Birth Grading Rubric

If you’ve ever been in school you probably have seen a grading rubric.  It is the list of things that must be included in your paper and how many points are possible to receive for each item. I’ve become quite fond of them, because they let me know exactly what the professor expects from me.

Today I was thinking about women’s reactions to their birth experiences.  More specifically, I was pondering over women’s disappointment and frustration with their birth experiences.  I thought about the words they use to describe their goals before labor and the words they use to explain their birth after. I’ve come to the conclusion that we all have our own unique birth grading rubric, but we don’t all know what to include on it.

For example, a common comment from a first time expectant mother is that she would like to have a natural birth.  Her plan is to keep a calm environment and stay home as long as possible.  She may even have a doula.  So from this, we see her birth grading rubric looks something like this:

  • Low lights
  • Play Music
  • Stay Home as long as possible
  • Doula present
  • Natural Birth

In reality, this may seem like all these things will give her a wonderful, beautiful birth experience.  But this is where it gets sketchy.  Lets say she stays home as long as possible and when she arrives at the hospital the nurse keeps insisting she needs to stay on the monitor and should order an epidural.  This will probably be frustrating to her, but she still will have met every criteria of her grading rubric.

We can go further, lets say she did stay home as long as possible but is at 5 cm when she gets to the hospital.  The on call physician breaks her bag of waters so she can progress, and since it is presented to her as a simple and non-pharmacological way to speed up labor, she still sees herself as meeting her criteria for a good birth.

But now the contractions are much more painful, and she isn’t coping well.  Her doula and labor support help her, but the experience is  nearly unbearable. And yet, she is still meeting all her criteria for a good birth. After her baby is born, when she reflects on the experience, she may be conflicted because she got everything she wanted, everything she said she needed to have a good birth; but she does not feel like the experience was good.

I hope you can see where this can go. The criteria by which you “grade” your own labor should really be reflective of the things that will make you feel good about your labor when it is over.  For some women this means the only criteria will be that they have a healthy baby and a healthy mom.  But for most women, I propose the following set of criteria:

  • I am respected during the process
  • I make decisions for my own health
  • I am given accurate and unbiased information to make those decisions
  • I am assisted in measures (natural or pharmacological) to be as comfortable as I need to cope with the work of labor
  • Every effort is made to allow those I choose to be with me

These are the things I have always tried to explain to the families I work with.  These are the things that really seem to make a difference in how a woman views her birth experience.  Even families who have used cesarean to give birth, though disappointed that they did not have a vaginal birth, do not walk away feeling manipulated or as if their birth had been stolen from them. Instead, cesarean surgery was a tool they used to help meet their goals when faced with a labor challenge.

Now this is where it gets difficult, because the truth about all these items is that you, as the laboring mother, are not really in control over them.  The best you can do is to select your care team as carefully as possible. Pay attention to the way your doctor or midwife treats you during prenatal appointments, are you respected, given accurate information and expected to make your own decisions? Tour your birth place before labor starts and really listen to the words being spoken.  Is this birth place prepared to support your decision making, do the nurses treat you with respect during a visit?

As you prepare to work with families, I encourage you to find ways to help families understand that usually things like how dim or bright the lights are do not compare to things like how respected and trusted the mother is.

Jennifer Vanderlaan (Author)