Lessons from a "Bad Birth"

And why psychological safety matters during childbirth

Several years ago, I had a difficult shift as a midwife. I was up all night with a mom whose long (and yes, medically necessary) induction of labor was finally coming to a close. She’d made it to the pushing phase, but we were racing against the clock because baby’s heart tones were increasingly concerning. We were struggling mightily to get this baby out (admittedly, her more than I). But as an experienced midwife, I have a few tricks up my sleeve. We tried everything: birth balls, hands and knees, side-lying. We were close—I could literally see the baby’s head. But we weren’t close enough.

I had been working closely all night with an attending obstetrician I deeply respected (may he rest in peace). He was a guy I loved working with because he was similarly dedicated to helping patients avoid unnecessary C-sections. If you don’t know me, you should understand that this is a big passion of mine. I think the United States C-section rate of 32% is too high; that there are many, many avoidable C-sections done every year in the U.S., and that this is in part because women don’t get the support they need during childbirth. I’ve even written on this topic for Stat News and Scientific American.

But this case was different. At a certain point, it did not feel safe to continue with pushing, so the obstetrician and I recommended a C-section for fetal intolerance of labor, which the mom accepted. Most C-sections are not emergencies. There is usually plenty of time to talk to the patient, introduce her to the care team taking over, and prep her for what’s to come. But with this birth, everything suddenly felt rushed.

As a midwife, I don’t always go back to the operating room (OR). Some certified nurse-midwives (CNMs) have additional training as surgical first assists for C-sections, but since I’ve always worked at hospitals with obstetrician residents, I was never needed in this capacity.

But in this case, the mom didn’t speak much English and she didn’t have a support person with her. We were in a rush because of the baby’s heart tones, and it was the middle of the night, which often makes finding a translator harder. So I went back to the OR to help out. I pulled up a chair and sat with her during the surgery. Within a few minutes I was relieved to hear a loud, lusty cry. Baby was out, and he was okay. I breathed a sigh of relief. The rest of the surgery proceeded normally.

But when I left the hospital that morning, ready to meet my bed, I was still reeling about this “bad birth.” I was playing out other scenarios in my head, wondering what I could have done differently. I was feeling bad about the last bit, where we’d rushed her to the OR and a swarm of people—from anesthesiology, neonatology, nursing—had surrounded her. I was thinking about how scary and overwhelming that must have been for her. I was wondering if she felt traumatized, and I was worrying that she must hate me and everyone else involved with her “bad birth.”

Fast forward a few weeks to her postpartum appointment. When I saw her on my schedule ahead of time, I felt a sense of dread. I was nervous to meet her again face to face. Postpartum visits usually involve a bit of reliving the birth and this was not a birth I was eager to replay.

But when I entered the room, I was met with a happy, satisfied mom: very much in love with her son, a little sore but recovering well and not blaming me at all. In fact, much to my surprise, she didn’t seem to view it as a “bad birth” at all! To the contrary, she shared that she felt very cared for during the process, that she understood the C-section was necessary, and that she appreciated everyone’s role in helping her son be born healthy.

After that, she asked if I was Christian, which is not a question I get too often in the exam room. I must have looked confused. “It’s just that, you seem like a really good person, and I want to know if you will be my son’s godmother.” I thought my Spanish was failing me, so I asked her to repeat the question a few times. Finally, it sank in. This person didn’t hate me. This person appreciated my support so much that she wanted to keep me in her life.

She saw something in me that I had forgotten was important. At the end of the day, I do care about whether my patients have a C-section or a vaginal birth. But I care about them more. It matters how they feel held during what is one of the most vulnerable moments of their lives.

I recently listened to a podcast from the Maternal Stress Project where Molly Dickens interviewed the author of one of my favorite books, Invisible Labor: The Untold Story of the Cesarean Section by Rachel Somerstein.

In the podcast, these two talk about the importance of psychological safety during pregnancy and childbirth, and how dismissive attitudes toward women's pain and concerns can lead to lasting psychological trauma. It got me thinking about this “bad birth” and why it might not have been so bad after all.

Birth is never just clinical. It’s cultural, emotional, and relational. These factors affect the outcome psychologically and there’s some pretty good evidence they affect clinical outcomes too. And a “good birth” can mean different things to different people. Which is honestly, kind of a relief!

Because the truth is, I don’t have the ability to promise anyone a perfect birth. I can’t control which risk factors a person brings to pregnancy, or which randomly occurring diseases or conditions pop up. Even using the best scientific evidence available, I can’t know with certainty what impact my intervention or non-intervention will have during any given pregnancy, labor, or birth.

But I do have a lot of control over whether people feel safe and supported during the process. For those of us who live and breathe birth, it’s important to remember that what is just another work shift to us can become a defining memory for a mom—an experience etched on her soul as she begins the parenting journey.

So, the end of the story is that I said yes! Here’s a photo of me and my godson (posted with permission) from his first birthday party, hence the snazzy suit and blue frosting on his face!