Wednesday, May 01, 2013

Birth is Unpredictable: Natural or Caesarean?


According to recent news, Mexico has the highest incidence of Caesarean births of any nation in theworld.  Add to that the fact that Oaxaca has the highest Caesarean rate of any state in the republic of Mexico, and you will understand why better birth options are desperately needed here in Oaxaca.

We at Casa Compasiva attempt to provide the very best birth experience possible for each of our clients, avoiding the unnecessary cascade of interventions that often lead to a Caesarean.  However, while our hope is always for a natural birth, sometimes circumstances conspire to necessitate a surgical birth, and at those times we are grateful to the Lord for such a lifesaving tool.  What might such circumstances look like? 

Well, sometimes it might have to do with the baby.  He or she could be showing signs of stress, reflected in his/her heart rate.  A very long and hard labour can tire out not just mama, but baby as well. 

Or baby could be poorly positioned in mama's pelvis, making descent impossible. No amount of work will move that baby down any further.  

Sometimes the mama's body just doesn't respond as it should.  Maybe the water breaks, but no contractions ensue.  After too many hours of waiting for active labour, infection can set in.  (Note: OB and midwifery protocols differ in this, and many midwives will allow days of waiting for labour to kick in before electing to transport.  At Casa Compasiva, however, we must be sensitive to Mexican norms, which allow only a relatively short leeway.)

Or perhaps the mama's body is doing a great job labouring, and baby is doing fine, but emotionally the mama just cannot make herself go on.  As a staff, we give all the active support and encouragement possible, using every conceivable comfort measure-- but sometimes in spite of our best efforts, mama just gives up.  Some labours are marathon events, and mama only prepared herself for a sprint. The body is willing, but the spirit is weak.  Result?  We need to transport, and another Oaxacan pregnancy ends in a Caesarean birth, adding to the already grim statistics.

So does a Caesarean outcome mean that we failed?  Hopefully not!  When we debrief as a staff after a birth, we discuss things that we could have or should have done differently. We always want to be in humble learning mode, but often we conclude that there was nothing more that we could have done to prevent a transport ending in a C-section.  We must then bow the knee to a sovereign God who is in control of both labour and birth.  We admit our human limitations, and trust God to bring the best result in each individual case.  And if the birth itself is an unexpected outcome, at least we know that we gave everything we had to give.  We also remind ourselves that every baby safely brought into this world is a blessing, no matter how he arrives!  

At Casa Compasiva, we cannot guarantee a perfect, natural birth for anyone.  Living in a fallen world as we do, we cannot even guarantee a perfectly healthy baby.  That is in God's hands. But we have found that what we can guarantee is kind and compassionate care for each client.  We can give each woman and her baby loving hands and hearts, and gentle treatment bathed in prayer.  If the need for transport arises, we as a staff all find comfort in remembering that the purpose of Casa Compasiva is not solely to improve the birth outcomes in Oaxaca, but --even more importantly-- to use quality maternity care to share the love of Christ with the women and families whom God sends our way.  That we are able to do in the context of a natural birth in Casa Compasiva's cozy delivery room, or accompanying a mama to a hospital operating room where she undergoes a surgical birth.   

Our mamas are very blessed that we can give them loving support even if they transport to hospital and have a Caesarean.  Surgery is always scary, but it is very assuring to the mama that a Casa Compasiva staff member is available to hold her hand, pray with her, cuddle her new baby, and get her started on breast-feeding as soon as possible.  
 

The relationship of trust that we establish with a client during her pregnancy will hopefully continue postpartum regardless of whether the birth method was natural or surgical.  The way we look at it is that no matter what the birth outcome was, we still have six weeks of postpartum visits with her and her baby to support her in her adjustment to motherhood and also continue encouraging her towards a walk with Jesus!  

Marbella is a new mama who recently gave birth via Caesarean section after a disappointing trial of labour at Casa Compasiva.   When we tried to refund a portion of their deposit (because they didn't actually deliver at Casa), she and her husband refused to take the money, expressing over and over again their gratitude to our entire staff for such loving care, such encouragement throughout the pregnancy, and such good prenatal education--including the spiritual support that we offer. 

Because of Marbella's response, and from the questionnaires that our other mamas fill out postpartum, we judge that we are almost always succeeding in our goal of providing the very best birth experience possible—natural or otherwise!  For that we thank God. 



-Lila Q.