Book Review: The Father’s Home Birth Handbook

Nov2

I came to my attention today that I have never posted this book review! (also, as I prepared to “tag” this post, I realized that I don’t have a tag set up for “homebirth.” Can this really be true??!!)

The Father’s Home Birth Handbook

By Leah Hazard
Victoria Park Press, 2008
Softcover, 208 pages
ISBN: 978-0-9560711-0-1
www.homebirthbook.com

Reviewed by Molly Remer, MSW, ICCE

The Father’s Home Birth Handbook is a succinct and easy to read little guide for fathers and adds to the growing library of birth resources specifically geared towards fathers-to-be. The book is written by a woman, but contains ample quotes from fathers which lend a male perspective. It also includes a number of good birth stories interspersed throughout, which were all written by men.

The target audience for the handbook is easily summed up in the prologue: “…I’ve met far more men who have responded to their partners’ home birth wishes with a mixture of shock, cynicism, and fear…Far from being domineering ogres who just want to see wifey tucked ‘safely’ away a hospital, these loving fathers have simply had very little access to accurate, impartial information about the safety and logistics of home births versus hospital births.”

The first chapter addresses “Risk & Responsibility,” because that is one of the very first issues of concern for most people new to the idea of homebirth. It moves on to a chapter called “Think Positive,” followed by “Choosing the Guest List” and then one titled “Pleasure and Pain” This chapter covers comfort measures and what to do while the woman you love is giving birth: “…away from the intravenous drip and ticking clocks, you can support your partner in experiencing labour in all of its awesome, challenging power.”

Chapter five—“Birth: Normal and Extraordinary” covers Labor 101 topics, including what to do with the placenta. This is followed by “Challenges & Complications” which covers some common issues of concern such as premature labor, being overdue, prolonged labor, distressed baby, cord around the neck, tearing, and blood loss. Each of these is followed by a “what can I do to help?” section.

The final chapter—“Now What?”—concludes with a nice segment called “how can I carry the lessons I’ve learned from my homebirth with me into the rest of my life as a father?”

Published in Scotland, the handbook has a UK perspective—it assumes participation in the NHS and a “booked” midwife and homebirth. There is no “how to choose a midwife” type of section (because there is no choice of midwives). For US readers, this leaves a set of issues unaddressed—such as varying legal statuses, etc. UK specific issues also arise based on the possibility of caregivers who are not thrilled about homebirth, but who have to come to the birth since it is a government supported option. It comes across that in Scotland homebirth may seem readily okay on paper, but in reality is more difficult to pull off.

The book does briefly discuss the birth climate in the US and soundly critiques ACOG’s position on homebirth.

The book has an index and a resources section.

The Father’s Home Birth Handbook is a friendly, practical, matter-of-fact, helpful little guide that neatly addresses common questions and concerns many fathers-to-be have about planning a homebirth.

——————

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

Associated amusing anecdote: my then three year old noticed me reading this book, looked at the cover and said, “The dad is trying to grab him, but that little baby is floating away!

Centering for Birth

Oct28

I have a strong commitment to active birth—the use of movements, position changes, and most of all laboring out of bed. As a result, in my classes I tend to emphasize movement-based coping strategies for labor. However, I have also come to realize that coping measures employing relaxation and breath awareness are extremely valuable. These tools cannot be stripped away from the birthing woman. Whatever happens during birth, whatever unforeseen circumstances that arise, or if her need for activity runs smack into the hospital’s need for passivity, the breath—and breath based tools—cannot be taken from her. I do not teach patterned breathing techniques in my classes, but I do teach various breath awareness skills.

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. Using the breath as a “container” for a thought or affirmation is the basis of centering. A meditative technique, the purpose is to “center” and to become mindful of the present moment. The container is a 10 second long breath—a five second in-breath and a five second out-breath—that holds a thought. You think the first half of the phrase on the in breath and the second half on the out breath (Maisel, 2007). Use this technique once or twice to “greet” the contraction and then continue breathing with awareness throughout the remainder of the contraction.

Some suggestions of centering thoughts to use during birthing include:

(I am open) (to birth)

(I am ready) (for my baby)

(I welcome) (my labor)

(I am confident) (and strong)

(Right here) (right now)

(I am equal) (to this challenge)

(I embrace) (this moment)

A pdf handout describing this technique (for use in birth classes), is now available here: Centering.

Another phrase I find useful in daily life, as well as applicable to birth is (I expect) (nothing). While this may initially appear pessimistic, it is a very useful reminder of the idea that most emotional suffering in life is a result of attachment to how something “should” be (i.e. “labor should only be taking 12 hours) (Dyer, 2002).

I frequently remind my birth class participants that coping techniques work best when they are incorporated into daily life rather than “dusted off” for use only during labor. Centering is a skill that is readily incorporated into real life. Indeed, when I first learned the technique, I quickly realized that it was a skill that I will use for the rest of my life. I let my class participants know that I regard this as a life skill, that happens to also be useful for birthing. It is essentially a tiny meditation technique that can be more readily incorporated into one’s daily life (especially a life that includes small children) than traditional, dedicated, more elaborate meditation techniques.

—–

Molly Remer, MSW, CCCE is a certified birth educator, writer, activist, and mother of two young sons. She is an LLL Leader and editor of the Friends of Missouri Midwives newsletter. She blogs about birth at http://talkbirth.me, midwifery at http://cfmidwifery.blogspot.com, and miscarriage at http://tinyfootprintsonmyheart.wordpress.com

References:

Dyer, Wayne. Ten Secrets for Success and Inner Peace, Hay House. March 2002.

Maisel, Eric. Ten Zen Seconds, Sourcebooks, Inc. March 2007.

—-

This article is modified from one that originally appeared in The International Journal of Childbirth Education, July 2009 (page 20)

Celebrate the Woman Pregnant

Oct27

Celebrate the Woman Pregnant

By Ani Tuzman

A woman pregnant,

I long to be seen

belly protruding,

life invisibly visible

churning inside

I want to be seen

honored, revered,

Exalted

not as my person,

but as the Miracle itself

of life begetting life

of human birth

Celebrate the woman

pregnant

don’t set her aside

nor cast her off as disabled,

or ever less woman;

Revel with her

feeling her firmness

knowing her softness

Carve her rare beauty

in smooth white marble

Look upon her.

Celebrate the woman pregnant

Hers is to know

the creative moment

of Life incarnating

——–

This poem came in the pregnancy newsletter I get from Mothering.com and it reminded me of the “magic” of being pregnant. I love that feeling (I’ve written about it before in the “the pregnant glow“). After this new baby is born, we do not plan to have any more children (though I have said to my husband, “what if she’s just so awesome we want to have one more?”) and I’m trying to take special time to savor and enjoy that magic feeling of being pregnant, since I will likely not experience it again personally. I told a friend recently that I feel like maybe I’m not savoring as much as I “should” be and realized that I think when I think of savoring, I think I’m picturing sitting around for hours rubbing my belly—possibly making multiple belly casts and drawing some fabulous art as well. Oh, and making some sculptures. And, then sitting and rubbing some more—preferably in the sunshine 😉 I have been making a very conscious effort to downscale my commitments to allow for more of this. I’m also taking a leave from teaching birth classes—I feel like I want to focus on my own pregnancy, rather than on other people’s. I feel a real inward-draw and not so much like being “of service” to others (I’ve been feeling this inner call since Noah was born last year, actually, but it has taken a while to actually get to the downscaling part). I also find that teaching college classes “uses up” most of my available teaching energy and I don’t have as much to give to birth classes—I am not expecting this to be a permanent leave, birthwork is too important to me for that, but I want to heed my inward call. I’ll have to stick with “virtual” birth education via this blog for a while!

I’ve had a post pending for a while that I guess will never get posted, about life balance and feeling like I’ve not been living up to a good guiding quote—“the things that matter most should never be at the mercy of the things that matter least.” Instead, the things that had been getting cut from my schedule were things like hanging out with my friends, sitting in the sunshine, writing in my journal, rubbing my belly, snuggling with my husband, reading books to my kids, chatting with my mom—HELLO! Not a good idea. So, I’ve done some cutting, some saying no, and also just some mental readjusting about how I think about things (like my to-do list). I’ve also been doing a “conditions of enoughness” thing that I learned from Jen Louden, wherein you set some conditions of enoughness for the day—not, just keep burning until the day is used up, not, “I can probably do this one more thing” and likewise not a “bare minimum” approach, but what is enough on a given day. Usually, this does not mean accomplishing everything on one’s to-do list, and it leaves some time leftover in the day for self-care—which is the piece I’ve been missing too. While everything is not perfect, obviously, I feel better about my life balance in recent weeks. My main reason for this downshifting is actually in preparation to enjoy my new baby when she gets here—I want to be all “cleared out” to enjoy a nice babymoon as well as to be free to take good care of myself as well as my baby.

The picture above was taken by my friend Karen at the park last week. She has launched a new photography business recently and if you click the picture, it will take you to her Facebook fan page. She is going to do both pregnancy photography and birth photography and I hope to have some more pictures in another month or so 🙂

And, I actually have been doing a lot of drawing during this pregnancy. Here is one I did when I was starting to re-incorporate the pregnant identity into my life again, as well as to feel some of the joy of pregnancy rather than just anxiety:

I’ve done others as well and then after finding out she is a girl, I drew this one:

Birth Blessing

Oct23

I have two friends who are right at full term (one slightly over) and eagerly awaiting their new little ones. I feel like I should be able to come up with beautiful birth blessings/wishes off the top of my head, but I had trouble coming up with anything profound, so I went looking online and found this lovely poem. I especially like the last eight lines. I wish you beautiful birthings, ladies!

Birth Blessing

by Natalie Evans

Close your eyes and breathe deep

Breathe in peace, breathe out pain

Imagine your feet

Toes curling into dirt

Think of yourself as rooted

Think of your place in the earth

How did you come to be here?

Through generations of women named

A maternal lineage

That brought you to this place

Think of their birth stories

What you know, what you believe to be true

Realize that their births carry deep wisdom

Some may carry the memory of joy and transcendence

Each birth is a powerful experience

Each birth traces down to you.

Just as you pass this knowledge on to your baby

Understand that your birth is your own

It will be different from all others

Like the swirls in your thumb

Your birth will have a unique pattern

Unfolding with each contraction

Rising and falling like a newborn’s chest

This birth belongs to you

This birth is an opening

This birth is the end and a beginning

May this blessing of birth come to you without fear

May this blessing of birth come to you with great understanding

My this blessing of birth make your heart soar

May this blessing of birth bring shouts of delight to your lips

Blessings to you and your birth.

—

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Pain with a Purpose?

Oct22

“The desire to help is so great, even from well-meaning, beautiful midwives, that they use intervention. We want to help. But what’s missing in our culture is that there is pain with a purpose, and that helping is sometimes interfering.” –Augustine Colebrook, CPM (quoted in “Do-it-Yourself Birth” article in Mothering mag)

When I shared this quote on the CfM Facebook page, a reader added: “Dr. Bradley wrote about ‘pain with a purpose’…Problem is, in our society, we don’t value the process of childbirth. Therefore, whatever it is you have to do to get thru it… Hence epidurals & nubain, and on and on. Please know I’m not dismissing your experiences if you went that route. But that phrase alone resonated with me when I was giving birth and helped me. I wish it would do so with more women.”

I’ve written a lot about birth having inherent value in its own right. Process AND “product” (i.e. healthy mom, healthy baby) are both important. A de-emphasis on the birth process and its significance in a woman’s life only serves to disempower, silence, invalidate, and violate women.

That said, I do also value the work of organizations like Hypnobabies that questions the very notion of pain as being an inherent part of birth.

So, what about pain?

I find that couples who come to my classes often have pain and managing pain (or witnessing pain) as their top issue of concern. For this reason, I spend time addressing the subject straight out and yes, I have been known to use the dreaded “pain with a purpose” phrase. Some would say that the word “pain” has no place in birth classes—that it sets women up for just that experience—however, as I noted, my clients come with “pain” on their minds and I find I need to use the p-word and sort of clear the air/get past that hurdle, before we do the rest of our work together. Also, as one of my clients once noted, “it wasn’t you who planted that seed [of pain being possible]. It was planted deeply a long time ago!”

And, what would be the purpose of pain in labor?

It is actually part of a beautiful hormonal symphony of labor—the sensations of labor signal our brains to release more endorphins, more endorphins leads to more oxytocin, and more oxytocin leads to increased intensity, which leads to more endorphins, etc., etc. When the pain to brain feedback loop is interrupted with medications, so too, are the oxytocin and endorphin messages that we need to get our babies born—and more interventions to “augment” labor are then likely to follow. As Preparing For Birth notes: “It is true that naturally occurring labor can feel larger and greater than the woman birthing. This is not so as she creates from within the very hormones that increase the strength, power, and frequency of her work of labor. That is the good news, it is from her, for her, by her.”

But, all these things said, I simply think the word “pain” is woefully inadequate to describe the feelings of labor. I like this description from Stephanie Soderblom better:

“VITA MUTARI – the literal translation from Latin to English is ‘Life Transformation.’ That is the closest thing I could think of the feeling of labor/birth…what you are feeling isn’t pain, it’s life transformation. Is it dramatic? You bet! I think it should be!”

I also love the description from Painless Childbirth:

“When I say painless, please understand, I don’t mean you will not feel anything. What you will feel is a lot of pressure; you will feel the might of creation move through you. Pain, however, is associated with something gone wrong. Childbirth is a lot of hard work, and the sensations that accompany it are very strong, but there is nothing wrong with labor.”

Now that’s what I’m talking about, might of creation moving through you. The word “pain” is way too puny to hold that!

I always explain to my clients that the sensations of labor are more similar to the exertion of intense physical effort more than the pain associated with accident, illness, or injury—both the effort AND the exhilaration are similar to doing good, hard, challenging, limit-testing, but doable work (though even bigger and more important). We need a bigger and broader vocabulary for completely describing the breadth, range, intensity, and beauty of birth experiences! What if we had more choices other than “painful” and “painless” to describe the experiences of birthing our babies? Though I wouldn’t say my births were “painless,” when I describe my own birth experiences, “pain” is simply not the word that rises to the top as the most appropriate descriptor.

“So the question remains. Is childbirth painful? Yes. It can be, along with a thousand amazing sensations for which we have yet to find adequate language. Every Birth is different, and every woman’s experience and telling of her story will be unique.” –Marcie Macari

We end up limited when we use only “pain” based language that fails to embrace the broadness and complexity and enormity of the experience.

Newborn Alaina, January 2011

Pregnant Women Driving…

Oct22

“In terms of mortality and injury, we know that driving a car is hundreds of times more dangerous for women and children than giving birth…Though it’s proven to be extremely dangerous and can often be fatal, no one accuses a pregnant woman who drives a car every day of being ‘selfish.’ And, when she arrives at her destination without having a crash, no one tells her how ‘lucky’ she was.” –Jennifer Margulis

I have blogged several times about birth having inherent value in its own right. Process AND “product” (i.e. healthy mom, healthy baby) are both important. A de-emphasis on the birth process only serves to disempower, silence, invalidate, and violate women—to shut down their very real and important reasons for choosing “alternative” birth options (reasons which usually have health of the baby as central anyway). Similarly to the writer above, I also use car/driving analogies when talking about the accusation people make about choosing “the birth experience” over a “healthy baby.” The way I word this same idea is that no one accuses a pregnant woman of placing her desire to get somewhere over her desire for a healthy baby (as women having homebirths are often accused—except in the case of homebirth, unlike with driving, there actually IS NO increased risk of death from staying at home!). I also use the car example in classes when talking about routine IVs—by the logic used to “justify” routine administration of IVs to women in labor, we should all make sure we are hooked up to at least a saline lock every time we drive anywhere!

Effectiveness of Childbirth Education?

Oct4

Some time ago a study was picked up by the media as proving that childbirth education “doesn’t work”. This BJOG study compared two groups of women—one group had 8 hours of childbirth classes that also included information about natural childbirth. The other group had classes that did not include natural childbirth information. The epidural rates for the two groups were the same and the couples’ satisfaction levels with their births was also the same. After this media attention, several birth bloggers addressed the study in-depth. The Science and Sensibility blog in a post titled Do Breathing Exercises Work? and The Family Way Publications in Natural Childbirth Class Not Useful?

What stood out to me in the article was the emphasis on breathing techniques. There is a lot more to childbirth education than “the breathing” and if that is all the “natural birth” classes had to offer, no wonder the results were what they were! As was noted in one of the blogs cited above, it is also significant that the women were randomly assigned to either group, indicating that they did not have a strong interest in natural birth (if they did, why risk being assigned to the non-natural birth classes!), so that perhaps the personal investment element was missing. A woman has to want to experience natural childbirth in order to do so!

Another birth educator commenting on The Family Way’s blog post, made an excellent observation that I think really got to the true heart of the issue. She said, ” Until childbirth educators emphasize this key component of CONGRUENCY in their classes women will continue to seek ‘care’ from professionals and institutions incompatible with their professed desire for natural birth. (emphasis mine) All this study proved to my mind it that both types of classes offered were ineffectual in promoting the with-women model of care in labor and birth… Both types of classes failed to address the real crux of the matter…are you receiving care from a provider/institution compatible with the kind of birth you want?” I explain to people in my classes that in the hospital women’s coping mechanisms are often stripped away from them-–sometimes by force, sometimes by misinformation, sometimes by excuses. I tell them over and over again to “ask questions before their chile is roasted” (Pam England). People tell me they can fight for what they want or that their husbands are good at “standing up for me” and I remind them that birth is not a time in a woman’s life when she should have to fight for anything! The time to get good care is NOW, not while “fighting” during labor and not during the “next birth” either (see more thoughts about “the next birth” here).

So, does childbirth education matter or not? Is the birthing woman’s environment of greater influence? I don’t think we have a full answer to this question. I do feel in my heart that childbirth education has important things to offer (otherwise, I wouldn’t be in the field!), but I also know in my heart that an unsupportive birth environment can steamroller right over most of the benefits. Birth is a lived experience and as such is greatly impacted by going on in the “here and now,” rather than past learning or ideas. Recently, I shared this quote from Suzanne Arms on my Talk Birth Facebook page:

“The knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on the acceptance of the process.”

In the comments, I noted: also helpful is to birth in an environment that shares that acceptance!

In July, I attended the annual CAPPA conference and enjoyed hearing Polly Perez speak about the benefits of childbirth education. She shared the following evidence-based benefits:

Knowledge
Less fear
Student more able to take responsibility for their own health care
Less need for medications/anesthesia
More satisfaction with birth experience
Life skills!

I definitely have been witness to the reduced fear as well as to the development of life skills that will continue to serve parents on the parenting journey. My own personal observations of additional benefits would be:

Increased confidence in their bodies, the birth process, and their own capacities
Enhanced father participation
Increased prenatal bonding/connection with baby and positive feelings towards baby
Reframing of birth from something to fear/greet with anxiety to something to embrace and greet with anticipation and enthusiasm.

It is hard for me to identify if these benefits carry over from my actual classes into the birth room, however, and this is an issue and question that I continue to ponder.

On a related note, here is a handout from Mother’s Advocate on choosing a childbirth class.

Poem: The Vital Truth

Sep27

In the fall issue of Pathways magazine there was an article called “The Genius of the Unborn Child by Sarah Farrant. I enjoyed this poem in the article’s sidebar:

The Vital Truth

Nature needs no help

just no interference

It’s best not to interfere with

what is a natural process.

Do you help the grass to grow?

Do you help the sun to rise?

Why is it that people feel compelled

to help a baby grow?

Babies know what to do every time,

all the time, in just the right sequence

and at just the right time to allow the expression of

their limitless potential.

Being pregnant feels like magic and I marvel each day at the unfolding of this whole process without my conscious intention or effort. Really incredible!

Birth Waves

Sep18

‎”Uterine contractions are felt by many women to sweep towards them, rise in crescendo and then fade away like waves of the sea, so that wave imagery is very useful when describing the sensations they produce. This wave imagery is closely associated with the idea of rhythm, which is all important in harmonious psychosomatic adaptation to labor.”

–Sheila Kitzinger (Education and Counseling for Childbirth)

Sheila Kitzinger is one of my all-time favorite birth writers and I quote her frequently. She has such a beautifully lyrical writing style.

I’ve noted before that even though I’m not much of a “water” person, wave/water imagery and analogies always strike me as very right/true for my own birth experiences. I shared the quote above on the CfM Facebook page and one person made a comment that quotes like the one above “hide” the truth about how birth is painful and that perhaps we should stop talking in flowery images and instead address how it really is. What was interesting to me is that I do not associate “wave” images with lack of pain or lack of intense sensation. Indeed, somewhat of the opposite! This is one of my personal experiences that leads me to identify with quotes about waves, water, and birth:

With my second baby, I described the contractions as having a “sharp edge” to them. My mental imagery of water and birth was not so much of peaceful, lapping waves, but of intense waves CRASHING into/around a rock. They would then part and flow around the rock (i.e. me), so it wouldn’t get knocked down by them but would be there waiting for the next wave to crash into it…I actually have this same image come to mind during the tough moments of parenting young children!

Additionally, the way contractions build to a peak of intensity much the way waves crest and break, as well as the unstoppable rhythm and flow of them also held power and relevance for me. The ocean is BIG and waves are powerful and so is birth!

Humor and Labor

Sep16

“Don’t forget to bring your sense of humor to your labor.” ~ Ina May Gaskin

I chose this quote to share on the Citizens for Midwifery Facebook page this week because it made me think about my own labor experiences.

I made jokes during the end of all of my labors and then laughed at my own wit—in a stroke of coincidence, one of the jokes was actually about Spiritual Midwifery ;-D I had just been told I was fully dilated with my first baby and I couldn’t believe it and said I was, “feeling all trippy like in Spiritual Midwifery.” With my second baby, I had inadvertently started saying “ouchie, ouchie” at the peaks of contractions and then joked, “ouchie, ouchie is a dorky thing to be saying!” With my third labor, which was an early second trimester miscarriage, I even managed to find some humor, joking to myself that I really should, “get into extreme sports” rather than keep having babies.

On a somewhat related note, one of my fears going into my first birth was about “being mean” to my husband and mother during labor. I think this idea came from all the media representations of women being “out of control” and yelling mean things at their husbands and/or grabbing the collars of their shirts and saying, “you did this to me!” and other such things. My actual experience was that I was nicer during labor than I am during my everyday life! I told my husband I loved him several times (perhaps because the normal hormonal symphony of labor was undisturbed) and we hugged and kissed and I felt very connected to him in the process of bringing our baby into the world. I think feeling safe and undisturbed is critical to birth for a variety of reasons, but one of them is to prevent fight-or-flight stress reactions from being activated. I had no reason to “turn mean” and snarl at my support people, because I was in my own protected environment with only a few carefully chosen people around me. When I think about those women snapping at their husbands during labor in media representations (i.e. being used as comic relief, rather than bringing their own sense of humor to labor!), I see a trapped, mistreated animal snarling and snapping and anyone who comes close 😦

I cannot remember being distressed or annoyed or upset with anything my husband or mom said during my labors. They knew well in advance that having quiet people in attendance is of paramount importance to me—aside from the obvious things, the top element of any birth plan for me is “NO extraneous noise or chatter.” Extra noise causes women to leave their “birth brain” mode (right brain) and switch into the logical, analytical part of their brain (left brain) which is not helpful to a physiological labor. The only person who was allowed to talk (or make jokes!) during my labors was ME! And, I could trust that the people around me would respect that.