The natural childbirth myth, by NATASHA PEARLMAN

On March 28, 2014, just under three and a half years ago, I gave birth to my daughter, Rose. And it was March 25, the day before my labour started, that was the very last time I felt properly myself.

I don’t mean that in a casual, ‘Oh, life changes so much after having children’ way. I mean it in a profound, heartbreaking, so-hard-to-write-down-it-brings-me-to-tears way.

My very hazy 33 hours of labour passed in what I can only describe as ‘a darkness’. From the moment my waters broke while I was at home at 10pm on a Wednesday, to the 18-plus hours in hospital where I was refused a bed (and left to sit in a side room with only a chair) while contractions came every two minutes, to the two morphine injections I was given after finding a doctor on the ward and literally getting down on both knees in a corridor and begging for help, to finally being allowed onto a labour ward after my mum irritated the nurses enough for them to send me, to the two epidurals (the first one mis-sited) and then pushing unsuccessfully for an hour, I existed in a blackness.

Two whole nights and a day had gone and yet I could not tell you anything about them. There must have been light. I just can’t remember it.

Everything went white in those final five minutes. The bright lights of the white operating theatre. Doctors in white gowns. The c-section I was prepped for never happened. But what did changed me – psychologically and physically – completely.

Rose, now three years old, was born on March 28, 2014, after Natasha went through 33 hours of labour

Rose was stuck. Too big to come out – me too small.

This is pretty normal in the scheme of birthing hitches. But it’s not one that you’re ever really talked through in detail beforehand.

The doctors, as they must do in thousands of births every week, went for the forceps.

My husband, whom I insisted stayed right up by my head the entire time (there are some things nobody needs to see), told me that it was the only time he had the urge to intervene. A doctor was sitting on a chair, pulling with all her weight, yanking Rose out of me with a pair of giant metal tongs. One go wasn’t enough. It took three.

Just imagine what that does physically to someone. I tore. I was cut. I was stitched up. I couldn’t sit down without a rubber ring supporting me (so utterly humiliating) for at least four weeks. I had haemorrhoids. I bled. I hurt for months. Physically and emotionally. I wasn’t depressed. I was in shock.

I had to go out and live a ‘normal life’, because I had another life to care for. And I had a baby who had allergies and needed help. Which seemed to take up so much of my time and brain space, I stopped really thinking about myself.

To be absolutely honest, I didn’t know how to speak about it. And nobody asked. Not a doctor. Or a midwife. And, for a long time, I only shared sparing details with my husband (I felt too ashamed).

I felt, I suppose, like a failure. I also felt I had been failed.

It’s these feelings of failure that the Royal College of Midwives wants to end, with the announcement last month that it is going to suspend its 12-year campaign for ‘normal births’ (ie, births without any drug or medical intervention) and redefine ‘assisted’ births as ‘physiological’. The RCM’s chief executive, Professor Cathy Warwick, told The Times, ‘There is a danger that if you just talk about normal births – and particularly if you call it a campaign – it kind of sounds as if you’re only interested in women who have a vaginal birth without intervention. What we don’t want to do is in any way contribute to any sense that a woman has failed because she hasn’t had a normal birth. Unfortunately, that seems to be how some women feel.’

It is. And yes, the ending of this campaign will hopefully help remove the current stigma attached to not ‘doing it naturally’. (What is so wrong with wanting pain relief? We take paracetamol for headaches, for goodness’ sake.) But what it won’t end, for me, is the overwhelming sense that women today are being failed, not just by a choice of words, but by the system, too.

Why was I so obsessed with having a natural birth? I have asked myself this a million times in the three years that have passed.

Natasha, pictured above with her daughter, Rose, describes how she felt as though it was ‘assumed’ she would give birth naturally, and she says no other options were discussed when she met with a midwife on the NHS

Childbirth is presented in a number of ways to women. As a challenge: are you real or tough enough to do it the ‘proper’ way? A holistic wonder: ‘The joy of passing through the pain’. A terror: although not, ironically, of what could happen during natural labour, but of c-sections and epidurals.

And the way most women encounter this information is via their midwives and NCT (National Childbirth Trust) classes.

Standing back from it now, I feel such immense heartbreak at the way birth was presented to me, but also my complicity in it.

From my first appointment with a midwife on the NHS there was a blanket assumption that I wanted to do it naturally. No conversations were initiated about birthing options. I saw a different midwife every appointment. When I asked to whom I should give my birthing plan once I’d written it down (in the bulging file you are required to carry around with you from your first scan), I was told dismissively that births vary anyway and whatever was best for the baby would be done regardless. (I still find this so difficult because it effectively dismisses the human who then has to piece together their body to take care of the child, although of course I understand that preserving life is of the utmost importance.)

At twenty-something weeks I made, as many pregnant women do, the transition to NCT – six weeks of ‘lessons’ at a cost of £300, thank you very much.

The teachers, trained by the organisation, are passionate advocates of natural birthing. From my experience, I’d go as far as to venture that, if you are planning to have a c-section from the off, it’s a particularly unwelcoming atmosphere. And the very reason a couple of my friends who were having c-sections chose not to participate.

I had actually gone into NCT classes believing I wanted an epidural. I left fearing all intervention.

The once-a-week sessions taught me how to breathe. But I was also told that epidurals carried risks, potentially delayed labour, made it hard to know when to push. One of the dads in my group was the obstetric anaesthetist at the local hospital. He stopped the NCT teacher to angrily remonstrate with her; regardless, the seeds of doubt had been planted in our minds.

Morphine or the equivalent wouldn’t help anyway. And with breathing, you could be in control. A water birth? The dream … C-sections? I can’t even remember it being on the syllabus, other than yet more fear-inducing over a six-week recovery, not being able to walk, not being able to hold your baby – which, while it may be true for emergency C-sections, did not appear to apply to some of my friends who’d had them selectively and started off parenthood without the mind-shattering trauma that I did. Although so much is never talked about that it’s impossible to really know.

At one point, our teacher passed round a faded 20-year-old picture of a woman ‘birthing’ her placenta. I turned the picture over and refused to look. Who needed to see that? I wanted to know what could happen – real scenarios, real options. Over and again I was reassured that I could do it naturally, that was it. I was made to feel that if it didn’t work out like that, somehow it would be my fault. I just needed to go with it.

Natasha, 35, admits that she is still traumatised by the birth of her daughter Rose, now three (pictured together)

I’m an educated woman. I should have been more inquiring. I wasn’t. I made my decision to go ‘natural’ in part because of fear. Also because my sister had had a successful – although accidental, due to the speed of her labour – intervention-free water birth.

And, at the fittest I’ve ever been, I believed my body was up to the challenge that had been presented to me. But mainly I trusted that my ‘educators’ had my best interests at heart. As shown by the RCM climbdown, I don’t think they did. And NCT? While I’m aware many people have a positive experience with these groups – and some have wonderful teachers – for me, for the reasons above, they are fundamentally no longer fit for purpose.

For a long time after, I played back the birth in my head to try to process it. At other times, it came in distressing flashbacks.

I was well aware that what happened to me wasn’t unique. But that was almost more upsetting. I felt like my wellbeing and my body had been completely disregarded. Surely I wasn’t alone?

There were moments when I blamed myself. When my waters broke at home on the Wednesday night and the contractions started coming every one to two minutes (the time at which I was told by my NCT teacher to come in), we drove to hospital. When I had asked my teacher what to do if your waters broke before full labour had started, she replied, ‘That only happens in the movies,’ and moved on. So right from the start I felt unsure, unprepared. The midwife who examined me in the admissions ward told me to go home. I wasn’t dilated enough (only 2cm, not the required 4cm) to be deemed admissible.

But I was scared. I also had no idea how I was supposed to know when to come back, when I was already experiencing nonstop contractions. I did not want to have my baby at home. Did everything else bad that followed stem from what I did next?

I refused to leave. They refused to give me a bed. If I was insisting on staying, then my ‘punishment’ was a windowless side room, with only a chair. To add insult to injury, the entire maternity ward was empty. Not a single bedroom occupied.

At first I remember feeling OK. It was my decision to stay. I was mentally coping. But when, after about eight hours, they finally discovered that Rose had turned back to back (which, I only found out after I’d given birth, halts labour), I still wasn’t assessed properly.

Given that there is a limited time to deliver a baby after your waters break (within 24 hours, to limit the risk of infection), looking back I would have expected to have been talked through some options: to be given a room, offered an induction, even just some simple advice on how to turn the baby.

The midwives did nothing. It seemed as if they had made the decision, without consulting me, to push me to the absolute limit to deliver the baby naturally. There was no option for me to change my mind. I was in a system out of my control. I also didn’t know how to ask for anything else – I didn’t even really know what to ask for.

Even when I was finally dilated enough to be admitted, I wasn’t. The windowless room remained my home. My spirit was broken.

She described how she had to beg a doctor for morphine while having contractions and said ‘she hurt for months’ after her daughter was delivered using forceps. Natasha (left) is pictured with former Vogue editor Alexandra Shulman and Glamour editor Jo Elvin

I hadn’t eaten for I couldn’t remember how long. I didn’t know what day it was. I was high as a kite after the morphine I’d had to beg for. And then, at some point late on Thursday, 19 hours after I had first arrived, when the doctors were insisting that I needed antibiotics to prevent Rose being at risk of infection, I was allowed onto the medical labour ward to be induced. Being under the care of doctors rather than nurses changed everything. I literally wept with happiness when the epidural and its huge needle threaded up my back.

It would have been about 5.15 on the Friday morning when I was asked to find the energy to push a child out of me. I tried so hard, I could feel my body breaking things I just knew could never heal. And when Rose didn’t come, I was sent to the operating theatre.

I was so relieved I was going to have my baby that I no longer cared what was happening. But I should have.

Because if I had not been so ill-informed, I might have been able to protect myself better. To prevent the long-term damage I still suffer from today. I paid good money to learn about birth. I came out so uninformed that I wasn’t able to insist on what was right for me. No forceps. Quick, fast pain relief. And a c-section.

The biggest shock of my difficult birth was the aftermath. It seems stupid to say but, by the end of my labour, I was so numbed with shock and pain relief that I hadn’t really expected what would happen to my body in those first hours, days and weeks after. I cannot begin to describe the horror of realising that I could barely walk because every centimetre of my pelvis was swollen, bleeding or stitched up. The pain of going to the toilet for the first time. The complete fear of what my body was going to do next, coupled with a tiredness that was unlike anything else.

I had to wear incontinence pads just to walk about, because maternity ones didn’t cut it. I shook constantly. The first time I got on the Tube, when Rose was six weeks, I had a panic attack. It sounds bonkers, but it was like climbing Everest. I couldn’t believe I used to do it every day without thinking.

I also hated my body. How can you find the confidence to love your body again, and to even imagine feeling sexy, when it doesn’t work as it used to? I remember my husband trying to initiate sex for the first time after about six weeks. I literally recoiled in fear.

Sex – that is the one thing no one ever prepared me for post-birth. The pain. Thankfully it got easier after a few months and pretty much back to normal after six. But for a while I just had to grit my teeth and get through it. You can see why so many marriages come under strain after a baby. It takes an enormous understanding on both sides that the thing you have loved, and made your child, can feel so violating for a woman after.

When I went back to work after six months it was a relief. I wasn’t cut out for maternity leave, but then I suppose my maternity leave was also a reminder of the bad times. My blind focus was on trying to restore as much of my old life as possible, and in many ways that has totally saved me. I filled hours with work and Rose. There was no time to think about it any more.

For a long time, I was aware that other friends had been through traumatic births, too. But apart from comparing a few surface horror stories, we never spoke about the long-term damage. How many of us sitting there over lunch felt like I did inside? Did any of them also weep silently alone at night? How many of them still find what happened difficult to talk about? I never hated my friends who’d had a better time of it. Maybe it wasn’t as simple as they said anyway. Who knows the real truth? We still don’t talk much about it through shame.

Natasha said the National Childbirth Trust (NCT) antenatal classes left her fearing all medical intervention, including an epidural

Three and a half years have passed since that day. In many ways, my life is more than I could ever want it to be. I’m the editor of Grazia magazine. I have Rose. A marriage I’m incredibly proud of.

Underneath it all is a trauma that defines me. I still can’t run, walk at a fast pace, get on a trampoline or even sneeze without suffering incontinence. (How’s that for front-row fashion-week chat?) And I am utterly terrified of getting pregnant again, while knowing that my husband would really love another child.

I carry my shameful little secret around with me constantly. One that isn’t actually my fault.

This is no pity party. My experience is by no means the worst. It’s also by no means the most traumatic (I am incredibly lucky never to have experienced loss). I don’t take huge pleasure in reliving what happened, and it’s unashamedly self-indulgent and selfish.

But it is the truth. About what can happen to a female body during birth and the psychological and physical consequences of the obsession with natural birth (no drugs, no epidurals, no inductions, no c-sections) at any cost. And, the reason I feel so passionate about talking about it, is that it is a truth that has been hidden for far too long.

There is growing evidence that I am not alone in feeling this way. The Birth Trauma Association, a peer-to-peer support group, estimates that as many as 200,000 women may feel traumatised by childbirth and develop untreated symptoms of post-traumatic stress disorder. Another 10,000 seek treatment every year. It is estimated that perinatal mental health problems carry a total long-term cost to the UK of about £8.1 billion for each one-year cohort of births, with £1.2 billion falling on the NHS and social services.

More than 90 per cent of women who have vaginal births tear or need an episiotomy (a cut). Up to half of all women who have children suffer some form of prolapse and, according to a 2015 study in the British Journal of Obstetrics and Gynaecology, 24 per cent of women suffered pain during sex for 18 months after birth.

How is it that childbirth – the one thing our bodies do that male bodies can’t – can feel so anti-feminist? How is it that while feminism has advanced our careers, it hasn’t advanced the one thing that can cause us the most trauma and most lifelong physical changes? And why has it taken so long for us to speak openly about it?

For many years, I think that giving birth was a badge we were meant to earn. When you have the entire Royal College of Midwives set fundamentally against the feminist founders of Spare Rib magazine, who were lambasted for their belief that every woman deserved a pain-free birth, how were we meant to move forward? Similarly, women who opted for c-sections were labelled ‘too posh to push’.

The magazine editor says she was left feeling like a ‘failure’ following the birth of Rose (picture). However, she says she also feels that she was failed

Then, more recently, the trend for natural birthing ramped up – with the explosion of hypnobirthing, ‘orgasmic birthing’ and the RCM’s ‘normal’ campaign. Yet all this is set against a 20 per cent rise over the past 30 years in women having ‘assisted’ births. (They now account for 60 per cent of all babies delivered in the UK – attributed to the rising average age of mothers and the increase in baby birth weights. Although figures in a 2016 RCM study suggest it’s even higher – nearing 80 per cent.)

But now we are on the cusp of another huge generational shift. Generation X and the millennials have become mothers in the age of social media. We share our lives on it. We use it to advance our careers. We are empowered in so many respects by it. And we are tentatively beginning to share the real birthing stories that have, in many cases, irrevocably changed us.

We have grown up expecting careers. And we take care of ourselves. We want to return to work after having a baby, and we don’t want to do that physically altered. We want to exercise, to run – not to have to wear sanitary towels just in case we sneeze. We want to have the information beforehand so we can make the choices that are right for us. We want, as much as possible, to be in control. We are aware that no man would ever accept this level of injury or lasting damage if they gave birth. We also don’t want Generation Z not to know this.

I’m certainly not advocating a switch to c-sections. Why shouldn’t women want, and have, a natural birth? But armed with knowledge, wouldn’t we know far better what to ask for when things stop going to plan? How differently would we feel about birth if it were placed more in our control?

In the three years since I gave birth I’ve often wondered what has stopped us telling women in advance what childbirth is really like, and I can’t help but think it’s a form of control – do we fear somehow that if we tell a woman what it’s really like, she might not want a baby? Are we being kept in the dark so that we continue to procreate?

Would I have wanted a baby despite knowing everything that could happen? Of course. Would I still have tried to have a natural birth? Probably. I just would have gone into it eyes wide open. And I truly believe that, at the very point I realised it was going to go horribly wrong for my body, I would have insisted on medical intervention.

If I were ever to do it again, though, I would never go natural. Just last week, at a doctor’s appointment, I joked to my amazing GP, ‘If I ever have another child, I’ll tell you right now it’s not coming out of my vagina.’ She laughed and replied, ‘Why do you think I had a caesarean for all three?’

She knew. She chose. Now it’s time the rest of us got told. 

The Times Magazine / News Syndication