks a strand of red hair behind her ear and places small, freckled hands on her pregnant belly. A full minute passes before she asks if she has any other option.

"You are two days shy of 41 weeks," the doctor replies. "It's time to have your baby."

The tension in the air is thick. The joyful anticipation of standing on the precipice of motherhood mixes with the unnerving challenge of navigating America's modern obstetrical system.

"What do you think?" Meredith turns to me. "Are there other options I can consider?"

Together we brainstorm a variety of scenarios and revisit what matters most to her. She has two days before she is 41 weeks. She could ask for an ultrasound to be certain all is well with the baby. If it is, she could go home and give herself the extra time. It may not seem like much, but as a doula I have seen remarkable things happen in 48 hours.

"Remember, if you choose to stay here, I am fully committed to supporting you. I'm your doula and this is your birth," I hold her hand as I speak. "Why don't you and your husband talk this over alone and make your decision together."

I leave the room and give them space to reflect. In the hallway, I watch nurses busy themselves with data entry and wonder about each woman's story behind the closed labor and delivery doors. How many of them feel empowered to trust their bodies in birth? How many of them are surrounded by supportive energy at this crucible moment in their lives?

"I want an ultrasound to check the baby," Meredith tells the doctor. "If all is well, I will go home and give myself the full 41 weeks." While the doctor is slightly unnerved by this unexpected news, my client has spoken and there's no good medical reason not to respond to her request.

An hour passes. Tests are done. Gratefully, the ultrasound is positive. As the couple packs up to go home, the doctor enters the room with discharge papers. "Most likely you will be back here in 48 hours for an induction anyway," she states. "Plus, I can't guarantee 100% that your baby will be safe at home."

"I understand," Meredith replies steadily as she signs the document. "I'm giving myself all of the time I can. My baby isn't ready to be born yet."

Before leaving the hospital, Meredith takes out her I-Phone and updates a close circle of family and friends via text message. "I'll keep you all posted," she texts. Then, she places the device in her purse and walks with her husband to their car.

Upon arriving home, the stress of the experience takes its toll. Meredith cries copious tears of release. Then, she eats an entire blueberry pie and falls into a deep sleep.  Her body begins to open.

She calls me that night in active labor.

At midnight, I drive to the expectant couple's home. Meredith moves and breathes through the contractions with calm determination. Her husband is a stalwart and loving support. Around 4am, we return to the hospital in good spirits. It just so happens that the doctor on-call is the natural birth advocate Meredith admires. He is extraordinarily kind.

As she pushes a healthy baby boy into our world, the doctor turns to me with a big smile. "I don't get to see this very much anymore," he exclaims. "A natural birth!"

A few hours later, Meredith posts the doctor's remarks along with a stunning photo of her newborn son on Facebook. Her post stands as a testament to her courageous embrace of birth's natural wisdom -- still accessible even in modern America.

Reflections on Power

The way we approach birth as a society can either empower or disempower women. According to Aviva Romm, a Yale trained medical doctor and former homebirth midwife, "Women can be partners in their care, not subjects of it." Meredith chose to advocate for herself in a system subjecting women to unfriendly birth protocols. She is one woman, yet her story contributes to a needed reflection about power and birth in America.

Meredith's story is a helpful reminder for pregnant women to pick their care providers thoughtfully. Meredith didn't want to be induced; yet the practice she chose had a high induction rate. She wanted to work with a provider who supported natural birth; yet only one of the nine OBs in the practice met this criterion. For healthy moms-to-be, studies affirm that a midwifery-based model of care provides the best outcomes. Within this mindset, birth is not treated a medical event. Rather, birth is regarded as a natural event that occasionally requires medical intervention.

One can analyze Meredith's story from the point of view of hospital policy makers. The fear of litigation prompts hospitals to rely on practices that have been proven to disadvantage birthing women. Meredith needed room to move and time to labor. Yet, external fetal monitors tether women to hospital beds and the "Friedman's Curve" sets rigid timetables for labor's progress. These practices continue to be used because they provide specific data useful in court should litigation arise. Reliance on such practices helps explain America's extraordinarily high cesarean rate – three times what the World Health Organization recommends. Cesareans exist because a minority of mothers and babies desperately need this form of medical intervention. Meredith did not. Birth via major abdominal surgery carries risks to both infant and mother -- risks far greater than those entailed in vaginal delivery.

By reflecting on Meredith's story, one can also examine the benefits doulas afford birthing women. Many studies confirm that the presence of trained labor support shortens the length of labor and reduces the use of interventions. Knowing this, Meredith sought out a doula. According to Christine Morton, a Stanford-based research sociologist and co-author of the forthcoming book "Birth Ambassadors," more and more American couples are hiring doulas. Morton argues that this is because midwifery care isn't widely available and a doula's presence at birth can lead to many of the same benefits found in a midwifery-based model. Morton writes, "Doulas are the birth ambassadors for the midwifery model of care in the US." Such a model empowers women to be full partners in their birth.

Finally, Meredith's choice to enlarge her circle of support via the use of text messaging provides much food for thought regarding the use of social media in conveying images and stories of birth. This is a new phenomenon. When I started working as a doula, only a few couples would pull out a computer in the hospital to share photos via email post-birth. Now, it's quite common to see women texting between contractions and posting photos online as their labor progresses. While some mothers choose to move into a circle of pure privacy during birth, others find comfort in sharing their birth experience with trusted loved ones who may be hundreds or thousands of miles away.

In fact, I've seen the spirits of birthing women remarkably buoyed upon receiving an encouraging text message. One woman I know was reminded via text to "breathe with the power of generations of women." This made a significant difference to her as she drew upon the strength of her ancestors while giving birth to the future.  Women benefit tremendously from knowing -- ideally through direct experience -- that the challenges of birth are surmountable, survivable, and symbolic of intuitive feminine power.

The Impact of Social Media

Birth stories and images shared via social media are plentiful. One need simply search for "birth" online and hundreds of thousands of links are immediately available. Meredith's celebratory post adds a digital drop of knowledge to a growing and needed database regarding birth -- especially natural, physiological birth.

Most American women have never personally witnessed a birth. So often, the first birth they experience is their own. When contractions begin, the majority of pregnant women embark upon one of the most transformative experiences of their lives without first hand knowledge of what awaits them. This fact stands in stark contrast to the birthing practices of our ancestors.  For the vast majority of human history, women have always surrounded each other in labor and delivery. This aids birthing women and emboldens future mothers with the first-hand knowledge of female strength. Today, we are missing the memories of the grandmothers that came before us. We are bereft of the courage such a lineage provides.

Can posts about birth via social media make up for this loss? Birth images are intense, beautiful, disturbing, and awe-inspiring. Yet, they remain images. Viewers must intuit the wonder behind the emergence of new life. A million birth photos shared via email, Facebook, Instagram or Twitter can't come close to conveying the experience of being present for even one birth. This is because birth takes time, sometimes lots of it. Days can pass as a woman works with the primal energies that open her body. Yes, photos shared via social media, and even well made documentaries, bring healing to our culture. But they can only convey so much. A great deal of our contemporary fear surrounding birth is due to the loss of the ancient wisdom drawn from direct experience.

Prior to becoming a doula, I felt a lot of fear when envisioning the birthing process. It was hard to imagine a woman's body opening. It was hard to imagine how she would deal with the pain. "If we ever have children," I once told my husband, "just sign me up for a C-section." I had no idea what I was talking about.

Today, I consider myself lucky. The fears underlying my earlier, uninformed point of view have dissolved. Why? I worked as a birth doula for six years before becoming a mother. Like women in generations passed, I held the hands of laboring mothers and witnessed their power. I came to see the beauty of vaginal birth. I came to see that birth doesn't just involve pain. Great love and insight also await birthing women. Finally, I've stood closely nearby and watched every step of a cesarean surgery. I now know that I would welcome such an invasive procedure only to save my own, or my child's, life.

While pregnant, I certainly benefitted from reading inspiring birth books and looking at triumphant photos of women post-labor. However, nothing prepared me more for the birth of my son as the honor of being personally present for other birthing women. During a truly difficult moment in my labor, memories of births once attended flooded my consciousness and lifted my spirits. I remembered the courage, strength, and beauty of women like Meredith. I knew that if they could do it, so could I. I knew this because I had seen it with my own eyes. The memories of the births I attended are woven into my memory of my own birth story.

Is it possible to recreate the atmosphere of ancient days when the direct experience of birthing informed and strengthened women? For most pregnant women today, viewing images is the closest they can come to witnessing a birth before embarking on their own. Given this, laboring women who choose to share their experience via social media offer up a precious gift. Photos and stories can also empower women to advocate for themselves -- a vital task given the state of maternity care in the US. American women are birthing the next generation within a vacuum of direct experience, a type of birth amnesia. Shared images and stories are the best medicine we have until women once again surround each other in birth.