Helping a Woman Give Birth?

“One cannot actively help a woman give birth. The goal is to avoid disturbing her unnecessarily.”

– Michel Odent

I shared this quote on my Facebook page and it generated enough comments that I feel it is worthy of a blog post of its own! My original thought upon sharing the quote was this:

I’m not actually sure what I think of this quote–-isn’t it possible to actively help a woman to give birth?! I’m thinking of doulas, whose active support and hands-on loving care sometimes makes the difference between having a labor that “progresses” and one that results in a cesarean (because mother has been lying in bed hooked up to monitors—though, that would invalidate the second part about not disturbing her…)

It is true that no one can physically do it for her, but the “active” word confuses me, because I believe one can take an “active” role in a birth and that it is possible for that to NOT be a bad/disturbing role, but to be a sustaining role…

A commenter on the CfM page shared her excellent  interpretation: “I believe what Michel may be saying here is that no one can do the work of a woman’s body. We can support her emotionally/physically but we need try to avoid other disturbances such as medical interventions, speaking during contractions, a disruptive atmosphere, etc.” Perhaps I personally became too hung up on the word “active” and did not pay enough attention to the words “avoid disturbing,” which is really the crux of the matter. And another commenter added this: “No one can do the miraculous job of a woman’s body in labor when left to do what it’s going to do. That being said, I birthed with my midwife and my sister as my doula. No one touched me and I needed nothing other than an occasional, ‘you’re doing great.’ had I had anymore of a difficult labor I’m sure the supporters I had in place would’ve been as hands on as I needed them to be!

And, I really agreed with this point from another person who said: “Although this may be true about one woman or even most women, it shouldn’t be stated as such a generalization, because some women really DO need active help, whether it be emotional, spiritual, or physical.” This comment echoed my own thoughts. I do not actually have the context for his quote, so I’m not sure what he may have gone on to say after it, but I think it is awfully “rigid” in its own way (it is just the reverse of the type of rigidity that we so often see from medical providers!)

Personally, I’m a hands-off birther and have no interest in people “supporting” me actively (other than my husband) as well as wanting no one to talk to me during birth, but having heard some challenging birth stories lately where it really seemed like the women were being “undisturbed” when they really could have benefited from some hands on/active help, I am pondering lately the role of “help” in birth and when not-disturbing can become neglecting. I think it is possible to be so invested in one’s own dogma and philosophy about natural birth that we can continue sitting on our hands when more active assistance is useful. I’m not talking about emergency situations here—I have yet to meet a midwife who didn’t respond quickly and appropriately in an emergency—I’m talking about the “variations of normal.” The really long labors, the slightly malpositioned babies, the mothers who experience an extra level of pain above the seeming “norm,” the women who become exhausted and just need something else—it doesn’t necessarily need to be a medical intervention or something drastic, but it does need to be something from outside herself, because her own resources are tapped. I have heard two beautiful, strong, wonderful women’s stories of cesareans recently that have prompted these thoughts—the stories were eerily similar even though the women do not know each other, gave birth in different towns, and had different midwives. In both the stories the element that seemed like it was missing to me—and, yes, I know deeply and truly that “a million factors, seen and unseen” [Pam England] go into a woman’s unfolding experience of birth and that it is almost impossible to “deconstruct” the event with full accuracy postpartum—but what was missing to my ears, was that element of hands-on, semi-directive active support and suggestion making. There are a wide variety of “tricks” that can be tried rather than waiting until a mother is completely depleted and then moving to a transfer and a cesarean.

Maybe some of these tricks might seem too “hands on” for some and, yes, they are mildly, or even significantly interventive (I’m thinking here of all the little methods of turning a malpositioned baby, up to and including, manual rotation of the baby’s head—yes, this may be more hands-on and disturbing than we would like in an ideal world, but—duh—isn’t a cesarean even more so?!). Can a midwife be so attached to a specific mode of hands-off, knitting-in-the-corner-care that she neglects to step it up a notch and try some of those model-bridging techniques? While I deeply believe in the knitting-in-the-corner approach and that is all I feel I need with my own births and that is also what many women need, I also know from the power of story that some women do need an additional level of care—a “bridging” level. Something not as dramatic as a hospital intervention, but something more than, “some labors are long, keep going.” My thoughts about a bridge reminds me of a friend of mine who was able to be helped immediately postpartum with a pitocin injection rather than having to transfer to the hospital, while another friend—lacking anyone appropriately trained to call in—had to transfer. It also reminds me of my own experience being helped by a midwife six days following my third birth (second trimester miscarriage), after I discovered the placenta was still being held in my body via some membrane through my cervix. The only option the medical model was able to offer to me was to go to the ER for a D & C. However, a midwife (with whom I had no prior relationship, but who was called in by a midwife I do know) was able to gently twist it loose and remove it—yes, this was indeed “hands on” and a small intervention (as well as uncomfortable), but it was just the “bridge” between types of care that I desperately needed and for which I remain intensely grateful!

There can be a specific element of “smugness” within the natural birth community that has been gnawing at me for quite some time. A self-satisfied assumption that if you make all the “right choices” everything will go the “right way” and women who have disappointing or traumatic births must have somehow contributed to those outcomes. For example, I’m just now reading a book about natural mothering in which the author states regarding birth: “Just remember that you will never be given more than you can handle.” Oh, really? Perhaps this is an excellent reminder for some women, and indeed, at its very core it is the truth—basically coming out alive from any situation technically means you “handled it,” I suppose. But, the implicit or felt meaning of a statement like this is: have the right attitude and be confident and everything will work out dandily. Subtext: if you don’t get what you want/don’t feel like you “handled it” the way you could or “should” have, it is your own damn fault. How does a phrase like that feel to a woman who has made all the “right choices” and tried valiantly to “handle” what was being thrown at her by a challenging birth and still ended up crushed and scarred? Yes, she’s still here. She “handled it.” But, remarks like that seem hopelessly naive and even insulting to a woman whose spirit, or heart, has been broken. By birth. Not by some evil, medical patriarchy holding her down, but by her own body and her own lived experience of trying to give birth vaginally to her child.

Of course, even as I’m having all these thoughts, I read a very disturbing story about a “power birth” experience in which the mother experienced very violating hands-on care involving an intense and violent amount of manual cervical dilation from a homebirth midwife. Maybe the midwife’s perspective was that she was providing the bridge I speak of, but that was NOT what the mother experienced.

And, then this afternoon I read a very thought-provoking post about birth rights, in which the author makes the point that, “Actually the natural birth paradigm, and its paraprofessions, are patriarchal. ‘Empowering women’ is by definition patriarchal because there is an assumption she isn’t already empowered.” There is a reason I chose “Celebrating Women” as my tagline/motto rather than “Empowering Women” and that is because I share the sentiment—I believe birth is an empowering event in women’s lives, but that outside people can’t do the “empowering” for her. I believe education and information are empowering also—when the woman seeks it out and integrates the information into her own being and her own “right way.” However, what I want to do is celebrate women—because they are already super awesome cool and worthy of celebration just as they are 🙂 The blog author also points out something interesting: “A childbearing woman’s locus of control firmly placed, by mommy-businesses, outside of the woman herself, and into the hands of western medicine model, or the natural birth model. There is a paradox in both paradigms. And our women suffer. And our girls need a future.”

When we replace medical experts with “natural” experts, the result is the same—the woman herself is not the power source and she tends to credit other people (or methods) with her own “success” (or with her own feelings, period).

However, the blog post also states: “I can say this: if I am lucky enough to be alive when my daughter, Miles, pees on the stick, I will go with her to the abortion clinic, to the elective c-section, to the pump-station, to the OB, to the midwife, to the hospital, to the shrink for meds, to the ends of the earth without judging her, without comment, without interference, but with witnessing energy of my ancestors, of all the women who faced the dilemma of life and death the moment they realize the full scope of reproductivity. That, is her birth right.” I do not actually agree that without comment is the best approach, because women are very powerfully influenced by a variety of forces around them. If natural birth proponents keep their mouths shut or act like all choices are “equal” choices, then that is actually withholding information from women and denying her the opportunity for fully realized decision making based on her own heart and her own needs. (I wrote some more about this theme—why birth activists should not stop sharing their stories—in a post a couple of months ago: Conclusions About Listening.)

I know I’ve meandered through several ideas in this post and maybe I’ve come around to a different point or subject than I initially began with, but these are the kinds of things that are on my mind during my “free time” this holiday season! I want to close tonight with a relevant, integrating quote from Elizabeth Noble in her Childbirth with Insight book:

“Birth is always the same, yet it is always different. Like a sunset, the mystery is also the appeal to those who get up in the middle of the night to attend laboring women. While the sequence of birth is simple, the nature of the experience is complex and unique to each individual. No matter how much any of us may know about birth, we know nothing about a particular labor and birth until it occurs.” (emphasis mine)

And, I would add, even after the birth maybe we don’t know as much about it as we think we do. Truly, in the end, each birth remains a unique mystery. A journey of its own. And, women have the right to define their own experiences in their own ways.

15 thoughts on “Helping a Woman Give Birth?

  1. My sister was one who had a very hands-off midwife and said afterwards that she felt like she could have used some more guidance and direction. Perhaps this was something they could have worked out prenatally, but my sister said that during labor, the midwife would just say things like, “Your body knows what it’s doing,” and my sister felt like that wasn’t the case… or that even if her *body* knew what it was doing, that she herself, her mind, her spirit, her intellect, needed more verbal (or physical) guidance and encouragement. Her labor “stalled” at 6 cm for 9 hours, and then transferred to the hospital because the mw couldn’t break the water bag because the baby’s head was too high and she was afraid of cord prolapse at home. Of course, there are no do-overs, but perhaps if the midwife had taken a more active role earlier, she could have avoided a transfer. As it was, when my sister arrived at the hospital (20-minute drive), she was 8 cm dilated — perhaps she was able to relax more, knowing that *something* was happening?

  2. I love this post! The word “naive” really struck a chord with me. I hadn’t been able to put a finger exactly on the nagging emotion that I feel when I read a lot of writing about anti-intervention in birth, but I now realize that I most certainly view the rigid belief that ‘intervention is unnecessary’ as very naive. I think that (like everything in life) until you’ve experienced a birth that requires intervention, it’s easy to trivialize it’s worth, and there is a naivete in that perspective. I don’t mean this in an insulting way. I was definitely naive regarding intervention until I required it during two births and now, of course, I have a totally different perspective about it.

    Thanks for posting these thoughts. I found a lot of comfort in your words.

  3. Thank you for this interesting post! I attended my first birth as a doula last week. I remember keeping very quiet during her contractions because that I what I preferred when I was in labor. However, this mother wanted lots of talking and reassurance during contractions. Thankfully, she was able to ask for what she needed from us and we could adapt to best support her. But it was a good lesson for me — don’t assume that what worked best for me is what will work best for other laboring women.

  4. Love this post! Especially this

    “Birth is always the same, yet it is always different. Like a sunset, the mystery is also the appeal to those who get up in the middle of the night to attend laboring women. While the sequence of birth is simple, the nature of the experience is complex and unique to each individual. No matter how much any of us may know about birth, we know nothing about a particular labor and birth until it occurs.” (emphasis mine)

    I think that is so true. Each birth is so different and each is magical in its own way.

  5. Unless he has recently changed his mind, Michele Odent has always been opposed to supportive care, for example, doulas. This was his model back from the days of his French clinic. He believes women should labor in a peaceful environment with caregiver close by but not disturbing the woman in any way. In fact, he is on the record as opposed to the presence of the woman’s partner because he views male partners, at least, as drawing her out of her internal preoccupation with her labor.

    I think the quote that generated your blog post may have morphed from an older version of a statement of Odent’s that itself was a paraphrase of a quote from David Stewart in *The 5 Standards of Safe Childbearing*. The original was: “When nature does work, it cannot be improved. Technology does not enhance a natural process that is working. It can only mar or destroy it” (p. 71). This, as you can see, has quite a different meaning.

    That being said, I agree with all the issues you raise and have spent more than a little time mulling them over myself. I think the way out of the thicket is the optimality concept developed by ACNM as a research tool, but, in my opinion, even more useful conceptually. In brief, optimal care is care that produces the best outcomes with the least use of intervention given the individual case.

  6. I really think the trick to helping women is knowing when to do something and when not to do something. It’s something of an art. I’ve thought a lot about this as I’ve provided labor support and nursing care for women. Some women seem to need more from me than others. I think it comes down to not sticking by any rigid rules but really talking with the mom and watching her to see what might be best.

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  9. I completely agree with Rachel’s comment. Birth support is best when practiced from the heart and intuition, while also having a “bag of tricks” to draw from when needed. It’s much like being a mother…knowing when it’s time to step back and when it is time to provide some support and guidance, but loving this other human being all the time with no judgement. I feel strongly that if I had been given just a little more support (emotional and physical) during my labor it would not have ended up as a cesarean birth. Thank you for your insight.

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