Tuesday, February 10, 2009

You never forget the first time

"How will she remember this?" -Penny Simkin

I got a packet in the mail from my doula trainer a week or two ago. It included info about our upcoming workshop as well as some pre-workshop homework and readings. One of the items is a reprint of Penny Simkin's research published in 1991 in the journal Birth: Issues in Perinatal Care--"Just Another Day in a Woman's Life? Women's Long-Term Perceptions of Their First Birth Experience. Part I." So I sat down and read it last night, with pen in hand, of course.

And I just gotta say... wow... I learned so much for this piece. The points that struck me most...

1) We've come a LONG way, baby! Penny Simkin's research reports her findings from interviews conducted with women who participated in her childbirth education courses between 1968 and 1974. So she gives a list of typical features of intrapartum care in that time period to develop a context for her research. For example... no private labor rooms, enemas/pubic hair shaves, restriction to bed, fathers rarely present, formula feeding (fewer than 20% of women breastfed), baby in nursery except for daytime feedings, and 4-5 day hospital stays for vaginal births. Wow. We still have a long way to go, but, man, I'm glad so much has changed.

2) 5% ?!
There is ONE thing I'm NOT glad has changed. The cesarean rate at this time was a mere 5%! Good heavens. So in the past 40 years doctors must have figured out that they could avoid malpractice lawsuits and sleepless nights best if they just played the "hero" card and sliced babies out of their mothers rather than letting nature take its course. Then, of course, placing the blame on the women: "Your body just wasn't built to handle birth," or "Your baby would have died if I hadn't cut you open," or "More women are asking for cesareans." Whatever helps them sleep at night, right? Clearly there are cases when cesareans are warranted, but 5% to a whopping 31.1%?! Unfortunately, just as the cesarean rate has increased, so have the rates of serious complications associated with them.

3) Even highly-interventive births can be highly satisfying. This one was a shocker for me. Simkin divided her research participants into two groups based on how they rated their level of satisfaction with their births--high satisfaction and less satisfaction or dissatisfaction. I was surprised to see that more women in the "high satisfaction" group were given Pitocin, episiotomies, and forceps deliveries than in the less satisfied group! How could it be?! Simkin concludes that what really makes the difference for women is not necessarily what happens to them during their births but how they felt throughout the process. The women in the satisfied group remembered their interactions with doctors and hospital staff as positive. The women in the less satisfied group all reported negative interactions with doctors and staff. How women are treated makes an ENORMOUS impact.

4) When will they listen?! I became livid when I read one woman's account of her negative experience: "Anyway, the doctor wanted to give me a spinal. And I was just sure I could push this baby out if I could just get up there and get some leverage, I could squat and push the baby out. 'Nope, not that, couldn't do that,' so about it seemed like 20 or 30 minutes, he said that I should have a spinal. So I had a spinal. . . . I was no only put down by the doctor and the supporting staff, but by that point there were a couple of other doctors that had come in and some interns, and I felt like this guy partly wanted to show off."

$*#&^*&%^@^@%#&!^&@^!! The sad thing is... this could have happened yesterday. In fact, I'm sure it's happening somewhere right now.

5) This sounds familiar... Another woman's account brought back fond memories of my own first birth experience: "One nurse had been there the whole time, and then when she was off shift, she still wanted to stay with me. She seemed like she was really interested and involved, and that she really cared. I thought it was neat and it made me feel very special." I will never forget my nurse, Eve. In fact, I like to call her Saint Eve. Heaven bless that woman and all the other nurses like her.

To close let me share Simkin's own conclusions:
"The way a woman is treated by the professionals on whom she depends may largely determine how she feels about the experience for the rest of her life. A woman in labor is highly vulnerable. Her most private body parts are exposed; she is in pain; she sweats, trembles, moans, and cries out while among strangers; she is in a strange environment. If she is treated without respect, if her efforts to maintain dignity and control are rebuffed, or if she is taken advantage of, the negative impact is permanent. If she is nurtured, treated with kindness and respect, and feels like a participant, the positive impact is permanent. . . .

"Because the woman may remember her caregiver forever, the question, 'How will she remember this?' should be in the caregiver's mind at all times. . . .

"[M]uch more is involved in the outcomes of 'a healthy mother and healthy baby' than coming out of it alive with no permanent physical damage. The potential for psychological benefits or damage is present at every birth. . . . In addition to a safe outcome, the goal of a good memory should guide their care."
Oh, I love you, Penny Simkin. I've loved you ever since I first opened The Birth Partner nearly four years ago. If you don't already love her, my friends, you will. Especially after you read this.

I'm so excited to join the doula ranks Penny spurred into action. :-)


Fig said...

I love the conclusions. Love the whole thing, in fact. Love love love love love.

Liz Johnson said...

I would be interested to hear how people felt about their birth immediately after, 1 year after, and 5 years after. I was actually pretty optimistic about my birth right after having Connor, thinking that I was the problem and that I had miraculously been saved from what was destined to be a disaster. But now? I'm fuming about it. So while I felt respected at the time, I realize just how much of a machine I was dealing with, rather than a natural process.

Buscando la Luz said...

Penny actually did the interviews 20 years later, I think. But you're totally right... your perspective can totally change over time. What makes you angry about Connor's birth?

Launi said...

What a wonderful post. I'm so happy to know of someone who feels that birth needs to be a gentle experience. I teach HypnoBirthing in the Orem area--for that very reason.
Thanks for posting this! I'll be back to read the rest of your blog!

Liz Johnson said...

I am mostly angry that my questions weren't fully answered about why I was being induced. I didn't even have the right frame of mind to question it. So his fluid is a little low... what does that mean? So the placenta was hard and calcified when delivered... what does that mean? So I was ten days overdue... why shouldn't I wait? I realize that I didn't ask, but I would've loved if my midwives had offered that information, rather than just setting an induction date and going with it.

Sarah H said...

You will be a great doula! I love coming to your blog for inspiration!
Just this very day, I was speaking to an obstetrician friend at church and she said, and I quote "I prefer c-sections, you know, you can schedule them".
(She doesn't know how mad I am about mine.)
I forgive her as person of course, and she is older and was practicing in the Phillipines so things perhaps are different. But still, if you have that attitude you shouldn't be delivering babies!!!

莫文蔚Karen said...
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