Women’s Health Today

Teresa Pitman writes about the influential role her mother and doctor played in helping her achieve normal births without the need for medical intervention.

What Dr. Joyce taught me

My dear friend Joyce Barrett died of cancer a few years ago. We had been friends for a long time, although when we first met she was just the new family doctor who had been recommended to me. I immediately loved her warmth and down-to-earth style, and it was into her hands that my next two children were born. Over the years, our doctor-patient relationship became a true friendship, and eventually we wrote a book together. By then, Joyce had stopped being a general practice doctor and was specializing in caring for women during pregnancy and birth—her true passion.

When I had my first baby (in 1977) I was lucky. I had been born in England: my mother had gone to a local birth center, where I was delivered by a midwife. Unlike most of her North American peers, my mother had no medication. She loved to tell me the story of her labor—how she walked around the garden paths with her own mother at her side—and the birth, where her mother supported one leg and a midwife supported the other as I was born. The midwife then laid me on my mother’s chest and when I headed straight for the nipple told my mother, “Well, she knows what she’s doing!”

So I went into pregnancy with that story in my mind. If my mother had given birth without drugs and found it a positive experience—one she liked to share with us—why couldn’t I? The doctor I was seeing at the time, however, had different ideas. He had his own method of managing labor, one that was popular with other doctors in our community at the time. I would be given a narcotic as soon as I arrived at the hospital and then an epidural as the time for the birth approached. He’d delivered lots of babies, so he knew this was the best way to do it. I hadn’t even given birth to one, so he felt I couldn’t possibly know what I was talking about.

Maybe I was inexperienced, but I knew I came from a long line of women—as we all have—who had given birth without narcotics and epidurals. I decided to find another doctor, one who was willing to support me in my plans. My 8 lb 15 oz baby boy was born at 42 weeks and two days gestation, into the hands of my new doctor. No narcotics, no epidural. He nursed right away.

The seven women who founded La Leche League were being pretty radical for their time when they wrote that “Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.” In the 1950s, most women were medicated during labor and birth and most had no memory of the experience afterwards. Over the next few decades, a revolution began to take shape. Women were asking for “natural childbirth.” They wanted to be aware and involved in labor and birth. They were concerned about the possible effects of labor medications on themselves and their babies. They started writing birth plans and hiring doulas. I was one of these women.

The doctor I had found who let me have my first baby without drugs moved away by the time I was pregnant the second time. My hunt for a new caregiver led me to Joyce. I had lucked out again. Joyce had a sign in her office that said, “Remember, I could be wrong.” She expected her patients to call her by her first name. And she believed that pregnancy and birth were normal, natural processes.

While that belief was the basis of her approach, Joyce also believed very strongly in the importance of high-quality research. When we wrote our book on pregnancy and birth, it was based on the Cochrane Reviews—carefully analyzed analyses of published research studies.

I’d read plenty of research before. But as we worked through the process, going through study after study, I was actually surprised to realize something that should have been obvious: every intervention has risks. All of them. Even an intervention that seems as simple as putting a mother on bed rest has risks for mother and baby.

… every intervention has risks. All of them.

Many things people do to “just to be on the safe side” (having a fetal monitor in place, for example) are actually making things more dangerous, not safer. The “safe side” when it comes to birth is the side with the fewest interventions.

Joyce pointed out to me as we reviewed study after study that anything that stresses the mother is a risk factor. I should have known that: I grew up on a farm, and it was very apparent that animals under stress slow down or stop their labors. I remember waiting much of the afternoon with my sisters for one of our horses to give birth, hanging around the stall as the mare moved restlessly and contractions tightened her belly. Finally my mother insisted we come in for a bite to eat. We hurriedly ate our supper then ran back to the barn, where the mare was already licking clean her newborn filly.

For some women, moving to the hospital is stressful. For others, staying at home would be. Having the right people with you matters too. When Joyce sat with me during my second labor, her calm and reassuring presence gave me confidence. As I struggled through the intense contractions of the transition stage, she said: “Hurts like hell, doesn’t it?” Yes, it did. Then she added, “But you can get through it.” She was right about that, too.

Knowing that interventions have risks doesn’t mean they should never be used. As an experienced doctor, Joyce had been at births where a Cesarean section saved the life of the baby or the mother, or where an epidural relieved pain that was beyond that which the mother could cope with. Her message was that we should always keep the risks and benefits in mind, so that interventions are not used without due consideration.

For example, if a mother is going to have an epidural, what can be put in place to help the baby get going with breastfeeding once it is born, since the epidural can affect his sucking abilities? If a mother has a Cesarean, who will be available to teach her how to breastfeed while protecting her incision? How will we respond to reduce the risks?

Joyce’s great gift to me—and to the thousands of other women she walked through labor with—was her confidence in a mother’s ability to give birth. Many of the young women I know today are afraid of birth. They know only that it’s painful and difficult and they expect to need medication to get through it.

Joyce would look puzzled if you told her you felt that way. She’d remind you of the generations of women in your ancestry who had birthed without medication or interventions beyond perhaps the encouragement of a midwife. She’d remind you of everything your body had already done for you in creating and growing a baby. She’d encourage you to give your body every possible chance to do its job of getting the baby out. And she’d promise to be with you throughout the process.

In labor, she’d encourage you to listen to your body for every signal, and she’d tell you about the research that shows how when women move freely in labor they naturally walk or sit or stand in ways that help the baby move into a better position for birth. She never coached you to push, but reminded you that the research showed women who began pushing only when they felt the urge were less likely to have tears in their perineum or babies with low oxygen levels.

Joyce retired from practice early. I’m glad she had those extra years with family and friends because in her late 60s she was diagnosed with cancer. Even as her health deteriorated, she still loved to talk about birth and babies and share information from the most current research.

I miss Joyce every day. She made a profound difference to me and to so many other women. I am so grateful to have had her as a friend, and to have been able to learn about birth from her.

Teresa Pitman mother of four and grandmother of eight lives in Canada and has been supporting mothers for more than 35 years with birth and breastfeeding. She is a prolific writer and popular speaker, much loved by all whose lives she touches.