What If? Shifting the Dialogue of Birth

Oct9

Sometimes at mother blessing ceremonies I share a modified version of a piece of writing by Leilah McCracken called, “Shifting the Paradigm of ‘What if?'” (I forget where I originally read it, perhaps in Hypnobabies?).

This is my re-working of McCracken’s words, with the addition of my own thoughts at the end:

Many of us think “What if?!” in fearful ways before giving birth: What if I need to transfer? What if the pain is awful? What if my uterus ruptures? What if the baby won’t come out? What if I lose control? and so on.

Let’s shift the internal dialogue and think “what if?!” in powerful ways: “What if I have the most beautiful experience of my life? What if I could actually feel a wet, moving baby on my belly—just after birth—and fall in love with that feeling forever? What if I give birth and feel pure exhilaration? What will happen if I give birth as a powerful, free woman—what will happen if I claim my right to give birth as my biology impels me to? What if I emerge victorious, free, and powerful? What if—what if my baby never feels anything in her first moments other than my body and my love? What if I push my baby out into my own hands, and pull her up, and kiss her wet head, and cry and moan and weep my joy in private, darkness and love—what if… what if this birth is the most loving, sweet and gentle moment of my life? What if I give birth with wild joy and courageous abandon? What if…

If I read this out loud to a woman, I substitute “you” for “I”—the “you” message puts her directly into that new framework of what if!

What if we become as powerful and wise as we are meant to be? What if we share our wisdom and our strength with other women? What if we act with courage and in solidarity with other women? What if we believe unshakably in the power of women to triumph and to act with courage? What if we expect birth to be beautiful? What if we trust that we can learn so much from each other? What if we trust women’s bodies and the wisdom of babies? What if we listen, really listen? What if we remember that she always has the right to define her own experience? What if we know in our hearts that all mothers love their babies? What if we act as though other women don’t need to be enlightened or “educated”? What if we believe she has the keys within herself to unlock her own steady power? We will change the way the world spins…

What if… the very future rests on our ability to engage with these what if’s?

—
Note: I then wrote a companion post about the flip side—the going ahead and thinking the “bad” what if’s—because I want to also acknowledge that there is power and value in experiencing and working through the so-called “negative” what if’s as well.

What if…she knows exactly what to do…

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

Where are the women who know?

Sep6

Ames, Iowa 1960

Pregnant and
no female friend to confide in
Scared and
no woman to tell it to
A male doctor who patronizingly
calls me by my first name
while I’m supposed to
respectfully
call him Dr. So-an-so

A husband so afraid of
his own fear that
He’s unwilling to know it’s there
not the person
to listen to mine

Where are the witches, midwives
and friends
to belly dance and chant
while I deliver
to hold me and breathe with me
as I push
to touch me and comfort me
as I cry?

Where are the womyn who know
what it’s like
to give birth?

–Antiga in The Goddess Celebrates, p. 152

This poignant poem spoke to me from the pages of an anthology of women’s rituals recently. It made me think about my plans and visions for the birthwork I’d like to offer to my community. Some friends/colleagues and I launched a local Birth Network this year and one of my primary hopes for it is that it will provide easy access to the women who know. And, that in simultaneously creating access for pregnant women to each other, the opportunity arises to uncover their own deep knowing, rather than needing expert advice or opinions. To that end, we’re planning a series of birth workshops (more details soon!) and hopefully a birth circle.

In the novel The Heart of the Fire recently I marked these two quotes:

“A woman who has borne children…loses many of her terrors.” The character speaking goes on to explain, “…for a Priestess it is, a path. A path of opening.”

Later the main character is attending the birth of one of her siblings and observes, “[the midwife] says the most important thing is to never bring fear into the room of a laboring woman. ‘A woman must be completely open to birth a child,’ she says, ‘and so she is unable to defend herself from the thoughts of those around her.'”

I’ve written about birth fear several times before. I think many women underestimate the potent impact the emotional condition of birth witnesses of all kinds (including doctors, nurses, grandmothers, doulas, and friends!) can have on their own birthing times. Women in labor enter a timeless, liminal space, and use their right brain–the primitive brain, the “birth brain” as I call it or “their monkey” as Ina May calls it–to dig deep and access the inner resources they need to birth their babies. When other people in the room are fearful or agitated or even just too talkative, the laboring woman has a heightened vulnerability to and awareness of those emotional states. This is what the fictional midwife quoted above means about being “unable to defend herself from the thoughts of those around her.” This is an important understanding. While to the birth attendant, this is just one more birth in a lifetime career, for the mother giving birth this is potentially a peak experience and definitely something she will remember for the rest of her life. This is a sacred moment and one deserving great care, tenderness, and respect.

In my ideal vision of the world, pregnant women would have ample access to other women who know what it is like to give birth under their own power and self-authority. And, these women who know would likely be women who have lost many of their “terrors” in the process. Access to women who know would render most traditional forms of childbirth education unnecessary, offering instead what Michel Odent would deem “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.” (previously quoted in thoughts on epidurals, risk, and decision making)

So, this is really what I’m hoping to be a part of creating for the women of my own community. I want to help open the door so that the women who know and the women who are preparing themselves to know can meet in safe space and in so doing lose many of their terrors and joyfully uncover their own unique strengths. I believe I’ve already seen it working.

—

The Value of Sharing Story

Information ≠ Knowledge

How Do Women Really Learn About Birth?

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…

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This post is updated from a previous edition.

Blessingways and the role of ritual

Aug28

In this circle No Fear
In this circle Deep Peace
In this circle Great Happiness
In this circle Rich Connection

I saw this gorgeous blessingway image pinned on Pinterest a while ago. Love it!

I’ve recently been on a reading streak with books on ritual. I’ve always been interested in ritual, especially women’s rituals, and I’ve planned and facilitated a lot of different rituals. I also have a huge variety of books that include information on planning rituals, women’s spirituality books, books about blessingways, and more. I’m branching out even more with my recent kick though, starting with buying books on officiating/planning wedding ceremonies (I have two weddings coming up in October). Then, I was talking to some mothers of newly teenage boys about planning some kind of coming of age rite/ritual for them and bought some more books on creating sacred ceremonies for teenagers. (I’m good with books for women/girls, but sadly lacking in resources for ceremonies and celebrations for boys/men.) One of the books I purchased was Rituals for Our Times, a book about “celebrating, healing, and changing our lives and relationships.” I left a mini-review on goodreads already:

There were some good things about this book about the meaning, value, purpose, and role of ritual in family life. I lost interest about halfway through and ended up skimming the second half. While it does contain some planning lists/worksheets for considering your own family rituals, the overall emphasis is on short vignettes of how other families have coped with challenges or occasions in their own lives. Also, the focus is on very conventional, mainstream “ritual” occasions–birthdays, anniversaries, holidays–rather than on life cycle rites of passage and other more spiritual transitions in one’s life.

However, one section I marked was about the elements that make ritual work for us and I thought about blessingways and how they neatly fulfill all of the necessary ritual elements (which I would note are not about symbols, actions, and physical objects, but are instead about the emotional elements of connection, affection, and relationship):

Relating–“the shaping, expressing, and maintaining of important relationships…established relationships were reaffirmed and new relationship possibilities opened.” Many women choose to invite those from their inner circle to their blessingways. This means of deeply engaging with and connecting with those closest to you, reaffirms and strengthens important relationships. In my own life, I’ve always chosen to invite more women than just those in my “inner circle” (thinking of it as the next circle out from inner circle) and in so doing have found that it is true that new relationship possibilities emerge from the reaching out and inclusion of those who were originally less close, but who after the connection of shared ritual, then became closer friends.

Changing–“the making and marking of transitions for self and others.” Birth and the entry into motherhood—an intense and permanent life change–is one of life’s most significant transitions. A blessingway marks the significance of this huge change.

Healing–“recovery from loss,” special tributes, recovering from fears or scars from previous births or cultural socialization about birth. My mom and some close friends had a meaningful ceremony for me following the miscarriage-birth of my third baby. I’ve also planned several blessingways in which releasing fears was a potent element of the ritual.

Believing–“the voicing of beliefs and the making of meaning.” By honoring a pregnant woman through ceremony, we are affirming that pregnancy, birth, and motherhood are valuable and meaningful rites of passage deserving of celebration and acknowledgement.

Celebrating–“the expressing of deep joy and the honoring of life with festivity.” Celebrating accomplishments of…one’s very being.

Notice that what is NOT included is any mention of a specific religion, deity, or “should do” list of what color of candle to include! I’ve observed that many people are starved for ritual, but they may so too be deeply scarred from rituals of their pasts. I come from a family history of “non-religious” people and I feel like I seem to have less baggage about ritual and ceremony than other people do. An example from the recent planning for a mother blessing ceremony: we were talking about one of the blessingway songs that we customarily sing–Call Down Blessing–we weren’t sure if we should include it for fear that it would seem too “spiritual” or metaphysical for the honoree (i.e. blessings from where?!) and I remembered another friend asking during a body blessing ritual we did at a women’s retreat, “but WHO’s doing the blessing?” As someone who does not come a religious framework in which blessings are traditionally bestowed from outside sources–i.e. a priest/priestess or an Abrahamic God–the answer felt simple, well, WE are. We’re blessing each other. When we “call down a blessing” we’re invoking the connection of the women around us, the women of all past times and places, and of the beautiful world that surrounds us. We might each personally add something more to that calling down, but at the root, to me, it is an affirmation of connection to the rhythms and cycles of relationship, time, and place. Blessings come from within and around us all the time, there’s nothing supernatural about it.

I also think, though I could be wrong, that it is possible to plan and facilitate women’s rituals that speak to the “womanspirit” in all of us and do not require a specifically shared spiritual framework or belief system in order to gain something special from the connection with other women.

In another book I finished recently, The Power of Ritual, the author explains:

“Ritual opens a doorway in the invisible wall that seems to separate the spiritual and the physical. The formal quality of ritual allows us to move into the space between the worlds, experience what we need, and then step back and once more close the doorway so we can return to our lives enriched.”

She goes on to say:

You do not actually have to accept the ideas of any single tradition, or even believe in divine forces at all, to take part in ritual. Ritual is a direct experience, not a doctrine. Though it will certainly help to suspend your disbelief for the time of the ritual, you could attend a group ritual, take part in the chanting and drumming, and find yourself transported to a sense of wonder at the simple beauty of it all without ever actually believing in any of the claims made or the Spirits invoked. You can also adapt rituals to your own beliefs. If evolution means more to you than a Creator, you could see ritual as a way to connect yourself to the life force…

As I continued to think about these ideas, I finished reading another book on ritual called The Goddess Celebrates. An anthology of women’s rituals, this book included two essays by wisewoman birthkeeper, Jeannine Pavarti Baker. She says:

The entire Blessingway Ceremony is a template for childbirth. The beginning rituals are like nesting and early labor. The grooming and washing like active labor. The gift giving like giving birth and the closing songs/prayers, delivery of the placenta and postpartum. A shamanic midwife learns how to read a Blessingway diagnostically and mythically, sharing what she saw with the pregnant woman in order to clear the road better for birth.

[emphasis mine, because isn’t that just a cool idea?! I feel another blog post coming on in which I “read” my own blessingway experiences and how they cleared the way for my births]

Baker goes on to describe the potent meaning of birth and its affirmation through and by ritual acknowledgement:

Birth is a woman’s spiritual vision quest. When this idea is ritualized beforehand, the deeper meanings of childbirth can more readily be accessed. Birth is also beyond any one woman’s personal desires and will, binding her in the community of all women. Like the birthing beads, her experiences is one more bead on a very long strand connecting all mothers. Rituals for birth hone these birthing beads, bringing to light each facet of the journey of birth…

“I wish for you a life full of ritual and community.” —Flaming Rainbow Woman, Spiritual Warrior

(in The Thundering Years: Rituals and Sacred Wisdom for Teens)

“Genuine, heartfelt ritual helps us reconnect with power and vision as well as with the sadness and pain of the human condition. When the power and vision come together, there’s some sense of doing things properly for their own sake.” —Pema Chodron

(in The Thundering Years: Rituals and Sacred Wisdom for Teens)

Other posts about mother blessings can be found here.

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Amazon affiliate links included in book titles.

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!

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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.

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.

The Impact of Birth on Breastfeeding

Jul31

Just in time for the start of World Breastfeeding Week, here is part 3 of my CAPPA re-cap series!

…they want you to believe it’s their power, not yours…They stick needles into you so you won’t hear anything, you might as well be a dead pig, your legs are up in metal frames, they bend over you, technicians, mechanics, butchers, students, clumsy or sniggering, practicing on your body, they take your baby out with a fork like a pickle out of a jar.

–Margaret Atwood in her novel Surfacing (opening quote of Dr. Jack’s presentation at the 2012 CAPPA conference)

As I mentioned, my favorite part of the CAPPA conference was hearing Dr. Jack Newman speak about controversies in breastfeeding (see next post) and then about the impact of birth on breastfeeding (breakout session). He was an amazing speaker. Very straightforward and almost blunt as well as funny and fast-paced. I really feel glad to have had the chance to see him in person after years of being familiar with his materials.

The notion of the birth-breastfeeding continuum isn’t new to me, having actually published articles about it previously, however Dr. Newman’s phrasing, descriptions, and reminders was just so perfect that it left me feeling even more enthused about the inextricable link between birth and breastfeeding. It is a biologic continuum that nature does not see distinct events—baby is born and goes to breast, it is part of the same event. Drawing on Diane Wiessinger’s work, Dr. Newman explained

With animal births: following a normal birth, infant feeding just…happens. Following an interventionist birth, the mother rejects the baby and there is no nursing at all.

In some hospitals, separation of mother and baby is routine as a way to “prevent” postpartum mood disorders. Dr. Jack’s own theory was that perhaps human mothers turn this “rejection” against themselves and it shows up as a postpartum mood disorder.

Babies NEED and expect to be with their mothers after birth. It is of critical importance. As I shared via Facebook, Dr. Jack explained this:

Know how much an incubator costs now? $50,000. Why don’t we just give half of that money to the mother and put the baby skin to skin on mother’s chest?

And, this gem:

“Our hospital births break every rule in the mammalian list of mother-baby necessities.” –Dr. Newman

He also noted that if baby is put skin-to-skin on mother immediately after birth regardless of original intention, the pair will breastfeed. It is biologically programmed.

Why do hospital births break the rules?

Because, as Dr. Newman explained we have a big, big problem in that HCPs do not recognize the critical importance of breastfeeding. He also repeatedly emphasized (in a very funny way) that there are many people who don’t know squat about breastfeeding and breastmilk and don’t feel like they need to learn anything before they start doing studies and writing papers about it.

Dr. Newman also emphasized the important point that the burden of proof rests upon those who promote an intervention! He was speaking with regard to recommending formula supplementation, but I strongly believe it applies to any birth practice. So simple and yet so profound. One example that he shared that is familiar to birth advocates is that lying down for electronic fetal monitoring is a position of comfort for the care provider, NOT for the mother.

And, he made this excellent point: “All medical interventions, even when necessary, decrease the mother’s sense of control, and increase her sense of her ‘body not being up to the task.” Again, the burden of proof rests on those who promote the intervention, not vice versa.

As I’ve touched on several times before, IV fluids that are commonly administered during labor may increase the baby’s birth weight, leading the baby to be more likely to experience the dreaded 10% weight loss (“totally bogus, by the way”). Also as I’ve noted before, IV fluids lead to significant maternal fluid retention which contributes to edema in the nipples and areolas and then…the dreaded “flat nipples.” The more fluid a mother gets in labor, the more a baby “loses” after birth!

Including the same picture as in my other post, because it is in this picture that Dr. Jack is specifically talking about his next point:

I disagree strongly with this statement:

‘Typically, loss of = or >10% of birth weight in the first few days suggests dehydration and the need to consider supplementation.’

He goes on to note that what is necessary is NOT supplementation but to help the mother and baby breastfeed well. The real question when it comes to newborn weight loss is, “is the mother-baby breastfeeding well?”

Newman also addressed something birth advocates are familiar with, the fact that epidural anesthesia can cause maternal fever. This leads to an infant sepsis workup and antibiotics and usually means separation of mother and baby. Here we again experience the failure of many medical care providers to recognize the importance of breastfeeding as beyond just a feeding method. Breastfeeding protects the baby–this is what most hospitals do not understand.

Of interventions that undermine breastfeeding, Dr. Jack pointed to Demerol (meperidine) as the “worst of the lot,” with newborns experiencing sedation and many of them not sucking at all. He also pointed out that all interventions increase the risk of cesarean section, which leads to increased discomfort for mothers and less willingness to breastfeed and increased likelihood of mother-baby separation.

The importance of skin-to-skin contact

Babies easily find their way to the unwashed nipple. And, given baby’s inborn feeding behaviors and instincts, it seems clear that, “if the baby expresses his or her choice, the baby would choose the breast.” (with regard to breastfeeding as maternal “choice”)

Not putting baby skin to skin with the mother, “increases the risk of hypoglycaemia significantly…Isn’t skin to skin contact a less invasive preventative measure than giving formula?” Newman then points out that most often we see “skin to blankets” which keeps baby from showing they’re ready to feed, doesn’t stimulate milk supply, and leads to engorgement which is not normal.

And, at the end he emphasized that when it comes to birth and breastfeeding, all too often WE MESS IT UP by meddling with the biological processes and rhythms of the mother-baby relationship.

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For more about controversies in breastfeeding, check out my next post.

Handouts from Dr. Newman are available here. One I’ve used recently is How to Know a Health Professional is not Supportive of Breastfeeding.

I’ve written about the birth-breastfeeding continuum and about some other systemic influences on breastfeeding in breastfeeding as an ecofeminist issue.

Fetal Model Update

Jul15

Some time ago I wrote a popular post about a newborn doll I bought at Kmart that is a perfect and affordable fetal model to use for childbirth classes. Unfortunately, Baby Sasha had a horrible run-in with mice in the closet and is now permanently disfigured 😦

We tried everything to remove these stains and nothing worked at all. Not even one bit. While I suppose I could still use her with her new “birthmark,” I’ve read that educators need to be very careful with the unintentional messages sent by their birthing class props—i.e. never jerk the placenta out of the knitted uterus, don’t hold the fetal model between your knees or drop it on the floor, and don’t throw the uterus down when you’re done with it. If you’ve done your job properly and used your props effectively, they’ve become associated in the clients’ minds with the “real thing” and the manner in which you handle these props sends unconscious signals to the clients about these items in their own lives. So, I don’t want their “baby” to emerge from the uterus “flawed” in this striking way.

I did discover that her little hat still tidily covers the mark on her head and she is restored to looking cute again:

I have ridiculous affection for this little face.

I sent my husband on a mission to Kmart to replace my beloved baby and alas, there were none to be found. Luckily, Kmart.com came to the rescue and I was able to order not one, but two, new little cuties!

This baby needs a name!

The replacement newborn isn’t quite as cute as my original and doesn’t look quite as realistic (Mark says they’re identical and the old doll is just dirtier). Close comparison did reveal that their eyes are different colors, original Sasha’s being a better, darker newborn blue and new baby’s being lighter and more gray.

Almost as big as a real newborn!

Now, I have triplet demo-babies!

Alaina has an obsession with dolls and she wants to take all of these babies from me. She also gets very stressed by trying to carry all three at once and keeps dropping at least one. She staggers around making kind of a panting sound and sort of whine-moaning for aid. The night the new dolls arrived she insisted on falling asleep with all of them, but the stress of trying to hold them all at once while also nursing, kept her awake for over an hour. She kept wanting them to get to nurse on the other side and actually acting a little panicky that they couldn’t all nurse on the same side.

Sorry, Alaina! Mine!