Modesty in Childbirth

So, those who know me know I am a student midwife (in addition to being a writer). As I am a student, answering these questions should be taken in the context of my learning as a student and not in place of contrary medical advice.

OMG.. but people are all going to be looking at my...

Well yes and no... That is kind of how babies come out. But there isn’t actually anyone taking notes or comparing your body with anyone else. Even though naked women giving birth is a daily phenomenon for medical staff, it isn’t for you. Answering the door in your pyjamas is something only some of us do – but even I am yet to answer it naked, while contracting, in pain and then invite people in.

Society has done a disservice to women, there is a shame about your body, a sea of constant flaw-finding and comparisons. Every bump, lump or freckle could be construed as an imperfection. Talking about sex is difficult and awkward for many people. Yet, when it comes to birth, people have an expectation that years of hushed whispering will magically evaporate now that there is a child involved.

It isn’t surprising that I have thus met a few women who have confided that they want a c-section due to modesty factors. So here is a little bit of a comparison from a modesty perspective caesarean versus vaginal birth.

Those words are a little off-putting aren't they? I remember secretly cringing when I was pregnant and people kept saying such words to me. After a couple of years of study, I can say such words as 'vagina' and 'penis' without giggling - most of the time! I can drop them into the dinner conversation; and have become oblivious to cringing looks my guests have while I discuss how much a placenta looks like the steak they are eating.

There are a lot of medical reasons to favour a vaginal birth. I'm not going to talk about those. I am going to talk about the emotional insecurities that tend to have us secretly favour the idea of anything that preserves modesty. Here is the harsh truth. You cannot really preserve your modesty through either method.

I'm sorry. This may be a reason for you to avoid getting pregnant, but if you are already growing a little life inside of you, mentally being prepared will serve you much better than false illusions.

Vaginal Birth

Say it out loud. It is just a word, don't be afraid of it. Vagina vagina vagina! See, the world hasn't stopped turning and the hell hasn't frozen over. Whether you had a conservative or more liberal upbringing, this is the time to become comfortable with you, your body and talking about it.

Many women come in to birth suite with a 'birth plan' and a lot of clothes on. As labour progresses, I often find that both of these are cast off and discarded in favour of anything that will make them more comfortable.

Points to remember:
No one should be in your birth suite without your consent. This includes partners, mothers, students or other staff. If you don't want someone there, then say so.

No one should touch or examine you without your consent. Consent doesn't need to be verbal, if I ask to take your blood pressure and you hold your arm out; that is called implied consent.

If someone says 'we have to do xxx'; that is not correct. You have a right to informed consent, if you don't consent it doesn't happen. Be informed and/or have someone that can help you discern the difference between medically necessary and scare tactics.

Awkward Moments:
So, you've come into birth suite, you seem to be contracting, they hurt, you've never done this before and people keep talking at you and not to you. Then someone says, "I'd like to examine you". "Right" you think, “they are going to put their hands on my belly and work out a few things". This is called palping. We do it to work out where baby is, is the head up or down, where is the spine and how far into the pelvis baby is. Pretty magical really. This is used to help us work out where to find the heartbeat and which way the baby will turn when it comes out. This is not the awkward part.

At some stage someone may ask to do an internal examination. You may have had one of these in an antenatal visit as your maybe date approached, you probably said yes, didn't ask too many questions and stared at the ceiling trying not to make eye contact. This time, the stakes are higher. You're contracting, in pain and now people want to put another glove on and insert two fingers into your vagina. This examination tends to last a little longer than antenatal ones and you may be asked if they can stay in during your next contraction. This one tends to have more of an audience too; you may have your partner there, a midwife, a student, perhaps a doctor and of course, any of your friends/family who are present.

An initial examination when you first present is often a good idea as it creates a baseline so we can assess whether or not any changes have happened later on. For example, in one case, this early examination allowed me to determine that the head was de-flexed (baby didn't have its chin down) and subsequent examinations then showed that the baby was gradually extending its head (chin away from chest) which is not what you want during birth. My advice would be to look at the ceiling and try to relax. Many hospitals have a policy of repeating these examinations every four hours to check for progress. Progress isn’t just in the form of cervix dilatation, it also includes position, length and thinning of the cervix. It isn’t all about you either, these examinations can also tell us where baby is sitting, which part of the baby or their head is presenting, positioning, membranes etc. Of course, this is something that should happen with consent and it should be presented as such.

When it is getting closer to birth, the midwives and medical staff may have quick look (to see if head is visible during contractions). They may also ask to do an internal examination, but often at this point we are looking for signs of pushing – this often doesn’t require touching you and isn’t too invasive.

This whole viewing aspect may be paralysing to think about while you are pregnant, by this stage of labour you would sell tickets to the show if it meant that baby would arrive faster. The contractions will be intense and most women start to zone out during this phase and you won't notice or care when it comes to it. Accept this as a fear and that there are other things you will be focused on.

At the end of the day, your midwives and medical staff have seen enough babies being born that no one is thinking twice about the intimacy of your privates. While there may be medical reasons to avoid a vaginal birth, please don't let your personal worries be the reason to avoid it.

Birthing position
Hollywood has been disastrous for setting women up with expectations of births. Let’s face it, without the drama it just wouldn’t sell. It involves a lot of screaming, often for an epidural and you’ll almost always see a woman lying on a bed, possibly with her feet up in stirrups.

Dear Women of the world, please stop fighting Mother Nature. Babies do not come out through your spine, lying on your back is not helping to stop the pain or speed up the process. Gravity will. Birthing standing up, on your knees or squatting is far more natural. It does take a while to get your head around. Water births also have their advantages.

Watch a few births online, or ask your midwife for a video or three. Watch them until you can honestly say you aren’t squinting, looking away from embarrassment or terrified of the process. While I will touch on it in other posts, your mental state will play such a crucial role in the birth.

Caesarean Birth

In my limited experience, occasionally women feel like this might be less physically awkward that a vaginal birth. Again, I am not addressing medical reasons for having a caesarean. To have a caesarean, you will have needle injected into your spine which will hopefully block the feeling from the lower part of your ribcage down. If it doesn't, they will keep playing with doses until it does.
Then they will prepare you for surgery – if they haven't already. A nurse or midwife will shave your pubic region as necessary. You will have a catheter inserted into your urethra so that your urine gets stored in a bag resting between your legs. This will stay in place for up to a day after surgery – depending on when you regain movement or are likely to be able to be up and mobile.
Doctors will cut through the layers of your lower abdomen to get to baby. Hopefully you have a cold at this point so that the smell of burning flesh doesn't put you off. They use a metal scoop to try to get babies head out. The surgeon will end up with their hands inside of your uterus – sounding awkward yet?

Which is better?

At the end of the day, both will hopefully result in a beautiful baby in your arms. Medically there are arguments for both. However both require you recognise that the process of childbirth is the beginning of a selfless adventure where you are no longer the most important person in the room. It is a personal journey for you, your support people and the new little family you are creating. Decisions based on choice, knowledge and information will guide you favourably. Those made out of fear or ignorance may adversely affect your birth experience. The memories of birth will fade over time but you will always remember that first time you looked into your little ones eyes – regardless of how they come out!