Will childbirth be easier the second time around?

November 24, 2011 5:07 PM

How can I support a friend who had a horrific first childbirth experience, and is now facing her second?

My friend is 8 months pregnant with her second child. Her first childbirth experience 3 years ago was horrific. Their birth plan, and the contingencies, went out the window early on. I won't go into the details but it left her physically and emotionally scarred (not a caesarian). I'm the only person she's gone into detail with - I think that's because I don't want kids anyway - if I did, it would have put me off completely!

The second child is wanted. She's seemed okay about the whole thing up until tonight - not exactly looking forward to it, but resigned and pragmatic about it. Tonight she admitted to me that actually she's incredibly scared and stressed about the birth, and the closer it gets, the more fear she feels.

Her husband knows this and is doing what he can to support her. Her doctor/midwife knows this as well but I get the impression they're not being particularly supportive. She's moved since her first child so while the NHS team she's working with now know about her previous experience, they weren't involved at the time. The birth will be in an NHS hospital. They don't have the money to go private.

I'm really worried about her - and I'm guessing that going into labour being stressed and scared isn't a great start, either for her or the baby...

I'm looking for anything that might alleviate her stress and fear. Websites / forums / evidence / anecdata?

Also, what else can I do to support her?

posted by finding.perdita to health & fitness (14 answers total)

She might benefit from a few therapy sessions. Is that an option?
posted by moira at 5:16 PM on November 24, 2011

Why isn't she having a caesarian? Is this not an option?
posted by smithsmith at 5:17 PM on November 24, 2011 [3 favorites]

She may not be able to afford a private birth, but she can likely afford an experienced doula for additional and most importantly, empathetic support from someone who is entirely focused on her but unlike her husband, not incredibly stressed out and fearful.

Her midwife should be part of a midwifery team; has she met with more than one midwife in the team? Not trusting her care providers is potentially a huge issue, and (again) a doula can help manage that.

Has she read a ton of successful 2nd birth stories? Has she spoken to women who have been through this same circumstances? If not, I would suggest she join and post at ADL stat. (It's basically Metafilter for birthin' babies.)

Why isn't she having a caesarian? Is this not an option?

Because apparently nothing indicates it's medically necessary? The World Health Organization opposes elective caesarian on the basis of increased risk.
posted by DarlingBri at 5:21 PM on November 24, 2011 [5 favorites]

It seems like having a guaranteed ally who will support her no matter what and act as a go-between for her when she's at her most vulnerable would be the most helpful, so a doula definitely sounds like a fantastic boon for her. If she can't afford it - or can only afford part of it - many doulas will work for a reduced fee. Some will even work for free, as they need to attend a certain number of births to get their accreditation. She should check with DONA to see what her options are. I very nearly ended up with a free doula myself by simply asking what my options were on a community LJ, and they educated me about the whole topic, so I know this is absolutely possible.

Ideally, she could also have a couple of therapy sessions with a counselor who can help her form a better frame for this experience and get some ideas for handling the stress and anxiety in the moment.

Having a friend to confide in who wants to be supportive and can hear her out without judging her is probably a pretty big help, too, so just keep doing what you're already doing as long as you're able. Directing her to a resource like DarlingBri's recommendation for ADL will give her another route of supportiveness, too.
posted by batmonkey at 5:52 PM on November 24, 2011 [2 favorites]

Because apparently nothing indicates it's medically necessary?

The OP indicates physical damage did occur in the first birth (yes, I know this is common), and surely psychological trauma falls under the umbrella of medical necessity.
posted by smithsmith at 6:21 PM on November 24, 2011 [8 favorites]

If she has access to and can afford to see a psychologist, she should. Arguably this is urgent, since she may be suffering from PTSD related to the first birth and it will almost certainly have an impact on her experience of this birth. A therapist might be fine, but what would be ideal is a psychologist who is experienced in treating trauma. She should say specifically that is she is looking for help with recovering from trauma related to child birth. Apparently some NHS hospitals offer psychotherapy as part of their obstetric practices (according the Birth Trauma Association, who might be very helpful to her).

The kicker with child birth is that, of course, there is no way to know whether it will be easier the second time around. It could be a walk in the park, it could be exactly the same as the last birth, it could be worse by several orders of magnitude. It's the not knowing that makes it so scary, particularly when her previous experience was so horrific.

With only four weeks to go, she doesn't have a lot of time, but some therapies, like EMDR, can be effective fairly quickly. And if she is specific about her goals, and the psychologist is good, it could help her enormously.


[Full disclosure: I am currently in treatment with a psychologist for PTSD related to my daughter's horrific birth. If you or she would like more info/to chat, memail me.]
posted by looli at 7:11 PM on November 24, 2011 [4 favorites]

Nthing the doula suggestion, a million times over. Also finding a provider that is supportive and willing to help her address her issues is extremely important (they absolutely exist), if she is open to change. Midwives would definitely be the place to start. If she really wants an OB, her doula should be able to suggest someone excellent.

Also- suggesting major abdominal surgery with not insignificant risks to mother and baby as a solution to a negative vginal birth experience is misinformed and unhelpful. Maybe ths woman needs the healing and personal empowerment that that a positive vaginal birth experience on her own terms can provide.
posted by LyndsayMW at 9:39 PM on November 24, 2011 [4 favorites]

Does she have to give birth in a hospital? (genuine question, as in due to previous problems she needs to be near specialists?) Homebirth in the UK is much more accepted than in places like the US or Australia, and perhaps being at home would be less stressful for her. Everything should still be provided by the NHS, so she could talk to her midwife about this option.
posted by Megami at 1:39 AM on November 25, 2011 [2 favorites]

The World Health Organization opposes elective caesarian on the basis of increased risk.

New NICE guidelines state that if she requests a c-section she cannot be denied one. She may be offered counselling (she should be offered but you don't always get what you're supposed to) .I am generally opposed to elective c-sections but while we don't have the specifics of the first birth, this doesn't side like a "too posh to push" issue. There are pros and cons to both methods of delivery. Its not like vaginal delivery is perfectly safe, risk free and clearly superior to c-section, they both have different risks. Being stressed out about the birth isn't good for either of them and she could end up needing an emergency c-section anyway. Without the specifics, we have no idea whether her second birth will likely be fine or as horrific as the first.
posted by missmagenta at 2:37 AM on November 25, 2011 [4 favorites]

Also, simply listen to her. Listen to her, listen to her, listen to her. This is going to be incredibly stressful no matter what, and if she needs to perseverate and just freak out, then by god, it will be such a great gift to just listen to her.

Affirm that it's terrifying. Affirm that things can go awry and there can be horrible, horrible outcomes. Affirm that there is a whole nightmare gallery of terrible things that never, ever, ever get discussed in the chirpy, woman-positive, affirming, empowering educated-womens'-guide-to-birth stuff, but that do in fact exist, and do happen to someone sometimes, and that she was one of the people who drew the awful, awful luck last time.

The flipside to empowerment is reponsibility. I'll bet somewhere deep down in your friend she still feels that she was somehow responsible for whatever terrible outcome happened. There is such a strong strain of "you can make the right choices to resist the overmedicalization of birth" in popular literature about childbirth education and preparation, that when shit really does go sideways, frequently through nobody's fault at all, that message of "you could have prevented this outcome" lodges deep and can be so, so, painful to live through.

Been there, done that. And was phenomenally healed by a second birth and neonate experience that was substantially different and better than the first. That's how I finally really internalized the message that so much of the experience of my first was truly not under my control. May your friend's second birth be much much better, and similarly healing.

Thanks for being her good friend.
posted by Sublimity at 8:03 AM on November 25, 2011 [1 favorite]

I would recommend a hospital birth, and a birth plan that gives her the option to ask for a surgical delivery if she feels that she needs it. There's a popular notion that birth can be a magical event. Maybe that works out for some people; I just heard 2 stories of births that were really fast and easy, but childbirth is dangerous for women, and sometimes it's difficult and/or damaging. It's hard to say much without knowing why it went badly.

My experience of birth wasn't fun.
2 days of mild induced labor during stress test,
induced 2 weeks past due,
stripped membranes[ouch],
1 bossy nurse made 8 hours of that labor miserable, and pushed me info more meds than I wanted, and those meds made things worse,
16 hours labor, including pushing for ?however long,
surgical delivery, baby had the cord wrapped his neck 3x,
home w/healthy baby 4 hours,
back to hosp. w/ post-surgical infection,
surgical complications lasted nearly a year.
I was at a teaching hospital, and somebody probably gave me the infection during an exam, or during surgery.

But. It was okay, and I don't think of it as traumatic, because I came home with a beautiful, healthy baby. The surgical delivery meant the cord didn't strangle him. We should have done it sooner. Help her by listening, and listening, and listening (on preview - 2nding sublimity), letting her express her fears, and gently reminding her of the desired outcome - a healthy baby. I hope that, despite her awful experience, her 1st experience ended with a healthy child. That is the most common outcome.

She should talk to her doctor about her experience and her fears. She'd probably benefit from a carefully selected labor nurse at her side, acting as her advocate. Or maybe a very good friend.
posted by theora55 at 8:22 AM on November 25, 2011

I know many people have suggested a doula, and I'm adding to the chorus, I just want to give you another reason why.

Part of the doula's job is to make whatever happens feel OK. So, whether you end up with a completely natural birth, or an epidural and then a c-section, the doula is there to make you feel like you are doing AWESOME, and the choices you are making are AWESOME, and your responses to the things that are out of your control are also AWESOME!

I have heard from a lot of women who say things like "Considering all the things that happened, I should be traumatized, but the doula make me feel comfortable and empowered the whole way along." A doula can't make it so that the horrifying things don't happen (although they can advocate on your behalf, get you food, rub your feet, etc) but they can help you interpret those events as less horrifying than you might otherwise have.
posted by arcticwoman at 12:58 PM on November 25, 2011 [1 favorite]

Does she need someone to talk with medical staff on her behalf? They may not be really understanding the gravity of the situation, particularly if she is minimizing it in any way. Is she able to make a list of what the traumatic things were and how things could be changed to make it not traumatic or not happen?msometimes the trauma is unavoidable, but sometimes it isn't, so it may help to work that out.
posted by geek anachronism at 7:55 PM on November 25, 2011

Thank you all - we had a long chat tonight, she's basically been avoiding thinking about it, but as it gets closer, she can't do that any more. She would also like to thank you all for going out of your way to help a complete stranger!

She's promised to tell her midwife team about her previous experience in detail, as she's starting to realise that at least if they know what it was like for her before, they are at least aware of her fears, and what went wrong last time. Part of the problem last time was poor care, and she recognises that, and does think that her new midwife team are better than her last, so that's encouraging.

She's been reticent to talk about it to other mums-to-be in her NCT group (second births), because she doesn't want to scare them (the "bad experiences" they shared paled into comparison against hers). She's also going to check out the forum suggested (and others, like mumsnet) - I think part of the problem is that she has never met anyone who had as horrific experience as she did, and she agrees that hearing positive stories about second births (as opposed to positive stories from first births) will be helpful.

The doula thing sounds like a great option, she had heard about it but didn't know much, I've got her in touch with another friend of mine who had one at both her births who can tell her a bit more about it. But the whole thing about being someone who's there to focus on her, and support her, knows the options, can explain what's going on, and can act as an advocate for her, sounds like something she'd really benefit from.
posted by finding.perdita at 4:55 PM on November 27, 2011 [1 favorite]