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Guest Post: The Midwife as a Storyteller and Teacher by Patricia Harman

The use of old-fashioned narrative to influence, and inform patients about health practices

As an author of memoirs, historical fiction and children’s literature, I am a storyteller, but I’m also a nurse-midwife, and I use storytelling as one of my primary teaching tools.

Storytelling is uniquely human.  Anthropologists have argued that storytelling is pre-verbal, that pictographs on the inside of caves are in fact stories.  Form the earliest days humankind has used narrative to record history, to entertain, to convey experience and to transfer information.

To convey information in narrative form is something no other species can do.  It’s an evolutionary advantage and allows each individual to harbor  more information than personal experience would allow.

Using stories to teach patients is not unique to midwives.  All good providers use stories to illustrate May 2016 004how individuals can make better health choices.

We all know that many patients are non-traditional learners  and even those in higher education love a good story.  Research and statistics are boring for most people and easy to forget .  Many patients, even if given a handout drop it in the trash as they leave our office. They don’t have time to read it or are non-readers.

On the other hand, if I tell a tale, in an amusing way, about a young woman who refused to take her birth control pills because she was worried they would make her fat…and now she’s pregnant…that’s a cautionary tale and brings a smile and a knowing nod from the fifteen-year-old here to discuss birth control: That’s not going to happen to her!  

Using self-disclosure about your own life can humanize a professional relationship and help patients be more honest with you about their lives.  For example, I might say with a smile, that I’ve gone to Weight Watchers for so long I could teach the class, even though I’ve never reached goal weight.  The patient and I share a good laugh and now she feels comfortable telling me she can’t stand to look in the mirror, has tried four different TV diets and is terribly discouraged.  A door for real communication has opened.  She no longer feels alone and she knows she has me as a non-judgmental advocate.

Stories can accomplish what no other form of communication can do; they can get through to hearts with a message.  I might tell a very stressed-out college student, sitting on the end of the exam table, about a patient of mine who had two jobs and was studying nursing full time.  Last year she started getting a series of illnesses.  Next thing she knew, she flunked two courses, lost her boyfriend and had a motor vehicle accident.  The moral is clear: don’t take on more than is humanly possible.  And the tale is more likely to induce lifestyle change than a lecture.

All health care providers, surgeons, nurses, physical therapists, family doctors or midwives must be teachers.  If you missed that part in school, it’s not too late.  With humor and love we can become part of the human story that will bring health and hope to our patients.

For the past twenty years, Patricia Harman has been a nurse-midwife on the faculty of The Ohio harman-2008-by_bob_kosturko-330State University, Case Western Reserve University and most recently West Virginia University. In 1998 she went into private practice with her husband, Tom, an OB/Gyn, in Morgantown, West Virginia. Here they devoted their lives to caring for women and bringing babies into the world in a gentle way. Patricia Harman still lives with her husband, Thomas Harman, in Morgantown, West Virginia. She recently retired from her thirty-five years of midwifery so she could write more books for people like you!

My past reviews of Patsy’s books:

Past blog posts on the subject of story power: october-2016-240

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Small Business Saturday: Pewter Figurines + Sacred Pregnancy Class Supplies

IMG_3699We got our pretty new business cards this week! I have several other business tidbits to share today as well. We are discontinuing our line of pewter figurines and reduced the prices of the remaining few we have in stock. If you have been eying one, this is your last chance, because after these are gone, there will be no more made!

While we’ve sold our little “scrap goddesses” individually for while, we have some new ones available in small lots. A friend called these “gummy bear goddesses,” and that is how they look! These are very small, have rough edges, and do not sit on their own, but they would make a lovely little token to give to birthy friends, to clients, or to transform into your own projects (magnets, glued to a candle holder, etc.). These are only available by the lot and only as we happen to have them available!

IMG_3538I also want to mention that we are happy to put together small lots of items by request at a discount, particularly for Sacred Pregnancy Retreat Facilitators, but for other birth educators and doulas too. These can be custom arranged for things that we don’t necessarily have listed in our etsy shop (for example, we recently sent 12 tiny goddesses and 12 tree pendants to a Sacred Pregnancy retreat in Canada). We have “beauty” charms and goddess charms and spiral charms that aren’t available by separate listing, but that can be mixed and matched to create something nice to give to the beautiful women who come to your retreats and classes.

We do not provide these for free (though we always include secret, surprise bonus goodies for free!), but we are happy to do bulk pricing. Why not free, you might ask? We actually do make donations of our work each month to nonprofit events and organizations, but if you are a for profit business, then a fair energy exchange is appropriate rather than a donation. 🙂 We are a small, two-person home business ourselves and we love to collaborate!

Sacred Postpartum, Week 1: Birth Stories and Vow

Backtracking a little into week one of my current Sacred Postpartum class, for the first week’s assignments in reviewing our own birth and postpartum experiences, I set up a mini sacred space and put on some of my birth power bracelets (Mark and I started making these recently and I love them! It is like carrying a mini-mantra, birth power reminder with me every day).

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I did my vow page and then a collage of reminders to myself. I made a birth stories page and then printed out copies of each of my kids’ birth stories and stapled them to the back of one journal page per story, including one for my third baby who was born in a second trimester miscarriage (the stories are all available on my blog here. I didn’t include pictures of the actual print outs! ). Then, I did a page on the front of each birth story with pictures of each kid and significant words/lessons from their stories. I ended with a collage of myself as I prepare for my upcoming birth at the end of this month (39 weeks now, 37 when I did the assignment) and took a picture of a blank page as well as a symbol of the story yet to be written…

(click for bigger pix)

I also just have to pat myself on the back again about having enrolled in these trainings at this point in my own pregnancy. It was a stroke of genius! And, while I knew I would benefit from them, I had no idea how very deeply I would do so.

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Birth Mystery

“Whether a woman knows it or not, she is a vessel of great magnitude born capable of reshaping humanities destiny if she only knew the true depths of her innate gifts. Be prepared now to see the fierce face of the feminine rock as her inner geographies of volcanic strength erupt from a love she has held in her belly for life all of her days. This is not a gasp of her last breath. It is her birthing cry into her wise leadership on our planet.” –ALisa Starkweather

“Birth, like love, is an energy and a process, happening within a relationship. Both unfold with their own timing, with a uniqueness that can never be anticipated, with a power that can never be controlled, but with an exquisite mystery to be appreciated.” –Elizabeth Noble

“Birth is not a cerebral event; it is a visceral-holistic process which requires all of your self–body, heart, emotion, mind, spirit.” –Baraka Bethany Elihu (Birthing Ourselves into Being)

Last weekend, I taught our final Birth Skills Workshop of the year. While I know I have been writing about my sense of separation from birth work or the phase of “moving on,” in which I find myself, this workshop was an excellent experience. The women were so beautiful and interested and anticipatory. The couple working together was so loving. My doula co-presenter was so present and grounding. I came home feeling really positive and enthused and I also found myself considering new birthwork-related ideas and new possibilities, including something that I’m really excited about, but don’t feel like I can share publicly just yet. This work is in my blood, my roots, my heart and my soul, regardless of how direct the services are that I offer or the primacy/priority of face-to-face birthwork in my life. I will never not care about birthing women. They’re too amazing. They’re too important. And, my own sense of being, my spirituality, my thealogy, is too intimately entwined with my own embodied experience of gestating, birthing, lactating, and mothering, to ever make a full separation from it. After I got home and looked at my few pictures from the evening, I realized that in eight years of teaching birth classes, I have exactly zero pictures of me doing so! But, here is one of some of the mamas were enjoying a much deserved relaxation session after a lot of active birth practice. 🙂

October 2013 036This photo reminds me of the amazing benefits of co-teaching a workshop with another birth professional. SO much better than teaching alone ever was! Doula Summer of Peaceful Beginnings Doula Services and I have been friends for a long time (we also co-founded Rolla Birth Network). She has helped me when I’ve needed help and I’ve helped her when she’s needed help, but our helping skills/abilities rest in different areas, which is why we work extremely well together with a workshop like this one. I provide the information and structure, Summer provides the gentle presence and soothing hand. A good workshop needs both!

I also re-discovered how I do enjoy putting together a nice information packet! 🙂

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In addition to my workshop-related epiphany, I had a lightbulb moment with regard to my M.Div thesis. It suddenly seemed clear to me that rather than create a scholarly, academic discourse proving a theory about birth as a spiritual experience, I need to integrate my theories with my birth art sculptures. I need to frame my work within this sculptural context, this personal experience, this lived reality of the might of creation. I have 234 pages of possible content for said thesis, all saved in an intimidating word document waiting to be sorted through and added to. It is overwhelming to even open. With my new idea of framing my thesis through my own art, I feel a pathway emerging through the information, a pathway that integrates the academic and the personal and that results in something uniquely my own…

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Some of my sculptures-turned-pewter-jewelry.

“Be soft. Think of [labor] as a fine silvery stream, not a raging waterfall. Follow the stream, have faith in its course. It will go its own way, meandering here, trickling there. It will find the grooves, the cracks, the crevices. Just follow it. Never let it out of your sight. It will take you.” -Sheng-yen

“We vibrate to that primordial rhythm even before we have ears to hear…We vibrate to the rhythms of our mother’s blood before she herself is born. And this pulse is the thread of blood that runs all the way back through the grandmothers to the first mother.” – Layne Redmond (August 19, 1952 – October 28, 2013): Drummer/Composer, Author and much more (via The Girl God)

“Within the womb of every woman glows the consciousness of Mother Earth.” –Roslyne Sophia Breillat (via The Girl God)

Business of Being Born: Classroom Edition

Childbirth is a women’s rights issue and a reproductive justice issue. The United States maternity system is one of the costliest in the developed world, yet our birth outcomes compare poorly to those of other industrialized nations. Among industrialized countries, we consistently rank last or second to last in perinatal and maternal mortality rates. Moreover, birth is depicted in mainstream media with fear, medical intervention, and crisis…

via The Business of Being Born Classroom Edition.

It took me some time to get around to it, but I’ve finally finished exploring The Business of Being Born: Classroom Edition and its associated toolkit of educational materials! As a long-time childbirth educator and birth activist, of course I was interested in this classroom version of the (new) classic birth advocacy film, but I’m also a college professor and therefore was doubly interested—how might this resource be incorporated into one or more of my human services courses? As the BoBB companion site explains…

Childbirth is an issue most people do not engage with until they have experienced the maternal health system. The Business of Being Born: Classroom Edition reaches out to young adults BEFORE they confront their own birth decisions, both placing the issue on the radar and challenging the prevailing assumptions about birth providers and current obstetrical management trends. The goal is for the next generation of policy makers, practitioners, educators, and parents to approach birth decisions with awareness and confidence. Our strategy is to incorporate this evidence-based presentation into classrooms around the country. We envision empowering the next generation of parents to seek out systemic change and new policies supporting domestic maternity care…

via The Business of Being Born Classroom Edition.

The Classroom Edition of the film runs about 25 minutes and comes packaged with one of my all-time favorite resources for birth classes and tabling events: The Guide to a Healthy Birth from Choices in Childbirth. It also comes with two additional celebrity interviews, the short film Birth by the Numbers, and a instructor’s toolkit with classroom activities tying the themes of the film to major subjects such as Women’s Studies, Public Health, and Sociology.

My only critique of the classroom edition of the film is that the assembled quotes at the beginning of the film are put together in a choppy sort of way that makes it difficult to perceive (for the average viewer), which are the “good” (i.e. accurate) quotes and which are popular types of misinformation. There is also an odd, repetitively distracting, monotonal quality to the music that plays through much of the footage. Excerpted from the full-length film, the classroom edition still includes Ricki Lake’s homebirth in her bathtub, which was one of my top favorite moments of the original film. Content from a historical perspective as well as content involving the shadowing of a homebirth midwife and the personal stories from families choosing midwifery care were greatly reduced from the original version and the classroom edition seems to have more of an emphasis on sociocultural analysis. It is noted that 90% of women in many hospitals experience some type of labor augmentation (usually pitocin) and also that hospitals are businesses, businesses that are not really interested in having women hang around in the labor room.

One of the college courses I teach is American Social Policy. I have always been interested in birth change from a systemic (macro) level as a companion to change on the individual (micro) level, so I especially appreciated watching the Birth by the Numbers presentation included with the classroom edition of BoBB. When speaking about the idea that the increase in cesarean rate reflects maternal choice, public health professor Gene Declercq says, “this blaming of women is farcical. It is not about the mothers, it is about the way we treat care in the United States. Nobody ever wants to admit there is a difficult inherent in the system.” Well, I want to admit it and this is the kind of macrosystem-level change we talk about in my Policy course. At the companion Birth by the Numbers website, you can download a powerpoint presentation and other teaching tools, as well as watch the short film, in which public health professor Gene Declercq debunks popular myths about the causes of the United States cesarean rate increase. The film also looks at disparities in maternity mortality rates and tackles questions of systemic influences on maternal health outcomes.

So, are mothers really asking for cesareans?

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Declercq also draws on writing from the classic obstetrics textbook, Williams Obstetrics, and shares this quote about one of the real reasons that cesarean rates continue to rise:
whycesareanAnd, he makes this important observation:womenhaventchanged
As Nadine Goodman says in The Business of Being Born Classroom Edition, “A woman will always remember how she was made to feel during her birth…if you don’t have the reverence and respect for birth, where do you go from here?”

Prior post about The Business of Being Born: Transformation Through Birth | Talk Birth

Disclosure: I received a complimentary digital package for review purposes.

Addressing Unexpected Outcomes in Birth Classes

“Birth brings powerful and painful sensations to the most intimate spaces of the female body…I stood transfixed by the life-giving strength found in her feminine power.” –Amy Wright Glenn writing about attending her sister’s birth (Birth, Breath, & Death)

What About Unexpected Outcomes?

If one factor contributing significantly to a woman’s satisfaction with her birth experience is having better than expected outcomes, how then can birth educators prepare women for unexpected outcomes? As Pam England notes, “Many women are conditioned to believe that if they have lots of information, then they will ‘pass the test’ or be able to control their birth outcome” (England, 2007). molly37weeks 018

Is it possible to truly prepare couples for unexpected outcomes? Though others may disagree with me, I have to wonder if the answer is “no.” (I confess to also wondering the same thing about truly preparing for giving birth!) I used to spend a whole class session on complications/unexpected outcomes, but suddenly awoke to the realization that most people’s whole lives have been a “class” in “birth complications.” Do they really need to hear it from me too or am I undermining the very confidence I seek to build? Undoing the new messages and competencies I’ve tried to instill?

Instead of a whole class on complications, I switched to spending a short section of class asking couples what they were worried about or if they had fears about specific complications. (Since I usually taught classes one-to-one, there was a certain sense of security with sharing vulnerable emotions that may not be present with larger class settings.) Bringing fears out into the open to “look at” helps shift the perspective from “frozen” fears to coping strategies. After they share their concerns, I usually mention maternal or fetal death because I believe it is important to acknowledge this most scary of fears. I also encourage them to include options for unexpected events during labor or with mother or baby on their birth plans (based on the birth planning worksheet in the book Pregnancy, Childbirth, and the Newborn by Penny Simkin). I share that most births—if not all—involve some element of surprise, the unexpected, loss, or grief. It could be as “small” as disappointment with the baby’s appearance or a sense of loss/grief of the specialness of being pregnant or as a big of a surprise as a baby in the NICU or even death of the newborn. It is normal and okay to experience feelings of grief and loss whether the unexpected event is “big” or “small.” It is helpful to have an understanding of the possibility of the unexpected and the emotions that follow.

I believe this acknowledgment and recognition as well as asking for their personal fears is more helpful as reviewing each and every complication of birth (which is how many CBE programs train their educators!), especially given the widely stated observation that couples dismiss and forget information shared during class that feels—consciously or unconsciously—irrelevant to them (this often includes complications or even postpartum and newborn care). I believe that a generally stated recognition of loss in all its forms is more likely to “stick” because it brings it into the couple’s personal sphere instead of being a more academic exploration.

For possible questions for exploring worries see: Worry is the Work of Pregnancy | Talk Birth.

This post is modified from a sidebar originally published in the International Journal of Childbirth Education accompanying my article about Satisfaction with Birth. I re-post it now in anticipation of a planned post about rituals for coping with unexpected outcomes…

Tuesday Tidbits: Teeth and Teaching

“Do not try to satisfy your vanity by teaching a great many things. Awaken people’s curiosity. It is enough to open minds; do not overload them. Put there just a spark. If there is some good inflammable stuff, it will catch fire.”
Anatole France (in The Earth Speaks)

A woman who writes has power, and a woman with power is feared.” —Gloria Anzaldúa, “Speaking in Tongues” (via The Girl God via Guerrilla Feminism)

Bits of the birth net:

It is old news, but this week a 2009 post from The Unnecesarean caught my eye: An OB’s Birth Plan: Obstetrician’s Disclosure Sent One Mom Running. The article describes the “doctor’s birth plan” a mother received from her medical care provider, which includes gems like this one:

“…I do not accept birth plans. Many birth plans conflict with approved modern obstetrical techniques and guidelines. I follow the guidelines of the American College of Obstetrics and Gynecology which is the organization responsible for setting the standard of care in the United States. Certain organizations, under the guise of “Natural Birth” promote practices that are outdated and unsafe. You should notify me immediately, if you are enrolled in courses that encourage a specific birth plan. Conflicts should be resolved long before we approach your due date. Please note that I do not accept the Bradley Birth Plan. You may ask my office staff for our list of recommended childbirth classes…”

One of many reasons to run far away from this doctor! One of my Facebook friends made a great point though: “at least he’s honest! I think there are other doctors with similar views who might not make it clear until it’s ‘too late.'” This is true–he said it, but you know a LOT of people are thinking it/acting on it. So, that IS good that he was up front. Another mother then commented to add her own similar experience: “We went to an OB who had us sign something saying we would not have a birth plan or hire a doula. It felt so creepy to sign away all involvement in my own child’s birth – and doing so at 9 weeks felt like I was signing that I’d keep my mouth shut throughout the pregnancy, too. But gratefully, as you’re saying, it was clear early on that way this was not the OB for us. I’m sure many don’t get to find out before labor.”

Speaking of teaching and igniting sparks, it isn’t too late to register for our next Birth Skills Workshop—rapidly approaching on February 2nd! This workshop is specifically designed not to be a lecture, but is a hands-on, skills-building workshop.

Also via ScoopIt, I shared this article: Bearing the Burden of Choice: A Young Feminist’s Perspective

“Based on personal observation, choices concerning women’s reproductive health are heavily concentrated in preventative action – what are the best practices to avoid pregnancy? Consequently, prevention inspired language lends to a negative association with child bearing. It is something to prevent rather than embrace…”

She goes on to address something that I find to be a reason why sometimes birth activists have trouble connecting to the larger feminist community:

Abortion is one of those issues that seems to leak into every “women’s issue” whether initially intended or not. Needless to say, we talked about abortion to the point of exhaustion. Not to take away from the weight of abortion to the feminist cause, I began to recognize a gap in our reproductive justice discussions. I found myself asking the question:What about the women who choose the path of childbearing?

Those women are basically why I’m here and why I do what I do. And, what has been on my mind recently is explored in my most recent post: What to tell a mother-to-be about the realities of mothering…

“Why didn’t anyone tell me?” and, “why isn’t anyone talking about this?” is a common refrain echoing in the postpartum tales of many mothers. So, why don’t we tell them? Or, what can we actually tell them? Is there a way to really do so? I kind of think there’s not

And, connecting the teaching and the sparks and the women’s issues and the women writing having power, I also made sure to sign this petition: Vigorously support women’s rights by fully engaging in efforts to ratify the 1972 Equal Rights Amendment. This is going to be one of the discussions towards the end of my current Social Policy class (I can’t really write much about it here, but suffice to say the class is extraordinarily challenging so far and we’re only to week three). I hope no one vigorously disagrees with it or I might FREAK OUT! When I shared it on Facebook, a friend commented: “I am enraged that women’s rights are an ‘issue.‘” To which I replied: “Isn’t that the truth?! I hate that. It boggles my mind that women’s rights are considered a political issue that anyone could have a ‘position’ on. The nerve!!! ARGH. FREAK OUT, I TELL YOU”

And now, the teeth…

This post is essentially all about what I shared on Facebook apparently (might as well get some mileage out of it!). This is what I wrote yesterday:

In case anyone cares, I’m totally sick of taking my kids to the dentist! All three had appointments in Sullivan today (1.25 hour drive one way). Alaina wasn’t cooperative and is clearly traumatized from prior dental experience and we will need to go back to a pediatric dentist for her (crowns on two molars). Zander’s were good and he got two seals. Lann had two extractions (previously filled teeth) and one filling. I’m exhausted!

I still haven’t written my planned blog post about the heartbreak of tooth decay. I came home yesterday all fired up to write it, but then I had to get caught up on grading instead. But, I did take these pictures of my little pearls-wearing, skirt-sporting, curly-haired, brave little girl:

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I told her I wanted to take a picture of her face and she ran away from me like this!

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Two other Facebook kid updates from this week that were funny:

Alaina put a bracelet on pushed high on her arm. When she took it off, it left a red mark. She looked at the mark solemnly and said, “scar.” Poor little sugar. She said it very acceptingly. Like, yep, I’m scarred now…

And

Yesterday, my little entrepreneurs cooked up a plan to raise some money to buy a pug. They decided they should raise Dobermans and sell them…”When people see the big cage of Dobermans in our yard, we’ll just tell them, don’t worry…it’s for pugs!” Hmm. I see a couple of flaws with this plan…

Hearing this, it suddenly became clear to me how puppy mills were invented—a couple of pre-ten-year-olds (or, adults with similar critical thinking skills) hung around talking about money-making schemes…