Bits of the (Birth) Net

Oct6

The following is a collection of the bits and pieces that caught my attention and then were shared via my Talk Birth Facebook page during the last two weeks.

Listening

From a good article by the National Association of Mothers’ Centers in Mother Support: When Words Get in the Way…

Words, whether written or voiced, are so very fragile. They can be bent or twisted, even become unrecognizable from their initial intentions. They can have different cultural meanings, regional understandings, and generational perceptions.

There will always be the opportunity for miscommunication…

Such a good reminder. What you say and what people hear are often two different things. What you say and what you mean can be different. How your words are received and interpreted can be very important and intent in many ways doesn’t matter! Communication is transactional process. A two-way process. And, it is symbolic. Meaning can never be fully interpreted and understood completely.

This article also reminded me of one of my own older articles, Listening Well Enough, which came to mind because I’m finishing up with the training of two women. The essay describes my own experience when I was training as a breastfeeding counselor in 2005.

Privacy

The topic of what to risk sharing online came up with friends recently and I enjoyed this article about answering the question of How Much Of Your Private Life Should You Keep Private On Your Blog?

Childbirth Education

“Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant…”

The above is one of the concluding points from an interesting article from Birth Works International about supporting women without epidurals.

Good article from Lamaze about your breath and how it can help during pregnancy and birthing!

Virtual labor simulator!

Pushing Positions

Very interesting article on What is the Evidence for Pushing Positions? Apparently there is more blood loss and second degree tears with upright pushing positions. Personally, I CANNOT imagine giving birth in a supine position. But, I’m also really, really, tired of tearing (tired enough that it is one of the factors in our decision not to have “just one more!” baby). For more thoughts about pushing, see previous post on Following Your Body’s Urges to Push…

And speaking of upright birth, Barbie homebirth photos! 🙂

Informed Consent

Valuable article addressing 10 Responses to Pressure to Consent (remember, it isn’t “informed consent” if you do not have the option of saying NO!)

Posts I’ve written about informed consent:

Conscious Agreement and Informed Consent

The Illusion of Choice

Honesty in Birth Preparation

Information ≠ Knowledge

Can I really expect to have a great birth? (updated edition)

Prenatal Yoga

Online video prenatal yoga class: Prenatal Yoga – when you feel good, your baby feels good.

And my own prior posts on the subject:

Incorporating Prenatal Yoga into Childbirth Education Classes

Birthing Room Yoga Handout

“Birth, this elegant, simple, yet intricate process has had unnecessary, complex, expensive technology superimposed onto it, creating a dangerous environment for birthing women.” -Alice Bailes

Loved this article on what really matters for midwives!

Epigenetics

NEW STUDY: Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes. “As parents, we have to understand better that our responsibilities to our children are not only of a social, economical, or educational nature, but that our own biological status can contribute to the fate of our children, and this effect can be long-lasting,” said Mihai Niculescu, M.D., Ph.D., study author from Nutrition Research Institute at the University of North Carolina at Chapel Hill, in Chapel Hill, N.C.–Epigenetics: Mother’s Nutrition — Before Pregnancy — May Alter Function of Her Children’s Genes

After CAPPA this year, I wrote about epigenetics here: Epigentics, Breastfeeding + Diet, and Prenatal Stress

Call the Midwife

Fun! Ms. Magazine linked to one of my blog posts about midwifery in their post about the PBS show Call the Midwife! And, after posting to the CfM Facebook page about how I didn’t get to watch the show myself because I have no TV channels, CfM fan Jackie clued me in that Call the Midwife is available online (no TV channels required!) Yay! 🙂

Older Posts of My Own

Birth Culture: “Birth is cultural, the way eating is cultural. We don’t just eat what our bodies need to sustain us. If we only did that, there would be no reason for birthday cake. Birthday cake is part of our food culture. The place you are giving birth in has a local culture as well. It also partakes of our national birth culture. Not everything doctors do regarding birth makes the birth faster or physically easier for you or the baby. Some things are just cultural.” -–Jan Mallack & Teresa Bailey

Creating Needle Felted Birth Art Sculptures: My first foray into birth art, before I fell in love with using polymer clay!

Centering for Birth: “Centering is a breath awareness strategy that I’ve adapted for use in birth classes based on the ten second centering process described in the short book Ten Zen Seconds…” Free handout available about centering for birth! (I was reminded of this post by Enjoy Birth!

Breastfeeding as an Ecofeminist Issue:“What happens when society and culture pollute the maternal nest? Is that mother and baby’s problem or is it a political and cultural issue that should be of top priority? Unfortunately, many politicians continue to focus on reproductive control of women, rather than on human and planetary health…”

During a week when I didn’t have time to craft delightful new blog posts, it was fun to have a post from a couple of months ago suddenly getting all kinds of hits and Facebook shares. Thanks, internet! ;-D (Around 150 shares on Facebook apparently. I ♥ Facebook!)

On Parenting Books

Mama Birth: Sadly, Parenting Books CAN’T Actually Raise Your Child: Enjoyed this post! (But I recommend NOT reading the comments on the original article she links to about “detachment parenting.” I lost about 30 minutes of my life, felt my blood pressure rising, and only made it to page three!)

“The revolution must have dancing; women know this.
The music will light our hearts with fire,
the stories will bathe our dreams in honey
and fill our bellies
with stars.“

-Nina Simons via Rebecca A Wright, Doula

DVD Review: Laboring Under an Illusion

Oct2

DVD Review: Laboring Under an Illusion: Mass Media Childbirth vs. The Real Thing
Filmmaker: Vicki Elson
50 minutes, $39.99 (personal use)
www.birth-media.com

Reviewed by Molly Remer, Talk Birth

Laboring under an Illusion is a treasure trove of discussion-provoking material. Filmmaker Vicki Elson is an anthropologist and childbirth educator who has created a striking documentary exploring media-generated myths about childbirth. As a childbirth educator, I often reference in my classes how our attitudes and expectations about birth are shaped by media messages—birth is an emergency, etc. This film eloquently and entertainingly provides 50 minutes of backup material for the idea!

The film blends media messages from comedy shows like Murphy Brown, Mad About You,and I Love Lucy, movie clips such as Juno, Coneheads, and Nine Months, along with “reality” based shows on Discovery Health with the inherently contrasting messages in clips of beautiful births from films like Birth as We Know It, The Business of Being Born, and Orgasmic Birth. It also contains brief voiceover narrations from “regular” women about birth. Occasionally, there is a scene with the filmmaker speaking directly to the viewer about concepts raised in the film. These scenes are less entertaining than the popular media clips and the friends with whom I watched the film wanted to fast-forward these segments—the media clips chosen so clearly speak for themselves that they don’t really need explanation, at least to the already birth-savvy viewer. Because of some strong language in the media clips, I caution parents to preview the film before sharing it with children.

Laboring Under an Illusion is an entertaining and illuminating film for consumers as well as for birth educators, doulas, and midwives. I highly recommend it!

—

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

Amazon affiliate link included in image.

Domestic Violence During Pregnancy

Sep26

By Molly Remer, MSW, ICCE, CCCE

Violence during pregnancy is an unfortunately common experience. Between four and eight percent of women experience domestic (intimate partner) violence during their pregnancies. The incidence of violence increases for women with unplanned or unwanted pregnancies with 26% of pregnant teens experiencing intimate partner violence and 15% of all women whose pregnancies are unwanted being in an abusive relationship. Indeed, murder is the second only to car accidents as the most common cause of injury related death for pregnant women.[1] Sadly, these statistics are likely higher in reality due to underreporting or misclassification.

Despite prevalence and severity, domestic violence is not often addressed in the birth community. Books directed at pregnant women rarely even mention violence in pregnancy (and most do not even include it at all), even though the incidence is similar to the rate of premature births and much higher than the incidence of various pregnancy related complications that generally warrant at least a paragraph in birth literature (such as placenta previa). Likewise, books and training programs for doulas, birth educators, and other birth professionals, generally neglect to address intimate partner violence.

An introduction to the issue of domestic violence during pregnancy requires an understanding of the following dynamics:

Cycle of Violence—the concept that violent behavior in a relationship tends to occur in three distinct phases. In the tension building phase, the battered partner feels as if she is “walking on eggshells.” The abuser’s temperament and mood becomes increasingly unpredictable and volatile and culminates in the explosion/eruption phase in which an acutely violent incident occurs. Early in a relationship, this phase is often followed by the honeymoon phase during which the batterer is contrite, asks for forgiveness, offers gifts, and assures the woman that, “it will never happen again.” The length of each phase varies by couple and with their relationship. Over time, the tension building or explosion phases may be very prolonged, with little or no time spent in the honeymoon phase.

The cycle of violence continues to repeat and tends to escalate in severity, despite the assurances that the batterer makes during the honeymoon phase.

Domestic violence is about power and control. It is NOT about anger management, substance abuse (though substances can increases violent incidents), or “nagging” from a girlfriend or wife.

The abusive partner tends to tell the woman that the violence is her fault and that she provokes or deserves the abusive incidents. He often isolates her from people and situations that will help her know otherwise.

Abusive relationships may involve physical, emotional, or verbal battering and frequently some combination of the three. Physical abuse includes pushing, choking, kicking, sexual abuse and other means of physical control/harm as well as punching or slapping. Verbal and emotional or psychological abuse involves name calling, insults, berating, shouting/screaming, humiliation, threats, intimidation, destruction of property, isolation, activity restriction, abuse of pets, and withholding of economic, physical, or emotional resources. Women often forget to acknowledge some physical forms of violence like choking or pushing as “real” abuse and will often not consider themselves abused unless they have been punched or slapped by their husband or partner.

Women stay in abusive relationships for numerous reasons. Battered women often leave their relationships several times before they end it for good. Reasons are dynamic, complex, and individual. Some very basic reasons include hope, love, and fear. The most dangerous time in the relationship is when she leaves—it is then that she is most likely to be severely injured or killed. As a society, we should NOT be asking why women stay, we should be asking how we can stop domestic violence from happening.

So, what can you do? If you are a pregnant woman who is being abused, please contact your local domestic violence shelter or hotline. Or, call the National Domestic Violence Hotline at 1-800-799-SAFE. Even if you do not feel ready to leave your relationship, many shelters offer “outpatient” support groups and counseling. If you are a prenatal health care provider (midwife, doctor, nurse, physician assistant), please include domestic violence screening questions during your prenatal visits and be alert and responsive to signs of violence. If you are a doula, birth educator, or other birth professional, include a discussion of domestic violence during your classes or prenatal visits and encourage exploration and acknowledgment of these issues during your networking with other birth workers. You may also wish to download and read the Center for Disease Control’s guide, Intimate Partner Violence during Pregnancy: A Guide for Clinicians. If you are a friend or relative of a pregnant woman experiencing abuse, help her develop a safety plan and encourage her to seek the services of a domestic violence shelter.

Though it can be very awkward to address domestic violence issues with women directly and can feel like an intrusion into private lives, if you choose silence, you contribute to a continued culture of fear, shame, denial, and invisibility for the many women experiencing violence during this time in their lives. Acknowledging the reality and prevalence of violence against women in our culture and encouraging open, respectful, and assertive dialog about it is a powerful tool in reducing the occurrence. Strive to help bring violence against pregnant women into public view instead of considering family violence to be private, family business. Women and babies are too important for us to remain quiet.

Portions of this article are excerpted from the booklet Talking to a Battered Woman: A Guide for the Short Term Helper by Molly Remer, MSW, ICCE. This booklet is available as free pdf file on Molly’s website (http://talkbirth.me). Molly is a certified childbirth educator, the editor of the Friends of Missouri Midwives newsletter, a breastfeeding counselor, and a college professor.

[1] National Coalition Against Domestic Violence Fact Sheet “Reproductive Health & Pregnancy,” http://www.ncadv.org/files/reproductivehealthandpregnancy.pdf

This article was originally published in Citizens for Midwifery News and was later reprinted in International Doula along with a companion sidebar by Susan Hodges.

New Birth Skills Workshop!

Sep18

Active Birth and Labor Support

Saturday November 17, 6-9:00

Location: Tara Day Spa in Rolla, Missouri

Cost: $35 for the pregnant woman + one support person (husband, partner, relative, friend…)

Workshop description: First, practice active birth techniques and learn about working with pelvic mobility. Next, spend some time learning labor tips and tricks and practicing comfort measures with doulas! Then, enjoy a friendly Q & A session all about what you most want to know. You will have access to three birth professionals for the price of one! We will close with some relaxation skills practice and a guided visualization.

Interested? Please email me and I’ll send you the registration form!

DVD Review: The Big Stretch

Sep13

DVD Review: The Big Stretch

By Alieta Belle & Jenny Blyth

60 Minutes, includes 20 page booklet

www.birthwork.com

Reviewed by Molly Remer, Talk Birth

Jenny Blyth the author of the book Birthwork, is also a filmmaker who co-created the film The Big Stretch with another mother. The particularly special thing about this film is that it is all about women sharing their own experiences and feelings–unlike many current birth movies there are no “experts” present in the film (other than the true experts–women themselves!), the focus is on the families preparing for birth or reflecting on their past birth experiences. The many topics addressed are insightful.

The film’s emphasis is on, “Women in different stages of pregnancy and preparing for a natural birth reflect on how they and ‘stretched’ in everyway – emotionally, physically and spiritually” and I enjoyed this “stretch” theme that ran throughout.

Introducing new scenes/topic is neat artwork and the images in this film in general are particularly gorgeous. In one exception, I was taken aback by footage at the close of the film of a totally naked man riding a bicycle and feel I should warn other viewers to be prepared for that!

The DVD is accompanied by a 20 page booklet full of questions that carries the themes from the film into personal questions to increase self-awareness during pregnancy.

The Big Stretch is a unique and beautiful film in which women’s voices are clearly represented. There are no titles, no degrees, no qualifications listed. This film is a perceptive “motherful” look at the many stretches of birthing: physical, emotional, mental, and cultural.

—

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

Review previously published at Citizens for Midwifery.

Becoming an Informed Birth Consumer (updated edition)

Sep3

“Birth is life’s central mystery. No one can predict how a birth may manifest…Our dominant culture is anything but ‘natural’ so it is no surprise that childbirth, even with the most natural lifestyle lived by an individual family, sometimes needs intervention and medical assistance. This is not to say that any one mother’s efforts to have a natural childbirth are futile. Just that birth is bigger than one’s personal desires.” –Jeannine Parvati Baker (in The Goddess Celebrates: An Anthology of Women’s Rituals, p. 215)

It’s Labor Day and it is also the start of Empowered Birth Awareness Week! A blog carnival is in full swing at The Guggie Daily and I’ve been having some thoughts about birth as a consumer issue. Very often, it appears to me that responsibility for birth outcomes is placed on the mother—if only she’d “gotten educated” she would have made “better choices.” Many people have a tendency or overlook or minimize the impact of the context in which she makes her choices. In that way, I appreciate Baker’s observation about that birth is bigger than one’s personal desires. That doesn’t mean that we can’t take vital steps to alter the larger culture of birth in which we make our choices, however, and one of those ways is to remember to think about birth as a consumer issue.

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 and Amy Romano’s new book Optimal Care in Childbirth 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, 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 or International Cesarean Awareness Network.
Check to see if you have a local birth network in your own community or even start your own (I recently co-founded one in my town!)
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. Pay attention to their experiences and how they feel about their births. If they are dissatisfied, scarred, unhappy, and disappointed, don’t do what they did.
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:

These care practices are evidence-based and form an excellent backbone for a solid, mother and baby friendly birth plan.

Why “evidence-based care” though?

Because maternity care that is based on research and evidence for best practice is not just a nice idea or a bonus. It isn’t just about having a “good birth.” Evidence-based care is what mothers and babies deserve and what all birthing mothers should be able to expect! Here is a great summary of pregnancy and birthing practices that the evidence backs up:

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!).

“As long as birth- metaphorically or literally-remains an experience of passively handing over our minds and our bodies to male authority and technology, other kinds of social change can only minimally change our relationship to ourselves, to power, and to the world outside our bodies” – Adrienne Rich (Of Woman Born p185)

Birth class handouts

Can I really expect to have a great birth? (updated edition)

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

Active Birth in the Hospital

The Illusion of Choice

Musings on Story, Experience, & Choice…

—

This post is updated from a previous edition.

Can I really expect to have a great birth? (updated edition)

Aug22

“Given my limited situation, can I really expect to have a great birth today?” For the woman who asked me this question a homebirth, a birth center, a midwife, and a doula were all not remotely feasible options. My answer to her question is a qualified “yes!” and it really got me thinking about ways to help yourself have a great birth when your overall choices are limited. In fact, there is a long list of ideas of things that may help contribute to a great birth!

Choose your doctor carefully—don’t wait for “the next birth” to find a compatible caregiver. Don’t dismiss uneasiness with your present care provider. As Pam England says, “ask questions before your chile is roasted.” A key point is to pick a provider whose words and actions match (i.e. You ask, “how often do you do episiotomies?” The response, “only when necessary”—if “necessary” actually means 90% of the time, it is time to find a different doctor!). Also, if you don’t want surgery, don’t go to a surgeon (that perhaps means finding a family physician who attends births, rather than an OB, or, an OB with a low cesarean rate).
If there are multiple hospitals in your area, choose the one with the lowest cesarean rate (not the one with the nicest wallpaper or nicest postpartum meal). Hospitals—even those in the same town—vary widely on their policies and the things they “allow” (i.e. amount of separation of mother and baby following birth, guidelines on eating during labor, etc.) Try checking with Cesareanrates.com for local information!
When you get the hospital, ask to have a nurse who likes natural birth couples. My experience is that there are some nurses like this in every hospital—she’ll want you for a patient and you’ll want her, ask who she is! If possible, ask your doctor, hospital staff, or office staff who the nurses are who like natural birth—then you’ll have names to ask for in advance.
Put a sign at eye level on the outside of your door that reads, “I would like a natural birth. Please do not offer pain medications.” (It is much easier to get on with your birth if you don’t have someone popping in to ask when you’re “ready for your epidural!” every 20 minutes.)
You might want to check out either or both of these two books: Homebirth in the Hospital and/or Natural Hospital Birth
Work on clear and assertive communication with your doctor and reinforce your preferences often—don’t just mention something once and assume s/he will remember. If you create a birth plan, have the doctor sign it and put it in your chart (then it is more like “doctor’s orders” than “wishes”). Do be aware that needing to do this indicates a certain lack of trust that may mean you are birthing in the wrong setting for you! Birth is not a time in a woman’s life when she should have to fight for anything! You deserve quality care that is based on your unique needs, your unique birthing, and your unique baby! Do not let a birth plan be a substitute for good communication.
Two resources I particularly enjoy that shake up the notion of a birth plan are, 1. the birth as a labyrinth metaphor from Birthing from Within and 2. this article about how does one really PLAN for birth.
When making a birth plan, use the Six Healthy Birth Practices as a good, solid foundation.
Cultivate a climate of confidence in your life.
Once in labor, stay home for a long time. Do not go to the hospital too early—the more labor you work through at home, the less interference you are likely to run into. When I say “a long time,” I mean that you’ve been having contractions for several hours, that they require your full attention, that you are no longer talking and laughing in between them, that you are using “coping measures” to work with them (like rocking, or swaying, or moaning, or humming), and that you feel like “it’s time” to go in. If you’re worried about knowing when you’re really in labor, check out this post: how do I know if I’m really in labor?
Ask for the blanket consent forms in advance and modify/initial them as needed—this way you are truly giving “informed consent,” not hurriedly signing anything and everything that is put in front of you because you are focused on birthing instead of signing.
Have your partner read a book like The Birth Partner, or Fathers at Birth, and practice the things in the book together. I frequently remind couples in my classes that “coping skills work best when they are integrated into your daily lives, not ‘dusted off’ for use during labor.”
Practice prenatal yoga—I love the Lamaze “Yoga for Your Pregnancy” DVD—specifically the short, 5-minute, “Birthing Room Yoga” segment. I teach it to all of my birth class participants.
Use the hospital bed as a tool, not as a place to lie down (see my How to Use a Hospital Bed without Lying Down handout)
If you feel like you “need a break” in the hospital, retreat to the bathroom. People tend to leave us alone in the bathroom and if you feel like you need some time to focus and regroup, you may find it there. Also, we know how to relax our muscles when sitting on the toilet, so spending some time there can actually help baby descend.
Use the “broken record” technique—if asked to lie down for monitoring, say “I prefer to remain sitting” and continue to reinforce that preference without elaborating or “arguing.”
During monitoring DO NOT lie down! Sit on the edge of the bed, sit on a birth ball near the bed, sit in a rocking chair or regular chair near the bed, kneel on the bed and rotate your hip during the monitoring—you can still be monitored while in an upright position (as long as you are located very close to the bed). Check out the post Active Birth in the Hospital for some additional ideas.
Bring a birth ball with you and use it—sit near the bed if you need to (can have an IV, be monitored, etc. while still sitting upright on the ball). Birth balls have many great uses for an active, comfortable birth!
Learn relaxation techniques that you can use no matter what. I have a preference for active birth and movement based coping strategies, but relaxation and breath-based strategies cannot be taken away from you no matters what happens. The book Birthing from Within has lots of great breath-awareness strategies. I also have several good relaxation handouts and practice exercises that I am happy to email to people who would like them. One of my favorites is: Centering for Birth.
Use affirmations to help cultivate a positive, joyful, welcoming attitude.
Read good books and cultivate confidence and trust in your body, your baby, your inherent birth wisdom.
Take a good independent birth class (not a hospital based class).
Before birth, research and ask questions when things are suggested to you (an example, having an NST [non-stress test] or gestational diabetes testing). A good place to review the evidence behind common forms of care during pregnancy, labor, and birth is at Childbirth Connection, where they have the full text of the book A Guide to Effective Care in Pregnancy and Childbirth available for free download (this contains a summary of all the research behind common forms of care during pregnancy, labor, and birth and whether the evidence supports or does not support those forms of care).
When any type of routine intervention is suggested (or assumed) during pregnancy or labor, remember to use your “BRAIN”—ask about the Benefits, the Risks, the Alternatives, check in with your Intuition, what would happen if you did Nothing/or Now Decide.
Along those same lines, if an intervention is aggressively promoted while in the birth room, but it is not an emergency (let’s say a “long labor” and augmentation with Pitocin is suggested, you and baby are fine and you feel okay with labor proceeding as it is, knowing that use of Pitocin raises your chances of having further interventions, more painful contractions, or a cesarean), you can ask “Can you guarantee that this will not harm my baby? Can I have in writing that this intervention will not hurt my baby? Please show me the evidence behind this recommendation.”
If all your friends have to share is horror stories about how terrible birth was, don’t do what they did.
Look at ways in which you might be sabotaging yourself—ask yourself hard and honest questions (i.e. if you greatest fear is having a cesarean, why are you going to a doctor with a 50% cesarean rate? “Can’t switch doctors, etc.” are often excuses or easy ways out if you start to dig below the surface of your own beliefs. A great book to help you explore these kinds of beliefs and questions is Mother’s Intention: How Belief Shapes Birth by Kim Wildner. You might not always want to hear the answers, but it is a good idea to ask yourself difficult questions!
Believe you can do it and believe that you and your baby both deserve a beautiful, empowering, positive birth!

I realize that some of these strategies may seem unnecessarily defensive and even possibly antagonistic—I wanted to offer a “buffet” of possibilities. Take what works for you and leave the rest!

I posted on my Facebook page asking for additional thoughts and suggestions and I appreciated this one from doula and educator, Rebecca:

“I think I’d tell people to stop closing doors on themselves you know? Stop making assumptions about what is possible and be open to creating new possibilities – maybe not perfect and exact but inviting in opportunity. No money doesn’t mean no doula in most cases.”

She’s right! A lot of doulas-in-training will offer free birth services, many doulas and midwives do barter arrangements or other trades, and many non-traditional birth professionals also have sliding scale rates.

Great births are definitely possible, in any setting, and there are lots of things you can do to help make a great birth a reality!

—

This post was revised (from this one) to participate in… And the Empowered Birth Awareness Blog Carnival!

Birth Customs

Aug14

“Pay attention to the pregnant woman! There is no one as important as she!”

(Chagga saying, Uganda)

The book Mamatoto is a look at birth in a variety of cultures (including the US) that was published by The Body Shop in 1991. Even though it is “old” it isn’t really dated since it is a brief overview of different customs and rituals and so forth and not a lot of statistics. There are a lot of absolutely fabulous (and fascinating) pictures and illustrations and these are the highlight of the book. Each chapter is followed by a “black page” of “facts you don’t want to know” about such things are reproductive health care policies in Romania and things like that.

One of the things that struck me about this book was that there is little distinction made between the customs of other cultures and the customs of the US. For example:

“People in Tibet believe that whether or not labour is due, a child won’t come out into the world unless the star under which it’s destined to be born is shining. Western medicine has developed a way of starting labour artificially, by injecting into a woman’s blood a simulation of the hormone oxytocin, which triggers contractions. For several years during this century, an unusual number of women laboured between the convenient hours of nine and five on weekdays…As the Malaysians say, a baby is like a fruit; it will be born when it’s ripe.”

I absolutely love seeing Western culture put into the proper context like this. Too often we see our way as THE way and forget that much of what the dominant culture views as normal for birth is not necessarily truly normal, but is instead an artifact of, or custom of, our culture. Viewed from a distance, the routines of birth in America are just interesting customs—in Tibet, born when the proper star is out, in the US, born when artificial hormones are injected…

(Since first reading this, I use the baby is like a fruit quote regularly.)

I may not be explaining myself clearly, but I find this distance in perspective refreshing and interesting. It reminds me of the work of anthropologist Robbie Davis Floyd whose book Birth as an American Rite of Passage explores the “ritual” elements of hospital birth in America and compares and contrasts the “technocratic” model of care with a holistic, woman-centered model of care (an example of which would be the midwives model of care). She asserts that there are many elements of hospital births that serve as rituals to reinforce the technocratic model (rather than to serve actual purposes, but instead to send cultural messages as well as to initiate the baby into the technocratic model). Examples of ritual elements include putting on a hospital gown, riding in a wheelchair, and having a routine IV. These elements serve to enculturate the woman and baby into a particular model–a ritual function–rather than an individually appropriate method of care.

Another example from Mamatoto that I enjoyed is as follows:

“‘Home birth’ can mean different things to different people. It can mean a bedroom, dimly lit and scented with myrr; a sweatbath perched on a Guatemalan hillside, or a birthing pool in an English flat; a warm fireside in a Himalayan kitchen; the packed-snow sleeping platform of an Inuit igloos; or a one-room shack in Jamaica, with a washing line dividing the family bed and the children waiting on the other side for a first glance at the baby who will be held up for them to see. When a woman gives birth at home, she and her family have a degree of control over the event; it’s their domain.”

In short, at home the family is in their own personal culture rather than having to adapt to the customs, culture, and “ritual elements” of an out-of-home environment.

When I think about American birth customs and culture, the first thing that comes to mind is this potent illustration from Mothering Magazine’s powerful article Cesarean Birth in a Culture of Fear, which was then published in booklet form by Childbirth Connection:

In this image we see a woman immersed in the hospital birth culture found in many hospitals in the US.* She is hooked up to a potential of 16 different attachments. When I see this image, I instantly see why women might not want to “be martyrs” and thus go ahead and have any medications offered to them. It can be very difficult to stand in her personal power and embrace her own body’s rhythms and rituals when she is literally strapped down in this manner. I also think of this quote:

“Since beliefs affect physiologic functions, how women and men discuss the process of pregnancy and birth can have a negative or positive effect on the women that are involved in the discussion. Our words are powerful and either reinforce or undermine the power of women and their bodies.”–Debra Bingham

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*Note: I am fully aware that this may not be what birth looked like in your hospital, but I’m speaking generically about many hospitals in the nation.

Modified from a post originally posted at Citizens for Midwifery

Amazon affiliate links included in book titles.

Breastfeeding Class Resources

Aug3

I became certified as a breastfeeding educator in 2004 and accredited as a breastfeeding counselor in 2005, so I’ve been working with breastfeeding mothers for a long time. I lead a monthly support group and offer help/counseling via phone, email, text, Facebook message, Words with Friends messages, you name it. Recently, a nurse contacted me asking for ideas for teaching an early pregnancy breastfeeding class. I think this is a great idea, since mothers’ decisions about breastfeeding are often made before the baby is conceived and if not then, during the first trimester.

These are the initial ideas I suggested:

Focus on what the mothers themselves want—what do they need/want to know? What have they heard about breastfeeding? What are their fears? What misconceptions do they need cleared up? I’m very much about peer-to-peer support and allowing space for the women to talk to/connect with each other—the facilitator is then available to clear up misinformation and provide tips.
Focus on what mothers can do to prepare for successful breastfeeding—there is evidence that prenatal breast massage/colostrum expression helps with both milk supply AND with mother’s comfort with her own breasts. It also helps her think of herself as a breastfeeding mother BEFORE her baby is actually born!
Suggest good books to have on hand and encourage attending a breastfeeding support group (like LLL!) prior to baby’s birth.
Promote/discuss/encourage “baby led breastfeeding.” I love sharing with mothers about how smart their babies are and how mother’s chest after birth becomes baby’s new habitat! Check out the resources from Suzanne Colson: http://www.biologicalnurturing.com/
Discuss and emphasize all of the other great ways dads and other family members can be involved with baby other than giving a bottle. Dad/grandma can do EVERYTHING ELSE baby needs! That’s cool! Leave the feeding to mom and let dad have the other special and important jobs like baths and burping and tummy time and more.
DON’T talk about “myths” and try to dispel them in a myth-fact format, because evidence suggests that this actually helps the myths stick more!
Use Diane Wiessinger’s approach to language (http://www.motherchronicle.com/watchyourlanguage) i.e. breastfeeding isn’t a “special bond” it is a NORMAL bond. People want to be normal—special is for celebrities and “other people,” normal is what everyone wants. She also has handouts here: http://normalfed.com/Why.html

Since her email, a couple of other resources and bits have caught my eye. One is that the AAP has a resolution about the distribution of formula “gift bags” by pediatricians and hospitals. Apparently this came out in 2011, but it only came to my attention when I saw this image on Facebook!

In keeping with the 10 Steps and consistent with the AAP’s resolution, the hospital advocacy project from the Illinois State Breastfeeding Taskforce makes available the following useful documents for mothers to communicate with their hospitals:

The Task Force explains:

We encourage you to make the Breastfeeding Bill of rights and Hospital Experience Letters available to moms in your classes, practices, community events, breastfeeding fairs, “rock & rest” stations, etc.

Encourage moms to fill out the appropriate letter and mail back to the hospital where she delivered her baby. Or collect the letters and mail them from your agency or task force. Help moms make their voices heard!

We hope that this will show hospital administrators that lactation consultants, knowledgeable staff and breastfeeding friendly practices are valued by moms and families using their hospital services.

The Missouri Breastfeeding Coalition clued me into this Breastfeeding Plan for Mothers (pdf) from the MO Dept. of Health. The handout may be downloaded and printed as needed and is a, “list of requests that support breastfeeding for the postpartum stay. Similar to a birth plan and based on the 10 Steps for Breastfeeding.”

Also, make sure to check out this awesome resource, the WIC Sharing Gallery—free programs, curricula, brochures, and more from different WIC offices. I found this because I was back at the Illinois Breastfeeding Taskforce’s website downloading their Grandmother’s Tea curriculum for intergenerational support of breastfeeding.

Another great resource is the FREE online Tear-Sheet Toolkit from La Leche League.

And, finally, I already touched on this, but remember there are ample handouts/articles available from the incomparable Diane Wiessinger about birth and breastfeeding.

Building Birth Bridges: Communication

Aug2

This post is part 5 of my CAPPA re-cap series.

The final day of the CAPPA conference I heard Polly Perez speak about Building Bridges with an emphasis on communication and fear. She described four basic communication and emphasized that communication is a two-way street.

The four styles are:

Expressive
Sympathetic
Direct
Systematic

Each style has its strengths and also ways in which it is perceived by others. You should give information in the simplest way to the person you are talking to and adjust your style of communication depending on who you’re talking to, changing communication behavior in order to improve communication. Communication is the lifeblood of all relationships.

She shared this quote:

Luke: I don’t believe it. Yoda: that is why you fail.

And she explained that listening is active, not a passive activity. Listen with empathy, openness, and awareness:“Use language that lets you share your heart openly.”

She also asserted that we must stop letting our practices be fear-based, quoting Connie Pike in saying, “We must give people the opportunity to challenge their fears. Not only will this change each person, it will change the political and medical climate in which they make these choices.”

In communicating within in the medical system, Polly pointed out that a fundamental issue is with the power hierarchy and that we must develop strategies that enhance problem solving, but still retain and support the person in power. (**I’m a little too radical, I guess, for this tip, which is perhaps why I’ve not found a niche working within a medical system and instead work outside of it.) She suggested asking yourself: What does this person you are talking to fear? She also quoted Bethany Hayes “Working in Circle” who said with regard to working in hospital climates, “we found a system that was as sick as the people it was treating.” Changing sick systems is not about subterfuge but bringing light to situations that need to be altered.

Polly then made an observation that I found very powerful and very telling:

We have taken the hearts and minds out of much of our work because we’re frightened of getting too close. But, close is where we need to be.

Yes.

During a different session, but closely related to this topic of communication, I laughed out loud watching this video clip of twin babies communicating with each other. I’m going to use this in future classes.