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Olympics & Birth

Dec8

Several months ago I previewed the new Business of Being Born film and one of the doctors interviewed said that made me really outraged. He said something to the effect of: “in three months you’re just going to be pushing a baby in a stroller, so what difference does it make how you gave birth?” What difference does it make?! Would anyone even THINK to say something like that to a marathon runner or Olympian–“in three months, you’ll just be pushing a baby in a stroller, who cares that you won a gold medal?”

Side note to this analogy: feeling good that you won a gold medal [gave birth in a triumphant and empowering way] does NOT invalidate or cause guilt in those who did not run the marathon, or had to quit early, or needed help finishing. There is no shame in not running, but there is also rightful PRIDE and “glory” in finishing the “race” you set out on.

Someday soon I will be developing this analogy into a real essay, so wait for that…

Care Practices that Support Normal Birth

Dec5

The Lamaze Institute for Normal Birth has a powerful series of research based care practice papers describing the six care practices that support normal birth. The papers were updated recently and are available on their website in both HTML and printer-friendly PDF formats. These care practices are of vital importance to the normal birth process. The papers are extensively researched and include many citations and are an excellent resource to share with your doctor or with curious (or doubtful) family members or friends. These care practices form an underlying basis for much of the information I present during classes and are practices that should underlie good care in any birth setting (though, sadly, all too often what women receive from their care providers is NOT evidence based and does not follow these care practices. I will write more about this later). Lamaze’s Care Practices are:

Care Practice #1: Labor Begins on Its Own

“Labor is a set of complex, interacting components. Alteration of the natural process can expose a woman and her baby to unneeded risks.”

Care Practice #2: Freedom of Movement Throughout Labor

“Free movement during labor allows a woman to manage contractions and assist the baby’s rotation and movement through the pelvis.”

Care Practice #3: Continuous Labor Support

“Current research supports the benefits of continuous emotional and physical support during labor.”

Care Practice #4: No Routine Interventions

“Supporting the natural, normal, physiologic process of birth requires clear medical indications prior to any medical intervention.”

Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions

“Allowing a woman to find positions of comfort and encouraging her to push in response to what she feels is beneficial to the birth process.”

Care Practice #6: No Separation of Mother and Baby, with Unlimited Opportunities to Breastfeed

“When a baby is kept with the mother, there are physiological benefits to both, including the facilitation of breastfeeding.”

My own short description of the care practices using more direct language would be:

1. Avoid induction.

2. Stay out of bed. Move around a lot!

3. Hire a doula.

4. Demand individualized care–no interventions that are “just because” or “hospital policy.”

5. Squat, kneel, or get on all fours to push.

6. Breastfeed your baby early and often! Keep your baby with you and do not let hospital staff separate you from your baby because of routines or policies.

 

Finding Your Question

Dec4

Another concept I like from Birthing from Within is that of, “finding your question.” Really, it is your question in response to the question, “what is it I need to know to give birth?” This question was personally meaningful to me during each of my pregnancies. During my first pregnancy, my question was simply, “Can I do this?” I felt like birth was a “test” that I had to pass and that I needed to make sure to study for so I could “pass” it well! After giving birth, I realized that it hadn’t really been a test, but was instead really a rite of passage.

With my second pregnancy, I revisited the concept of finding my question and it was, “Can I mother another?” I finally answered this question for myself late one evening (while not in labor and resigned to being “pregnant forever”) and less than four hours after that I was holding my baby in my arms! 🙂

My personal experiences have led me to believe that finding your question can have important implications for your birth and it is an interesting concept to consider.

Worry is the Work of Pregnancy

Dec3

This is a concept I like to introduce in childbirth classes. I first came across the phrase “worry is the work of pregnancy” in my most favorite of birthing books, Birthing from Within by Pam England. I’ve noticed that women often feel like they shouldn’t have worries during pregnancy and that talking about their fears is somehow “dangerous” (like it will make the fear come true). Bringing fear out into the open and “looking at it” instead of keeping it tucked away and bothering you is actually one of the best ways to work with it. Another common concern is that your worries are “silly” or unfounded. It is okay to have worries, even “silly” ones! The strategy Pam suggest for exploring your worries is as follows:

Explore each worry with questions:

° What would you do if this worry /fear actually came true?

° What do you imagine your partner and/or birth attendant would do/say?

°   What would it mean about you as a mother if this happened?

° How have you faced crises in the past?

 °  What, if anything, can you do to prepare for, or even prevent, what you are worrying about? What is keeping you from doing it?

 °  If there is nothing you can do to prevent it, how would you like to handle the situation?

What Do I Mean By Normal Birth?

Nov28

I realized I have used the term “normal birth” several times without explaining what I mean. First, I wish to be clear that there is no value judgment in the phrase normal birth–it simply refers to the physiologically normal process of birth. It is birth as it is biologically programmed to happen and allowed to unfold without interference in a physiologically normal way. This is “normal birth”–birth that is unhindered, undisturbed, and not interfered with. Approximately 90-95% of births would be normal births if left undisturbed. The other 5-10% benefit from the presence of (or access to) a skilled birth attendant.

Birth is physiological and biological in nature, but is influenced and shaped by personal, social, cultural, and historical factors.

Normal birth is sadly a rarity in our present birth culture in the U.S. What we have come as a society to view as “normal” parts of birth are often actually things that impair or interfere with the normal process and the natural unfolding of this exquisite biological event.

The Three P’s

Nov28

Continuing my alphabetical “theme” I thought I’d write about the three P’s of birth. The “classic” three P’s are the passageway (pelvis), the powers (contractions), and the passenger (baby). Some people include a fourth P–the psyche (mind). These three P’s interrelate to create the labor and birth experience. This is a very mechanical, reductionist, and very simplistic way to look at the intricacies of birth and the interplay of a variety of physical, emotional, psychological, and even social factors that influence birth. So, I started thinking about other P’s involved with birth and came up with quite a list!

Powerful, praise, people, pain, partner, pleasure, pride, planning, patience, persistence, productive, purposeful, proactive, plasticity, plentiful, pragmatic, pleasant, precious, presence, perseverance, preparation, and privacy!

Of this new list of P’s I think patience, privacy, and preparation are most important. I include “pain” on this list of positive P’s because pain is an important part of birth–it is pain with a purpose. I have lots more to say about pain, but I’ve saving it for another post! 🙂

I also thought up a list of P’s that are often unhelpful or detract from or hinder labor and birth:

Protracted, presumption, peremptory, pelvimetry, pitocin, pressure, program, performance, PUSH, PUSH!, “proper/polite” (feeling like you have to be), prolonged, proscribed, prescribed, probing, “progress,” people, problems, panic, politics.

The Three R’s of Childbirth

Nov26

A concept I find useful to share in birth classes is that of Rhythm, Relaxation, and Ritual–the Three R’s of Childbirth. This is a concept developed by Penny Simkin and is illustrated in her labor support video by the same name. Ritual refers to a repetitive coping mechanism that spontaneously arises during labor–it usually is rhythmic and may be something like humming, singing, repeating a favorite phrase, tapping, vocalizing, rocking, swaying. You can think about and plan for possible labor rituals in advance, but the ritual that is most useful to you is often one that just arises on its own during your own individual labor and birth.

These are three R’s that enhance a woman’s experience of birth and help her cope with her sensations. When thinking about them today, I also came up with three R’s that detract from a woman’s birth experience: Routine, Restriction, and Risk (perception of).

I also considered other supporting R’s: Rest, Relationships, Rapport, and Respect.

Birthing Affirmations

Nov22

One tool I like to offer during birth classes is the use of birthing affirmations. I have a list of favorites that I hand out and I also encourage couples to create their own affirmations that hold personal meaning for them. An affirmation is a positive phrase that you repeat to yourself. Some women like to cut these phrases out and post them around the house to read during pregnancy (such as on the mirror in the bathroom or on the wall in the bedroom). The affirmations can then “sink in” and when labor comes, they are part of your mental vocabulary of birth. Also, some women in labor find the use of rhythm to be a useful tool (humming, singing, swaying, rocking, etc.) and repeating a soothing phrase can be part of this rhythm.

Another use of affirmation is to have your labor support partner read your favorites aloud to you as you labor.

Some favorites from my list are:

  • I trust my body to know what it is to do.
  • I feel confident, I feel safe, I feel secure.
  • My mind is relaxed; my body is relaxed.
  • My body is made to do this.
  • This present moment is all I have to be with.
  • My body knows how to birth our baby.

The corresponding affirmations for a partner to use:

  • Trust your body to know what it is to do.
  • You are confident, You are safe, You are secure.
  • Your mind is relaxed; Your body is relaxed.
  • Your body is made to do this.
  • This present moment is all you have to be with.
  • Your body knows how to birth our baby.

Mammal Birth

Nov14

At the LLL of MO conference this month, I attended several wonderful sessions by Diane Wiessinger who makes the connection between giving birth on a woman’s own terms contributing to an easy breastfeeding relationship. She also emphasized the fact that we are mammals and just like other mammal mothers certain things contribute to or detract from our ability to give birth in a safe and healthy manner.

Diane shares the following description of why your baby’s birth matters:

“A trip to a strange place with strange smells. Bright lights, busy people. Numbness. A carefully cleaned and wrapped baby who doesn’t stay with Mama. Any other mammal would reject her baby after a beginning like that. Which means that most American mothers have to welcome their newborns with their heads and not their hearts. Not the best start for confident mothering. Not the best start for breastfeeding. Not the best start for love.”

She also says, “Don’t be fooled by the Birth Channel. A normal birth is not a medical event or a source of horrible pain. It happens on its own, with the woman moving in whatever way feels right to her, feeling the labor and feeling–being–in charge. Find someone who will support this.”

Read more of Diane’s insights on her website.