They Saw It All

Dori Butler and Sheila Kitzinger
Issue 85, Winter 1997

"I'm nervous, Grandma," I heard my four-year-old son, Ben, whisper.

"Maybe you and I should go down to the playroom for a while," my mom suggested.

I never heard Ben's reply because I was suddenly riding the wave of another contraction. I gripped my husband's arm and concentrated on my cassette of Pachelbel's Canon with Sounds of the Ocean Surf. I was nearing the end of transition. The pain was intense, but I did not cry out. I breathed, and rocked my body in time with the music, and tried to visualize my cervix opening like a rosebud.

When it was over, Ben was still standing at the side of my bed. He stroked my arm and smiled shyly at me. I saw both excitement and apprehension in his smile. "Are you sure you want to be here?" I asked him.

He nodded eagerly.

My husband, Bob, stood on one side of him. My mother stood on the other. And my father stood in a corner with a video camera. I couldn't believe I was going through this with all of them.

I never imagined I'd allow my first-born child to witness the birth of my second child. I had always planned to include him, but what I had in mind was bringing him to my doctor/midwife appointments so he could hear the baby's heartbeat, letting him help unpack baby clothes and toys, even giving him a vote when we were choosing names -- Andrew for a boy, Elizabeth for a girl. But that wasn't enough.

Ben was so curious about babies and where they came from. We read books like How You Were Born and I prided myself on my ability to explain how the baby got into my uterus and how it would get out -- all with proper terminology. The only question that threw me for a loop was, "Can I cut the umbilical cord?"

I paused for a moment before I calmly explained that the umbilical cord is cut almost immediately after the baby is born, and since he wasn't going to be at the hospital ...

"Why can't I be at the hospital?" Ben interrupted, obviously upset. it had never occurred to him that he wouldn't be there.

I remembered what his birth had been like: 18 agonizing hours, pitocin, an IV, two epidurals, a vacuum extractor, and when that didn't work, forceps. I shuddered at the memories. This was not something a four year old should see.

But how could I tell him -- this child who massaged my swelling belly and told the baby inside everything from what color our dogs were to what kind of a day he'd had at preschool? He was so excited about this baby. I didn't want to put a damper on his enthusiasm by giving him something to worry about. Besides, I was worried enough for both of us.

I had done everything right when I was pregnant with Ben. I had eaten right, taken my vitamins, done my Kegel exercises, practiced m breathing and relaxation; but still, everything that could have gone wrong in birth did. And I was terrified this time would be the same.

That fear alone would have been enough for me to put my foot down and tell Ben he couldn't be in the birthing room if it weren't for one thing. I've seen a baby come into the world, other than Ben. And if things were different for us this time, I knew exactly what Ben would be missing.

My friend Janela had her second baby at home on what became the most incredible night of my life. It's one thing to go through childbirth, but it's quite another to stand on the sidelines and watch somebody else go through it. Janela's daughter Leandra was also there. I'll never forget how still she sat, her eyes glued to the baby emerging from her mother's body. And now, two years later, I see very little jealousy between Leandra and Irissa. They have a special bond that I've never witnessed between any other siblings.

I wanted that for Ben. I wanted him to experience childbirth the way his friend Leandra had. I wanted him to share a special bond with his sibling. And I wanted him to have the opportunity to cut our baby's umbilical cord if that was what he wanted to do.

I talked with my midwife about the possibility of Ben's being there for the birth. "It's not as uncommon for siblings to attend childbirth as it used to be," Melanie told me.

"But is childbirth really appropriate for a four year old to see?" I asked.

"It depends on the four year old. Some four year olds can handle it. Some eight year olds can't."

There were no long-range studies that looked at how observing childbirth affected older siblings. It came down to the individual child. Does this child really want to be there? Can this child handle it? Ben was very mature for his age; I was pretty sure he could handle it. The question was, could I?

Could I come to terms with all that had gone wrong during Ben's birth and put it behind me? Or would I be paralyzed with fear right up until the moment the baby was born? The only way Ben could be in the birthing room was if I could control my fear.

For the next few weeks, I submerged myself in natural childbirth books. I read about how gravity helped during labor, how the contractions were more effective if a laboring woman remained upright and walking, how squatting made pushing more comfortable. I had spent most of my first labor flat on my back, so I was convinced that being upright would make all the difference.

I also read about relaxation techniques and visualization. I taught myself to visualize my cervix opening, to imagine my baby moving down through my vagina, to envision a positive birth experience overall. I made tapes of my favorite music and practiced relaxing every muscle in my body.

I told myself all this mental preparation was for Ben, so that he could be in the birthing room. But maybe it was really for me, since I needed to have a more positive experience this time.

I still wasn't sure about having Ben there, but it was time to make some plans, just in case. We asked my parents if they would stay in the birthing room with Ben. We needed somebody to be in charge of him, somebody who could tend to his needs and take him out if he got upset.

I wasn't sure how they'd react, but my mom didn't seem at all shocked. in fact, she even seemed a little excited. "We can do that," she said.

A couple weeks before my due date, my midwife, Melanie, met with us at the hospital. She showed Ben around the room, explaining what he could touch and what he couldn't. She showed him a birthing doll and was impressed by his knowledge of the mechanics of childbirth. Then she showed him a video of an actual birth, and we talked about it afterward.

Everything was set. As my due date approached, I felt more confident than I had before Ben's birth, but I still didn't know if I could handle having Ben there. I was honest with him about that, telling him we'd just have to see how things went.

A week before my due date, I woke up with some cramping and bleeding. I told Ben that the baby would probably come today or tonight.

He swallowed hard. "I'm scared."

I took him in my arms. I wanted him to know that it was OK if he had changed his mind.

But he shook his head. "I'm not scared to see the baby!" he said. "I'm scared the baby is going to come in the night and that I won't be able to see it."

"If it comes during the night, we'll wake you up," I promised.

He sniffed. "OK."

As the morning wore on, the contractions got a little stronger, and the bleeding got a little heavier. I called my mom and told her this might be it.

We dropped Ben off at preschool and drove from there to the hospital to check things out. It was a warm, sunny day -- a beautiful day to have a baby. Things were going to be different this time, I was sure of it. I was going to have a natural birth. Ben was going to be there. And everything was going to be perfect.

But when we got to the hospital, reality set in. My blood pressure was up. "That means we're going to have to keep you lying on your left side," the nurse told me.

"Lying down!" I cried. "I can't lie down. I have to be up. I have to walk."

"I'm sorry," said the nurse as she gestured toward the bed.

This was exactly how Ben's birth had begun: high blood pressure. Next, they'd tell me my cervix wasn't dilating, so they'd wheel in the pitocin. That would make my contractions so unbearable I'd need an epidural. I'd probably end up with a cesarean. And Ben would never get to see the birth he wanted so badly to see.

"You know," Bob said, "it won't be the end of the world if Ben can't be here. He can come in as soon as the baby's born."

"I know," I said.

"Then let's take each contraction as it comes. Stop worrying about whether Ben will be here." I said I would try.

I handled the next contractions much better. I focused on my music and imagined my cervix opening. And for an hour I visualized a natural birth -- with Ben and my parents there.

When my midwife arrived to check my cervix, I held my breath. "Please don't let me still be at 3 centimeters," I prayed.

"You're about 8 centimeters dilated," said Melanie.

"Eight!" I cried. That was almost transition!

How had I gone from 3 to 8 so quickly? I felt a tremendous rush of power. I was in control. And this time I was going to have a natural birth.

"Call my parents!" I told Bob. "Tell them it's time to bring Ben!"

The contractions were coming hard and fast when my family arrived. I could hardly believe I was going to let them stay and see this. But as they trooped into the room, it felt so right to have them be present.

After a few minutes, I forgot they were even there. The contractions took every ounce of concentration I had.

"Breathe!" said Bob. "Come on, breathe!"

I was breathing! If he thought he could breathe better, he was welcome to get in the bed and try.

The contractions were coming one on top of another.

"Don't push!" said Melanie.

I couldn't stop myself from pushing.

"Blow it out. Short puffs!"

Puff! Puff! Puff! Oh God, it hurts!

"Focus!"

I can't!

"Breathe!"

I can't!

"Let me check you again," said Melanie. "OK you can push."

Music to my ears! I had to stay on m left side, but Melanie held my right leg, and with each contraction, I pushed against her with all the strength I could muster. Between contractions I settled back and tried to catch my breath.

The contractions didn't hurt as much now, not when I could push through the pain.

But I was getting tired. So tired. I couldn't push anymore. Melanie said something about some burning, but I didn't feel any burning. All I felt was exhaustion. I couldn't do this anymore.

"Your mom's working very hard," someone told Ben.

No, she's not, I thought. Not anymore. She's giving up. The baby can just stay... Argh! I was suddenly gripped with more pain than I'd ever felt in my life. It felt like my entire body was being turned inside out. But I gritted my teeth and pushed. I pushed until I felt an enormous pop between my legs. And then I heard cheering. The cheering brought me out of my daze and back into the hospital room.

"There's the head!"

"The head's out?" I asked.

I could tell by the look on Ben's face that the baby's head was indeed out. I'd never seen his eyes so wide. He knew there was a baby inside me, and he knew how it was going to come out, but I don't think he really grasped the concept until he saw it with his own eyes.

"The next push will be the shoulders."

Melanie turned the baby's head, while I pushed the shoulders out. It was almost over. I glanced around the room -- from Ben's wide-eyed amazement to my mother's quiet strength. Then there was my father, hidden behind the camcorder. I wondered what he was thinking. When my brother and I were born, fathers weren't even allowed in the birthing room. But here he was, videotaping the birth of his grandchild.

Finally, my gaze settled on Bob. He smiled. "You're doing great," he said as he kissed my forehead.

"OK," said Melanie. "Reach down and pull your baby out."

I grabbed my baby under the arms and felt him slide the rest of the way out. A boy. I had another beautiful little boy. I pulled him as close to me as the cord would allow.

He cried out. I shifted position so I could pull him closer.

Ben was at my side then. He reached over and lightly stroked our baby's cheek. "Hi, Andrew," he whispered.

The placenta slid out without my even noticing. And then it was over.

"Who's going to cut the umbilical cord?" asked Melanie.

"Let Ben," I said quickly. After all, that was why he was here.

His mouth dropped open. I could tell he wanted to, but he was a little nervous. "I don't know how," he said.

"I'll help you," said Bob, as he held the scissors out to Ben. Ben wiggled his fingers in. And ever so carefully, with his dad's hand closed over his, Ben cut his brother's umbilical cord.

The next hour was very peaceful. I didn't need any stitches, so Melanie and the nurse cleaned up quickly and left me alone with my family. This was how childbirth was supposed to be, I thought. A woman in control, basking in the warmth of her family. I had Ben to thank for that. If it hadn't been for him, only Bob would have been there with me. And I wouldn't have felt I had to maintain control for him.

A few days later, I asked Ben how he felt about having been in the birthing room. "I was worried about you," he said.

I was sad to hear that. That wasn't what I'd hoped he'd take away from this. "You know, you could have gone to the playroom if it was too scary."

"I know," he said. "But I didn't want to. I wanted to stay with you and make sure everything was OK."

"What if we have another baby?" I asked him. "Would you want to be at the hospital again, or would you rather go to a friend's house?"

I'd rather be at the hospital," he said right away.

"You would? Even though it was a little scary?"

He nodded. "Even though it was scary, seeing Andy come out made me feel bigger than I really was! " I smiled. Childbirth has a way of doing that to a person.

Telling Children the Birth Story

At age five, my grandson Sam was invited to witness the birth of his sister. My daughter Tess had decided on a homebirth, in a water pool. Sam made it clear that his place was right where the action was going to be. He would have felt rejected otherwise.

Sam was a fully informed little boy; in fact, he knew more about birth than many pregnant women do. He had seen his own birth photographs, and all his questions had been answered candidly. Recently, he had pressed the button on the slide projector as I spoke to one of the groups of midwives and doctors who regularly visit my house for workshops. He had heard Tess talk to them about her physical and emotional feelings at each phase of labor and his birth.

During Tess's pregnancy, my picture book, Being Born, was Sam's favorite during our quiet times together. He knew how the baby developed in the uterus and what it could do at each stage of pregnancy. Equally important, he had seen and held babies and knew that they couldn't play with him, though they could communicate with their gaze, their attention, and the sounds they made. He realized that they needed to be handled with consideration and gentleness. Sam was present at each prenatal examination, which took place in the familiar environment of home. He watched the midwife palpate Tess's uterus, heard the baby's heartbeat with the hand-held Doppler ultrasound, and felt the baby's movements.

Tess talked with Sam about her birth plan and suggested that he might make a birth plan, too, listing the things that were important to him. So, with help, he wrote carefully:

If Tess has to go to the hospital, I want to go, too. I want to take the birth photographs. I want to cut the cord. If she needs a caesarean operation, I want to see it. Tess can hold the baby first, then Sheila, then me.

When the great day came, Sam and his father, Jon, settled in the kitchen with felt-tips and paper, while Tess floated in the pool that had been set up in the sitting room. Sam wandered in and out, obviously aware that something momentous was happening but not anxious about it.

He was in the room as the baby was born, sharing his mother's excitement and anticipation as she pushed. Afterward, he sat on the rug by the log fire, cradling his baby sister tenderly in his arms. She looked up into his eyes, and he spoke softly to her. They were friends already.

Laura is now 14 months old, and Sam adores her. They romp together, and he is always gentle with her. As I watch them, I have come to realize that having a younger sibling is an important way of learning how to be sensitive to another human being, of creating a relationship in which, although power is not equally shared, there is understanding and fairness, in which the individual with more skills and strength learns to make concessions, to negotiate, to share, and to value the rewards that come from having a loving, trusting relationship.

Whether or not you have your children with you when you give birth is a very personal decision -- one that can only be made based on your understanding of their personalities, as well as how you feel about their presence and its effect on you. There are no rules, no formulas for success.

You may want to help a child see birth as a normal, natural part of family life, rather than a medical crisis. If so, you may decide to have a homebirth with midwife care. This is the primary reason some women choose to have a homebirth.

Or you may feel your older child is still too young to be separated from you while you go off to the hospital to have a baby. You may also see participation in birth as a vital educational experience for both girls and boys, one that most children are denied in our culture.

Whatever you think, children's preparation for birth should be about emotions and relationships as well as about anatomy and physiology. Fear of birth is often rooted in childhood experiences -- hearing it discussed as a taboo subject, in hushed, horrified tones, or overhearing tales of disaster, with phrases like "... the cord was around the baby's neck."

Though you cannot completely insulate children from this, you can explain, "The baby is tucked up in the bag of waters -- like a balloon filled with salty water. When this is not broken by someone who is trying to hurry the Labor, the cord nearly always floats in the water. Even after the waters have popped naturally, which they usually do just before the mother wants to push, the cord is like wet spaghetti, so it doesn't matter that it is often around the baby's neck. The baby is born sliding down through the loops of cord, or the person is helping can slip the cord over the baby, like lifting a necklace over its head."

The sounds of birth can be disturbing for children who are not prepared for them. Rehearse them ahead of time so that your child knows what to expect. Explain that these are noises of surprise, rather like when you shout "Oooo!" when you jump into cold water or a big wave splashes over you at the seashore, and they are noises of very hard work, as the mother presses the baby's head through an opening that is getting larger and larger, with all the tissues around it opening like a fan, or like a huge flower spreading its petals in the sun.

To tell the story of pregnancy and birth in a vivid way, you need to be confident in your own knowledge and completely honest. You also need to translate information into an idiom meaningful to a child of that age. In Being Born, for example, I wrote, "Once you were in a small, dark place inside mother's body, floating in a balloon of warm water. It was your mother's uterus. The the uterus were firm and springy. They were made of muscle -- like the muscles in your arm which get hard when you pull or push, and the muscles in your legs which get hard when you climb or run."

Describe everything in terms of the child's own experience, according to the old pedagogic principle "From the known to the unknown." When I wanted to communicate what the baby could do with its hand in utero and how that might feel to the baby, I wrote, "Your fingers reached out and felt water. Your fingers touched wet, shiny skin. Your face felt touch and your fingers felt it too. Then they slipped away again, into the water. Your fingers were the first things you played with. They moved like the fronds of a sea anemone in a rock pool. Then one day your fingers found your mouth and brushed your lips. You liked the feeling feeling and you began to suck your hand."

It is important to discuss feelings -- yours and the child's. "And now the mommy feels -- whoosh -- it's like a great wave coming, and it's very exciting -- I've got to push!" With children under four, be sensitive to doubts they may be expressing, ideas they may be testing even when they don't ask questions. One of my daughters was concerned about how the baby would get out but was too young to find the words to ask. One day, a tiny doll was missing from the children's dollhouse. I noticed that Tess was walking in great discomfort, as it she had something stuck between her legs, and I asked her what it was. She had pushed the doll inside her vagina -- and it hurt! She wanted to find out how the great big baby could get out of this tiny hole and if it would be incredibly painful Once we had inserted a little petroleum jelly and eased the doll out, I explained to her that juices in the mother's blood flowing through her body soften her skin and the inside of the hole so that it can spread out and open up wide and the baby can wriggle

Remember that after a child has asked how the baby comes out, he or she will want to know how the baby got in. Think ahead to how you are going to describe this simply and honestly. Be ready to tell die story of conception, pregnancy, and birth over and over again if necessary. A child enjoys repetition and is not likely to remember all the information at once. It is a process of fitting the story together like pieces of a jigsaw, finding odd bits that don't seem to fit, and building up the whole picture in a satisfying way. You can talk about cesarean and other kinds of births, and if the child shows interest, as many older ones may do, discuss doctors, hospitals, homebirths, midwives, and your beliefs about birth, explaining that other people have different ideas. This is an important preparation for exploring values and can help a child question, analyze, and develop critical faculties.

I believe that each child needs to be respected as an individual, to be listened to, and to play a positive role in preparing for and welcoming the baby.

Birthing Waltz

Two weeks late you were and too many pounds. Lucky for you, Aaron, when things got slow around midnight and the midwife said Try to keep going, But your mama said No, I can't anymore -- just let me rest; That your dad, who has never, ever danced with your mom, coaxed her up with a murmur, lifted the lovely weight of you both; And then, with her own tired toes cradled in his strong smooth feet, waltzed her in slow motion round that dusky room until you were ready to join the dance.

Breastfeeding Successes

The American Academy of Pediatrics recommends that infants be fed breastmilk during the first six to 12 months of age; the World Health Organization recommends two years. Everyone agrees that breastmilk is good for babies.

Researchers at the Centers of Disease Control and Prevention and the Food and Drug Administration concluded from a study of 2,000 families that formula-fed babies had an 80% increased risk of developing diarrhea, while ear-infection risk was 70% greater. A formula-fed infant living in poor social conditions in the United Kingdom has a ten times greater risk of gastrointestinal illness than a breastfed baby.

The UK Government Committee on Toxicity recently announced a 30% drop in dioxin levels throughout Europe. All the evidence to date demonstrates that breastfed babies are developmentally and neurologically healthier, and that breastfeeding can even counteract the neurological effects of contaminants transferred before birth. (Baby Milk Action, The Women's Environmental Network, May 14,1997; American Academy of Pediatrics www.pediatrics.org)

Sheila Kitzinger, a well-known author and social anthropologist, lectures internationally on childbirth and female sexuality. She is the mother of five daughters and is married to Uwe, who is currently a visiting scholar at Harvard University. She lives near Oxford, England. Sheila is very interested in ideas from Mothering readers, and look forward to hearing from you about what you believe and how you have handled these subjects with your own children. You can write to her care of Mothering.

For More Information

Books for Children Kitzinger, Sheila. Being Born. New York: Putnam, 1986.

Books for You Kitzinger, Sheila, with Vicky Bailey. Pregnancy Day by Day. New York: Knopf, 1990. Kitzinger, Sheila, with Celia Kitzinger. Tough Questions. Boston: Harvard Common Press, 1995.

Dori Butler is a freelance writer/book reviewer and stay-at-home mom to Ben (7) and Andy (3). She is the author of nine children's books and 24 magazine stories. She serves on the Iowa Children's Choice Award and the Iowa Teen Award book selection committees. She and her husband, Bob, have been married for 11 years.