[Diary of an Expat Bride] The natural vs. cesarean debate (1)

My first battle was with my husband. I needed him to truly understand what natural birth was all about, so that he could support me and also be my “lawyer” in the hospital. He needed to fight with the staff if necessary to keep our birth plan on track, so that I could just focus on the birth. When we talked about it, Can seemed to understand and be in agreement with me. Just to make sure, and so that we could take another step towards enjoying our pregnancy together, Can and I enrolled in a “Birthing from Within” course given by Julia Steils, an American doula with a practice in Istanbul. A doula is a woman who assists the mother during labor. Can and I wanted to hire her, especially since my family would not be at the birth, and so that someone could be with me given Can’s erratic schedule as a pilot. I did not think that Can’s mother would be a beneficial addition to our birthing environment, given her nervousness and our conflict-fraught past. I preferred to hire someone instead, as sad as that may sound. At least I knew that a doula would help me stay on track with my birth plan and provide a calm face in the delivery room.

My next step was to talk to my doctor. Given my bleeding problems during the first trimester, I hadn’t really talked much about my birth with my doctor because I honestly thought I would end up losing the baby; why jump the gun and talk about giving birth? However, when I reached my sixth month mark, that voice of doubt began to quiet as I realized that this baby would, in fact, live. My doctor seemed supportive of my decision for a natural birth. But, upon further discussion, I realized that our views on what constituted a “natural” birth differed greatly. For him, and most doctors, a natural birth is considered a vaginal birth. This is not necessarily true. I could give a vaginal birth after having been induced with Oxytocin, aided by an epidural and cut open with an episiotomy, and this would all be considered a “natural” birth by most doctors. I informed my doctor that I didn’t want any of these medical interventions. He kind of laughed at me, and informed me that most patients come into his office so scared of birth that they beg for a C-section. This in part counts for the high cesarean rate in Istanbul’s private hospitals. I was a bit unique for my doctor, in that I was requesting to go through the pain of birth without and interference. In my opinion, the minute you get pregnant you have to accept that you will be in pain for childbirth, no matter which kind of birth you experience. Accepting and coming to terms with that pain are crucial.

I explained to my doctor that my traumatic pregnancy had already exposed both me and my baby to excessive ultrasounds, hormone shots and various other heavy medications. I really wanted to give both my body and my baby a chance to do what nature intended it to do. My doctor respected my opinion but disagreed with me on several of my points. He told me that he would, however, honor my wishes as long as my birth was going well. I wanted him to know how much I didn’t want a cesarean and that I viewed a C-section as a very last resort rather than an easy fix. I recommend all women to have this talk with their practitioners, the earlier in the pregnancy, the better. Many women are unpleasantly surprised to find that the doctor they loved for nine months has drastically different views when the birth actually happens. I truly liked my doctor and as difficult as this talk was for both of us, I felt that we at least knew where the other stood.

I next asked for the hospital’s birth protocol. These are the “rules” the hospital puts down that the doctors have to obey. My hospital, for example, said that a woman should deliver eight hours after her water breaks. If she passes the eight-hour mark, she should have a C-section. There were several other surprising rules, all of which I discussed at great length with my doctor. The good news is that in my hospital (and from what I hear, in many private hospitals in Turkey) the doctor can override hospital protocol in some cases. This is not the case in the US, where hospital policy overrides doctors. So I was even more relieved to be having this open discussion with my doctor. I didn’t want to feel stressed about time if both my baby and I were still in good health at the eight-hour mark but forced into a C-section because we had taken too much time.

Choosing to keep your options open for a natural birth in Turkey is quite a big step, for expats and Turkish women alike. Unfortunately the culture now supports cesareans and most people, and doctors you meet strongly support and recommend them. Should you choose to try for a truly natural birth free of medication, prepare well in advance by speaking to your partner, your doctor and your hospital well before your due date. Unfortunately learning who and what you are up against is critical. Natural births do happen and are possible in Turkey, so don’t lose heart. Check out the Natural Birth Turkey Yahoo group, which is a wealth of information and a support group of like-minded people who prefer the natural option. I also liked www.birthingfromwithin.com, which helped me view my upcoming birth as something beautiful. To learn about C-sections I particularly liked the International Cesarean Awareness Network’s website, www.ican-online.org. In my opinion, being informed about all the different ways of giving birth would help me relax as my due date drew closer. This was more important since I would be experiencing all of this as an expat outside of my own culture and language. I not only wanted to be informed, but made sure that Can was too, since as my husband he would be my primary champion when I would deliver. All the research that I accumulated I shared with him and we discussed, because he needed to be as prepared as I was for whatever birth we might have.