Woman Rising

Mar14

No time for a long post today (or, probably, this week), so I share this quote I had saved from the book A Dozen Invisible Pieces by Kimmelin Hull (p. 229):

“When faced with behavior battles, health concerns, family finances, and the struggle to stretch time to the fullest, I could choose to sink into the quicksand of life with young children–becoming engulfed in the daily grind, unaware of my own loss of self–or I could rise to the occasion. And I am rising.”

Hull goes on to share the following:

“Whether it be the thick memory of enduring a non-medicated labor and finally pushing our third child into the world, despite feeling as though I hadn’t an ounce of energy left, or the meager sprint I managed as I neared the finish line of the marathon…, I hold tight to these images as proof that I can and will be able to rise to the occasion–again and again, if and when I need to-–because the ability to do so is in my very bones. Because I am a woman.” [emphasis mine]

The birth face, immediately following birth of second son. This feeling--this crying, laughing, euphoric, I DID IT, feeling is the one I draw upon in the rest of life.

This is one of things I find so powerful about women’s birth memories—they can hold onto them as a touchstone, as an affirmation of strength and personal capacity, during other challenging (or mundane) moments of their lives. I also don’t think births have to be “empowering,” natural, or unmedicated births in order to hold this affirmation for women. There is a lot of courage to be found in most birth journeys and the ability to find moments of powerfully conscious strength to draw nourishment from in the rest of life exists in many types of birth experiences. Personally, my birth experiences created a lasting sense of personal worth, that I have drawn from ever since. This includes the birth of Noah, which was not a “happy ending” to my pregnancy. In the months after his birth, I found myself at many times thinking, “I gave birth to my little, nonliving baby alone in my bathroom, I can do this too.” I did the same with the births of my other two boys—only thankfully without the “nonliving” part. Alaina’s birth is more “integrated” somehow, and I don’t find myself thinking about it or referring to it in quite the same way, though I’ve definitely had moments of remembering, “I caught my own baby, I can do this too!“

The Rest and Be Thankful Stage

Feb26

During my first labor, I experienced what Sheila Kitzinger calls the “rest and be thankful stage” after reaching full dilation and before I pushed out my baby. The “rest and be thankful stage” is the lull in labor that some women experience after full dilation and before feeling the physiological urge to push. While commonly described in Kitzinger’s writings and in some other sources, mention of this stage is absent from many birth resources and many women have not heard of it. After writing recently about the spontaneous birth reflex, I received a comment stating the following: “I was particularly interested in the idea of resting after full dilation before pushing. This makes sense if you are only following your body’s urges to push, but never something I had seen (or remember seeing?) spelled out before.”

I always make sure to tell my birth class clients about the possibility of experiencing a lull like this, because it is during this resting phase that labor is sometimes described as having “stalled” or as requiring Pitocin to “kick it off again” or as requiring directed or coached pushing. Also, think of the frequency of remarks from mothers such as, “I just never felt the urge to push.” When exploring further, it is often revealed that what the mother actually experienced was no immediate pushing urge instantly following assessment of full dilation. Depending on the baby’s position, this can be extremely normal. The way I explain it to my clients is that the lull represents the conclusion of the physiological shift happening in the uterus—the transition between contractions that open the cervix and the contractions that push the baby down and out.

As I wrote in a previous post from several years ago:

Your uterus is a powerful muscle and will actually push your baby out without conscious or forced effort from you–-at some point following complete dilation your body will begin involuntarily pushing the baby out. Many women experience the unmistakable urge to push as an “uncontrollable urge”–-but, in order to feel that uncontrollable urge, you often have to wait a little while! Though some care providers and nurses encourage you to begin pushing as soon as you are fully dilated there is often a natural lull in labor before your body’s own pushing urge begins. Some people refer to this lull as the “rest and be thankful” stage. It gives your body a chance to relax and prepare to do a different type of work (in labor the muscles of your uterus are working to draw your cervix up and open. During pushing, the muscles of your uterus change functions and begin to push down instead of pull up). If you wait to push until you really need to, you will often find that your pushing stage is shorter and progresses more smoothly that pushing before you feel the urge.

In the book, Our Bodies, Ourselves: Pregnancy and Birth they share the following important point:

“Research suggests that the length of time before the baby is born is the same if you allow one hour of ‘passive descent’ of the baby (when you relax and don’t consciously try to push) or you start pushing immediately after you are fully dilated.”

via Waiting before pushing… « Talk Birth.

That’s right, the length of time between full dilation and baby’s birth is the same, whether the mother waited one hour before pushing, or started pushing without the urge immediately following full dilation. I know which one sounds easier and more peaceful to me!

In my own experience with my first baby, I found that I felt like I should be pushing after full dilation and thus began to do so before feeling the full urge. I ended up pushing for about an hour and fifteen minutes. I suspect if I’d just continued hanging out for 45 minutes to an hour, he may have flown out in 15 minutes. Prior to pushing though, I did experience a rest and be thankful stage of about 30 minutes in which I sat in a rocking chair, joked about feeling “trippy,” and talked about being an A++ birthing woman. I describe it in my son’s birth story:

After finding out that I was fully dilated, I started to feel very odd and I really think I had to go through a sort of emotional/psychological transition to adjust myself to the fact that I had “missed” the physical transition point…I sat in the rocking chair for a while and kept saying things like, “am I dreaming? Is this real?” I also made a joke about feeling “trippy” like in Spiritual Midwifery. We also joked about what an A+ + + laboring woman I was (a family joke–I was a 4.0 student throughout college and grad school and so we always say that I like to get an A+ + + on everything I do). Those pressure feelings I had been having for a while, got a little more intense and I started pushing kind of experimentally. I was on my knees with my head on the bed on my pillow again and during one of the little pushes my water broke with a giant, startling POP and sprayed across the room including all over my friend. At this point, the midwife left saying, “I think I should call the doctor.” via My First Birth « Talk Birth.

The blog Birth and Baby Wise has some great thoughts to share on resting and being thankful (note the blog is from an educator in London, thus the use of the term Syntocinon, rather than the U.S. based brand Pitocin):

… it seems that there is little appreciation for this well documented pause amongst health professionals working in the consultant-led units of hospitals. Any stop in action once the magic ’10 cm dilatation’ is reached is met with almost instant medical intervention to get the contractions back up and running, ie a syntocinon drip. Women experiencing this are already on a consultant-led unit, where a higher level of medical intervention can be anticipated, but it is strange that there seems to be such a rush to use a syntocinon drip to get the contractions going again, providing mother and baby are both coping well.

One reason the contractions may ease temporarily is in order to allow the baby’s head to get into a better position. If this is the case, then artificially speeding contractions up is hardly likely to have the benefit of a faster birth for the woman – if anything, a slower and more complicated birth as she tries to push out a baby that is not quite in the right position. In addition, she has to cope with stronger contractions that she might find difficult to deal with, necessitating further medical help in the shape of an epidural – which in turn makes pushing the baby out even harder…

…At this stage, the woman and her partner are incredibly vulnerable to this well meant ‘help’ from midwives and obstetricians and are unlikely to question the requirement for additional medical help. It is also unlikely that the calm and relaxed environment so important for a peaceful birth can survive the worries of the health professionals, which will affect most women and their partners. via Rest and be thankful – or panic and have a drip shoved in? | Birth and Baby Wise.

I agree. In my own personal experience with my first birth, I was very vulnerable to just the perceived expectation of it being “time to push.” With later babies, it was intensely important to me that I have very few people present at the birth, knowing how sensitive I am to the expectations of those around me. It is truly only my husband and my mother than I trust to not disrupt my “birth brain” and the freedom of my birth space.

I’d love to hear more from readers about their experiences with the rest and be thankful stage.

Did you experience this lull between full dilation and pushing out your baby?

Was the lull recognized and respected by your birth attendants?

If you pushed without feeling the urge, was the pushing stage fairly long?

With subsequent babies, I had no internal checks during labor, so I never really knew if I experienced the rest and be thankful stage with them. I just pushed when my body started pushing—I have no idea how long after full dilation that was. So, I also am curious to know if women find they experience this stage with all babies, with only the first one, or with only some of their babies?

I suspect I did experience it with Alaina, because I remembering feeling concerned that contractions were suddenly “far apart.” I started talking more and analyzing myself and the labor and this was probably part of a lull in the intensity of the contraction action while my body prepared for a powerful spontaneous birth reflex.

Spontaneous Birth Reflex

Feb24

“Why do we, then, continue to treat women as if their emotions and comfort, and the postures they might want to assume while in labor, are against the rules?“

– Ina May Gaskin (via Birth Smart)

I’ve been intrigued for some time by Michel Odent’s description of what he calls the “fetal ejection reflex.” Personally, I would like to rename it the “spontaneous birth reflex.” Essentially, this reflex involves the spontaneous birth of the baby without coaching or conscious effort on the part of the mother. It is most likely to occur when the mother feels very safe and very private, which may be why we do not read descriptions of it occurring during many births. In an article about the fetal ejection reflex Odent writes: “During the powerful last contractions the mother-to-be seems to be suddenly full of energy, with the need to grasp something. The maternal body has a sudden tendency to be upright. For example, if the woman was previously on hands and knees, her chest tends to be vertical. Other women stand up to give birth, more often than not leaning on the edge of a piece of furniture. A fetus ejection reflex is usually associated with a bending forward posture.”

Flicked forward hips?

In the book Optimal Birth: What, Why & How, which was heavily influenced by the work of Odent, the author frequently describes spontaneous birth reflex occurring with a swift “flicked forward” motion of the mother’s hips. I found the description curious at the time that I read the book, not really conceptualizing how one would flick one’s hips forward when pushing out a baby. However, following the birth of my daughter last year, I was completely amazed to hear my husband describe the pushing stage in these words, “…you were down on your hands and knees, but then you pushed up and moved your hips forward and suddenly you were holding her.” I would describe her birth as involving an authentic spontaneous birth reflex much like Odent and Sylvie Donna (the author of Optimal Birth) describe. This is what I wrote three days after her birth:

Shortly following a spontaneous birth reflex!

I was down on hands and knees and then moved partially up on one hand in order to put my other hand down to feel what was happening…her head pushed and pushed itself down as I continued to support myself with my hand and I moved up onto my knees, with them spread apart so I was almost sitting on my heels and her whole body and a whole bunch of fluid blooshed out into my hands… I didn’t realize until some moments later than both Mark and Mom missed the actual moment of her birth. Mark because he was coming around from behind me to the front of me when I moved up to kneeling…I had felt like the pushing went on for a “long” time, but Mark said that from hands and knees to kneeling with baby in my hands was about 12 seconds.

via Alaina’s Complete Birth Story « Talk Birth.

Birth without pushing?

I’ve been meaning to write about the experience for some time and then I received a comment on an older post I wrote titled Pushing the issue of pushing in labor… which addresses physiological pushing vs. coached/directed pushing. The mother wrote: “I would so love to give birth without pushing..I hope I can do this without pushing but is it really possible?? If it’s possible, why isn’t it practiced more widely?”

While I did not experience such a dramatic spontaneous birth reflex with any of my other births, Yes! It IS possible. There are a variety of reasons why it is not practiced more widely, two common ones being that many mothers do not give birth in the atmosphere of privacy that facilitates the reflex and secondly because many birth attendants ascribe to the notion that 10 centimeters of dilation = time to push, regardless of what mother’s body is telling her to do. With my own first baby, I was checked at 10 centimeters and told I could push whenever I felt the urge. While no one coached or directed me to begin pushing, I felt like I “should” be doing so and so start to experiment with actively pushing a little with contractions. It took a little over an hour before my son was finally born. I never felt an intense or irresistible or spontaneous urge to push. With my second baby, I felt literally driven to my knees by the force of the birthing energy. I did not consciously push him out, but it definitely took several pushes and maybe about 15 minutes to push him out. There was a process of pushing involved with his birth. With my daughter, as I describe above, it was like an irresistible force gripped my body and she just came flying out with no directed physical or mental involvement from me.

Trusting the urge

I shared the mother’s question with the CfM Facebook page in order to get some other perspectives on births with “no pushing.” I received several comments to share with the questioning mother-to-be. Most mothers referenced the idea of pushing when their bodies told them to. It is difficult to communicate this with someone who has not yet experienced it—how to recognize the “urge” and what it really means to “push when your body tells you to.” I also suspect it is frustrating for women who are honestly and courageously seeking “answers” in order to best prepare their bodies, minds, and hearts for birth, to receive responses like, “just trust your body,” which can feel trite or dismissive to the pregnant woman who hungers to know. However, then once on the other side of the birthing bridge, we discover there are really few better answers to give. I believe the capacity to trust that her body will communicate the unmistakable urge to push comes with an environment where the mother is treated with dignity and respect. She has her need for privacy honored and that she is mentally able to surrender to the birthing process and let her body take over—no attempting to wrestle with or control the birth, but to dig deep and then to let go.

Personal experiences in birthing without pushing:

ARA shared: “I will say that with my last birth I started out with having coached pushing. Then I felt my body take over. The nurse told me to stop pushing and I told her I can’t my body is doing it on it’s own. It was the most awesome feeling in the world.”

And AK shared: “I pushed when my body said to do so. It was relieving!! lol”

EW wrote that she, “highly recommend physiological pushing over directed pushing. listen to your body. Consider hypnobirthing if you are wanting to birth without pushing, it encourages laboring down.”

DF had this experience to share: “I don’t know if this is the same thing but with my first child, the nurse didn’t listen to me when I said I thought it was time and when my midwife came to check I was crowning, I had ‘labored down’ as she called it by my body doing the work. So I only actually pushed once on her cue and my baby was here. The second child the same happened automatically I wasn’t even aware it was happening…..maybe subconsciously?”

NB shared that, “Because of my uterine prolapse issues, I do not push until the baby is essentially crowning on his own. I also don’t have anyone check to see how far dilated I am (since baby #1, that is) so when that burning feeling starts to get really strong I try a gentle little push to see what happens, and that usually initiates complete crowning… at which time, despite my best efforts, I CANNOT control the pushing urge any longer because I need to get that baby out!! 😉 I think it does make ‘transition’ longer in the sense that perhaps birth would have happened earlier if I’d begun pushing before the baby slid down that far on his/her own, but it makes the pushing stage much shorter and is certainly better for the baby – and me, too, since I’m not putting that strain on my uterine ligaments until the very last seconds.”

JD shared her different experiences: “With my first baby, I felt the need to push waaaay too early. (Baby turned posterior; I had back labor contractions less than a minute apart for several hours.) I spent over an hour pushing, but I can’t blame the wonderful midwives who attended my homebirth. They told me several times that it wasn’t time to push yet. But I was in so much pain, and had exhausted all my coping strategies, and just had to get that baby OUT! Then we had a dystocia, and everybody ended up yelling at me to push even though I wasn’t having a contraction, and my very calm, collected midwife sounded worried, so I pushed some more. Lots of pushing, lots of pain, lots of tearing. My second baby was smaller and lined herself up better. I didn’t push until the very end, and she came in a big hurry and surprised everybody. Nobody told me to push, and I barely needed to. So, yes, it can be done, but there are more factors at play than your doctor/midwife. I had two very different pushing experiences, both at home with the same midwife.”

G wrote: “Unmedicated, midwife-assisted home birth, pushed for 3 hours, never really got the hang of it. Baby was not quite lined up right and was stuck, crowned, for an hour. I was exhausted and basically checked out. Eventually it was gravity that got him out – they hauled me upright and he basically fell out of me. I look back and wonder if maybe I should have taken more of a break after dilation – I FELT like I was ready to push, but who knows if I actually was. Maybe he would have labored down on his own if I’d just zonked out.”

Why isn’t it encouraged?

I’ve already addressed several reasons why and then LDM shared these important points: “It’s not widely practiced because the obstetric timetable doesn’t allow for it. The physiological urge to push will be there, for some women sooner than others. Most care providers are taught to coach pushing (after all we all know women just can’t do the job they were designed to do) and to have that coached pushing happen under certain conditions (wait for the dr! Ok, doc is here!) Some women say they never felt any urge- they may have had normal physiological signals quelled from drugs or other common labor practices and/or they were not given time to rest and sleep after fully dilating. There is such urgency to force a baby out once she reaches 10, but if she is tired and cannot feel her body pushing, then mom probably needs a nap & maybe a snack. Letting a woman take that break is unheard of in hospitals.”

And additionally, Mommy Baby Spot offered this tip: “Stay away from “helping” drugs so that your body knows what to do and learn different positions so that your body puts itself in the prime position to get the baby out with the minimum of hassle (which is different for everyone).”

I thank the women who shared their experiences for their thoughts and I wish the mother who posed the question the very, very best with her upcoming birth. May you birth smoothly, peacefully, and spontaneously in harmony with your body’s wisdom, cues, and urging!

—

(Note: personal experiences are reprinted directly as shared on the CfM FB page, but have had some spelling corrected for readability.)

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Honoring Miscarriage

Feb22

When I had my first miscarriage, I vowed several things in the immediate aftermath. One was that I was going to write a book about it so that other women would not have to experience the same total dearth of resources about the physical process of coping with home miscarriage. While I did publish my miscarriage memoir this year, I am still collecting stories and experiences for a different, more comprehensive book on this theme. However, in the time since I made that vow and since I had my miscarriages, a new resource emerged for women: Stillbirthday. This is the website I NEEDED when I was preparing for the birth of my tiny, nonliving baby. While I received emotional support from a variety of sources, I found a void where the physical information I sought should be. That information is skillfully covered in the birth plans section of the Stillbirthday website. I reprinted information from their “early home birth plan” in my Footprints on My Heart memoir, since it was the information I was desperately seeking during my own home miscarriage-birth. I am grateful the information is now available to those who need it.

My second vow was that, if I knew about it, I would never leave another woman to cope with miscarriage alone on her own. My third vow came a little later after more fully processing and thinking about my own experience and that was to always honor and identify miscarriage as a birth event in a woman’s life.

A friend’s loss

In March of 2010, my good friend, who had doula’ed me very gracefully and respectfully and lovingly through my miscarriage-birth postpartum experience and processing, experienced a miscarriage herself. She didn’t call me while she was experiencing it, so I couldn’t go to her as I had imagined I would if needed, but afterwards I went to her with food and small gifts and hugged her tightly, recognizing all too well that hollow, shattered look in her eyes and the defeated and empty stance of her body. Later, I bought her a memorial bracelet. However, I was still in the midst of coping with my own grief and loss process—my second miscarriage having just finally come to a long-drawn out end only a month before and the experience of which having brought another friendship to an almost unsalvageable point—and my dear friend’s own process, her feelings, got lost along the way. She recently wrote about the experience on her own blog and it was harder for me to read than I would have expected. As she noted, I agree that doesn’t matter how little the baby, or baby-start, or baby-potential that is lost-–there is no quantifying loss and no “prize” for the “worst” miscarriage. It is a permanent experience that becomes a part of you forever. Also permanent for me is the empathy and caring showed to me by my friend/doula during my time of loss and sorrow. I regret that I was not able to be that same source of solace, companionship, and understanding to her. I thank her for having held space for me to grieve “out loud” and I’m really sorry that part of the cost of that was the suffocating of her own sadness or minimization of her own experience. While I do feel like I did what I could to acknowledge her miscarriage at the time that it happened I really wish I would have done more, particularly in terms of acknowledging how very long the feelings of emptiness and grief persist. I made a mistake in taking her, “I’m okay” remarks as really meaning it, rather than being part of the story that babyloss mamas often tell themselves in a desperate effort to “get over it” and be “back to normal.”

That said, I also compassionately acknowledge that it can be hard for people to know what it is that we need if we don’t tell them. So, now I’d like to hear from readers. What are your own thoughts on recognizing and acknowledging miscarriage—how do we best hold the space for women to experience, identify, and honor miscarriage as a birth event in their lives?

Charm & book giveaway (**Giveaway is now closed. Veronica was the winner***)

In harmony with my question and associated thoughts, I am hosting a giveaway of a sterling silver footprints on my heart charm exactly like the one I bought for myself after Noah’s birth and that I gave to my husband and my parents afterward (my husband carries his on his keychain). If you win the charm, perhaps it is something that will help you to honor your own miscarriage experience or that you can give to someone else to acknowledge their loss. This giveaway is in concert with the blog contest on Stillbirthday and will end on March 20. Additionally, everyone who enters will receive a free pdf copy of my miscarriage memoir.

To enter the giveaway, please leave a comment addressing the subject of honoring miscarriage. I am wondering things like:

What did you need after miscarriage?

What did you wish people would do/say to honor your miscarriage experience?

How could people have helped you more?

What do you still wish you could do/say/write/share about your miscarriage experience(s)?

What do you wish you had done for yourself?

What did you want to tell people and what do you wish you had been able to say?

What did you want to do that you didn’t feel as if you had “permission” to do? (personal, social, medical, cultural, whatever type of permission…)

I will share my answers to these questions in a later post, but I do want to mention that one of the things that was most important to me to have acknowledged was that this was REAL. That was one of the first things I said to my parents about it when they came over to help me immediately after Noah was born—this is real.

Water babies

I continue to honor the experience of miscarriage and babyloss in my own life in various ways. Recently, I found a buddhist monk garden statue from Overstock.com that reminded me of the “jizo” sculptures that honor and protect “water babies” in Japan (mizuko is a Japanese word meaning “water baby” and specifically refers to babies lost during pregnancy—the only specialized word that exists). I have a small jizo inside on my living room windowsill, but I’ve wanted one that could weather the outdoors by Noah’s tree.

I took this one for size perspective, but you can barely see the sculpture in the shadow to Alaina's right.

I believe I may be partially responsible for the widespread usage of the following quote on the internet now with regard to babyloss mamas:

“Miscarriages are labor, miscarriages are birth. To consider them less dishonors the woman whose womb has held life, however briefly.” –Kathryn Miller Ridiman

I found it in an issue of Midwifery Today from 1995 and shared it multiple times on Facebook and on my blog. I have since seen it in many locations around the web and I feel happy that I was able to be a conduit for the sentiment and the increased recognition of miscarriage as a birth event.

To participate in the Stillbirthday blog contest/carnival go here. And, make sure to check them out on Facebook too.

Alaina’s Birth Story–Baba Style!

Jan28

On Alaina’s birthday I received a special treat—her birth story written by my mom (called Baba in our family). I asked her if I could post it here and here it is!

Alaina’s Birth Story

Baba’s version

Waiting for a baby to be born can be exciting and stressful at the same time – but waiting for baby Alaina was especially poignant because of Molly’s previous loss of little Noah. I was worried. I knew she had a specific vision of how this – her last – birth would be, and I was concerned that my presence would somehow ruin things for her, or not live up to her expectations. I was also actually afraid. I was afraid something would go wrong, either with the birth process or with the baby herself. I was afraid I’d have to be the one who was called upon to act in some heroic manner and would fail. I was afraid I wouldn’t measure up to Molly’s birth expectations. I wanted to do it all right, perfectly, and was afraid I couldn’t. I felt that voicing these fears would somehow manifest them, and I didn’t want to carry the fear into the sacred birth space. I felt prepared – I had been trained in neonatal resuscitation, knew where all the tinctures, supplements, and supplies were located, had a little bag packed for myself – but I was still emotionally and mentally concerned.

However, a few days before the birth, Molly and I had a talk, and it really cleared the air! When the “stand by” call came from Mark, I knew I was ready to be of service to my daughter and arriving granddaughter. The first request was for us to collect the big brothers, who had awakened early and were impacting Molly’s birth environment. I picked them up and brought them to home with me. At that time, Molly was very clear and focused, doing her work on the birth ball. When Mark called me to come back to the house at about 9:00, I scrambled into the car and tore over there, as if there might not be enough time! Molly has a history of precipitous births…….

There was definitely some birthy energy going on! Molly was on the ball with Mark rubbing her back. I knew she wanted to be left alone and have a peaceful environment, so I spoke as little as possible. At some point, I slipped over to her futon nest and tucked my little cheat sheet list underneath. I didn’t want to forget any of the resuscitation steps or what supplements to give her. I tried to remind her to eat, drink and use the bathroom, without being obtrusive about it. She was obviously making progress, and I could hear in her voice that the contractions were growing in intensity. She worried about being too much “in her head” and analyzing things. I tried to reassure her that this is always how she approaches the world, and that it was fine to be that way. She was up and moving around, talking and considering, and also worried that she might not be progressing. This made me think transition might be near, but I didn’t say that to her. She felt some rectal pressure and decided to sit on the toilet for a while. It seemed to me that things were progressing apace, when she reached down and felt something squishy. She said she thought she was pushing, and I decided it was time to abandon my “silence” (really hard for me, by the way!) and comment that she should probably get to her nest if she wanted to avoid having the baby on the toilet. She agreed, but didn’t really seem to want to move. No wonder. She barely made it! Meanwhile, I had called Summer, the doula, and midwife E.

Baba meets Alaina!

Molly dropped to her knees on her futon nest, and had an obviously intense contraction. We helped her get her clothes off. She was upright on her knees, intent upon finding heart tones, when the phone started ringing incessantly. It was SO annoying that I ran over to, picked it up and slammed it down to make it stop. That’s when I heard some garbled crying and Molly had baby Alaina in her arms! In my mad dash to the phone, I had missed the actual moment of birth :(. We all burst into tears and Molly was repeating, “You’re alive! You’re alive! I did it! There’s nothing wrong with me!” The baby was crying lustily, so we got Molly into a prone position (she was still kneeling) with the baby on her chest and covered up. My job was to pop things into Molly’s mouth – supplements, vitamins, chlorophyll, etc., so I got ready to do that. Summer arrived, midwife E arrived, and all was right with the world. Baby Alaina was safe and in her mother’s arms! And in mine, as soon as I could get my hands on her…..

—-

Molly’s version of Alaina’s full birth story.

Footprints on My Heart: A Memoir of Miscarriage & Pregnancy After Loss

Jan27

As of this week, my miscarriage memoir, Footprints on My Heart, has finally been published and is now available in eBook format via Kindle and Lulu, Inc. (epub format compatible with Nook and iBooks). There are a few formatting errors and some other general problems (like with the sample/preview–it is totally wonky–and with the lettering on the cover), but guess what, it is DONE, it available, and it is out there. I’m really, really excited about it and I feel this huge sense of relief. I still want to write my Empowered Miscarriage book someday, but for now, this memoir is what I had in me and it will have to do for the time being. I realized after Alaina was born and was, in a sense, the happy “ending” to my Noah story, that in writing my miscarriage blog I had actually ended up writing most of a book. So, the bulk of the book is drawn from my miscarriage blog and from this blog as well (for the pregnancy after loss content). I also included an appendix of resource information/additional thoughts that is fresh.

I’ve felt haunted by the desire to publish this for the entire last year. It took a surprising amount of work, as well as emotional energy, to prepare for publication, even though I actually did most of the actual writing via blog in 2010. Now that it is ready, I just feel lighter somehow and have this really potent sense of relief and ease, as if this was my final task. My final act of tribute. My remaining “to do” in the grief process.

If anyone really, really, really wants it and cannot afford the $3.99 for which I priced it, I do have it available as a pdf file, a mobi file, and an epub file and I will be happy to email it to you in one of those formats.

<deep breath> Aaaaaahhhhhh….

Thoughts on epidurals, risk, and decision making

Jan22

In the Winter 2012 issue of The Journal of Perinatal Education I read several interesting tidbits related to women’s experiences of medication during labor, expectations for birth, and thoughts on risk and choice. In an article by Hidaka and Callister titled, “Giving Birth with Epidural Analgesia: The Experience of First-Time Mothers,” I was struck by one mother’s explanation of why she “chose” an epidural: “‘I was nervous about lying down and being confined to the bed again.'” As the researchers explain, “She wanted to stand or sit to cope with labor pain; however, many times she had to lie down for monitoring, and that position made her pain worse, so she was inclined to opt for an epidural” (p. 29).

Some questions immediately arise here. Did this mother actually want an epidural? Do women really need to lie down to be monitored? Was normal labor unbearable without medication? Did she make a free choice? The answer to all is, no. In this case and in so many others around the nation every day, the physiologically normal and fully appropriate need for freedom of movement during labor ran smack into the hospital’s expectation of stillness. And, medication was a consequence of that stillness, not an inability to cope with normal labor–it was an inability to cope with enforced passivity that was directly counter to the natural urges of her birthing body. Where is the “opting” here? When birthing women are literally backed into corners, no wonder epidural analgesia becomes the nationally popular “choice.”

Risk and birth

In another article titled “Risk, Safety, and Choice in Childbirth,” Judith Lothian explores our risk-driven obstetrical model, drawing on material from Raymond De Vries who, “describes that the common strategy of professional groups gaining control is to create risk or exaggerate risk. One ways groups gain power is by reducing risk and uncertainty. Where there is limited risk, it can be ‘created’ by redefining ordinary life events as risky and emphasizing whatever risk exists. The medical model encourages women to see birth as inherently risky for mother and baby…The obstetrician is then in the powerful position of reducing the risk and uncertainty. During pregnancy, women are advised and cautioned about every conceivable, however small, risk; but interestingly, when it comes time for the birth there is little, if any, discussion about the risks of routine interventions, such as continuous electronic fetal monitoring, elective induction, and epidurals…” (p. 45-46).

What are the implications for childbirth educators and doulas? We need to be cautious of perpetuating a medically oriented model that implies that women are responsible for minimizing all possible risks during pregnancy and yet then accepting a climate for giving birth that actually increases risks for both mother and baby. Lothian notes that educators must make it clear “that the current maternity care system increases risk and makes birth less safe for mothers and babies. Women need to know the care practices that make birth safer for mothers and babies and the practices that do not.” She goes on to address a key point, stating that “Childbirth educators need to take a strong stand in support of changing the system to increase safety for mothers and babies…safety is not about frantically trying to minimize small or exaggerated risks during pregnancy and then giving birth in hospitals that protect obstetricians’ interests while increasing risk for mothers and babies” (p. 47). [emphasis mine]

Storytelling and birth

In a later article by Barbara Hotelling about styles of teaching about medications in birthing classes, she references Lothian who suggests, “childbirth educators replace in-depth discussions of stages and phases of labor, medical interventions, hospital policies, and complications…’Let go of trying to fit everything in. Women don’t need to know everything about labor and birth.'” What to do instead? She suggests replacing traditional forms of education with storytelling and other strategies that recall how women through the ages have traditionally come to know and understand birth, stating that, “‘Storytelling is a powerful way to convey basic information about physiology, coping strategies, and confidence'” (p. 51). I’ve written before that what women need isn’t actually just more information and to get educated and these experienced educators agree, “Now there are many books, videos, YouTube videos, and magazines that give expectant parents the information. In their classes, childbirth educators can add storytelling from friends and family about their experiences with pain medication during labor and birth, allowing educators and their class participants to learn from the wise women who went before them” (p. 51).

I’ve long sought ways to help parents cultivate their inner knowing and body wisdom and to focus classes around the development and enhancement of personal resources, rather than on simple information sharing. I would like to re-vision my own approach to childbirth education into a cooperative, woman-to-woman, birth circle type of environment. Michel Odent describes this in his book Birth and Breastfeeding as “new style” childbirth education: “for the most part, these are mothers who have no special qualification but, having given birth to their own children, feel the need to help other women who could benefit from their personal experience. They organize meetings, often at their own homes. They do not usually encumber themselves with any particular theoretical basis for their teaching, but may find it useful to give this or that school of thought as a reference. Their aim could most accurately be described as being to provide information and education, rather than specific preparation.”

Addressing the subject of pain…

Returning to the first article quoted above, in their discussion, Hidaka and Callister state, “Our findings confirm those of a recent systematic review of women’s expectations and experience of pain relief in labor. Across studies, women underestimated the pain of childbirth, we’re not prepared for the intensity of the experience, and often had unrealistic expectations” (p. 29). I’d like to address the other points in a future post, because I think they are very significant, but for now they offer several good tips for childbirth educators to address the topic of labor pain during birth classes:

Teach that some pain/sensation has a purpose to alert the laboring woman to the need for movement, doing something different to encourage rotation and descent, or to push

Teach that the sense of empowerment for accomplished tasks and goals cannot be replaced only with pain relief

Teach that perception of pain is different for every woman

teach that every situation is unique so that no single pain management strategy works

Teach that the word labor means “hard work” and not “big pain”

teach that labor contractions intensify until about 5 cm, and that other sensations (e.g. “downward pressure”) may seem scary or painful

Teach that the sensations of labor are not all unique to labor (e.g. bad menstrual cramps, back pain, nausea, pressure)–they have lived through these experiences before

The Value of Sharing Story

Practical Ways to Enhance Knowledge for Birth

Information ≠ Knowledge

Women and Knowing

Asking the right questions…

The Illusion of Choice

Dec30

A choice is not a choice if it is made in the context of fear.

Informed choice is a popular phrase with birth professionals and healthy birth activists. I’ve read impassioned blog posts from doulas and birth activists claiming that if we support women’s right to homebirth, we must also support her “choice” to have an elective cesarean. But, I believe we have constructed a collaborative mythos within the birth activist community that an informed choice is possible for most women. The statistics tell us a different story. I do not believe that women with full ability to exercise their choices would choose many of the things that are typically on the “menu” for birth in mainstream culture.

What’s on the menu?

Women give their blanket “informed consent” to all manner of hospital procedures without the corollary of informed refusal–is a choice a choice when you don’t have the option of saying no?

In many hospitals, women are STILL not allowed to eat during labor despite ample evidence that this practice is harmful–is a choice a real choice if made in the context of hospital “policies” that are not evidence-based?

Women are told that their babies are “too big” and then “choose” a cesarean. Is a choice a choice when it is made in the context of coercion and deception?

Women choose hospitals and obstetricians that are covered by their insurance companies. Is a choice a real choice when it is made by your HMO?

Women choose hospital birth because they cannot find a local midwife. Is a choice a real choice when it is made in the context of restrictive laws and hostile political climates?

Women often state they are seeking “balanced” birth classes that aren’t “biased” towards natural birth (or towards hospital birth), but is a choice a choice when it is made in the context of misrepresented information? Because, as Kim Wildner notes, balance means “to make two parts equal”–what if the two parts aren’t equal? What is the value of information that appears balanced, but is not factually accurate? Pointing out inequalities and giving evidence-based information does not make an educator “biased” or judgmental–it makes her honest! (though honesty can be “heard” as judgment when it does not reflect one’s own opinions or experiences).

On a somewhat related note, recently, the subject of “quiverfull” families came up amongst my friends and comments were made about feminists needing to support those women’s “choice” to have so many children. However, I worry about women who are making reproductive “choices” in the context of what can be a very repressive religious tradition. Women’s choices about their lives are not always made with free agency. And, that is where some feminist critiques of other women’s choices come from–a critique of the larger context (patriarchy) rather than the woman herself. Is a choice a choice when it is made in the context of oppression?

Where do women get information to make their choices?

In his 2010 presentation, Birthing Ethics: What You Should Know About the Ethics of Childbirth, Raymond DeVries uses data from the Listening to Mother’s studies to help us understand where women are getting their information about birth—this is the context in which their “informed choices” are being made and this is the context we need to consider.

Our choices in birth and life are profoundly influenced by the systems in which we participate…

Some choices shaped by the system

Women learn from books and experiences of others (and self):

The number one book women learn from is What to Expect When You’re Expecting, which has been number four on NY Times Bestsellers list for over 500 weeks and counting.

According to De Vries, via the Listening to Mothers data, this is what women tell us about how they learn, what they learn, and upon what their choices are based:

Television explains birth
Pain is not your friend
But technology is
Mothers are listening to doctors (and nurses)
Medicalized birth allows mothers to feel capable and confident
Interfering with birth is mostly okay
Our health system works (mostly)
We like choice
We want to be “informed”

He also explains polarization: “We seek information to confirm our opinion. Contrary information does not convince, it polarizes.” How do we share information so that women can make truly informed choices without polarizing?

As advocates, I think we sometimes fall back on the phrase “informed choice” as an excuse not to be outraged, not to despair, and not to give up, because it promises that change is possible if only women change and most of us have access to change at that level.

Birthing room ethics

In another presentation, U.S. Maternity Care: Understanding the Exception That Proves the Rule, DeVries explores the ethical issues surrounding choices in birth, noting that “choice is central at all levels – but can choice do all the moral work?” We wish to respect parental choice, but information does not equal knowledge and we often err on the side of treating them as one and the same. In maternity care, often there is no choice. Tests become routine or practices become policy, and “information [is] given with no effort to understand parental values (the ritual of informed consent).”

Is choice possible while in active labor?
De Vries also raises a really critical question with no clear answers—is choice really possible during active labor? He also asks, “should a healthy pregnant woman be allowed to choose a surgical birth? But is it safe? The problem with data…Interestingly, those who think it should be allowed find it safe, and those who oppose it, find it to be unsafe.” When considering where this “choice” of surgical birth comes from, he identifies the following factors:

The desires of women
• Preserve sexual function
• Preserve ideal body
• The need to fit birth into employment
• Options offered by health care system

The desires of physicians
• Manage an unpredictable process
• The limits of obstetric education

Why should we care, anyway?

Another popular phrase is, “it’s not my birth.” I agree with the opinion of Desirre Andrews on this one:

“I do not believe in the saying ‘Not my birth.’ Women are connected together through the fabric of daily life including birth. What occurs in birth influences local culture, reshapes beliefs, weaves into how we see ourselves as wives, mothers, sisters, & women in our community. Your birth is my birth. My birth is your birth. This is why no matter my age or the age of my children it matters to me.”

Victims of circumstance?

While it may sound as if I am saying women are powerlessly buffeted about by circumstance and environment, I’m not. Theoretically, we always have the power to choose for ourselves, but by ignoring, denying, or minimizing the multiplicity of contexts in which women make “informed choices” about their births and their lives, we oversimplify the issue and turn it into a hollow catchphrase rather than a meaningful concept.

Women’s lives and their choices are deeply embedded in a complex, multifaceted, practically infinite web of social, political, cultural, socioeconomic, religious, historical, and environmental relationships.

And, I maintain that a choice is not a choice if it is made in a context of fear.

But, what do we know?

I read an interesting article by anthropologist and birth activist, Robbie Davis-Floyd, in the summer issue of Pathways Magazine. It was an excerpt from a longer article that appeared in Anthropology News, titled “Anthropology and Birth Activism: What Do We Know?” In the conclusion, Davis-Floyd states the following:

“Doctors ‘know’ they are giving women ‘the best care,’ and ‘what they really want.’ Birth activists…know that this ‘best care’ is too often a travesty of what birth can be. And yet on that existential brink, I tremble at the birth activist’s coding of women as ‘not knowing.’ So, here’s to women educating themselves on healthy, safe birth practices–to women knowing what is best for themselves and their babies, and to women rising above everything else.”

I believe that every woman who has given birth knows something about birth that other people don’t know. I also believe that women know what is right for their bodies and that mothers know what is right for their babies. I’m also pretty certain that these “knowings” are often crowded out or obliterated or rendered useless by the large sociocultural context in which women live their lives, birth their babies, and mother their young. So, how do we celebrate and honor the knowings and help women tease out and identify what they know compared to what they may believe or accept to be true while still respecting their autonomy and not denigrating them by characterizing them as “not knowing” or as needing to “be educated”? As I’ve written previously, with regard to education as a strategy for change: People often suggest “education” as a change strategy with the assumption that education is all that is needed. But, truly, do we want people to know more or do we want them to act differently? There is a LOT of information available to women about birth choices and healthy birth options. What we really want is not actually more education, we want them to act, or to choose, differently. Education in and of itself is not sufficient, it must be complemented by other methods that motivate people to act. As the textbook I use in class states, “a simple lack of information is rarely the major stumbling block.” You have to show them why it matters and the steps they can take to get there…

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

The systemic context…

We MUST look at the larger system when we ask our questions and when we consider women’s choices. The fact that we even have to teach birth classes and to help women learn how to navigate the hospital system and to assert their rights to evidence-based care, indicates serious issues that go way beyond the individual. When we talk about women making informed choices or make statements like, “well, it’s her birth” or “it’s not my birth, it’s not my birth,” or wonder why she went to “that doctor” or “that hospital,” we are becoming blind to the sociocultural context in which those birth “choices” are embedded. When we teach women to ask their doctors about maintaining freedom of movement in labor or when we tell them to stay home as long as possible, we are, in a very real sense, endorsing, or at least acquiescing to these conditions in the first place. This isn’t changing the world for women, it is only softening the impact of a broken and oftentimes abusive system.

And, then I read an amazing story like this grandmother’s story of supporting her non-breastfeeding daughter-in-law and I don’t know WHAT to do in the end. Can we just trust that women will find their own right ways, define their own experiences, and access their own knowings in the context of all the impediments to free choice that I’ve already explored? What if she says, “why didn’t you TELL me?” But, if we share our information we risk polarization. If we keep silent and just offer neutral “support,” regardless of the choice made, then doesn’t it eventually become that the only voice available for her as she strives to make her own best choices is the voice of What to Expect and of hospital policy?

“Our lives are lived in story. When the stories offered us are limited, our lives are limited as well. Few have the courage, drive and imagination to invent life-narratives drastically different from those they’ve been told are possible. And unfortunately, some self-invented narratives are really just reversals of the limiting stereotype…” –Patricia Monaghan (New Book of Goddesses and Heroines, p. xii)

—-
Related posts:

What to Expect When You Go to the Hospital for a Natural Childbirth
Birth & Culture & Pregnant Feelings
Asking the right questions…
Active Birth in the Hospital
Why do I care?

References:

De Vries, Raymond. May 20, 2010. Birthing Ethics: What You Should Know About the Ethics of Childbirth, Webinar presented by Lamaze International.

De Vries, Raymond. Feb. 26-27. U.S. Maternity Care: Understanding the Exception That Proves the Rule. Coalition for Improving Maternity Services (CIMS). 2010 Mother-Friendly Childbirth Forum

Magic of Mothering

Dec28

Nursing baby A at two weeks old

(The first part of this post is an excerpt from an assignment in one of the classes I’m taking)

“Remember, when Keplet postulated that the moon effected the tides on earth, Galileo dismissed the hypothesis as ‘occult fancy.’ It involved action at a distance, and, therefore, violated the ‘solid laws of nature’ of that time. Now these laws of nature (as they were understood by classical physics only a century ago) have already been transcended; this progression should gently hint to us that many of the solid laws of our day are beliefs that obscure the otherwise obvious” (Passmore, 168).

I have long been wary of the phrase, “we used to think, but now we know…” usually stated with great conviction and little room for debate.

Body Wisdom

As Passmore goes on to note, “It is important to make a distinction between ‘progress in science’ and its explanatory power. This power for explanation depends upon the kind of question being asked. History shows that the questions change with changing beliefs/values in both time and space, periods and cultures.” It is exciting to me to consider how much we just don’t know and yet, the world keeps on spinning along, with or without our “knowing” all the facts. I think about this with regard to birth and breastfeeding. How many generations of women have pushed out their babies and fed them at the breast without knowing the exact mechanics of reproduction even, let alone milk production. There are all kinds of historical myths and “rules” about breastmilk and breastfeeding and even ten years ago we used to think the inner structure of the breast was completely different than what we think it is like now. Guess what? Our breasts still made milk and we still fed our babies, whether or not we knew exactly how the milk was being produced and delivered. Body knowledge, in this case, definitely still trumped scientific knowledge. I love that feeling when I snuggle down to nurse my own baby—my body is producing milk for her regardless of my conscious knowledge of the patterns or processes. And, guess what, humans cannot improve upon it. The body continues to do what the human mind and hand cannot replicate in a lab. And, has done so for millennia. I couldn’t make this milk myself using my brain and hands and yet day in and day out I do make it for her, using the literal blood and breath of my body, approximately 32 ounces of milk every single day for the last eleven months. That is beautiful.

The protective impact of a mama

And, on a somewhat related note, several years ago when I read Birth Book, I marked a section about “imprinting” in it (I think it has been fairly well established that there isn’t really human “imprinting” after birth, but when this book was written it was still one of the ideas). Anyway, there was a section about research done with baby goats done to look at the ability of a mother to protect her offspring from environmental stress. They separated twin goats and put some in rooms alone and the others in rooms with their mothers. The only difference in the room was the presence of the mother. An artificial stress environment was created involving turning off the lights every two minutes and shocking the baby goats on the legs. After the babies were conditioned like this, they were tested again two years later. This time all the babies (now adult goats) were in rooms alone and were again “treated” to the lights off and shock routine. The goats who had been with their mothers during the early experience showed no evidence of abnormal behavior in the stressful environment. The ones who had not been with their mothers did show “definite neurotic behavior.” Somehow, the presence of the mother alone served to protect the baby goats from the traumatic influences and keep them from being “psychologically” disturbed in adulthood.

Except for feeling sorry for the baby goats, I thought this information was SO COOL. How magic are mothers that just by being there we can help our babies–even if there is still something stressful going on, our simple presence helps our babies not be stressed by it and continue to feel safe. Magic!

Birth stress?

The goat research was included in the book because of the idea that birth may be a stressful environment for a baby and if the continuity of motherbaby is maintained after birth (immediate skin-to-skin contact and opportunity for breastfeeding), the baby does not become stressed or “neurotic.” But…if the continuity for mother and baby is broken by separation (baby whisked away for weighing or whatever), both mother and baby are stressed by this and it may have an impact on their future relationship and behavior. The book also talks about how the sound of the baby’s first cry has a sort of “imprinting” effect on the mother in that her uterus immediately begins to contract and involute after hearing her baby’s first cry, whereas mothers who are immediately separated from their babies and do not make contact with them have a higher likelihood of postpartum hemorrhage (I have no idea if this has been debunked or not since the book was written in 1972, but it was an interesting idea to read about).

Mothering is magic. Seriously.

Sand Tray Therapy

Nov7

I hoped to finish Noah’s book before his birthday today, but I didn’t quite make it. I’m still editing the last half, adding resources to the appendix, and waiting for my husband to design the cover for me. Hopefully I will publish it by the end of the year! Instead, I wanted to share some pictures and thoughts from a sand tray therapy exercise that I did during a session at the ICAN conference in St. Louis in April. I’ve been meaning to post about it since then and haven’t found the opportunity, so in honor of his birthday seems very fitting and appropriate. The session was intentionally kept small for personal sharing and when we walked in the therapist, Maria Carella, asked if we were there to celebrate a birth or to grieve one. I said I was there for both (I had Alaina with me and she slept in the Ergo during the session). Each of us had a tray of sand and there were long tables at the front of the room full of objects and materials (like shells, feathers, and so forth). We were paired up and after arranging our items on our sand, we were asked to share our tray with the person next to us as well as the message, lesson, reflection, or insight we received from the process of making the tray. While some people used the sand in various creative ways—mounding it up, etc.—I just smoothed mine out and put stuff on top of it. The experience of sharing with my tablemate was very moving and profound. We had a lot of surprising similarities in our feelings about our births, though our stories were very different. And, our closing thoughts or insights about our trays were almost identical.

While it might be hard to see everything, I chose the bridge to symbolize my feeling of having crossed the bridge to the “other side”—meaning first the fact that after Noah and my second miscarriage, I felt separated from women who had not experienced loss by a bridge and as if I’d crossed over into new territory and left my old, happy, naive pregnant self behind (along with the other non-loss mamas. A little more about this bridge here). AND, that I also felt like with Alaina’s birth that I crossed a bridge into the unknown and to the end of the pregnancy-after-loss journey. Her birth represented the “other side” of PAL. So, at the end of the bridge I drew a question mark in the sand, representing all the questions I had to get past and over in order to get to my new baby. The little baby on the side of the bridge represents how I still had Noah with me. He didn’t get “left behind” on the other side of the bridge, but was next to me on my journey. The spiral on the other side represents the continuous, unfolding spiral of life. Sitting by the question mark is a sort of Kachina-type figure holding many babies. To me she represents all of the babyloss mamas and also reminds me of the jizos who protect lost babies. There is also a coffin on the other side of the question mark, summing up how the fear of the death was everpresent for me and I had to pass over that fear as well to get to my new baby—my light, the candle on the other side of death. The little sparkling gems also represent my joy at her birth and what a treasure she is to me. The bone on the side of the candle represents the places where the “meat was chewed off my bones” by all my births, including Noah’s (I had just attended Pam England’s birth story sharing session prior to this sand tray session). I placed the Goddess of Willendorf figure, that I had immediately snatched off the table as soon as I spotted her, at the top to represent how my sense of spirituality had surrounded and enfolded both my experiences—She is “holding” it all. And, I explained to my tablemate how the roundness of the tray to me also represented the full circle—how Alaina’s story and Noah’s are entwined and how her birth was the “end” (of sorts) of his story, but that they are part of one whole.