Heroes, Heroines, and Healthy Babies:

1. Heroes, Heroines, and Healthy Babies: The Effects of Medical Intervention on Women’s Birth Narratives Christina Michaud Boston University College of Arts and Sciences Writing Program cmichaud@bu.edu

2. Data • Internet messageboards (forums) • ivillage.com: The Women's Network • founded in 1995, now owned by NBC • one of the top 1-2 sites in unique visitors of all sites aimed at women • one of the top 50 sites in unique visitors of all websites • September 2008: ranked 44th worldwide, with 19,183 visitors, above WebMD and Expedia (rankings from comScore, Inc.)

3. Data • “Expecting Club” messageboard for Sept. 2008 • Birth Stories folder • 250 birth stories • average of 481 words • publicly accessible--no log-in required • "Please remember that any information you disclose in these public forum areas becomes public information” (iVillage Privacy Policy) • all identifying names removed • qualitative analysis

4. One type of birth story. . . • “The wonderful epi man” • Heroic doctors • Life-saving interventions • Failure of the woman’s body/natural process • Justification of interventions by hindsight • Satisfaction with birth experience = The Medical Birth Story

5. Another type of birth story. . . • The wonderful husband/doula • Heroic, unconfined, women • Birth as a woman-centered process • Continuum of acceptable interventions • Triumph of instinct over intellect • Satisfaction with birth experience = The Woman-Centered Birth Story

6. A third type of birth story. . . • Lack of a hero/heroine • “A healthy baby” • Conflict between desires and necessity • Questioning of interventions in hindsight • Dissatisfaction with birth experience = The Conflicted Birth Story

7. The Medical Birth Story • “the wonderful anesthesieoligist came in.” • “the epi guy had shown up. I swear to God i could have kissed him. [. . . ] epi guy (i later found out his name was Dan) had that epi in within five minutes.” • “At 7:30 AM, the epidural man arrives. Boy, do I love him!” • “The anesthesiologist (my new best friend) gave me some Phentergen to combat the nausea.” • “The lovely epidural guy did an awesome job and got me hook[ed] up the fastest and easiest of all my 5 kids.”

8. The Medical Birth Story • “I finally agreed to get the epidural [. . .]. Mr. wonderful and his very cute assistance came in... did I say cute. [. . . The doctor] said [“]her uterus is over stimulated we need to get her to or stat.[”] Then Mr. wonderful and his gang came in and started getting me all ready. [. . . ] What I remember is one of Mr. wonderful[’s] buddies [. . . ] telling me everything that was going on.

9. The Medical Birth Story • “After pushing for about 2 hours, [my baby] was not progressing down the canal enough, so we all decided that c-section would be the best thing. I was getting extremely tired and poor [baby]'s head was getting molded to the canal, but just was not coming down anymore.” • “The doctors had to push and push on my stomach [during the c-section] to get [my baby] out because he just did not want to leave. He was born at 9:05 am on the 6th. His head was so big there's no way it could have gone down the birth canal.”

10. The Medical Birth Story • “[The doctor] said we have a choice to make. [. . . ] at that time hubby and I looked at each other and was like lets just get him out..i was in sooo much pain i couldnt lay still in the bed..and the thought that i was still only 2 was terrifing![. . . ] ...so off we went to the OR and little [baby] was born! both hubby and I are very pleased with our birthing experience together..and i know that i made the right choice..for some reason baby wanted to come out but my body was saying no....”

11. The Medical Birth Story • “the contractions were coming every 2 minutes and were painful. I was doing fine....so I thought. [. . . ] All of a sudden [the baby’s] heart rate dropped....and almost stopped. [. . . ] Next thing I knew I was being prepped for surgery and wheeled into the OR. This wasn't optional. I was scared. [. . . ] Bottom line.....he would not have survived a vaginal delivery. It was super scary, but he is just fine. Perfectly healthy and adorable in every way.”

12. The Woman-Centered Birth Story • “Once I finally decided I was ready for drugs, they checked me again and said I was 8-9 cm [. . . ]. So, I thought, ‘I'm almost done. Screw the drugs, let's get this show on the road!’” • “According to my nurse, I was in ‘transition’ for 4 hours with a posterior baby, holding firm @ 9cm! No meds. It brought out my primal nature to say the least.” • “They then weighed her......10 pounds 1 oz!!!!! I didn't have any medication (no epi, no iv, NOTHING) and didn't tear at all! I was soooo amazed.”

13. The Woman-Centered Birth Story • “I did it all my way - no epidural, no induction! I did give in to some IV pain meds after they broke my water [. . . ]. Aside from the pain of hemmorhoids, constipation, and a third degree tear lengthened by an episiotomy, we are doing great. Even with the pain, I wouldn't change it for the world!” • “Going through an induced labor with no pain meds was by all means the most painful thing I've ever done, but also the most liberating, exciting, and awesome thing too! All in all I was only in pain for about 2 hrs and didn't tear or need an episiotomy at all! My body is made to have babies!”

14. The Woman-Centered Birth Story • “the BIGGEST, most overwhelming feeling of I-don’t-know-how-to-explain-it hit me, and I let out a yell so primal that I didn’t recognize my own voice. [. . . ] when I felt the first urge to push it scared the crap out of me! What a powerful sensation. [. . . The doctor] let me do my thing. No counting, no telling me when to do what. I just went with it. One big push, and her head was out. I reached down and felt it. One more big push, and I felt her shoulders and the rest of every inch of her little body come out of me. It was amazing. [. . . ] This was one of the most incredible things I’ve ever experienced [. . . ] because I worked so hard to get what I wanted, and I got it. I did it. In my mind, I gave my daughter a gift, the best possible start to life.”

15. The Woman-Centered Birth Story • “Delivered au natural with 3 pushes in 10 minutes! [. . . ] Everything progressed very very fast and i was not able to get my epi - also because her heart kept decelerating and they were thinking about a c/s. I made it through with no drugs, and after 10 minutes and 3 pushes [my baby] arrived! I only tore a very little bit on my labia and no where else. I am so amazed, it was the experience of a lifetime and i feel great!!” • “I was in so much pain I bit [my husband] in the back. [. . . ] Other than the scare of not making it to the hospital it all went so well. Especially for me going all natural (I thought I wasn't strong enough) and no epi or tears.”

16. The Woman-Centered Birth Story • “my OB never made it and, in fact, the on-call OR doc barely made it! The nurses kept saying, "Don't push!" and I was thinking, "BS! This baby is coming out NOW whether any of you like it or not!!" LOL, [my husband] said I was like a naughty kid who refused to listen. I felt like a wild animal in the throes of death or something. It was a crazy labor.” • “I did it all natural with no stitches this time!!!! I feel so empowered!!”

17. The Woman-Centered Birth Story • “Let me tell you about the ‘TRANSITION’. I was transformed into some primal cavewoman. I was growling, moaning, grunting, you name it. Time literally stopped and I had no control over my body. The world around me was a haze and I was just in it. [. . . My husband] and I stood at the foot of the bed [. . . ] We faced each other and I had my arms around his neck. [. . .] During some of the pushes I was lifting myself off the ground and all he could do was brace himself. [. . . ] the hardest part was when her head came out and they asked for me not to push.”

18. The Conflicted Birth Story • “Finally, when he was out and they announced that it was a boy, I almost passed out. I said, "omg" and [my husband] had to get me oxygen. I was delirious by this point! [My husband] said he'd never seen my face look like that. I had no idea what was going on around me, no idea that the DR had given me an episiotomy.” • “they decided to go ahead and induce. After about 4 hours of pitocin [. . . ] I was only at 3 cm (went in at 2) and I had to get an epidural. Didn't want to but that's okay. I pushed for about 2 hours [. . . ]. So we had to use forceps. OUCH! But out she came.”

19. The Conflicted Birth Story • “I ended up getting an epidural [. . . ]. I had wanted to go totally naturally, but I just couldn't even breathe any more, let alone think about pushing. [. . . ] I went into the hospital on October 1 at 7:30 to begin the induction. She was one week late, and while I considered putting it off longer, I really wanted to meet my little one, so I agreed to the induction.” • “I can't believe how much harder labor was being induced compared to going naturally. Holy moly I would never chose to be induced by choice! I came home today and I am exhausted and feel like I have been beaten or run over or something - my entire body hurts. BUT it's all worth it to have this precious little girl”

20. The Conflicted Birth Story • “I pushed for over an hour and finally the doctor and my sister (who is also a doctor) convinced me that i needed an episiotomy to get him out otherwise I was going to tear through the rectum. [. . . ] I was so scared at first when they put him on my chest, because I was so overwhelmed [. . . ]. So it took me a while to come around - but now i'm so thrilled [. . .]. But owsie, I am so sore.” • “[After four days of induction] I was done and asked for an epidural. Despite the fact that this is number 4 and my first 3 were all natural I just found myself completely drained and unable to go any further. It wasn't even the pain. I was just exhausted and completely disinterested. I had no desire, what so ever, to give birth.

21. The Conflicted Birth Story • “i was checked again for dialation and i had regressed [from a 10] to a 6....30 minutes later i was checked again and had regressed to a 4. I stayed that way all night. My midwife handed me over to the other dr. at the clinic who i never met before, and at 8 AM he told me if i dont have significant progression by 10 he would have to do a c-section. at 9:58 he came in and i was only at a 5, so he told me we were gonna do the c-section. I panicked.”

22. The Conflicted Birth Story • “He basically told me that he could give me pitocin [. . . ] and have me labour all day long, and end up having to have an emergency c-section. Or I could opt for the c-section which would be safer in the long run because of all the circumstances. It was a really easy decision to make, but it was emotionally hard for me, I cried a lot because I had really wanted a natural birth and I was terrified of a c-section. I know that everyone says as long as the baby is healthy (it's absolutely true) but I feel like the process is important too.”

23. The Conflicted Birth Story • “They sent in an OB to let me know things weren't progressing well, she was still fairly high, she could be stuck, etc. So he said we could try forceps after a spinal or c-section, but he wouldn't recommend the forceps [. . .]. So I just said at that point, fine, go with the section. It wasn't what I wanted, but at that point I was too exhausted [. . . ]. I was crying, but [. . . he said] he knew it wasn't what I wanted, but all in all, it's easier than continuing with the pushing [. . .] The whole experience was so surreal. I feel like we spent no time in the hospital, although we were there 3 days. Now we're home and settling into our new reality. Breast feeding has been a challenge [. . . ] I also have been extremely weepy, crying many times a day, so we're trying to deal with that. I'm hoping I will feel better emotionally in the next week or so. I know it will get easier.”

24. Conclusions:Different Women, Different Stories • The Medical Birth Story • The Conflicted Birth Story • The Woman-Centered Birth Story • differences among them in: • theme • imagery • word choice • verb tense, aspect, and voice • repetition/emphasis • story structure

25. Conclusions: Some Surprises • no clearly-defined natural vs. medical division • clear distinction between woman’s own terms and doctor’s terms (active/passive) • same interventions, different interpretations:IV, continuous fetal monitoring, AROM, pitocin (induction/augmentation), epidural, IV pain drugs, episiotomy, c-section. . .

26. Conclusions: More Surprises  traditional story structure • The Medical Birth Story • The Woman-Centered Birth Story • The Conflicted Birth Story • Ideal outcomes: • a healthy baby and a hero • a coherent, well-plotted birth story • an active, woman-centered approach to birth  nontraditional story structure

27. One Final Story • “I got up as fast as I could and got back on the ball, but nothing seemed to work anymore. I had been ‘vocalizing’ through contractions all this time, making low, open-throated sounds... basically [my husband] said I sounded like someone having a really good back rub. LOL Now I was groaning and growling and by the end, I was ROARING through them, trying to remember to keep my throat open and the tones low. I didn't feel ‘pushy’ (they kept asking me!) but I started to feel uncomfortable on the ball. I started to panic and told everyone I was done, I wanted to quit, I wanted my mommy... I can't do this anymore!!! slide 1 of 4

28. (continued) • “Somewhere in the back of my mind I knew this meant something (transition, duh!), but at the moment I was so overwhelmed that all I could do was try to keep from losing it. Then I felt it... like I had to move my bowels... really really bad! :-P I tried to tell them, but the only thing I could say at the time was ‘the baby is coming out my behind!’ ROFL They didn't think it was close enough since I was still not pushing, but I knew something was up and I convinced them that I needed to get up on the bed, since you can't have a baby on a ball! LOL They helped me get up on the bed, I climbed up on my hands and knees facing the end of the bed and I felt it... something was coming out! slide 2 of 4

29. (continued) • “It wasn't hurting as much anymore, in fact [. . . ] this part was almost painless. (usually, this is the part that hurt the worst for me!!!) I put a hand down to feel what was going on and I felt myself opening up and the baby's head pressing through!!!! Incredible!!! I yelled that the baby was coming, but no one believed me, they were running for the doctor and telling me to blow and not push... but I wasn't pushing! I said, ‘no, really, I have his head!!!’ slide 3 of 4

30. (continued) • By the time they pulled my gown up and checked, his head was already out, I was holding it up with my hand! A nurse slipped behind me and helped catch his body as he slid out and we laid him down on the bed below me. He was breathing fine, turning pink and looked absolutely perfect!!! I managed to sit, still upright, and just admired this incredible little miracle. No one could believe what had just happened. (least of all me!) Not a tear, no pushing, nothing... he just slid out into my hands. If I had not lived through it, I would never have believed something like that was even possible!” slide 4 of 4

31. Heroes, Heroines, and Healthy Babies: The Effects of Medical Intervention on Women’s Birth Narratives Christina Michaud Boston University College of Arts and Sciences Writing Program cmichaud@bu.edu