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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)

Guest Post: Squatter’s Rights

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Squatter’s Rights

A couple of posts ago, I mentioned I’d made a new sculpture that I titled after a friend of mine and an article she wrote several years ago. She originally sent me the article to review, because she was thinking of sending it to a magazine. Several years passed, several more babies were born, her computer got fried, and the article was lost. However, it stayed with me anyway. It stayed with me when I prepared for the birth of my rainbow baby girl, it stayed with me as I created birth art to prepare for her birth, and it stayed with me as I reached down to catch my baby’s whole pink wonderful self in my hands as she was born in one smooth reflex almost three years ago. So, I created my figure and I emailed Shauna about it and then I went digging. Deep in the ancient, archived messages in my Outlook Express folder on my old laptop that now belongs to Zander (age 7), I found it. I found Shauna’s squatter’s rights article that had so touched my birth consciousness in such a way that I never forgot—even though babies, computers, friendships, and time have all marched on. I was already a childbirth educator when I read it, had already given birth myself, and was deeply immersed in birth work and childbearing. However, that doesn’t mean that certain descriptions cannot reach us and grab our attention in new ways. I’m delighted that Shauna gave me permission to publish her article here and to share her insights and experiences in this way!

Squatter’s Rights

by Shauna Marie

Would the new child coming from me be slippery like soap? I rubbed my fat belly. I loved each pound I gained, each craving I had, and every trip to the bathroom. Okay, maybe not every trip to the bathroom. But, I loved this growing baby. Tucked away like a pearl in the sea just waiting to be discovered. I was in a constant state of marvel.

Would I be able to physically do this? No, I don’t mean the labor, nor do I mean the birth. I knew I could do that. I got lost in thought as I planned in my head every moment that would come after my body did the work of labor. The moment would come once my body was ready and the crown of a child’s head pushed itself from me, the moment the child would emerge. That’s what I was planning for; I planned to catch my own baby.

I imagined opening my legs and squatting, I even practiced. I wondered where I’d put my hands, how I would have my legs, and if this little wet creature would be so slippery that I’d drop him or her. In December of 1999 this would be my second birth, but my first time catching a baby.

Like many people from a young age I was led to believe that women didn’t and couldn’t birth outside hospitals. The ones who did were radical or even dangerous. I was led to believe that the birth doesn’t matter, the baby matters. For my own personal sanity, due to cultural birth fear, I had to just come to the conclusion that as long as my baby was okay I could endure anything and that it would all be over soon.

Now rewind a little bit here, because there is something to be said about being at the right place at the right time; or knowing the right person. As a person who now tries to make a difference by being a strong home birth and natural family living advocate, I know who you know can sometimes make all the difference. For some people they just need that connection with real birth; they need to know someone who will talk about what birth really is about from a natural and physiological point of view. Above all people need to be exposed to home birth because it normalizes birth.

I was almost connected at one small point during my first pregnancy, just weeks before my first birth a friend of a friend was having a baby. I asked where she was having the baby at and when. My friend said she was in labor now, and having the baby at home. A jolt of sudden uncomfortableness and worry struck me, “At home! Why?” (Thinking oh my gosh there is no epidural at home!) My friend responded with a rather obvious sounding answer, “Well her mom is a midwife.” “Oh,” I said in an understanding tone. Somehow this made total sense now. If her mom is a midwife then it’s okay for her.

Quickly all home birth thoughts were intercepted with other conversations of non-birth related content. To this day I feel that should have been my contact with home birth. Instead I missed my first calling and just two months later I was induced two weeks before my due date against my own wishes (along with two other women from my OB’s office) to fit into the OB’s schedule.

I learned an awful lot that night. I learned I would never give birth to a healthy baby in a hospital again. I learned that in a hospital it is okay for others to look at your body, touch you, reach into you, and deliver your baby; but it’s not okay for you to do so.

I also learned that birth does matter, not just a healthy baby. Healthy empowered moms matter and instincts are stripped away by technology and birth colliding. This often even includes the instinct to breastfeed.

I was shocked at how disconnected I felt from the waist down. These strangers were in charge of me. There is something about being tied to IV’s and monitors, naked from the waist down in a hospital bed, legs in stirrups, that takes your power away. Even though some one at some point said, “Here comes your baby, look at your baby come” I felt like I wanted to reach over my belly and feel, or catch. I’d seen that in a birth video once –a nurse said something like ‘you can touch your baby’s head and feel’ to a mom giving birth flat on her back. I waited for someone to say that to me, but no one did.  Be it because of hospital policy, or be it because of shame, it was a no-no to touch or even catch what was mine. I felt so disconnected as I tried eagerly to see over my belly, knees being held up to my ears by three sets of hands to the chants of, “Push, push, pushhh…. good girl.”

I wondered so much about just staying home. I had what I thought was an unexplainable and unfounded desire to hibernate in a dark corner like an animal.

Around the same time that I got pregnant with baby number two I heard a doctor on television actually say that women are physiologically unable to catch their own babies. Already committed to having a home birth that comment further sealed the deal. I was catching my own baby this time. Not only do I dislike someone telling me that I can’t do something, I didn’t believe a woman would let her baby just fall to the floor (many mammals are born that
way though). Surely even if a woman didn’t squat with intent to catch her baby the child would be born slipping onto bed or floor without assistance or harm. My research lead me to discover that women have given birth effortlessly while in comas, unassisted and unmedicated. We’ve all heard the stories of scared teens giving birth suddenly, alone in a bathroom. The body just gives birth when it’s time. Not to mention National Geographic taught me from a young age more than just that women in tribes go topless; they also sometimes give birth to babies unassisted and catch them.

Shauna’s eighth baby, born into her hands this summer.

I was also somehow sure a woman could give birth in total control; in control of her thoughts, feelings, and use of good judgment. I was no longer buying into the stereotypical out of control agony portrayed in movies. I didn’t know, but I deeply believed a woman giving birth, if allowed, could totally be in control and instinctively know how to give birth.

I figured that squatting would give me the best angle to catch my baby. Being in a squat, on bent knees, or even on all fours is clearly the most natural and easiest way to birth a baby. Squatting has roots in ancient history as far as birth goes back. It is only within the last 100 to 150 years, since physicians took control of birth, that women have been required to have babies laying their backs in the lithotomy position. Lying on the back (or semi lying) has obvious benefits from the doctor’s perspective as it provides a good view and way to manually remove a baby, as well as use a scalpel to cut a wider opening to the vagina. The use of gigantic tongs (forceps), vacuum suction extraction on the baby’s head, and even manually pulling on the baby’s head have all been routinely practiced by physicians.

Elizabeth Noble, author of Childbirth with Insight, states, “Women who squat for birth can generally deliver their babies without any manual assistance at all. Gravity and the free space around the perineum allow the baby’s rotation maneuvers to be accomplished spontaneously.”

There are vast differences in giving birth in a squatting position rather than lying down. Well over half of all the births in this country currently involve some type of surgical or operative procedure such as; cesarean section, episiotomy, vacuum extraction, or the use of forceps. These interventions and their accompanying risks could be avoided if women would just adopt a squatting position for birth. Aside from working with rather than against the body and gravity the birth canal depth is shortened during a squat, and the pelvic diameter is increased. In fact just the simple act of squatting can open a women’s pelvic outlet by up to 28 percent. All of these benefits can shorten the second stage of labor and the need for interventions. Squatting also reduces the risk of tearing. Dr. Michel Odent writes in Birth Reborn that, “This position assures maximum pelvic pressure, optimal muscle relaxation, extensive perineal stretching, and minimal muscular effort. It also provides the best safeguard against serious perineal tears.”

Routinely birthing moms are put on their backs or reclined in beds which center the mother’s weight on her tail bone, narrowing the pelvic outlet and compressing major blood vessels which reduce proper circulatory function. This in turn reduces oxygen to the baby and to the uterus making contractions less productive and more painful. Less oxygen to the baby signals distress in the infant, which if in a hospital could cause a whole round of interventions. Combine an oxygen deprived baby with a mother trying to push uphill with a baby that cannot move into a good birthing position because of restricted pelvic room, and ultimately you have mothers who are very good candidates for a birth that must be forcefully assisted by forceps, vacuum extraction or the ever so common routine C-section. The Centers for Disease control states on their website that cesarean sections are now at 32.8% in North America (2011).

Delivery of the after birth in an upright position also has clear advantages. When the placenta isn’t compressed there is less chance of blood pooling up and creating large clots, and gravity aids in placental expulsion.

When the day finally came for me to catch my baby I talked myself through the contractions. I told myself I could do this. I said over and over I can do this, because as a pregnant mammal it’s what I was put here to do. When I felt it was time I squatted over a mirror and saw the crown. I told myself to enjoy this moment, not everyone gets to catch their own baby, and I didn’t want to miss one second of this experience. I swirled the thick wet black hair that was presenting around in a circle with my fingertips. Any and all pain was gone, it was amazing. I focused on this new life that was unfolding from my body. I waited for contractions and I let my body do the work without forceful pushing or feeling agony. When the baby slid into freedom and the room was engulfed with newborn smells and newborn cries I cried out, “It’s a boy, it’s a baby boy!”

The impact of that birth was powerful and amazing; so much so that I have caught five more children from my body since then. There is a saying about the “thrill of the catch,” and midwives and doctors know this. It’s intoxicating and it’s very powerful to catch a baby.

So much harm has been done to cloud the process of childbirth. Birth isn’t just about babies, it’s about mothers too. It’s about how they work together. Catching your own baby puts you focused on your birth, and without trying you take the control and suddenly you feel and know what you need to do. Focusing on the important task of birth made an impact on me a very positive way as a mother. True freedom over my body gave me independence, confidence, and self-control.

Not every woman may want to catch her own baby, but every woman should be encouraged to do so, or at the very, very least know they can if they do wish to. Most women I have spoken with actually say they have never even thought of it.

The state of birth in this country lies squarely in the hands of birthing women. Until we start demanding more respect and more variation in our birthing options we have no one to blame but ourselves. We must first credit ourselves with being able to birth safely the way nature intended before anyone else will give us that credit. The seeking out of safe and natural birth options will slowly continue to influence and change how birth is perceived.

There are specialized hospital beds that can be converted in a way that women are more upright. If you will be giving birth in a hospital request them, demand them. Hill-Rom makes such a bed; the Affinity Three Birthing Bed aids a woman to side lie, squat, kneel, sit, and lean in various positions. It has a labor bar and position controls that are quite impressive. The bed can be lowered or raised up, down, back, and forth

There are birth balls, birth bars, and birthing stools that can aid in more natural upright positions in whatever birth setting you choose. There are showers and tubs to soothe a mother.

I share my experiences with catching my own babies, and have even shared very private birth photos and even one video with others in the past; because I have been told by so many women it has empowered them. I also hear from lots of women who say how strong both me and my legs must be to squat down like that. I assure that it’s not my legs that are strong; it’s my heart and my passion, and the willingness to open up and catch what is mine.

Shauna Marie is happily married to the man of her dreams. They live in the Midwest where they juggle eight energetic children while homeschooling and developing upon a one acre hobby farm of veggies, fruits, chickens, geese, and the dream of a dairy goat. She blogs about her life at Life with Eight Kids. Shauna is very passionate about family with an emphasis on childbirth and healthy, happy moms and babies.

Postscript: Shauna’s most recent birth story, excerpted below, is an excellent description of a squatting birth!

I was standing there in the still of the labor lull a rush of hormones hit me and the baby’s head slipped fully into the birth canal. I squatted down instinctively. I was then super indecisive: I flip-flopped between on my hands and knees to squatting, then squatting with one leg up and one leg down, then a leg up on the side of the tub, then standing upright, then a squat-stand and finally then back to the other positions all over again. This baby was going to start to seriously crown in a big way and I had no idea where I wanted to be! Having done this so many times I had way too many choices in my head and I knew what they all felt like. Later Ricky told me he got nervous that I was moving around so much in the tub; he was worried I’d slip and fall. I however felt firmly planted like a rock. I told him later I felt like I had sticky gecko pads on my limbs and slipping never crossed my mind.

Our baby was starting to crown as I finally squatted down low with one leg higher than the other (I was out of time to change things up. I’ll just squat and do it the same ‘boring’ highly effective way I always do it I thought lol.) I used some counter pressure on her velvety head to help ease her head out but it wasn’t really needed and a painless contraction inched her head fully out.

via Life With Eight Kids: Beatrice’s Unassisted Birth Story (half hour labor and birth -with extra info on my favorite topics of vernix, cord cutting, and not pushing).

Related Talk Birth resources:

Active Birth in the Hospital

Spontaneous Birth Reflex

How to Use a Hospital Bed without Lying Down

What to Expect When You Go to the Hospital for a Natural Childbirth

References:

(Elizabeth Noble, Childbirth with Insight, 78). See also Golay, J., et al., “The squatting position for the second stage of labor: effects on labor and maternal ad fetal well-being,” Birth 20(2) (June 1993):73-78.

Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives.Terry RR, Westcott J, O’Shea L, Kelly F. J Am Osteopath Assoc. 2006 Apr;106(4):199-202. Conclusion: Nonsupline positions during labor and delivery were found to have clinical advantages without risk to mother or infant. Enhanced maternal outcomes included improved perineal integrity, less vulvar edema, and less blood loss.

Dr. Martha Collins D.C., Pregnancy and Chiropractic Planetciropractic.com

Russell JGB. Moulding of the pelvic outlet. J Obstet Gynaec Brit Cwlth 1969;76:817-20

Squatting can enlarge the pelvic outlet up to 28 percent (Russell, J.G., “The rationale of primitive delivery positions,” Br J Obstet Gynaecol 89 (September 1982):712-715

Paciornik M; Commentary: arguments against episiotomy and in favor of squatting for birth. Birth 1990; 17(2): 104-5.

The total U.S. cesarean delivery rate reached a high of 32.9% of all births in 2009, rising 60% from the most recent low of 20.7 in 1996 Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2009. National vital statistics reports; vol 60 no 1. Hyattsville, MD: National Center for Health Statistics. 2011.

Marion Sousa writes: “[Squatting shortens and widens the pelvic outlet.” (Childbirth at Home. New York: Bantam, 1976 in Judith Goldsmith, Childbirth Wisdom from the World’s Oldest Societies, 153)

Several studies have reported that in the majority of women delivering in the lithotomy position, there was a 91% decrease in fetal transcutaneous oxygen saturation (Humphrey et al. 1973, 1974)

Robertson, Empowering Women: Teaching Active Birth in the 90s, (105)

Dr. M. Odent Birth Reborn, (101)

Hill-Rom Affinity Three Birthing Bed educational video and website. Online user manual http://www.hill-rom.com/PDFs/manuals/UserManuals/u025_iet.pdf

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?

slide

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.

MamaFest!

Last summer, my Rolla Birth Network friends and I conceived of a local event to be held celebrating mothers. We made a couple of August 2013 020decisions in planning our event that were really smart: we decided to focus on celebration rather than education (or even activism), we decided not to involve any money (either for the attendees or the hosts [aside from tabling materials/supplies]), and…this is key…we also decided to only do that which was within our own personal resources to provide. It worked! We pulled off a lovely MamaFest event at Tara Day Spa in Rolla. It was well-attended and fun and involved very little expense for anyone. It was work, of course, but it was within our resources/capacities. Community organizations were welcome to have a table at the event for free with the only stipulations being no formula/bottle materials (this event is co-sponsored by La Leche League of Rolla in conjunction with World Breastfeeding Week) and that they had to provide something to do at their table. Our vision was that this event would not involve simply walking around picking up flyers and leaving, but instead would provide an opportunity to hang out with friends, see cool things, learn some stuff, and make some projects. I had a birth art booth that was a delight for me to offer to the women.

This year in August, we hosted our second annual MamaFest event, again with a similar vision. Our resources/time were a little slimmer August 2013 017this year due to peoples’ schedules (particularly my own, leaving my co-founder shouldering most of the organizing effort), new babies, etc. We had fewer exhibits and fewer attendees and slipped more into the boothy-vibe that we hoped to avoid, and learned some things to try next year. I still consider the event a success, especially considering the fairly minimal womanpower with which we had to work. It was an especially good outreach opportunity for LLL and I said at the end that even if I hadn’t been involved at all with the planning of it, I would definitely have considered it a worthwhile event to continue attending with my LLL booth. I was super excited about my simple, but pretty (and free!) offering for the birth art booth this year: mother affirmation/blessing cards. Unfortunately, very few people took me up on my offer and I was a little sad about that, but my LLL booth with its breastfeeding trivia game and got breastmilk ™ pins was pretty popular. We have lots of ideas for next year and the possibility of experimenting with new directions, such as doing away with the booths altogether and having more retreat-like experience stations (i.e. yoga). What we know we want to keep is our commitment to celebrating women and their capacities, because they’re just super awesome and worth celebrating!

Here are some pictures of my booth and some projects from the event:

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Birth art booth!

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Loved this thumbprint necklace project offered at the booth of a local doula/photographer. Alaina appropriated it immediately because, “me like hearts!”

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Babyloss memorial charms offered by the Rainbow Group (local pregnancy/infant loss support)

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Emergency back up project that I scrambled for when I realized people weren’t making my cards–affirmation “stones” (glass pebbles written or drawn on with glass paint markers).

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At least my own loyal family members showed up and made my project! (mom, sister, and visiting cousin)

What I learned from this event again this year was that you do not have to live in a city to be able to offer something like this in your community, all you need is a small handful of women who care and who can use their skills and resources to make it happen! 🙂

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…

Book Review: The Doula Guide to Birth

Book Review: The Doula Guide to Birth

The Doula Guide to Birth: Secrets Every Pregnant Woman Should Know
By Ananda Lowe & Rachel Zimmerman
Bantam Books, 2009
Softcover, 270 pages
ISBN: 978-0-553-38526-7
www.thedoulaguide.com

Reviewed by Talk Birth

The Doula Guide to Birth is written for pregnant women, though the title may suggest that it is for doulas. It also has a chapter and sections specific to birth partners. However, doulas will also find the book to be a friendly, enjoyable read and may pick up some fresh perspectives for their work with birthing women.

The book also includes (short) sections for often-ignored or marginalized segments of the birthing population such as same-sex partners, parents using a surrogate mother, and women planning for adoption.

The first five chapters of The Doula Guide to Birth cover benefits of doulas, the role of fathers/partners and the complementary nature of the doula role to other support people, general overview of labor, childbirth education options and medications, and finding a doula.

The later seven chapters delve deeper into less typical subjects such as doulas and medical providers, when should you really go to the hospital, labor techniques, unexpected interventions, birth plans/birth essays, and what really happens postpartum.

Though not a criticism per se, I did feel like the first half of the book reads very much like an extended “commercial” for doulas. The second half of the book really shines. My favorite chapter was “labor is not about dilation”: “Although there is currently a heavy emphasis on dilation, vaginal exams, and timelines for giving birth, labor is not about dilation. Your body knows how to give birth whether or not you ever have a pelvic exam during labor. Birthing women need encouragement to trust their bodies, and to be the stars of their own labors. Doulas help provide this encouragement. And the confidence a woman discovers in labor can help carry her through the demands of parenting and future challenges in life.” (emphasis mine).

The Doula Guide to Birth is supportive of the midwifery model in philosophy, but only includes very brief mentions of midwives, the assumption being that most births will be in the hospital.

The book has extensive endnotes and an appendix with a birth evaluation form.

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

Review previously published on Citizens for Midwifery

Women of Color Can Push for Better Outcomes: What Every Mother-to-Be Should Know About Birth

Guest post by Tara Owens-ShulerImage

As an African American Lamaze Certified Childbirth Educator, I have observed over my 18 years of teaching that childbirth education class participants are less likely to be women of color. My desire for more women of color to attend childbirth education classes is rooted deeper than just their presence in a classroom – it is rooted in my desire for more women of color to understand the disparities that exist in maternal and birth outcomes.

In a recent Science and Sensibility blog post by Christine Morton on maternal health disparities, she reviewed the work of several well-known public health researchers – Dr. Eugene Declercq, Dr. Mary Barger and Dr. Judith Weiss. Their findings point to the fact that African American women have higher rates of cesarean births at nearly every age group and across every level of education.

In addition, the U.S. Department of Health and Human Services reports that one of every five non-Hispanic,black births are pre-term, African American mothers experience an infant mortality rate twice that of non-Hispanic, white mothers, and breastfeeding rates among African American mothers are 16 percent lower than white mothers.

Given the disparities that exist in maternal and birth outcomes for women of color, I think April as Minority Health Awareness Month is a great opportunity to talk about a few other factors that minority moms or mothers-to-be can control or influence. It’s a hard reality that mothers face real challenges in getting the childbirth care they want and deserve. Even though medical evidence may tell us certain practices are good for mothers and babies, the “system” is not always geared to deliver that care. Health care providers are rushed, spread thin, or incentivized for practices that are not most beneficial to the mother.

Let’s go back to the fact that African American women have higher rates of cesarean births than non-Hispanic,white women. Is it because African American women are sicker and need to have a cesarean birth? Researchers report that this is untrue. They conclude that higher rates of cesarean births among African American women are a result of a shift in obstetric practices to focus more heavily on use of childbirth interventions. And, when we bring in an induction to the equation, there is a correlation between the increased rates of induction to the increased rates of cesarean births!

Research shows that babies pay a steep price for these early births caused by inductions or a failed induction, which led to a cesarean. Babies have greater difficulties breathing, breastfeeding, and maintaining their temperature, which usually means being separated from moms and spending time in the Intensive Care Unit. While an increasing number of hospitals and health care professionals are shying away from unnecessary cesarean birth and induction, it’s one of many care practices that just aren’t supported by good medical evidence.

So how can women of color push for better care?

  • Become an active partner with your care provider. While doctors or midwives have professional knowledge and skills, they may not know everything about your personal background and preferences. Finding a provider who will also act as your partner can help you push for the care that’s best for you and your baby.
  • Ask questions – lots of them! Labor and birth in particular can be unpredictable. That’s why it’s a smart idea to prepare a list of rolling questions throughout your pregnancy to help you determine if the right care is being recommended during labor, birth and after birth.
  • Do your research. Understand your available care options before, during and after labor at the hospital or birth center. If you know that during labor you’d like the ability to walk around, eat and drink – choose a birth facility that will be more aligned with your birth preferences or wishes.
  • Participate in a childbirth education class. Taking a Lamaze class will help you understand maternity care best practices and be better prepared to navigate your labor and birth. A childbirth educator will help you identify the right questions to ask when making decisions about your care.

I encourage all women – particularly African American women – to learn more about getting the right care in pregnancy and childbirth by attending a childbirth education class. Skipping out on childbirth education is a lost opportunity to stack the deck in your favor and become a well-informed consumer of evidence-based practices! As a consumer, it is your right to be a partner in your health care decisions.

Tara Owens Shuler, MEd, LCCE, FACCE is the president of Lamaze International. She has practiced as a childbirth educator since 1995. In 2005, she became the Director of the Duke AHEC Lamaze Childbirth Educator Program. In addition to training individuals to become childbirth educators and preparing expectant women and their partners for a safe and healthy birth experience, Tara provides labor support services. Along with coordinating the Lamaze program in the Duke AHEC office, Tara works with her statewide AHEC partners in developing continuing education programs and/or resources for healthcare providers in North Carolina and assists with the Duke AHEC PATHWAYS Health Careers program for K-12 students. When not working, Tara and her husband enjoy playing with their dog, Gramps, and traveling.

Visit Lamaze International for great resources to help mothers and mothers-to-be learn their options.

Tuesday Tidbits: Birth Research

“Women around the world and throughout time have known how to take care of each other in birth. They’ve shown each other the best positions for comfort in labor, they’ve used nurturing touch and repeated soothing words, and they’ve literally held each other up when it’s needed the most…”

–The Doula Guide to Birth

New experiment with a business card holder!

New experiment with a business card holder!

A lot of things caught my eye to share this week. A Faceboook friend is conducting research about birth professionals for her master’s thesis for Sociology:

Ahmie Yeung is working on her Master’s thesis in Sociology at Cleveland State University, under the guidance of Dr. Linda Francis. Ms. Yeung’s thesis research is looking at the attitudes of professionals in the United States who provide care for women and infants during pregnancy, birth, and the newborn period – also known as “perinatal care providers.” This can be anyone who is normally paid for the services they are providing during that time period. Examples of kinds of professionals we want to hear from are: doulas, midwives, OB/Gyns, Family Practicioners, and Pediatricians. This research will hopefully provide some insight into differences between types of providers that may be of use to future families seeking maternity and newborn care. Please ask those who are or have provided care for you to take the brief survey at http://tinyurl.com/perinatalcaresurvey and forward this request on to any other expecting/new parents or perinatal care professionals you may know.

And via Citizens for Midwifery:

Researchers are developing a new tool to educate pregnant mothers about their birth options. They need your help to learn what matters most to pregnant mothers. Pregnant or planning another birth? Please share!

Childbirth Preferences Study

The Spring issue of the Friends of Missouri Midwives newsletter is finished and available online! The theme of this issue was Siblings and we’ve got a variety of articles about including siblings at births 🙂

I got a little crazy with my ScoopIt page and went through over 100 articles of possible things to “curate.” And, I found some good stuff!

Which included this gem:

“To paraphrase Simon, everybody loves mothers, as long as they restrict their fertility to the outlines demarked by the social and moral norms of the age they find themselves in, and don’t have the audacity to give birth too young, or too old, or too regularly, or at too great a cost to the state, or to a child that they share with another parent of the wrong race or gender…”

And, an interesting article debunking the idea that women “forget” the feelings of childbirth. Memories are affected by the “halo effect” of the euphoria following birth, but the feelings are not actually forgotten:

I also thought of a couple of older posts of my own:

Talk to Your Baby

“Babies are primed to hear their mothers’ voices after birth. They expect to be snuggled into the maternal nest. Mammal babies expect to receive a warm breast and to hear comforting words in their own language…”

Birth as a Rite of Passage & ‘Digging Deeper’

“All cultures believe that women become better and more generous through the process of giving birth. That is why some cultures use words such as ‘sacrifice,’ ‘suffering’ and ‘labour.’ These terms can seem overwhelming and to be avoided’ however, seen from a different viewpoint, childbirth helps us to become strong, resourceful and determined…”

Birth & Culture & Pregnant Feelings

“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…”

Where are the women who know?

“…the most important thing is to never bring fear into the room of a laboring woman. ‘A woman must be completely open to birth a child,’ she says, ‘and so she is unable to defend herself from the thoughts of those around her…’”

And, a funny story from a couple of weeks ago:

“Visiting kid working on costume: “why do you have all this red fabric?” Me: “I think I planned to make placentas out of it.” Later, same kid: “this is an interesting color of yarn.” Me: “I got that to knit uteruses.” Kid: “maybe I should dress up like a scary doula.” 😉

Women’s (Birth) History Month

…we  need to grasp an honest understanding of birthing history – one that tells HERstory not HIStory.  Because birth is about Women.  It is a woman’s story. And we need to also understand why and how this herstory compels women to make the choices they make surrounding birth in the present day.

People become the product of the culture that feeds them.

It takes an immense amount of work to deconstruct cultural lies. Especially ones as insidious as the ones that we, as birthing women, have been fed for more than a century. We need to stop blaming women for their place in this System. Women are victims and by-products (not accomplices) of medicalized birth.

via That Joke Never Gets Old. Or Good

March 2013 039In honor of Women’s History Month, I’ve been considering the women in (recent) history who have changed the climate surrounding pregnancy and birth. While I’m sure Ina May Gaskin’s name would probably spring to the lips of most birth activists considering the theme, I felt like taking a quick look at the many other classic authors who have had a profound influence on my own ideas about birth. This thought, coupled with the fact that for some time I’ve wanted to write a post about “older birth books” that are still excellent reads today, has brought me to the present moment: a list of my favorite “old” birth books and the lovely women who wrote them. When I first started out in birthwork, I wanted to read “new” stuff—stuff that was “up to date” and “current.” After I read almost all of the “new” books, I started to cast my eye around for more and guess what I discovered? No surprise to many of you, but many of those “out of date” books with the retro-looking covers are still just as good and just as relevant as they were 20-30 years ago. Since medical information and science/evidence changes fairly rapidly and a pregnancy and childbirth 101 type book from 30 years IS more often than not completely inappropriate today, I had made the mistake of thinking ALL “old” birth books would be similarly irrelevant. Instead, many have a power and passion that is not easy to come by in any decade and that rouses the activism spirit, or stirs the heart, or challenges the psyche just as effectively today. Here are some of my recommendations (and of course, Spiritual Midwifery remains a good choice too, I just want to add some less usual recommendations!):

  • Transformation through Birth by Claudia Panuthos (also known for writing another great resource: Ended Beginnings: Healing Childbearing Losses). Written in 1984, this book “goes beyond” the scope of traditional birth books and really gets into some deep topics and insightful ideas. Previously written about here.
  • Special Delivery by Rahima Baldwin (another good, less well-known one from her is Pregnant Feelings, explored in depth in this post). Revised in 1986, this book is one of my favorite homebirth resource books. Though some segments are in fact, “outdated,” I still find this to be one of the very best (“old” or new!) resource books for women planning to give birth at home.
  • Open Season by Nancy Wainer (Cohen) in 1991 (how can 1991 be called “old”? Well, it is over 20 years ago and considering that many women giving birth today were born after that date, it IS old!). Nancy has a lot of FIRE and I love it. Some people have been known to call her “angry” or “bitter.” I call her…amazing. Her writing lights you up and calls you to action. She has incredible passion, fire, brightness, drive, and enthusiasm. One of her articles in Midwifery Today that is available online is also well worth the read: VBAC and Choice. And, I use some of her quotes in this post.
  • Birth Book by Raven Lang. This is the original counterculture birth book written in 1972 at the launch of what would become the modern movement to return birth to the hands of women.
  • Childbirth with Insight written in 1983 by Elizabeth Noble, is another one of the birth books that I say “goes beyond.” As a childbirth education, I especially benefited from her exploration of some of the failings of traditional approaches to childbirth education.
  • Lots of older books from Sheila Kitzinger are very good also. I particularly enjoy The Experience of Childbirth and Giving Birth: How it Really Feels.
  • My last recommendation for the moment is Mothering the New Mother by Sally Placksin (revised in 2000, which again sounds reasonably recent, but in reality is thirteen years ago–how is that possible?). It is classic must-read for doulas as well as any other birth companions. It is wonderful and I wish I would have read it before my own first child was born.

There are many more excellent books out there, both modern and “herstorical,” but I’ll leave you with these treasures for now. I’m grateful for each of these birth activists whose words and spirits helped deepen and refine my own passion for birth.

I long to speak out the intense inspiration that comes to me from the lives of strong women.” –Ruth Benedict


(Adapted from a post originally made at CfM several years ago.)

Book list: Preparing Children for Homebirth

MR_024The theme of our spring issue of the Friends of Missouri Midwives newsletter was Siblings. Happily, I got a lot of great content for this issue without having to write everything myself (sometimes I prepare issues that should be called “The Molly Issue”). Other than the letter from the editor, the only piece I contributed this time around was a short list of homebirth resources for children. If you have other good resources to add, I’ll gladly accept your contributions and update the list accordingly.

Here’s my list:

(Amazon affiliate link included)

  • Runa’s Birth by Uwe Spillmann and Inga Kamieth– my all-time favorite children’s homebirth book. The illustrations in this book are amazing; I love the tiny details like little shells/rocks on the windowsill and phone messages on the bulletin board.
  • Welcome with Love by Jenni Overend and Julie Vivas (also published as Hello Baby). It has nice, softly drawn pictures that glow with excitement and I really enjoy reading it to my kids.
  • Birth Day DVD by Naoli Vinaver—this one is great because the whole family is involved and older brothers join mom in the birth pool.
  • We’re Having a Homebirth by Kelly Mochel. This book is inexpensive, cute, and informative.
  • Being Born: The Doula’s Role by Jewel Hernandez and R. Michael Mithuna–really nice, detailed illustrations. Focus is on doulas and their job and the wide range of settings in which mothers give birth.
  • Mama Midwife: A Birth Adventure by Christa Tyner— this new children’s book about homebirth and midwifery is available to read for free online. It is cute, though kind of trippy. (I would have preferred it to be just people though, rather than a somewhat incongruous collection of animals.) LOVE the “birth song” at the end.
  • My Mommy’s Midwife by Trish Payne CNM—this one has children’s drawings as the illustrations. It isn’t about homebirth, but instead explains the role of the midwife and that she might come to a birth center, a hospital, or a home birth.

Books that I’ve not read, but would like to check out include:

  • Our Water Baby by Amy Maclean and Jan Nesbitt (water birth specific)
  • Mama, Talk About When Max Was Born by Toni Olson (home waterbirth)
  • Mama, Talk About Our New Baby by Toni Olson (companion book to the above about integrating new baby into the home)

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