Recently I finished reading (and reviewing) the new book Our Bodies, Ourselves: Pregnancy & Birth. In the opening chapter, they identify a concept that I have *felt* for some time, but hadn’t really put a finger on. The authors refer to it as a “climate of confidence” and a “climate of doubt.” I love this way of articulating the messages swirling around pregnant women in our society.
A Climate of Doubt comes from “The media’s preference for portraying emergency situations, and doctors saving babies, sends a message that birth is fraught with danger. Other factors, including the way doctors are trained, financial incentives in the health care system, and a rushed, risk-averse society, also contribute to the popular perception that childbirth is an unbearably painful, risky process to be ‘managed’ in a hospital with the use of many tests, drugs, and procedures. In such an environment, the high-tech medical care that is essential for a small proportion of mothers and babies has become the norm for almost everyone…[a] ‘climate of doubt’ that increases women’s anxiety and fear.”
A Climate of Confidence “reinforces women’s strengths and abilities and minimizes fear. Some of the factors that nourish a climate of confidence include high-quality prenatal care; healthy food and time to rest and exercise; a safe work and home environment; childbearing leave; clear, accurate information about pregnancy and birth; encouragement, love and support from those close to you; and skilled and compassionate health care providers.”
——-
I encourage my birth class clients to consider ways in which they can create a climate of confidence in their lives as they prepare for their births and their babies.
I’ve got a whole collection of thoughts rolling around and wanting to be shared! Tonight is my teaching night, however, so I have to boil it down.
First of all, I’m 20 weeks pregnant already! I can hardly believe it, though I also feel as if I’ve been pregnant for a “long time” too. I remain in a state of being both constantly aware of being pregnant and constantly in something like disbelief or “denial.” I feel surprised when I see myself in the mirror and in my head I still feel distanced from the idea of being pregnant and the identity of Pregnant Woman. It still feels somehow “far away,” like that chapter of my life is still closed for me mentally.
This picture was taken at the St. Louis Renaissance Festival on Sunday, one day before 20 weeks. I wasn’t sure my pretty Holy Clothing dress would actually still fit, but it did!
One of the reasons I decided to hire a midwife for this pregnancy was because I feel like I need to bring it back into the front of my mind and to give time and attention to this experience. I need some time to focus on being pregnant and on my new baby and have interaction with someone who cares about exactly that. I need someone to pay attention to me as Pregnant Woman and to care about me in that way that midwives do so well.
(Yes, I do still have Alaina’s Ergo, but apparently I think maybe each baby needs its own new baby carrier!)
With regard to Pregnant Woman, I took the leap and signed up for the online Sacred Pregnancy retreat training in August. I’ve thought about it several times and now feels like the right time for me—I hope to benefit from it both personally and professionally.
Signing up for this training represents another moment of Leonie Dawson‘s #AmazingYear workbook 100 Things list, ftw. I had it on my list as a tentative, but it has now become a reality.
Speaking of the Amazing Year workbook, I’m gearing up to give two presentations at the La Leche League of Missouri Conference coming up this week. I’m doing a session on the amazing year and my first continuing education eligible session on active birth/pelvic mobility. I’ve been working hard on preparing for both sessions as well as getting all of our booth stuff ready, since we’ll be having a Brigid’s Grove booth at the conference too. (Mark will be working at it while I attend sessions.) My LLL Group also has a sales table in the boutique for which I am providing most of the items and we also got silent auction donations ready over the weekend.
Back to the Renaissance Festival where some dear friends were working as pirates, I received this lovely surprise birthday gift.
Speaking of the Red Tent, I enjoyed watching this video again today and thinking about my plans and wishes for this event:
And, surfacing from celebration and shifting to the pain women experience as part of the childbearing year, I appreciated two powerful articles this morning. The first was about a backlash to the backlash with regard to traumatic birth:
If we want to reduce the prevalence of traumatic birth experiences, we’re going to have to confront some common expectations, narratives, and perceptions around childbirth to help shape women’s beliefs and emotionally prepare them for the realities of childbirth. Childbirth is often glamorized as a spiritual journey, but physically, it is called labor for a reason. Sure, it can be a transcendent experience for many women, but it can also be a challenging ordeal involving blood, sweat, and tears, among other bodily fluids. Without adding any other stressful or complicating circumstances, childbirth already has all the necessary ingredients to be bewildering, frightening, and emotionally exhausting. And yet, because of the subjective nature of experience, two mothers can have the same events happen during birth, and one can emerge merely rattled while the other emerges with PTSD.
A good place to start with recalibrating beliefs and expectations of childbirth is with the image of an ideal birth with little pain, no complications or medical interventions, dim lights, and soft music. It’s a lovely and inspiring conception of birth, but we should also acknowledge that absolute perfection is rarely a reality. Most births don’t have complications but some do, and it is unfortunate when women feel they or their births are failures for failing to meet their preconceived notions of success. Women should strive for a birth that is manageable and meaningful, but without a sense of entitlement that it must be fast, painless, and stoic. Holding unrealistic expectations of childbirth can set women up for disappointment…
(Just a note that the conclusion of this otherwise powerful piece felt a little forced and a little too close to “at least you have a healthy baby” for my taste.)
And, then there was this essay about a cesarean picture on Facebook that was reported as “violent”:
This is motherhood. Raw and uncut. Refuse to be silent, show up and stand out, rip off the covers and be seen. This is the motherhood behind closed doors. This is the warriors path and these women are foot soldiers on the battlefield to make miracles and bring fragile lives onto this Earthen soil. Don’t let anyone tell you your birth wasn’t beautiful, that that your moment of utter transcendence wasn’t real. Never believe for a moment that you, too, did not emerge a butterfly…
The cesarean post reminded me of some of my own previous posts about Cesarean Courage. And, the piece about recalibrating childbirth reminded me of these two articles, the first about the strength found in our most shadowy “what’s ifs” and darkest places:
I’ve also come to realize that despite the many amazing and wonderful, profound and magical things about birth, the experience of giving birth is very likely to take some kind of toll on a woman—whether her body, mind, or emotions. There is usually some type of “price” to be paid for each and every birth and sometimes the price is very high. This is, I guess, what qualifies, birth as such an intense, initiatory rite for women. It is most definitely a transformative event and transformation does not usually come without some degree of challenge. Something to be triumphed over or overcome, but something that also leaves permanent marks. Sometimes those marks are literal and sometimes they are emotional and sometimes they are truly beautiful, but we all earn some of them, somewhere along the line. And, I also think that by glossing over the marks, the figurative or literal scars birth can leave on us, and talking about only the positive side we can deny or hide the full impact of our journeys. What if it was okay to share our scars with each other? Not in a fear-mongering or “horror story” manner, but in honesty, depth, and truth—what if we let other women see the full range of our courage?
And, the second about the many possibilities for birth regret:
I’ve come to realize that just as each woman has moments of triumph in birth, almost every woman, even those with the most blissful birth stories to share, have birth regrets of some kind of another. And, we may often look at subsequent births as an opportunity to “fix” whatever it was that went “wrong” with the birth that came before it. While it may seem to some that most mother swap “horror stories” more often than tales of exhilaration, I’ve noticed that those who are particularly passionate about birth, may withhold or hurry past their own birth regret moments, perhaps out of a desire not to tarnish the blissful birth image, a desire not to lose crunchy points, or a desire not to contribute to the climate of doubt already potently swirling around pregnant women…
Last night, I enjoyed looking at photos from a very interesting art exhibit called Mama that explores birth as a creative process…
The artist has a beautiful etsy shop as well in which she sells her “mamamore” sculptures:
I’m currently looking into ways to reproduce some of my own sculptures, so that I can make them more readily available to women without burning myself out in the process. Here is a photo of a recent batch that mostly headed to Canada for a shop there, with a few extras that went on etsy (and a few are prototypes for possible casting in resin).
May we celebrate pregnancy, birth, and motherhood in all of its unfolding mystery—both the power and the pain.
As Americans, we are under the impression that new moms are ‘Superwomen’ & can return to life as it was before baby. We must remember to celebrate this new mother and emulate the other cultures that honor new mothers by caring for them, supporting them, & placing value on the magnificent transformation she is going through. This is the greatest gift we can give to new mothers & newborns…–Darla Burns (via Tuesday Tidbits: Postpartum Mothering)
“The first few months after a baby comes can be a lot like floating in a jar of honey—very sweet and golden, but very sticky too.” –American College of Nurse-Midwives
The United States are not known for their postpartum care practices. Many women are left caught completely off guard by the postpartum recovery experience and dogged by the nagging self-expectation to do and be it all and that to be a “good mother” means bouncing back, not needing help, and loving every minute of it.
This country is one of the only utterly lacking in a culture of postpartum care. Some version of the lie-in is still prevalent all over Asia, Africa, the Middle East, and particular parts of Europe; in these places, where women have found the postpartum regimens of their own mothers and grandmothers slightly outdated, they’ve revised them. The U.S. seems only to understand pregnancy as a distinct and fragile state. For the expectant, we issue reams of proscriptions—more than can reasonably be followed. We tell them what to eat and what not to eat. We ask that they visit the doctor regularly and that they not do any strenuous activity. We give them our seats on the bus. Finally, once they’ve actually undergone the physical trauma of it, their bodies thoroughly depleted, we beckon them most immediately to rejoin the rest of us. One New York mother summed up her recent postpartum experience this way: “You’re not hemorrhaging? OK, peace, see you later…”
…“A culturally accepted postpartum period sends a powerful message that’s not being sent in this country,” said Dr. Margaret Howard, the director of the Day Hospital for Postpartum Depression in Providence, Rhode Island. “American mothers internalize the prevailing attitude—‘I should be able to handle this myself; women have babies every day’—and if they’re not up and functioning, they feel like there’s something wrong with them.”
Via First the Egg, I then read this powerful reflection prompted by the article above:
In the piece, one woman mentions that women are literally still bleeding, long after they’re expected to “bounce back” and reclaim their old lives and be totally self-sufficient. Our bodies haven’t finished healing, and we’re supposed to look and act as though nothing even happened here, it’s all good. It’s all just the same as it was.
Secretly, I’ve been the slightest bit ashamed of all the help I’ve needed.
I also read this raw, honest, and touching look at the “betrayal” experienced by women who enter into the mystery of birth expecting a blissed out, earth mother, orgasmic birth experience:
…But inside my head, I could not believe what was happening. How painful it was. How terrifying. I felt helpless. And degraded and humiliated by there being witnesses. And at the same time, I felt so, so alone. I remember at one point saying, completely out of my mind, “I don’t understand why no one is doing anything to help me! Please help me!” Della reminded me that what I was feeling was the baby coming. That I was doing just what I was supposed to, having the baby, right then….
And, that made me think of my own thoughts about birth regret and how we may hide it from the pregnant woman we perceive as vulnerable in her beautiful, fleeting state as Pregnant Woman:
I’ve come to realize that just as each woman has moments of triumph in birth, almost every woman, even those with the most blissful birth stories to share, have birth regrets of some kind of another. And, we may often look at subsequent births as an opportunity to “fix” whatever it was that went “wrong” with the birth that came before it. While it may seem to some that most mother swap “horror stories” more often than tales of exhilaration, I’ve noticed that those who are particularly passionate about birth, may withhold or hurry past their own birth regret moments, perhaps out of a desire not to tarnish the blissful birth image, a desire not to lose crunchy points, or a desire not to contribute to the climate of doubt already potently swirling around pregnant women…
May all pregnant women and tender postpartum mamas dance in a circle of women!
I’d hoped to have time to post a festival recap and some lessons learned, but other responsibilities take precedence at least for today, so I’ll leave you with one of the pictures my sister-in-law took on a misty morning, sunrise stroll around the lake and another that I took in the Temple at the festival:
“I usually talk in my classes about how ‘this’ is the only chance you’re going to get to birth this baby. Sure you may go on to have other babies, but you only get *THIS* chance to birth *THIS* baby. I also share with moms that because of this fact, the significance of this birth is infinitely greater than the significance of this birth is to your nurse, OB, midwife, etc.” – Louise Delaney
As I was writing my post last week about “bragging rights” in birth, I was also considering the role of birth regret. I’ve come to realize that just as each woman has moments of triumph in birth, almost every woman, even those with the most blissful birth stories to share, have birth regrets of some kind of another. And, we may often look at subsequent births as an opportunity to “fix” whatever it was that went “wrong” with the birth that came before it. While it may seem to some that most mother swap “horror stories” more often than tales of exhilaration, I’ve noticed that those who are particularly passionate about birth, may withhold or hurry past their own birth regret moments, perhaps out of a desire not to tarnish the blissful birth image, a desire not to lose crunchy points, or a desire not to contribute to the climate of doubt already potently swirling around pregnant women. I’ve already acknowledged all of my own moments of birth regret, but never all in the same post…so, here they are…
First birth: This birth was great and very empowering, but I also learned a lot of things I’d like to do differently the next time. Maybe “regret” is too strong a word, but there were things I definitely knew I wanted to change for next time. I regretted feeling pushed into several things I wouldn’t have chosen on my own, such as giving birth in a semi-sitting position rather than on hands and knees. I wished I hadn’t had quite so many people around me at the birth and I wished I would have just stayed home, rather than driving to a birth center. I regretting not asking to squat after the placenta to help the “sequestered clots” come out and possibly avoid the manual extraction I experienced which was pretty awful (I swear my uterus actually twinges when writing/thinking about it). I regretted having a pitocin shot after the birth, because I still don’t think I actually needed it and it bothered me for a long time that I couldn’t figure out whether or not I’d really needed it. I was also pretty physically and emotionally traumatized by the labial/clitoral tearing I experienced and desperately wanted to fix that next time! Interestingly, most of these regrets were clearly connected to other people and to events in the immediate postpartum period, rather than anything to do with the labor or birth process itself.
Second birth: With this birth, I see very clearly how I deliberately made choices to “fix” the things that nagged at me from my first birth. I gave birth at home, I had very few people present, I gave birth on hands and knees. I was extremely distraught to tear again in the same unfortunate and traumatic way. I’d been totally convinced before the birth that it was all related to positioning and I could fix it, next time. I regretted getting up and showering, etc. so soon after the birth and I wished for more postpartum care (noticing a theme here…). I wished I hadn’t almost fainted several times and still recall the feeling of my head snapping back as I almost went under. That said, I felt the proudest and most exhilarated after this birth.
Third birth: Aside from the obvious of wishing my baby had been born alive, I “fixed” some things from prior births in that I stayed down after the birth to keep myself from fainting. I regretted drinking Emergen-C after the birth. I regretted not being better informed about coping physically with a miscarriage. And, I wished I’d been better able to assess blood loss. I also wished I’d had an attendant of some kind, particularly for immediate postpartum care. I still feel traumatized from the memory of what felt like extreme blood loss during this birth. This was the most physically demanding experience of my life. Not just my birth life, my whole life.
Fourth birth: My biggest regret from this birth was having tried to use a hypnosis for birth program while in labor. I feel as if there were some pre-birth benefits from using the program, but it was not a match for the way I labor and birth and I actually feel as if using it had a negative impact both on my ability to clearly remember and to focus my energy. I did still tear in the same place and in what seems like some new ways as well. I never want to tear like that again. I hate it. I’ve reached my physical and emotional limit with experiencing that type of tearing and I feel like I still have some negative lasting effects. I also think I had some nerve damage that continued until about six months ago. What I “fixed” this time was having a living baby and rediscovering that I could in fact do this and there was nothing wrong with me. I loved that I caught my own baby. (Best. Moment. Ever.) I also had the immediate postpartum care I’ve finally learned I really, really need. I consumed a small piece of placenta postpartum, I drank chlorophyll (and not vitamin C), when I went to the bathroom and did not look down, so I didn’t get all fainty and woozy from seeing the blood, and my doula encapsulated the placenta and I loved it.
It is interesting to me to look at these feelings and situations in the same place. With my last birth, I finally “fixed” the postpartum and blood loss issues that haunted me, but I created new things to fix by experimenting with hypnosis rather than the active birth, birth warrior, Birthing from Within type of experience that truly suits me. I guess I will never fix the tearing situation (I still want to write about that someday!). I also notice how impacted I was and still am by the two births that involved major blood loss. This came up for me very viscerally in reading the current Midwifery Today issue about hemorrhage. While the topic is important and the issue is really informative and useful, I actually had to put it down by page nine because my uterus was hurting/twinging so much (low back too). I really don’t think it was only my imagination either. (This is one reason my work with birth is never going to actually include becoming a midwife!)
I’m curious to know…do you have birth regrets? Or, things that you used subsequent births to fix, overcome, or cope with? Do you see any patterns to your birth experiences like I see in mine?
The other thing this exercise brought up for me is the important of preparing for the birth you want during this birth. This baby is only born once. This birth only happens once. I have clients tell me sometimes while still pregnant with their first baby, “well, next time, I’ll try XYZ…” Don’t wait for next time, do it this time!
The first birth is the pivotal birth. Every birth experience that follows builds on that one. Our choices now are choices for the NEXT birth. The first birth doesn’t have to be either perfect or awful and earth shattering to make us think. We don’t have to choose differently than the first birth; but it’s the first one that gives us a place to begin experiencing not just birth but ourselves as mothers, women, people. We may not all have ground shaking, earth thundering thoughts but we have them. The experience belongs to us. We choose what to do with it. Choosing to do nothing different is still an influenced choice ~ made on that experience…
…What will YOU do to have a first birth that leaves you with few regrets or changes for your NEXT birth? Why not have the birth of your choosing, rooted in truth and your ability to know yourself and your baby now?…
These types of triumphs and regrets produce both birth professionals dedicated to helping others and also mothers who become so hurt and disillusioned with birth that they may actively reject the “natural birth” movement.
I read this poem in an anthology of women’s prayers, blessings, and readings and it spoke to my heart and to the heart of birthwork, of women’s work, of why I do what I do, and care about what I care about. This is what I wish for women, not just in birth, but in life. I wish for baby girls around the world to be greeted with love and joy, “oh, good! It’s a girl! Another girl! We’re so blessed!” rather than viewed as second class citizens or as property or as burdens or as objects. I wish for the lives and bodies of women to be honored and respected and for their wisdom to be cultivated.
I’m happy to be reviewing a really great book right now called Into These Hands, Wisdom from Midwives. In the introduction is a great quote that makes me think of the above sentiments as well: “Every new member of the human family arrives on Earth through the body of a woman. Each day on our planet, the majority of babies emerge into the hands of a midwife. Since the dawn of time, midwives have been receiving the generations into their hands.” –Geraldine Simkins
Birth culture
For a dozen years now, birth and breastfeeding advocacy have been areas of intense and sustained interest to me. I feel like these are core, basic women’s issues and that women in our present day U.S. birth culture, as well as women around the world, experience significant amounts of devaluation, disempowerment, and even abuse in the medical birthplace. I agree with anthropologist Sheila Kitzinger who said that, “In any society, the way a woman gives birth and the kind of care given to her and the baby points as sharply as an arrowhead to the key values of the culture.” Our current birth culture does not value women and children. Though my focus is usually on the women, it also doesn’t much value men or fathers either. I also agree with Kitzinger’s assessment that, “Woman-to-woman help through the rites of passage that are important in every birth has significance not only for the individuals directly involved, but for the whole community. The task in which the women are engaged is political. It forms the warp and weft of society.”
A popular saying in the birth activist community is “peace on earth begins with birth.” Perhaps it really means, “respecting the birth-givers, eradicates patriarchy.”
Women’s voices & social discourse
In an article by Grassley and Eschiti in summer 2011 Journal of Perinatal Education, they state, “Women’s health research is grounded in women’s voices and experience…’What matters to people keeps getting told in their stories of their life.'” I’ve written before about the value of stories and story power. I would love for us to reach a cultural point in which the most common element found in most women’s birth stories is about their own power, rather than about times in which they experienced distress and victimization. How we talk about birth and about women matters. It matters a lot. Some time ago I read an interesting article by Debra Bingham about Taking Birth Back. It it she asks you to consider–when talking about birth–how your basic assumptions affect your discourse (the way you talk about birth):
1. Does your discourse include stories about the power of women?
2. Or do the stories shift the locus of control away from women and their bodies to other authority figures such as nurses, physicians, or machines?
3. Does your discourse assume that women are physiologically capable of giving birth and nourishing their own children?
4. Or does your discourse assume that women’s bodies are fundamentally flawed and in need of medical attention and intervention?
I frequently attempt to shift the locus of control from “authority” figures back to women–it is shocking to me how ingrained the terminology is about medical care providers (even midwives!), “letting” someone do something, etc.
As I’ve previously written, the prevailing social discourse about birth assumes a locus of control external to the woman and you rarely hear stories about the “power of women” amongst the general public or mainstream media. Ditto for the assumption of women’s bodies as fundamentally flawed, except replace “rarely” with “frequently.” These messages are so dominating that I think it is hard for women to really “hear” positive birth talk–it seems like a “joyful birth” must be a myth or impossible. Likewise, when a woman is striving to keep the birth talk around her positive, it can be very difficult to override the predominately negative messages coming at her from every side. I see this in my classes, “I believe birth is a natural event, etc., etc. BUT….” (followed by a “I trust my doctor’s judgment and if he wants me to have this GTT test or this extra ultrasound to check my fluid level, etc. I guess I will do it…” comment that contributes to the “climate of doubt” in her life). There are also the woman’s own “inner voices” to contend with—I hypothesize that the loudly-shouted cultural voices about birth contribute a good deal to the “negative voice” in her inner dialog.
Women’s stories have not been told. And without stories there is no articulation of experience. Without stories a woman is lost when she comes to make the important decisions of her life. She does not learn to value her struggles, to celebrate her strengths, to comprehend her pain. Without stories she cannot understand herself. Without stories she is alienated from those deeper experiences of self and world that have been called spiritual or religious. She is closed in silence. The expression of women’s spiritual quest is integrally related to the telling of women’s stories. If women’s stories are not told, the depth of women’s souls will not be known. (Carol Christ, p. 341, emphasis mine)
Yes. May we see and hear women. May we witness them in the act of living, of birthing, of struggling, of triumphing. In surrender and in self-doubt. In exultation and joy. May we hold that space for her story. May we listen well and wisely.
As Penny Simkin has frequently noted: “We can’t control labor, whether it’s hard; that’s a leap of faith. But we can always control how we care for [the mother]” [1]
In 2001 and in 2004, I attended the births of two of my dear friend’s children in the same hospital in a mid-sized Midwestern city. I was not a childbirth educator or doula at this time, but was there in the capacity of friend and “witness.” Both births were intervention-heavy and not what I would call ideal, natural births; but the feelings were vastly different, which made all the difference.
At the 2007 LLL International conference in Chicago, I picked up several of these great "Listen to Women" buttons from the ACNM booth in the exhibit area. I love them. Isn't this what it is all about? So simple and yet so profound. Imagine how the world would change if we just listened to women.
One had an atmosphere of respect, caring and trust; the other had a “climate of doubt” throughout. The difference was a certified nurse-midwife (CNM). My commitment to homebirth midwifery often leads me to forget what a profound and true difference a caring CNM can make in a hospital birth. All the other hospital procedures can be present, but the care factor a CNM provides can transform a woman’s experience from powerless to powerful. Sometimes I forget how CNMs are poised to bridge the gap between home and hospital effectively. The US needs lots of them (not as subordinate “junior obstetricians”—but as expert guardians of normal birth in a hospital setting).
The details were similar in each birth. The babies were both almost 9 lb; a doula was present (same doula in both births); and the mother labored with an IV, spent a large portion of the labor in bed and had internal fetal monitoring. In the first birth (with the CNM), the mother even had several hours of Pitocin augmentation; in the second, with the obstetrician, she had no Pitocin until third stage. With each birth, the mother also had an extensive tear and long repair (a third-degree with the CNM, a second-degree with the obstetrician).
However, some things were very different.
When the mother said, “Can I have a birth ball?” the CNM said, “Yes,” and the obstetrician said, “Not until the baby has been monitored.” And then, “The baby doesn’t like that; you need to get back into bed.”
When the mother’s confidence waned, the CNM said, “You can do it. You are.” The obstetrician said, “I don’t think this baby is moving down.”
When the mother said, “This is taking such a long time,” the CNM said, “I know. It is taking for-freaking-ever!” and everyone laughed (including the laboring mother). The obstetrician said, “I think we should consider a c-section based on your history. The baby is not moving down.”
The CNM said, “You have such strong muscles in your legs and bottom, do you exercise a lot? I think because you are so strong, you’re holding a lot of tension here. Try to let it go.” The obstetrician ironed the perineum until the mother screamed with pain.
The CNM waited. The obstetrician did another internal check.
In both, a baby was eventually born (the first after four hours of pushing, the second after a little over an hour). A strong, healthy baby. Vaginally and without pain medications. After the first birth—though she would have done some things differently—my friend felt triumphant, empowered, powerful, strong, capable, happy and proud.
After the second birth she felt abused, disappointed, ashamed, guilty, angry, assaulted, diminished, wounded and scarred.
I believe the CNM’s personality, attitude and basic belief that vaginal birth would work was the critical difference between these two experiences. These births dramatically, viscerally illustrated for me that no matter what else is happening around the birthing woman, we can control how we care for her.
Endnote: My friend went on to have her third baby at home in 2008. She pushed this baby out in fifteen minutes, with no tear, and she shone with her power.
Molly Remer, MSW, ICCE, CCCE is a certified birth educator, writer, and activist who lives with her husband and children in central Missouri. She is the editor of the Friends of Missouri Midwives newsletter, a breastfeeding counselor, a professor of human services, and a doctoral student in women’s spirituality. She blogs about birth, motherhood, and women’s issues at https://talkbirth.me/posts.
Book Review: Secrets of Confident Childbirth
By Vanessa Turner, Jackie Fletcher, Janay Alexander
HotHive Books, 2009
ISBN 978-1-906316-34-1
160 pages, paperback, £24.99 http://www.thebirthspecialists.com/book.html
“Your body is a complex work of art that functions perfectly” –The Birth Specialists
In an era when much pregnancy and birth literature seems to written in a “climate of doubt,” books like Secrets of Confident Childbirth offer a welcome and affirming alternate perspective—that of celebration and anticipation.
Accented with many beautiful, artistic photos of pregnant women, babies, and couples, Secrets of Confident Childbirth was written by a team of childbirth educators–“The Birth Specialists”–in the UK. The book emphasizes mind-body preparation for birth, with a special emphasis on hypnosis for childbirth as well as other methods of using the mind in a positive way to achieve healthy birth outcomes. The book includes information about the benefits of natural childbirth, prenatal bonding with your baby, the powerful impact of words and language on the birth experience, the role of hormones and the impact of fear, visualization, relaxation, pain management, labor positions, massage, and more. It also includes a brief section on birth planning and evidence-based care.
I do have a slight concern that the emphasis on “focus on what you want and you will achieve it” can possibly lead to self-blame or to “blaming the victim” if a woman’s birth does not work out the way she hopes and dreams. My observation about approaching birth with only “positive thinking” is that it can discount or undervalue the very critical role that the birth environment and the attitudes and fears of the others within that environment can have on the birthing woman’s experience and outcome. That said, I truly love the confident approach, affirming language, and positive attitude towards pregnancy and birth expressed in Secrets of Confident Childbirth. This book is a tremendous gift to the birth world!
—
Disclosure: I received a complimentary copy of this book for review purposes.
As I have referenced several times before I have a special interest in the language of birth. That is part of the reason my blog/business is so-named—because is it is a blog that “talks birth” (as in, “let’s get together and talk birth!”), but also because the way you talk about birth matters. I have also referenced before that it was originally going to be called Birth Talk, but when I went to get the gmail address, it was already taken (by a childbirth educator I coincidentally later came to know!). I’ve come to really “bond” with my Talk Birth name and now “birth talk” sounds slightly odd to me (though “talk birth” is really the odder phrasing).
A couple of months ago, I read an interesting article by Debra Bingham about Taking Birth Back. It it, she asks you to consider–when talking about birth–how your basic assumptions affect your discourse (the way you talk about birth):
1. Does your discourse include stories about the power of women?
2. Or do the stories shift the locus of control away from women and their bodies to other authority figures such as nurses, physicians, or machines?
3. Does your discourse assume that women are physiologically capable of giving birth and nourishing their own children?
4. Or does your discourse assume that women’s bodies are fundamentally flawed and in need of medical attention and intervention?
I am frequently attempting to shift the locus of control from “authority” figures back to women–it is shocking to me how ingrained the terminology is about medical care providers (even midwives!), “letting” someone do something, etc.
And, an enormous part of my life revolves around stories about the power of women, so I think I have that one down 😉
The prevailing social discourse about birth assumes a locus of control external to the woman and you rarely hear stories about the “power of women” amongst the general public or mainstream media. Ditto for the assumption of women’s bodies as fundamentally flawed, except replace “rarely” with “frequently.” These messages are so dominating that I think it is hard for women to really “hear” positive birth talk–it seems like a “joyful birth” must be a myth or impossible. Likewise, when a woman is striving to keep the birth talk around her positive, it can be very difficult to override the predominately negative messages coming at her from every side. I see this in my classes, “I believe birth is a natural event, etc., etc. BUT….” (followed by a “I trust my doctor’s judgment and if he wants me to have this GTT test or this extra ultrasound to check my fluid level, etc. I guess I will do it…” comment that contributes to the “climate of doubt” in her life). There are also the woman’s own “inner voices” to contend with—I hypothesize that the loudly-shouted cultural voices about birth contribute a good deal to the “negative voice” in her inner dialog.
I don’t know any way to “fix” this other than to continue “talking birth”–good, healthy, positive, normal, humanistic, natural, joyful birth–as widely and frequently as I can!
“Given my limited situation, can I really expect to have a great birth today?” For the woman who asked me this question a homebirth, a birth center, a midwife, and a doula were all not remotely feasible options. My answer to her question is a qualified “yes!” and it really got me thinking about ways to help yourself have a great birth when your overall choices are limited. In fact, there is a long list of ideas of things that may help contribute to a great birth!
Choose your doctor carefully—don’t wait for “the next birth” to find a compatible caregiver. Don’t dismiss uneasiness with your present care provider. As Pam England says, “ask questions before your chile is roasted.” A key point is to pick a provider whose words and actions match (i.e. You ask, “how often do you do episiotomies?” The response, “only when necessary”—if “necessary” actually means 90% of the time, it is time to find a different doctor!). Also, if you don’t want surgery, don’t go to a surgeon (that perhaps means finding a family physician who attends births, rather than an OB, or, an OB with a low cesarean rate).
If there are multiple hospitals in your area, choose the one with the lowest cesarean rate (not the one with the nicest wallpaper or nicest postpartum meal). Hospitals—even those in the same town—vary widely on their policies and the things they “allow” (i.e. amount of separation of mother and baby following birth, guidelines on eating during labor, etc.) Try checking with Cesareanrates.com for local information!
When you get the hospital, ask to have a nurse who likes natural birth couples. My experience is that there are some nurses like this in every hospital—she’ll want you for a patient and you’ll want her, ask who she is! If possible, ask your doctor, hospital staff, or office staff who the nurses are who like natural birth—then you’ll have names to ask for in advance.
Put a sign at eye level on the outside of your door that reads, “I would like a natural birth. Please do not offer pain medications.” (It is much easier to get on with your birth if you don’t have someone popping in to ask when you’re “ready for your epidural!” every 20 minutes.)
Work on clear and assertive communication with your doctor and reinforce your preferencesoften—don’t just mention something once and assume s/he will remember. If you create a birth plan, have the doctor sign it and put it in your chart (then it is more like “doctor’s orders” than “wishes”). Do be aware that needing to do this indicates a certain lack of trust that may mean you are birthing in the wrong setting for you! Birth is not a time in a woman’s life when she should have to fight for anything! You deserve quality care that is based on your unique needs, your unique birthing, and your unique baby! Do not let a birth plan be a substitute for good communication.
Once in labor, stay home for a long time. Do not go to the hospital too early—the more labor you work through at home, the less interference you are likely to run into. When I say “a long time,” I mean that you’ve been having contractions for several hours, that they require your full attention, that you are no longer talking and laughing in between them, that you are using “coping measures” to work with them (like rocking, or swaying, or moaning, or humming), and that you feel like “it’s time” to go in. If you’re worried about knowing when you’re really in labor, check out this post: how do I know if I’m really in labor?
Ask for the blanket consent forms in advance and modify/initial them as needed—this way you are truly giving “informed consent,” not hurriedly signing anything and everything that is put in front of you because you are focused on birthing instead of signing.
Have your partner read a book like The Birth Partner, or Fathers at Birth, and practice the things in the book together. I frequently remind couples in my classes that “coping skills work best when they are integrated into your daily lives, not ‘dusted off’ for use during labor.”
Practice prenatal yoga—I love the Lamaze “Yoga for Your Pregnancy” DVD—specifically the short, 5-minute, “Birthing Room Yoga” segment. I teach it to all of my birth class participants.
If you feel like you “need a break” in the hospital, retreat to the bathroom. People tend to leave us alone in the bathroom and if you feel like you need some time to focus and regroup, you may find it there. Also, we know how to relax our muscles when sitting on the toilet, so spending some time there can actually help baby descend.
Use the “broken record” technique—if asked to lie down for monitoring, say “I prefer to remain sitting” and continue to reinforce that preference without elaborating or “arguing.”
During monitoring DO NOT lie down! Sit on the edge of the bed, sit on a birth ball near the bed, sit in a rocking chair or regular chair near the bed, kneel on the bed and rotate your hip during the monitoring—you can still be monitored while in an upright position (as long as you are located very close to the bed). Check out the post Active Birth in the Hospital for some additional ideas.
Bring a birth ball with you and use it—sit near the bed if you need to (can have an IV, be monitored, etc. while still sitting upright on the ball). Birth balls have many great uses for an active, comfortable birth!
Learn relaxation techniques that you can use no matter what. I have a preference for active birth and movement based coping strategies, but relaxation and breath-based strategies cannot be taken away from you no matters what happens. The book Birthing from Within has lots of great breath-awareness strategies. I also have several good relaxation handouts and practice exercises that I am happy to email to people who would like them. One of my favorites is: Centering for Birth.
Use affirmations to help cultivate a positive, joyful, welcoming attitude.
Read good books and cultivate confidence and trust in your body, your baby, your inherent birth wisdom.
Before birth, research and ask questions when things are suggested to you (an example, having an NST [non-stress test] or gestational diabetes testing). A good place to review the evidence behind common forms of care during pregnancy, labor, and birth is at Childbirth Connection, where they have the full text of the book A Guide to Effective Care in Pregnancy and Childbirth available for free download (this contains a summary of all the research behind common forms of care during pregnancy, labor, and birth and whether the evidence supports or does not support those forms of care).
When any type of routine intervention is suggested (or assumed) during pregnancy or labor, remember to use your “BRAIN”—ask about the Benefits, the Risks, the Alternatives, check in with your Intuition, what would happen if you did Nothing/or Now Decide.
Along those same lines, if an intervention is aggressively promoted while in the birth room, but it is not an emergency (let’s say a “long labor” and augmentation with Pitocin is suggested, you and baby are fine and you feel okay with labor proceeding as it is, knowing that use of Pitocin raises your chances of having further interventions, more painful contractions, or a cesarean), you can ask “Can you guarantee that this will not harm my baby? Can I have in writing that this intervention will not hurt my baby? Please show me the evidence behind this recommendation.”
If all your friends have to share is horror stories about how terrible birth was, don’t do what they did.
Look at ways in which you might be sabotaging yourself—ask yourself hard and honest questions (i.e. if you greatest fear is having a cesarean, why are you going to a doctor with a 50% cesarean rate? “Can’t switch doctors, etc.” are often excuses or easy ways out if you start to dig below the surface of your own beliefs. A great book to help you explore these kinds of beliefs and questions is Mother’s Intention: How Belief Shapes Birth by Kim Wildner. You might not always want to hear the answers, but it is a good idea to ask yourself difficult questions!
Believe you can do it and believe that you and your baby both deserve a beautiful, empowering, positive birth!
I realize that some of these strategies may seem unnecessarily defensive and even possibly antagonistic—I wanted to offer a “buffet” of possibilities. Take what works for you and leave the rest!
I posted on my Facebook page asking for additional thoughts and suggestions and I appreciated this one from doula and educator, Rebecca:
“I think I’d tell people to stop closing doors on themselves you know? Stop making assumptions about what is possible and be open to creating new possibilities – maybe not perfect and exact but inviting in opportunity. No money doesn’t mean no doula in most cases.”
She’s right! A lot of doulas-in-training will offer free birth services, many doulas and midwives do barter arrangements or other trades, and many non-traditional birth professionals also have sliding scale rates.
Great births are definitely possible, in any setting, and there are lots of things you can do to help make a great birth a reality!
“Giving birth is not an isolated event in a person’s life. A woman births with both her mind and her body and participates in the attitudes toward childbearing of her culture and her family.”
This quote from the book Pregnant Feelings by Rahima Baldwin reminds me of two other relevant quotes about culture, birth, and women’s choices:
“Although pregnancy and birth is a richly intuitive and instinctive process, a woman will prepare her ‘nest’ and birth according to the style of her culture, in the same way that a particular species of bird will build its nest with whatever is available.” –Pam England
“One does not give birth in a void, but rather in a cultural and political context. Laws, professional codes, religious sanctions, and ethnic traditions all affect women’s choices concerning childbirth.” –Adrienne Rich
I think we get onto slippery ground when we start talking about how women just need to “educate themselves” and then they will make different (i.e. “enlightened like ours”) choices. If education was all that was needed, we would see much different things in our present birth culture (more on this later!). As Pam England would also say (paraphrased), thousands of factors seen and unseen go into the resulting birth experience, it is hard to point to one, two, or three factors and say “that was it! I have it all figured out.” (Reminds me of another quote that women birth as they live.) With regard to the second quote, I have to ask myself whether couples truly have a free choice of where to give birth? Ultimately speaking, yes they do, but according to my clients’ perspectives insurance companies and the political climate surrounding midwifery in our state dictate their birth location, as well as opinions of family, friends, books, and so forth. I do a “pain pie” exercise during my classes and after I do it, I always talk about how sometimes choices are actively stripped away from women and we need to keep that in mind when we hear “bad” birth stories—not, “she ‘failed’ or made the ‘wrong’ choices” but that her pieces of the pie were taken away from her (sometimes forcibly!).
The reason I initially marked Rahima Baldwin’s quote is because I am fascinated by how my birth experiences continue to inform the rest of my life–while not the defining moment of motherhood for me, I continue to draw upon the lessons of birth throughout the rest of my life, as well as retaining a total fascination with the subject. I wonder why I’m so “stuck” on birth? Why fixate on this one element of a lifespan? Does it mean I’m not “moving on” somehow—like a high school football player still reliving the glory of that touchdown from 10 years ago? I think it is because birth touches something else. Something deep and raw and true and we glimpse something that we rarely glimpse in everyday life. A touch of the sacred perhaps. Magic. Mystery. Or is it a sense of personal power and satisfaction in being a woman? I know that the “birth power” experience is a rare one for me—I have never felt so powerful and capable and amazing as I did giving birth. I like to think about how this “birth power” sense could be drawn into the rest of my life—how can I live a powerful and affirming and amazing life, not just as a birth giver, but as a woman? Lately, I am finding some answers in feminine spirituality, but it is a question I love to consider and hope to write more about in the future.
Okay, moving back to Rahima and the quotes from Pregnant Feelings:
Anthropologists’ reports of women working the fields, going to a sheltered spot to drop their babies without any ‘preparation’ and then returning to work describe a kind of mythical natural childbirth that is nearly impossible for Western women. We are far too cerebral, and our twentieth-century consciousness intrudes between us and our instinctual selves. The fact that we question both how to birth and how to parent shows how awake our consciousness is. We must of necessity involve our minds in understanding what we do and create, for it is impossible to turn them off. Nor can we simply erase, or afford to ignore, our culture’s view that giving birth is a dangerous and painful event requiring intervention and technology. Rather, we must consciously replace that view with new knowledge and new images if we are going to be able to reclaim our ability to birth with harmony of mind and body.
Loved this. The mythical woman giving birth by the side of the road and popping back into the field to work is strongly ingrained amongst “natural birth” advocates. Some women draw strength from the image—“if she could just squat in the field, so can I!” Others make a joke of it—“are you one of those nuts who encourages women to just squat in the field?!” And others are doubtful that it has any basis in reality. I also suspect that if said women did ever exist they did not return quickly to the fields because they wanted to do so, but because of the framework of their culture and those seen and unseen factors that shape our lives—perhaps their other children would starve if they didn’t run back to the field, perhaps the overseer would beat them, etc., etc. It doesn’t mean those women were stronger or more capable, but perhaps less valued and less cared for than they should have been.
Okay, back to Rahima again:
Our task is to integrate our minds and bodies, so we can give birth in a way that feels whole and nurturing—to ourselves as parents and to our babies…We cannot go back to ‘natural childbirth’ in which we just let it happen. There must be knowledge of birth and an assumption of responsibility for our own health care and for decisions affecting ourselves and our children. There exists for us the exciting possibility of giving birth with full awareness, participating in the joy and exhilaration of working in harmony with the tremendous energy of creation. But it does not occur automatically or unconsciously…
The potential for conscious birthing can exist independently of the place of birth, although some places require more watchfulness than others….Let us just say that it is actively giving birth in an environment which is woman-centered and child-centered, in which the cues are taken from the birthing woman while she experiences fully the sensations and emotions of new life coming into the world through her. She is not medically managed or manipulated, but is supported with the knowledge, love and experience of her attendants (doctors, midwives, husband, other support people) to birth in a way which is safe, yet does not deny the intense physical, emotional, and spiritual aspects of giving birth.
Birthing in this way is rare in today’s culture…less than 5 percent of women in this country today experience ‘purebirth’ [positive birthing/conscious birthing]…
Given the wealth of images of birth that surround us, our task is to recognize that none of them adequately denies or exhausts the potential of birth. Perhaps their infinite variety can help to free us from any one fixed idea of giving birth and help us to realize our freedom to birth in the way that is right for us. We cannot control the energy of birth, but we can control our response to it by deciding to be open, relaxed positive, noisy, grouchy, whatever. We don’t need to behave in a certain way and we can accept ourselves and our births without self-judgment.
What caught me about this section was the mention of not being able to go back to a time when we could just “let it happen.” Though I feel like getting out of my own way and “letting it happen,” was a personal key to my own births—that the surrender is what gets the job done—I agree with her point that there is no letting it happen in today’s culture. A long time ago someone mentioned in an online forum that they were not planning to take birth classes or read any birth books because they felt like they should just let it happen and not have any preconceived notions; that cluttering up their heads with this other information would cloud their ability to do so. While I hear the motive and feeling behind this sentiment and believe there is some (perhaps idealized) truth to it, I simultaneously feel like it is impossible to do this, because women do not give birth in a void or outside of their culture. Women give birth in a context, usually involving other people (even with unassisted births, there is usually someone else there). If you enter the birth room (the aforementioned woman was planning to give birth in a hospital, not unassisted) without any ideas or pre-knowledge about what to expect or what you want, the stories and dramas and ideas and myths and preconceived notions and reading and media-exposure of all the other people present DO enter the room and impact your birth. You cannot just “let it happen,” because they will not just let it happen. Right or wrong, this is the environment in which many of us our building our birth nests.
I’d like to close my thoughts with another quote. This one is from one of my favorite birth books, Transformation Through Birth by Claudia Panuthos. In giving birth, regardless of our nest and our choices and all the seen and unseen elements shaping our lives, perhaps we can simply, “…celebrate ourselves for our courage to birth. The real question becomes not, ‘Have you done your breathing exercises?’ but rather, ‘Can you love yourself no matter how your birth, where you birth, or what the outcome?'”
Talk Birth 