Anne's take: "No Regrets Birth"

Host Anne Nicholson Weber shares her thoughts on how to have a "no-regrets birth".

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Transcript

Anne Nicholson Weber (00:02):

Today's episode is a little different. I'm going to fly solo and talk about a subject that's very near and dear to my heart, which is the idea of a no regrets birth. A no regrets birth is what you get if you look inside to see what you truly want, understand where you have power and where you don't exercise the power you have bravely and knowledgeably and accept with grace what you truly can't control. I hope you'll stick around to learn more about how to have a no regrets birth. 

Welcome to the Birth Guide Chicago podcast, conversations about building your circle of support in the childbearing year.  We connect you with experts in our community who can help you conceive, stay healthy during pregnancy, have a safe and satisfying birth, and embrace the joys and challenges of becoming a new family. I'm your host, Anne Nicholson Weber and the founder of birthguidechicago.com, where every month, thousands of Chicago area families find relationship centered care from conception through the postpartum period.

Anne Nicholson Weber (01:18):

I started BirthGuideChicago to help expectant families find providers who are the right fit for them. That's the core mission of the work I do. And the reason I focus so much on choice of provider is because the moment you make a final decision about where you'll give birth and who will support you, you've largely determined the kind of birth experience you'll have. You'll foreclose many options because each birth setting and provider has a way of doing things and it's swimming against a very powerful current to try to have a different kind of birth than the kind that's offered there. It's kind of like going to a Mexican restaurant when what you want is Chinese. And I think many, many pregnant people are unaware that the models of care can be so dramatically different from one setting to another. People seem to have the impression that obstetrical care is pretty uniform from one place and provider to another, and that is emphatically not the case.

Anne Nicholson Weber (02:13):

So if I could wave a magic wand and plant a single idea firmly in your head, it would be that there's one moment when you have a great deal of power to set yourself up for a no regrets birth. And that's the moment when you choose your birth setting and providers. And the corollary is that once you've made that choice, you have much, much less control. So it's really important to choose a setting and a provider with full knowledge and understanding of the consequences. And that means understanding exactly what you want and why. And then learning about all your options. you need to understand how models of care differ from one birth setting to another. You need to be open-minded and not limit yourself to the obvious choices. Preparing yourself for a no regrets birth means not limiting yourself to the choices your friends have made or the norms in your family or in our culture, or the expectations of anyone else except your partner.

Anne Nicholson Weber (03:11):

It might mean being willing to travel further than you'd first think. It might mean paying more out of pocket for your care even if funds are tight. And it definitely means paying attention to your intuition, for instance, by switching providers if your gut is telling you that the fit is not good. 

It might help to think about some of the kinds of regret that you're trying to avoid. I see four types of regret around choices for birth: 

• 
  If only I'd known, 
• if only I'd listened to my gut,
•  if only I'd followed through, 
• if only I'd pushed back. 

So for instance, if I'd only known that my likelihood of having a c-section at the hospital I chose is three times higher than at another hospital I didn't even consider.

 If only I'd known that in some birth settings I can move around at will while others require me to be hooked up to a monitor that prevents me from walking and moving around in labor.

Anne Nicholson Weber (04:07):

If only I'd known that hydrotherapy is safe and incredibly soothing for most laboring women, but the delivering in water is an option offered in only a select few birth settings. 

If only I'd known that in some settings my baby will be skin to skin with me from the very beginning and for the entire golden hour after birth, where in other settings that is not the routine. 

If only I'd listened to my gut. I knew I wanted a midwife, but I let others talk me out of it.

 I knew I didn't wanna be induced, but I went to a doctor who induces over half of her patients.

 I thought I might want a home birth, but it was much more expensive out of pocket and I let myself be convinced it was too expensive. Or I wanted a birth center birth but everyone in my family thought I was crazy not to be in a hospital.So I caved.

Anne Nicholson Weber (04:52):

I knew I felt rushed and not heard after my prenatal appointments, but I felt like it was too late to change providers. 

And maybe most importantly, in my heart, I knew that my birth experience would really matter and was worth fighting for, but I was afraid of setting myself up for disappointment. 

And this brings me to a very common idea that can undermine your goal to have a no regrets birth. And you've almost certainly heard this: “childbirth is unpredictable.”  And that is absolutely true, but it is also an insidious and misleading half-truth. So let me give two examples. The first relates to your risk of having a C-section, and the second is for you if you hope to have a natural unmedicated birth. 

So talking about C-sections first primary C-section rates at Chicago area hospitals range from a high of 23% to a low of 6.7%.

Anne Nicholson Weber (05:51):

And primary by the way means the rate for women who haven't had a prior C-section. These are risk adjusted rates, so there are apples to apples comparisons. And that means that if you go to the hospital with the highest rate, your odds of having a C-section are around one in four. And if you go to the hospital with the lowest rate, your odds of having a C-section go down to one in 14. Put another way, two thirds of the women who had C-sections at the hospital with the highest rate had unnecessary C-sections, C-sections they could have avoided if they had gone to the hospital where the rate is lowest. For women who choose to give birth in a birth center or at home, primary C-section rates average around three to 5%. That means if you qualify for and choose out of hospital birth, you reduce your odds of having a C-section to only one in 25.

 C-section is always a possibility.

Anne Nicholson Weber (06:48):

You can do everything right and you still might need to have a C-section, but if you've done your research and chosen your provider thoughtfully, you should be really glad you had a c-section because you can feel confident that your c-section was necessary and potentially lifesaving for you or your baby. No regrets. But if you're at a hospital with a rate that's two or three times higher than it needs to be, you'll never know if you could have avoided a c-section by choosing a different birth setting and that is something you're likely to regret. 

Here's another example, natural or unmedicated childbirth. Most women who want a natural childbirth don't end up having one. And you might conclude from that that you shouldn't set your heart on natural childbirth because you'll feel like a failure if it turns out to be too hard. And it's true that you shouldn't set your heart on anything in birth.

Anne Nicholson Weber (07:38):

Once you're in labor, you often have to go with the flow. But before you're in labor, you need to choose which river -- which flow --you wade into because whether you'll have a natural birth is driven largely by where you choose to give birth and who you choose to care for you. To demonstrate this, let's look at some epidural rates in different birth settings. And some of these are old, but they're approximately right. If you look at all US women who labor under the care of an ob, the epidural rate is around 75 or 80%. If you look at all US women who labor under the care of a midwife, the epidural rate is maybe 60%. Locally, the epidural rate among women cared for by the midwives at Hinsdale Hospital here in the Chicago area has been 33%.  For wome with the midwives at the West Suburban Alternative birth center, the epidural rate is around 18%.

Anne Nicholson Weber (08:31):

For women giving birth at Burr Ridge birth center, the epidural rate after transporting to the hospital -- 'cause you can't have an epidural in the birth center -- ends up being around 8%. And for women who begin labor with a Chicago area home birth practice, the epidural rate -- after transporting to the hospital -- is four to 5%. So childbirth is unpredictable. Whatever you hope for, you do need to prepare yourself for changes in plan. But these statistics demonstrate how much power you actually have over how your birth will go. It's predictable that you will have an epidural if you choose a birth setting with a 75 or 80% epidural rate. And it's predictable that you will be much more likely to achieve your goal of a natural childbirth if you choose a birth setting with an epidural rate of 18% or 8% or 5%. What lies behind those very low epidural rates are birth stories of women just like you who chose providers who are skilled at supporting unmedicated birth.

Anne Nicholson Weber (09:31):

There's another true but insidious idea that can undermine your chances of having a no regrets birth. And that's the adage that birth is just one day, parenting is a lifetime. And in one sense that is obviously and completely true, but the message it conveys is that if you're passionate about setting yourself up for a satisfying birth experience, and if you think that it really matters how your birth unfolds, then you're being kind of naive or entitled or precious or spoiled. And I think that's really just nonsense. Penny Simkin was an eminent birth researcher, a childbirth educator, doula and physical therapist. In 1991, she published a landmark study about women's memories of the day they gave birth. It was called Just Another Day in a Women's Life?. Her research showed that women's birth memories remain sharp and very potent emotionally even decades later. You've probably noticed that once you're pregnant, many people want to tell you their birth stories, and this is why.

Anne Nicholson Weber (10:37):

The fact is that memories of the day you give birth will be with you for a lifetime. And the choices you make about childbirth therefore really matter. At one end of the spectrum, traumatic birth can increase your likelihood of postpartum mood disorders, interfere with bonding and undermine your confidence as a new parent. At the other end of the spectrum, a no regrets birth can start you off as a mother feeling confident and in empowered symptoms. 

Her research showed something else though that's equally important to pay attention to as you set yourself up for a no regrets birth. And that other key finding was that women's satisfaction with the day they gave birth had less to do with exactly how their labor went and how they gave birth, and much more to do with how they were treated. Kind words were permanently etched in women's memories and so were callous words. Women who felt that their wishes were ignored, never forgot it. While women who felt supported reported vivid and deeply felt memories of accomplishment, self-confidence and joy, regardless of whether their births went according to plan. What matters is that you choose a birth team that makes you feel heard, supported, who are aligned with your philosophy. And once you've done that, you can navigate the unpredictable way your labor plays out on that one day with confidence that you did everything you could to have a no regrets birth.

Anne Nicholson Weber (12:06):

Now, there are some other barriers I commonly see that make it harder for families to make regret proof choices about their care. And those include:

• 
   insurance that limits your choices of providers,
•  societal norms that are based on a profound misunderstanding of the state of obstetrical care in this country -- notably the idea that more technology is safer;
•  and feeling like crap in your first trimester, which makes it hard to pay adequate attention right at the time you're choosing a provider. 
• Also, the fact that some of what you need to know is only taught in prenatal classes, which may come too late in your pregnancy after you've already made a choice. 
• And finally, the myth that a good birth plan is all you need to get what you want in childbirth. 

BirthGuide already offers tools to address some of these challenges, especially by making available information to you early in your pregnancy before you're committed to a particular provider. And we're working on some more.

But for now, I just want to say again, you have the greatest power to set yourself up for a no regrets birth when you choose your birth setting and providers. So I hope you'll take that decision seriously.