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Pain Pie Exercise for Birth Classes

I address the issue of pain in several ways during my classes. I have struggled with doing this—by mentioning pain do I plant the seed that their births will be painful? etc. I’ve eventually come to a place where I feel like it is important to mention pain directly and to look at it head-on. Many people have the perception that birth is THE most painful thing ever and essentially the most painful thing anyone could ever imagine. So, I feel like by not talking about pain in class, I would be ignoring the elephant in the room of THE (cultural) pinnacle of pain. While I have no doubt that birth can be very painful for some women, I deeply feel that our current birth culture and manner of treating birthing women makes birth painful for more of them.

A very useful tool in exploring sources of pain is the “Pain Pie” idea from Teaching Pregnancy & Birth: A Childbirth Educator’s Perspective by Marcy White (published by ICEA).  With this tool, you create a red circle with the word pain on it and a separate set of white wedges (pie pieces) each containing a supportive element, such as “movement” or “relaxation techniques.” Each piece of pie covers up a portion of the red “pain”—as elements of the pie are removed, the pain piece gets bigger and bigger (an alternative presentation is to add pieces, so that the pain gets smaller).

I mention that too often women in our society are left feeling as if they “couldn’t do it” or that their bodies failed them, but in reality their coping pieces of the pie were stripped away from them (sometimes forcibly). I also talk about how sources of distress to the mother during labor: lack of emotional support, disrespect, ignoring of needs, repeatedly offering medications when none are desired, and restriction of movement, often have little to nothing to do with pain, but instead to what is happening around her (environment and caregivers).

Interview with Elizabeth Stein, CNM

Recently I had the opportunity to interview certified-nurse midwife, Elizabeth Stein, CNM, MSN, MPH. Elizabeth practices in New York and has experience with high-risk populations. Visit her at her website: Ask Your Midwife.

1. Please tell me a little bit about your services as a midwife:

My private practice provides obstetrical care, which includes prenatal care, labor and delivery, postpartum and breast feeding. After delivery, women are seen 6 weeks postpartum. Alternatively, women who had a cesarean delivery are seen for an incision site check at 10-14 days post partum and once again at 6 weeks.

GYN care includes an annual GYN exam, which includes a Pap smear, STD testing and treatment, breast exam, urine test and blood work. I also address common GYN complaints, such as family planning/birth control, basic infertility, and pre/ postmenopausal care. I provide primary care and stress the importance of being proactive.

2. How long have you practiced?

I have been a certified nurse midwife 25 years and have delivered more than 2600 babies.

3. What inspired you to become a CNM?

I was an EMT before I was a nurse. On one occasion, I was working in the emergency room when the director told me to go upstairs to L & D to learn how to do a delivery, since that would be helpful while working in the ER. The female doctor I worked with was so beautiful, calm and relaxed, yet very attentive. She calmly and gently delivered the baby. Instantly, I knew this was what I should be doing!

4. What are the top questions you are asked by expectant mothers?

Is my baby ok? Is it a girl or boy? Where will I deliver? When can I have a sonogram? When is my next appointment? How much weight should I gain? Do I have to take prenatal vitamins? How will I know if the water breaks? How will I know when labor starts?

5. What are your thoughts on current bioethical issues in maternity care? (particularly elective cesarean section)

  • Elective cesarean delivery (maternal request)
  • TOL/VBAC (trial of labor-vaginal birth after cesarean) versus repeat cesarean delivery
  • Home births
  • Circumcisions
  • Cord blood collection (fetal stem cells)
  • Chorionic villus sampling (CVS) and amniocentesis
  • Oocyte and embryo storage (prepregnancy)
  • 6. Any tips for women planning a natural hospital birth?

    The hardest yet most rewarding day of your life! Natural means vaginal versus abdominal (surgical).

  • Baby’s going to come, when the baby’s going to come (doesn’t read the sonogram report or prenatal chart). Baby is in charge.
  • Stay home as long as possible (exceptions: rupture of membranes, group b strep positive, vaginal bleeding, other medical or obstetrical reason to come right in)
  • Your birth plan is a wish list, not a guarantee!
  • Don’t start labor exhausted! Rest!
  • Eat and drink (you may vomit later)
  • Know who will deliver you
  • Know  when to go to labor and delivery
  • Beware of unrealistic expectations. Go with the flow of your body. Be flexible and open minded.
  • Know how you may labor…..in bed, on the ball, walking, on the fetal monitor, in the shower
  • You may have to bail out……and have a cesarean delivery….it’s not a failure, just another route of delivery
  • It’s your baby……everyone wants the baby in the first 5 minutes! Bonding is ongoing and forever
  • Breast feeding is not as easy as it sounds but everyone will help you
  • Nobody is judging you! Once you are a mom, you wear the badge MOM.
  • Whatever pregnancy and birth experiences it took to make you MOM should remain a memory and should not haunt you.

    Enjoy your baby!

    Thank you for sharing your expertise with my readers, Elizabeth!

    Book Review: Painless Childbirth: An Empowering Journey Through Pregnancy and Birth

    Book Review: Painless Childbirth: An Empowering Journey Through Pregnancy and Birth

    By Giuditta Tornetta
    Cumberland House, 2008
    ISBN 978-1-58182-640-1
    320 pages, softcover, $16.95

    http://joyinbirthing.com/

    Reviewed by Molly Remer, MSW, CCCE

    Written by a mother of two who is also a doula, childbirth educator, hypnotherapist, Painless Childbirth takes the pregnant mother on a physical, mental, and spiritual journey from conception through postpartum. The text is interspersed with personal stories from the author’s own pregnancies and births as well as those of her doula clients.

    A lot of people are initially skeptical of the phrase “painless childbirth” and I really loved the author’s description of what painless childbirth means: “When I say painless, please understand, I don’t mean you will not feel anything. What you will feel is a lot of pressure; you will feel the might of creation move through you. Pain, however, is associated with something gone wrong. Childbirth is a lot of hard work, and the sensations that accompany it are very strong, but there is nothing wrong with labor.” The book has no rigid concept of what “painless” means and no suggestion that mothers who do not experience birth as painless have “failed.” Painless Childbirth is written in a gently nurturing tone throughout (you can “hear” the author’s doula skills coming through), but is also very assertive that painless childbirth is very reasonable, doable, and is, indeed, the birthing mother’s right.

    The book contains a lot of ideas and concepts that are of use to doulas and childbirth educators. I particularly liked Tornetta’s characterization of the three phases of first stage labor according to the primary means of coping with each phase—distraction, concentration, and surrender.

    After my own experiences with pregnancy loss, I have become more aware of the treatment of the subject in birth books. Painless Childbirth directly addresses childbearing losses in a short, but compassionately written segment about healing past grief. The book also has content about exploring and overcoming fears.

    The book is holistic in its approach, addressing body, mind, and spirit. It contains a lot of spiritual content of a “new age” flavor (for example, lots of references to the law of attraction and the book is organized by month according to fetal development as well as associated body chakra). While I definitely agree that birth is a spiritual event, my practical, down-to-earth side stumbled a bit over some of the concepts and phrasing, and the esoteric content may not appeal to all audiences. That said, Painless Childbirth presents a positive, loving, welcoming approach to giving birth that is both refreshing and interesting.

    Disclosure: I received a complimentary copy of this book for review purposes.

    The Birth-Breastfeeding Continuum


    Birth professionals have long been aware that there is a connection between birth and breastfeeding, but in recent years experts are making this link more explicit and the inextricable nature of the two experiences is becoming clearer. Birth and breastfeeding exist on a continuum. They are not discreet events. As speaker and author Dia Michels says, “we need a new word—birthandbreastfeeding.” Human women are mammals and the same things that disrupt bonding and breastfeeding for other mammals also apply to women. Darkness, quiet, no disruptions/interruptions, safe, upright, mobile, easy access to food and drink as they choose….these things support healthy births for female mammals! In brief, a normal, healthy, undisturbed birth leads naturally into a normal, healthy, undisturbed breastfeeding relationship. Disturbed birth contributes to disrupted breastfeeding.

    New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed. An example is a mother who has an epidural, which leads to excess fluid retention in her breasts (a common side effect of the IV “bolus” of fluid administered in preparation for an epidural). After birth, the baby can’t latch well to the flattened nipple of the overfull breast, leading to frustration for both mother and baby. This frustration can quickly cascade into formula supplementation and before she knows it, the mother is left saying, “something was wrong with my nipples and the baby just couldn’t breastfeed. I tried really hard, but it just didn’t work out.” Nothing is truly wrong with her nipples or with her baby, breastfeeding got off track before her baby was even born!

    Problems with breastfeeding often start before baby is born. According to Linda Smith, BSN, FACCE, IBCLC, co-author of the book Impact of Birthing Experiences on Breastfeeding (2004), birth practices that impact breastfeeding include:

    • Mechanical forces of labor (positioning of baby, positioning of mother, etc.)
    • Chemicals (drugs) used in labor
    • Injuries to mother or baby
    • Treatment of mother during labor
    • Treatment of mother after birth
    • Separation from mother after birth
    • Procedures that alter behavior

    Linda Smith also notes that a mother’s confidence and trust in her body’s ability to give birth is related to her confidence in her body’s ability to breastfeeding. There are several birth related risk factors for breastfeeding problems (please note that not all babies with risk factors will actually have problems):

    • Induction of labor
    • Epidural and/or narcotic medications
    • Cesarean
    • Instrumental delivery (forceps or vacuum)
    • Post birth suctioning of baby’s airway

    Additional procedures that affect baby’s ability to breastfeed if they are done before baby’s first breastfeeding include:

    • Separation of mother and baby for any reason.
    • Weighing and measuring
    • Vitamin K injection
    • Metabolic tests
    • Circumcision
    • Infant hypothermia

    According to the Academy of Breastfeeding Medicine (www.bfmed.org), “unmedicated, spontaneous, vaginal birth with immediate skin-to-skin contact leads to the highest likelihood of baby-led breastfeeding initiation.” Immediate skin-to-skin contact restores the biologic continuum begun during conception.

    When I was in graduate school, one of my professors used the following analogy to make a point and I now use it with my own students:

    There is a river running through town. Daily, emergency workers are called upon to rescue people from the river who have fallen in and are floating downstream drowning. Day after day they pull the gasping people back to land until one of the workers suddenly realizes, “maybe we should go see what is happening upstream and try to stop these people from falling in to begin with?”

    My professor then encouraged us to always remember to go “upstream” when working in the helping professions rather than only addressing the immediately presenting problem. Childbirth professionals are in an “upstream” position when it comes to protecting the birth-breastfeeding continuum!

    —-

    For more about the value of keeping mothers and babies together following birth, check on Healthy Birth Practice Six: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding from Lamaze.

    —-

    References:

    If my mom were a platypus: what we can learn by studying mammal lactation, presentation by Dia L. Michels, La Leche League of Missouri Conference, November 2007.

    Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Mary Kroeger and Linda J. Smith, Jones and Bartlett Publishers, Inc.; 1 edition (February 2004). ISBN-13 978-0763724818.

    Mother-Baby Togetherness, presentation by Dr. Nils Bergman, La Leche League International Conference, July 2007.

    The Power of Touch, presentation by Diane Wiessinger, La Leche League of Missouri Conference, November 2007.

    Winning at Birth, presentation by Linda J. Smith, La Leche League International Conference, July 2007.

    ——

    This article is adapted from “Celebrating World Breastfeeding Week and the Birth-Breastfeeding Continuum” by Molly Remer, MSW, ICCE, published in the International Journal of Childbirth Education, June 2008.

    Information ≠ Knowledge

    Last week I attended a webinar about the ethics of childbirth. The presenter, sociologist Raymond De Vries, noted that choice is central to each of the ethical questions surrounding birth and then made the point that the problem with choice is that information does not equal knowledge. (He also mentioned the “ritual” of informed consent.) In the context of the webinar, the point was being made about ethical issues of prenatal testing, birth planning, and asking women to make decisions while in labor, but I think it has broader implications for our work as childbirth educators as well. We spend a lot of time informing and educating women about their choices surrounding birth and are often then surprised that this apparent information does not translate into experience once in the birth room. Obviously, this is partially because the birth room is a context impacted by a large number of social, cultural, psychological, and environmental factors, but I believe it is also because with all of our information we still haven’t managed to help parents develop knowledge and the two are not the same. Parents are often not able to recall or to mobilize information resources while actually embroiled in the birth experience. They need an inner knowing and inner resources to draw on for coping.

    While I have known this for a long time, I still find it difficult to translate my conviction into practice. How do people develop knowledge about an experience that is ultimately unknowable until they are in it?

    I do think that within the field of childbirth education, Birthing from Within is the method that most attempts to address this issue and I really value these two quotes from Pam England:

    “A knowledgeable childbirth teacher can inform mothers about birth, physiology, hospital policies and technology. But that kind of information doesn’t touch what a mother actually experiences IN labor, or what she needs to know as a mother (not a patient) in this rite of passage.”

    “While all of your (birth) planning may spin a cocoon of security, in actuality, the course of your labor is unknowable…your critical task is to prepare for a birth that has NO script.”

    Personally, though, even with the practices and ideas offered by wonderful resources like Birthing from Within, I find I am still working on the actual execution of the how in my classes of translating information into knowledge…

    Edited to add…I’m working on resolving this discrepancy through my new plan to offer birth workshops as part of a birth network, rather than as an independent educator.

    Film Review: Natural Born Babies

    Film Review: Natural Born Babies

    South Coast Midwifery, 2009
    DVD, 24 minutes, $24.95

    www.naturalbornbabies.com

    Reviewed by Molly Remer, MSW, CCCE

    This lovely short film produced by a midwifery service in California, is a great “ad” for the benefits of homebirth and of midwifery care. Natural Born Babies has a very clean, fresh, and contemporary feel and features a multicultural collection of homebirth families talking about their experiences in front of a white screen. Something that is particularly striking is that some of the people speaking with love and enthusiasm about their midwives and their birth experiences include a cardiologist, an anesthesiologist, and an ER physician!

    The first part of the film is titled Interventions and features both men and women speaking about birth, referencing how pregnancy and birth are treated like medical conditions and including a lot of discussion about the prevalence of cesareans. The point is made that, “no epidural can replace human touch.” The second part is titled The Birth Specialists and points out that OB/GYNS are pathology specialists, whereas midwives are trained in normalcy—“we take low-risk women, and keep them low-risk.” Midwives are specialists in normal pregnancy and birth. Because of the film’s emphasis is wholly on out-of-hospital birth and hospitals are critiqued very soundly, hospital-bound couples viewing the film may find that it causes their defenses to rise.

    Several of the parents are holding their babies as they speak and a CNM speaks briefly as well (citing both ACNM and MANA). The CNM manages Orange County’s only accredited birth center. I enjoyed the presence of a bio-physicist dad originally from Holland saying, “everyone I know was born at home” and noting that “you give birth the same way you live.” Several of the couples speaking do refer to the father as “delivering” the baby, which is a long-term pet peeve of mine.

    Special features include a 10 minute version of the film, an outtakes section, and a look inside the South Coast Birth Center. At the end of the film we see that one of the couples is the director/producer of the film.

    Natural Born Babies is a fast-paced film and though it is filmed in a “talking heads” format, it cuts quickly from person to person, thus keeping the viewer engaged. If you are looking for an informative video that is homebirth and midwifery friendly, but that does not include any birth footage, this would be a good addition to your library.

    Disclosure: I received a complimentary copy of the film for review purposes.

    Birth, Motherhood, & Meaning

    Birth Activist is having a Mother’s Day blog carnival focused on these questions: “As Mother’s Day approaches I always stop to reflect about how I give birth influences how I mother.  Would I have been a different mother had I birthed differently?  Just what does giving birth do to our ability to mother?”

    I instantly thought of a post I made several months ago and decided to revise and update it for this carnival. In initially re-reading the post, I was interested to note that my life as a mother has already changed since I wrote it!

    The post I am revising/excerpting now was a post in response to a quote from a Midwifery Today blog post: “your birth is the most important event in shaping your life as a mother.” I did a lot of thinking about this—IS birth the most important event that shaped my life as a mother? I’m not so sure. I am also interested to note how the texture of the question changes if I ask myself, “what is the most important event that shaped my life as a woman?” instead. The answer to that question—of my then-developing sense of womanhood—I believe is giving birth. But, the answer to the question about motherhood is a different and more complicated.

    I definitely believe that birth is “NOT just another day in a woman’s life” and that giving birth does have lasting impact on women’s memories and quality of life, primarily because they stand out in the memory as transformative events and it becomes an issue of the mudane vs. the miraculous (so, of course your every day life with your children is more important than that “one day,” but that the one days blend into one whole, while the birth experience stands out as, “HEY! Pay attention. Something BIG is going on here!”)

    I believe you can hold the two experiences simultaneously—you can enjoy (or suffer from) the birth memory while also cherishing the daily life with the little ones. One doesn’t have to trump the other or to be “what really matters.” There’s room for lots of mattering in an every day life :)

    Birth is (or can be) a “peak experience” for women (and families). I want all women to have a chance to experience that. I certainly do not want her to feel diminished, unworthy, inferior or lacking if birth is not a peak experience in her life, but I also want all women to certainly be given a reasonable opportunity to let birth unfold in all its power and be treated respectfully and humanely by those around her—regardless of what is going on or the eventual outcome.

    I love birth and cherish my memories of my sons’ births and consider them to be some of the most transformative, empowering, and significant single days in my life—peak experiences, powerful memories—and I also feel that birth matters as a distinct (and relatively rare) occurrence in a woman life. I believe birth has inherent value and worth on its own terms. I also believe that your feelings about the birth and the baby can most definitely be separated—you can feel pleased as punch with your delightful, precious baby and also be disappointed (or super thrilled with) your birthing. One does not take from the other—you can hold the reality of both and a breadth of feelings about them. And additionally, it is not wrong to want both things—a “good birth” and a “healthy baby.” The two go hand in hand and are not mutually exclusive concepts at all.

    I also think we can draw on powerful memories for present strength—I remember my “birth warrior” feelings and it helps me with other tasks or with day to day life. I remember the laughing, crying, “my baby, MY BABY!” moments of triumph and bliss and ecstasy immediately postpartum and it buoys me with a fresh charge of  love for my boys. I remember the sense of profound inherent worth that I felt after giving birth and bring that sense into my present-day awareness. I remember the feeling of transcendence and power and know that that power is still in me, even while performing mundane daily tasks.

    All that said, however, I also do not feel that my children’s births were the most important events shaping my life as a mother.

    For me, the profound shaping event was the experience postpartum with my first baby. I have never had an experience that shaped me and impacted me and SHOOK me more profoundly than adjusting to life with my newborn son. That was my journey. That was my struggle. That was my challenge. That is what dissolved me and burned me into ashes and let me rise again as someone the same but also brand new—a mother. I was not “born” when my son was born, I was forged. Made, in those intense weeks that followed his birth.

    When originally writing this post, I was pregnant with my third son. That pregnancy ended very unexpectedly in November, rather than May, when my baby was born after almost 15 weeks of pregnancy. Interestingly, my experience of miscarriage has supplanted the birth of my other two sons as essentially the most powerful/significant and transformative event of my life. (My sense that his birth has “replaced” the birth of my other children as most significant makes sense to me, because though it is classed as miscarriage, it is still my most recent birth experience—all of their births stand out as special, important, and meaningful days and I will remember each with clarity for the rest of my life, but his birth is the freshest and most recent and came with the additional transformative journey of grief. And thus, when I think of giving birth or when I think back to birth memories or birth feelings, his birth is the first one that comes to mind.) Though I still “vote” for postpartum as the most significant event in my life as a mother, I now “vote” for my birth-miscarriage experience as the most significant event in my life as a woman.

    New Training!

    This year, I completed several new trainings that I am very excited about.

    Prenatal Yoga Training

    This weekend I fulfilled a 7 year old dream and attended a prenatal yoga teacher training in St. Louis. I have wanted to teach prenatal yoga since I was pregnant with my first baby, but a training opportunity just never opened up for me until now. I felt like this was perfect timing. The training was through YogaFit and was pretty basic, but it was just what I needed to feel like I can move forward with this dream. YogaFit is a very “fitness” oriented type of program vs. any kind of holistic-mind/body connection stuff, but I can add those elements in myself. I think I will be able to offer something fairly unique—not just yoga and not just childbirth education but yoga-childbirth-education. There are several other programs like that, of course, but none in the local area! At the training, I also learned some really cool partner yoga stuff that I didn’t know how to do before.

    Birth Art Training

    In February, I completed something else that I’ve been dreaming about for some time—I took Birthing from Within‘s online course, “How to Lead the Birth Art Process.” Aside from a few minor complaints about the sometimes-frustrating “Zen” underlay and occasional contradictions within the course, I really LOVED this class. I found the online course format to be an ideal format for me—real-person interaction through message board, chat, phone call, and email; written information; writing journals/essay responses; hands-on personal practice with the assignments; and real-life application with other people/clients in birth art sessions. I felt like I got more out of actual use out of this workshop than most of the other classes and workshops I’ve attended—I think this was because the course was spread out over 5 weeks, not just a weekend, which allowed plenty of time to really assimilate and USE the information. It was very affordable too and I was able to attend right from the comfort of my own chair! The class is marketed as suitable for beginners, but personally I found my past background in childbirth education to be very important and I cannot imagine having taken the class with no prior birth class teaching experience—I think the people who had little experience were kind of disadvantaged in this course. Birthing from Within is my all-time favorite birth preparation book/resource and it was so exciting for me to have a little taste of direct training with them. Hopefully at some point in the not-too-distant future, I will take further training with BfW.

    Childbirth Educator Certification

    In March of this year, I was pleased to earn my childbirth educator certification with CAPPA. Since I am already certified with other organizations, I enrolled in the dual certification program option. I am very excited to be “throwing my hat in” with CAPPA. The organization is very friendly and stable and I really connect with the CAPPA Vision. The program information itself was pretty basic and I didn’t really learn anything new from it, but that makes sense because it isn’t specifically designed for people who already have CBE teaching experience—I think it is a great program for someone starting out in this field.

    Comparing CBE Programs:

    I get a lot of inquiries from people seeking information about different childbirth education programs and thought I would provide a super-quick mention of the things I enjoyed most about each of my certification programs/organizations. Keep in mind that I certified with ALACE first, hence, I had the most direct experience with their full training program, vs. the other organization’s “accelerated” options (which I SO deeply value and I am SO grateful that ICEA and CAPPA make that option available to people—I’m very, very grateful!). In sequential order:

    ALACE (now IBWP)—phenomenally in-depth training program with a wonderful woman-oriented, holistic, midwifery-model. Very homebirth friendly. When I finished this program, I felt like I’d earned another master’s degree—this time in birth. At the present time, however, I do not get a “stable” or professional feeling from the organization and that is very disappointing 😦

    ICEA—very professional. Lots of really good information on how to teach and on the principles of adult education in general. I learned the most about the “how” from ICEA (and the “how” is very, very important). They also have several great teaching manuals that are super-affordable. I enjoy the International Journal of Childbirth Education as well. Very professional. The training information assumes educators will be teaching a “mainstream” population, probably in a hospital, but their position papers are very sound and I can really get behind their mission as well. Their certification exam was the most difficult of the three programs and I feel like I really earned my certificate!

    CAPPA—I am really pleased with my association with CAPPA. As I noted, they are very friendly and I feel like they will be around for a long time to come. I just get a lovely, warm feeling of “sisterhood” from CAPPA and that is very important to me. I feel connected to the organization and the people and it is a very supportive atmosphere. I recommend them for training, especially for people who are just starting out. I’m excited about the free conferences CAPPA offers as well and I’m going to my first one this July! I also enjoy the CAPPA Quarterly and and I am proud to write the book/film reviews column.

    Thoughts About “Let”

    “The effort to separate the physical experience of childbirth from the mental, emotional, and spiritual aspects of this event has served to disempower and violate women.” –Mary Rucklos Hampton

    Related to my recent birth consumer post, I wanted to write a little bit more about the word “let.” One of my strongest birth-related pet peeves is the use of the word “let” when applied to birthing women. Women and providers and even doulas and CBEs often use terminology like “well, they let me get up for a while and walk around” or “my doctor is going to let me go to 41 weeks” or “the nurse let her get off the monitor for about 30 minutes” or “my husband won’t let me have a homebirth.” I do not like this phrase because of the “victim” mentality I feel like it conveys—-that women are passive and things are being “done to” them and they have no power of their own. I feel like it removes autonomy and empowerment and women’s control over their own bodies and births.

    I often remind people that birth is not a time in a woman’s life when she should have to fight for anything. I also like to gently remind clients that no one can “let” them do anything. With colleagues, I occasionally have to clarify or explain my perception of the term as disempowering. Though in the end, sometimes I need to let (!) it go and realize that some people are perfectly satisfied with the term. And, I also have to acknowledge that the word DOES accurately describe many women’s experiences-—they are “let” or “not let” to do things even if I think it should be different and think they should have more power and control during their own births!

    Becoming an Informed Birth Consumer

    Though it may not often seem so, birth is a consumer issue. When speaking about their experiences with labor and birth, it is very common to hear women say, “they won’t let you do that here” (such as regarding active birth–moving during labor). They seem to have forgotten that they are customers receiving a service, hiring a service provider not a “boss.” If you went to a grocery store and were told at the entrance that you couldn’t bring your list in with you, that the expert shopping professional would choose your items for you, would you continue to shop in that store? No! If you hired a plumber to fix your toilet and he refused and said he was just going to work on your shower instead, would you pay him, or hire him to work for you again? No! In birth as in the rest of life, YOU are the expert on your own life. In this case, the expert on your body, your labor, your birth, and your baby. The rest are “paid consultants,” not experts whose opinions, ideas, and preferences override your own.

    There are several helpful ways to become an informed birth consumer:

    • Read great books such as Henci Goer’s The Thinking Woman’s Guide to a Better Birth or Pushed by Jennifer Block.
    • Hire an Independent Childbirth Educator (someone who works independently and is hired by you, not by a hospital). Some organizations that certify childbirth educators are Childbirth and Postpartum Professionals Association (CAPPA), BirthWorks, Bradley, Birthing From Within, Lamaze, and Childbirth International. Regardless of the certifying organization, it is important to take classes from an independent educator who does not teach in a hospital. (I’m sure there are lots of great educators who work in hospitals, but in order to make sure you are not getting a “co-opted” class that is based on “hospital obedience training” rather than informed choice, an independent educator is a good bet.)
    • Consider hiring a doula—a doula is an experienced non-medical labor support provider who offers her continuous emotional and physical presence during your labor and birth. Organizations that train doulas include CAPPA, DONA, and Birth Arts.
    • Join birth organizations specifically for consumers such as Citizens for Midwifery or Birth Network National.
    • Talk to other women in your community. Ask them what they liked about their births and about their care providers. Ask them what they wish had been different.
    • Ask your provider questions. Ask lots of questions. Make sure your philosophies align. If it isn’t a match, switch care providers. This is not the time for misplaced loyalty. Your baby will only be born once, don’t dismiss concerns your may have over the care you receive or decide that you can make different choices “next time.”
    • Find a care provider that supports Lamaze’s Six Healthy Birth Practices and is willing to speak with you seriously about them:
    1. Let labor begin on its own
    2. Walk, move around and change positions throughout labor
    3. Bring a loved one, friend or doula for continuous support
    4. Avoid interventions that are not medically necessary
    5. Avoid giving birth on your back and follow your body’s urges to push
    6. Keep mother and baby together – It’s best for mother, baby and breastfeeding

    Remember that birth is YOURS—it is not the exclusive territory of the doctor, the hospital, the nurse, the midwife, the doula, or the childbirth educator. These people are all paid consultants—hired by you to help you (and what helps you, helps your baby!).