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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:

20120813-083208.jpgIn 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.

A Bias Toward Breastfeeding?

Aug9

During World Breastfeeding Week, Lamaze’s Science and Sensibility blog published an interesting and thought-provoking guest post called “Instructor Has A Clear Bias Toward Breastfeeding!” The post explores a birth educator’s experience with teaching breastfeeding classes and receiving the title phrase on one of her evaluations. She is very disturbed by the evaluation and offers this profound and potent reminder: “We must not leave mothers less than whole.”

While I very much appreciate this observation and reminder, we also absolutely need to remember that biased means to exhibit “unfair prejudice”–it simply IS NOT “biased” to support breastfeeding as the biological norm and most appropriate food for babies. I was very concerned to read the comments on the post from other educators talking about their own “biases” toward physiologic birth or breastfeeding and how carefully they guard against exhibiting any such bias in their classes. Hold on! Remember that the burden of proof rests on those who promote an intervention—birth educators and breastfeeding educators should not be in a position of having to “prove” or “justify” the biological norm of unmedicated births or breastfed babies. I hate to see birth instructors being cautioned to avoid being “biased” in teaching about breastfeeding or birth, because in avoiding the appearance of bias they’d be lying to mothers. You can’t “balance” two things that are NOT equal and it is irresponsible to try out of a misplaced intention not to appeared biased. So, while I appreciate some of this educator’s points, I do think she’s off the mark in her fear/guilt and her acceptance of the word “bias.” The very fact that making a statement that someone has a bias toward breastfeeding can be accepted as a reasonable critique is indicative of how very deeply the problem goes and how systemic of an issue it is. If I say that drinking plenty of water is a good idea and is healthier for your body than drinking other liquids, no one ever accuses me of having a “bias towards water.” Breastfeeding should be no different. But, as we all know, breastfeeding occurs in a social, cultural, political, and economic context, one that all too often does not value, support, or understand the process.

This reminds me of an excellent section in the book Mother’s Intention: How Belief Shapes Birth about judgment and bias. The author also address how the word “balanced” is misused in childbirth education–as in, “I’m taking a class at the hospital because it will be more balanced.” Balance means “to make two parts equal”–-what if the two parts aren’t equal though? What is the value of information that appears balanced, but is not factually accurate? Pointing out inequalities and giving evidence-based information does not make an educator “biased” or judgmental-–it makes her honest! (though honesty can be “heard” as judgment when it does not reflect one’s own opinions or experiences).  (formerly quoted in this post. And, see this post for some thoughts about pleonasms.)

I do value the reminder that pregnant and postpartum mothers are vulnerable and how we speak to them really matters. I know that. I also worry that too much “tender” speech regarding breastfeeding as a “choice,” a “personal decision” and “we support you no matter what”—leaves the door wide open for continued systemic support of a bottle feeding culture that treats formula feeding and breastfeeding as similar or interchangeable. I’m not sure what the answer is. Maternal wholeness matters, so does breastfeeding!

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.

DVD Review: Birth as We Know It

Jul29

Birth as We Know It: Educational Edition. DVD directed and produced by filmmaker Elena Tonetti-Vladimirova. 2006, www.birthintobeing.com (40 minutes), $39.95.

Reviewed by Molly Remer, MSW, ICCE, Talk Birth

As a birth educator, I am always on the lookout for the “perfect” video to show in classes. Though not a film I would show in its entirety to the average class, Birth as We Know It is a gorgeous compilation and I’m delighted to have it amongst my educational resources.

The film is available in two versions—the feature film edition and the “educational edition.” The feature film contains almost 4 hours of total footage (a number of bonus features), including 11 births. The educational edition consists of two condensed versions of the feature film—a 40 minute presentation and a 25 minute version designed to show in groups. I chose to purchase the educational edition and this review is based on that edition. I have not seen the full length feature film.

The forty minute version of the film contains gentle, moving footage of 7 births. All the births occur in water—some in the ocean, but most at home. It also includes footage about birth trauma, cesarean section, and circumcision that is not included in the 25 minute presentation version (which also includes only 6 of the births). The DVD also contains instrumental versions of both.

The births included on this film are all exceptionally peaceful, beautiful, gentle, quiet, and calm births. Some of the birth footage is in slow motion, the sounds are muted, and there is instrumental music as the soundtrack as well as occasional voiceover commentary by the filmmaker. The film alternates between birth footage and spoken descriptions/interviews about conscious birth, emotional presence, limbic imprinting, etc. The voiceover commentary addresses things like toning and healing one’s own birth trauma.

The births are wonderfully undisturbed and unhindered—in most the only hands near mother’s perineum are her own and this is such a profound difference from the usual media representations of birth! A highlight is during “Tanya’s Birth” in which she speaks to her older child, smiles with extreme beauty and peace, then casually glances down again and as the camera follows her glance, we see the baby’s head has emerged between her legs and she is cradling it gently. I love for people to have a chance to see this powerful moment!

Though interesting, I find the voiceover content and non-birth portions of the film to be too abstract or “metaphysical” to appeal to the average birth consumer. It is even a bit too metaphysical for me and I find that the concepts she mentions are not well explained and do not seem immediately reasonable or easy to accept in stride. The instrumental version is one way to gloss over this element, but then you are unable to scene select to specific content the way you are able to do in the regular versions.

So, though I do not show the complete film in classes, there are several birth clips that I do show routinely. I find two of the births in particular to be potent educational tools and they have been very well received in classes and have had a profound impact. The births are so different from general media representations of birth that they leave couples stunned with amazement about what birth can be. Since the births are in water, they are a very gentle, non-messy, not very “graphic” way to expand people’s understanding of normal birth. People in my classes have said things like, “wow! You never see something like that!” or, “that was so beautiful, I’m just in shock.” I find men in particular are more receptive to this footage than to other, more detailed, videos I show and I have had a few request to borrow and view the whole video instead of just the clips I have chosen for class.

In conclusion, this is a lovely film and though I have some reservations about showing the entire educational edition, some of the birth footage has been a powerful addition to my work with birth.

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This review was previously published at Citizens for Midwifery.

Epigentics, Breastfeeding + Diet, and Prenatal Stress

Jul27

This post is part one of my CAPPA Re-Cap series.

CAPPA linchpins Laurel Wilson and Tracy Wilson Peters are co-authors of a new book, The Greatest Pregnancy Ever, that focuses on the depth, intensity, and value of the MotherBaby bond. As I noted, I listened to Laurel talk about Bridging the Nutrition Gap and to Tracy speak about the “accidental parent.” In both, they addressed the biological wisdom that mothers possess and of the deeply interconnected nature of the maternal relationship.

Laurel reminded us that there is a brain in our gut, essentially. This brain literally tells us how we should be feeling our emotions, based on the nutrition that we’re putting into our bodies. She discussed epigenetics–a term meaning literally “above the gene”—explaining that this is the “translator that ‘reads’ the book of instructions from our genome.” The translator tells the body to turn on or off the genes we’ve inherited from our parents. Epigenetics is essentially the environment–those things in our environment that influence our biology. Laurel pointed out enthusiastically that we want to create an excellent “translator” for our children. She also emphasized repeatedly that one important job of the placenta is to “train” the baby for the environment it will be experiencing. This is why prenatal diet matters, it is helping to prepare the baby to thrive in the environment into which it will be born. So, chronic stress leads to a stressful womb environment, which leads to a baby that is biologically primed to be born into a stressful postnatal environment. Mother’s body primes baby’s body for success in that environment. As I listened to her speak and discuss the things we’ve learned from science about genetics and how our bodies function, I kept thinking: science can do a lot, it can do wonderful things. Mother’s body can do even more… And, isn’t that just cool?!

So, what’s going on in the maternal habitat?

One important point Laurel made about prenatal diets was that prenatal diets high in hydrogenated oils predispose mamas to postpartum moods disorders. She said this is because hydrogenated oils essentially “leach” EFA’s out of the mother’s system.

She also noted that mice up to three generations are affected with PCOS by BPA and phthalates (in food packaging. Our food is literally making us sick). These influence change the endocrine system and are connected with reduced sociality and community engagement.

Laurel explained too that no artificial sweeteners are considered safe for pregnant women and that stevia too is linked to epigentic damage. She suggested using honey and molasses as sweeteners if needed.

One tip that I found funny, basic, but so true with regard to choosing healthy foods is to make sure to choose to eat foods that will rot!

In Tracy’s talk she passionately affirmed that we have to eliminate chronic stress from pregnant women’s lives because she is laying an emotional and physical foundation for another person’s life. This matters! Babies are feeling before they are thinking and we are designed to live in the environment we are being born into.

Also remember, babies don’t need to be in nurseries–they need to be with their mothers. This MATTERS!

Book Review: Birthwork

Jul27

Birthwork
By Jenny Blyth
Reprinted 2007
Softcover, 460 pages
ISBN: 0-9757610-0
www.birthwork.com
Reviewed by Molly Remer, MSW, ICCE, Talk Birth

From Australia, comes a gorgeous and unique book called Birthwork. It is such an amazing and compelling read that it took me a very long time to write my review—it is difficult to describe such a remarkable book. I have never read another book like this. It is truly extraordinary. Subtitled “a compassionate guide to being with birth,” Birthwork was written for all birthworkers–anyone who works directly with birthing women (midwives, doulas, nurses, childbirth educators, physicians…).

This book covers issues of a range and depth I’ve never before seen in a birth text. Subsections include titles like: touching vaginas, respect and relationship, dipping in and out of the birth milieu, group dynamics, conflict, birth culture, loving presence, birth is sacred, trauma release, letting down in the pelvis, and stresses and stretches of childbearing. This is just a sampling of the amazing, comprehensive range of topics explored in Birthwork. I particularly enjoyed sections on directed breathing and “dynamic anatomy in labour.” The book delves into a lot of the emotional and psychological elements of being in a caregiving field and also covers physical components as well.

The book includes lots of questions to ask yourself to increase self-awareness, understanding, and personal development and also exercises to try/explore. Some of the questions are difficult to answer and require you to take a deep look at your motives and ideas about doing birthwork.

The photographs are stunning and there is gorgeous cover art (front, back, and inside). Birthwork has a spiritual component that runs throughout—sort of an Eastern philosophy—that might not appeal to all readers.

The book includes sources and a glossary of fields of care, but no index and no resources sections. It is an expensive book, but so very worth it!

Birthwork is deep and intense. I usually read very quickly and this book took me several weeks to finish because it needs time and space to soak in and be absorbed. Truly a phenomenal read!

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

This review was previously published at Citizens for Midwifery.

CAPPA Re-Cap

Jul24

Yesterday I got home from Kansas City where I’d been attending the annual free birth conference hosted by CAPPA. While there I concluded that Desirre Andrews is officially a superhuman live-tweeter. You can catch up with all of her rapid-fire tweets about the conference at CAPPA’s Twitter account.

I also tried my hand at posting a few things that particularly grabbed my attention to my Talk Birth and Citizens for Midwifery Facebook pages which automatically feed into Twitter. I’m not very good at catching short snippets for live-tweets, but some thoughts that I grabbed to highlight are as follows. If they don’t have quotation marks, they aren’t necessarily direct quotes, just “essence” summaries as I tried to take notes and pay attention!

First I attended Laurel Wilson’s talk about Bridging the Nutrition Gap and next, I listened to Tracy Wilson-Peters speak passionately about the “accidental parent.”

Essence tweets from Laurel and Tracy’s talks:

Babies don’t need to be in nurseries–they need to be with their mothers. This MATTERS!

Science can do a lot, can do wonderful things. Mother’s body can do even more…

Prenatal diets high in hydrogenated oils predispose mamas to postpartum moods disorders.

And, then I attended a breakout session from Darla Burns about postpartum rituals and snagged this interesting tidbit:

In Holland, all pregnant women are required to buy a homebirth kit, “just in case.”

The second day, I found myself entranced by the most awesome Dr. Jack Newman. His presentations were the highlight of the conference for me. I loved him! I attended two–his general session on Controversies in Breastfeeding and then his breakout sessions, Impact of Birth Practice on Breastfeeding:

20120724-174258.jpg

If you ever get a chance to see this man, don’t miss it!

We have a big, big problem in that HCPs do not recognize the critical importance of breastfeeding.

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. Jack Newman

There is no such thing as “standard” breastmilk. It is a physiological fluid and varies from person to person. We DO NOT have to prove that breastfeeding is better than formula. Those comparison studies are unnecessary.

The burden of proof rests upon those who promote an intervention! –Dr. Newman

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.

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

Lying down for electronic fetal monitoring is a position of comfort for the care provider, NOT for the mother.

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? –Dr. Newman

Seriously, Dr. Newman’s talks were amazing. Be prepared to hear more about them soon!

The final day I heard Polly Perez speak about Building Bridges with an emphasis on communication and fear:

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

“Use language that lets you share your heart openly.” –Polly Perez

Listening is *active*, not a passive activity. Listen with empathy, openness, and awareness.

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.

“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.” –Connie Pike, via Polly Perez

Polly shared the first home birth she attended – made her fear of it “melt away like butter in a pan.”

You do not have to be an OB to be knowledgeable about birth. –doctor working with Polly Perez

Follow up from same doc: “if you tell me a baby is going to come out, I’m a gonna believe you!”

Changing sick systems is not about subterfuge but bringing light to situations that need to be altered.

Since micro-blogging is simply not my gift and is unlikely ever to become so, I am also planning longer posts based on several of the conference sessions. They will be (links will be updated as the posts become live):

At the CAPPA conference I also made a large custom order of great gifts from Joy Belle jewelry.

And, I ate tons of sample honey sticks from Glorybee–yummy! (see prior post: Why Honey Sticks During Labor?)

Other treats involved getting to spend some quality visiting time with a Friends of Missouri Midwives friend from St. Louis. We spent a lot of time talking over the FoMM newsletter (of which I am editor) and I feel very enthused about our ideas for its future.

I also got to meet a Facebook friend who started out originally two years ago as a Talk Birth fan on FB (after finding my site via my all-time most viewed post: In-Utero Practice Breathing). We spent some good time together visiting and laughing and it was fun to make the friendship connection with someone who was previously only an internet friend!

Incorporating Prenatal Yoga into Childbirth Education Classes

Jun29

Incorporating Prenatal Yoga into Childbirth Education Classes

By Molly Remer, MSW, ICCE, ICPFE

Note: This is a preprint of an article published in the International Journal of Childbirth Education, Volume 27, Number 2 (April 2012)

The essence of yoga can be distilled into four key elements: breath, feeling, listening to the body, and letting go of judgment and expectation (YogaFit, 2010). When considering the essence of yoga, it is easy to see what a natural complement it is to conscious, active preparation for a healthy birth. Most birth educators would agree that paying attention to her breath and to her feelings, listening to her body, and letting go of preconceived expectations of what birth will be like are perhaps the most crucial messages to convey to the pregnant woman and her partner. Additionally, experts widely agree that exercise during pregnancy has beneficial effects for the cardiovascular and musculoskeletal systems and is associated with physical and psychological well-being. There is also some evidence that recreational exercise may reduce the incidence of premature labor and low birthweight babies (Hyatt & Cram, 2003).

Anyone involved with educating adult learners (in any context) is likely to be familiar with the concept that people are most likely to retain information that they have actually practiced (versus reading about, hearing about or seeing demonstrated). I have found that incorporating a few simple yoga poses into each class session is a beautiful way of illustrating and applying many important elements of childbirth preparation. In approximately 10 minutes of movement, important points can be underscored without having to actually say anything or “lecture” to clients. The hope is that as we move together through a carefully chosen series of poses, subtle emotional development and trust in birth occurs—again, in a more effective manner than by the childbirth educator saying during class: “Trust birth!”

One rationale for incorporating yoga into prenatal classes is as follows: First, people often learn and retain information more effectively by actually doing something. Practicing the yoga poses together allows experiential practice of pelvic floor exercises, pelvic rocks, tailor-sitting, leg cramp alleviation, and back pain coping techniques, to name a few, instead of just hearing me talking!

Second, and most important, Yoga in prenatal classes emphasizes that birth happens in the body. As childbirth educators we spend a significant amount of time talking and sharing information, but birth does not only happen in the mind. Birth happens most profoundly in the body. Not only does birth happen in the woman’s body, but supporting and being with a woman in labor is also an intensely physical process, so it is important for partners to try the yoga series.

People today spend much of their time “living in their heads”, and many of us do not feel comfortable with, or at home in, our bodies. Practicing poses in class helps couples out of their heads and into their bodies and begins a process of feeling comfortable with moving and using their bodies in positive ways. This may help them develop the trust and confidence that will contribute to a smooth and peaceful birth process.

Each pose is followed with a birth affirmation such as, “the magic and mystery of birth delight and amaze me” (Miller, 2003). Positive affirmations help plant positive seeds of confidence and trust in the wisdom of women’s bodies and of the beauty of birth. These cognitive adjustments may also send a welcoming message to the woman’s body and baby as they both prepare for birth.

Opening classes with a series of poses is an effective way to “frame” the class. Class can be opened with a brief check-in period asking how people are feeling, about recent prenatal appointments, and any questions can be addressed. A transition from “regular time” into “class time” occurs with a brief series of simple poses. This routine helps people transition from their normal days into feeling ready and excited for birth class information.

Each pose was chosen because it has specific birth- or pregnancy-related benefits. Begin with healthy sitting—seated crossed legged or tailor-style on the floor with spine straight. Do some neck rolls and shoulder rotations to help release tension. Move into a brief series that includes knee-rocking, leg stretches, Divine Mother Pose, Star Pose, pelvic rock, standing squat, Palm Tree Pose, Half Moon Pose, Triangle Pose and seated Mountain Pose. There is an additional short series of “birthing room yoga” poses described with photographs that is available as a free handout here.

The series is closed with a very brief meditation or visualization exercise. The series of poses and the affirmations are kept the same each week for retention purposes, but the meditation is varied. A quick visualization or relaxation exercise (under two minutes) is often more effective and more readily welcomed by couples than the longer visualization exercises often used in classes (which can seem esoteric to some people). A mindfulness meditation that is effective is:

Inhale and repeat silently: “I exist in the here and now….”

Exhale and repeat silently: “The present moment is all I have to be with…”
Continue inhaling and exhaling as you silently and simply repeat: “Here and now…present moment.”

A favorite resource for easily and smoothly incorporating yoga into classes is The Prenatal Yoga Deck by Olivia Miller, published by Chronicle Books in 2003. The poses listed above were selected from this deck. The deck contains 50 cards, so the educator can easily build a series for use in classes. Each pose card is accompanied by a lovely affirmation. The deck also includes six cards with simple meditations (the meditation above is adapted from one in the deck). The deck format, tidy box for holding the cards and sturdy card for each pose is an ideal format for transport to class as well as serving to provide subtle reminder cards as you lead couples through poses. Each card has a line drawing on the back illustrating the pose, so assessing whether you are doing the pose correctly is easy (sometimes just reading a description of the pose is more complicated than seeing it completed).

Occasionally the childbirth educator may get some eye-rolling or “weird, hippie exercise!” responses from pregnant couples. Regardless of how much or how little they appreciate the practice of yoga in classes, the poses used lay a physical foundation for a positive attitude toward birth and a sense of confidence as a birth-giving woman or supportive partner. Through the simple incorporation of yoga into birth classes, the expectant couple receives an irreplaceable, experiential grounding in the rhythm, focus, release, and conscious awareness so essential to the intensely embodied experience of birthing.

 Molly Remer, MSW, ICCE, ICPFE is a certified birth educator, writer, and activist. She is a professor of Human Services, an LLL Leader, editor of the Friends of Missouri Midwives newsletter, and a doctoral student at Ocean Seminary College. She has two wonderful sons and a toddler daughter and she blogs about birth, motherhood, and women’s issues at Talk Birth (http://talkbirth.me)

Suggested Resources for Birth Educators
The Prenatal Yoga Deck: 50 Poses and Meditations, Olivia H. Miller, ChronicleBooks, (2003)
YogaFit: PreNatal DVD, YogaFit (2009)
Yoga for Your Pregnancy DVD (2004)

All available via Amazon.com

—

All photos of the author, January 2011, 37 weeks. (c) Karen Orozco, Portraits & Paws Photography

References

Hyatt, G.& Cram, C. (2003). Prenatal & postnatal exercise design. DSW Fitness, Tuscon Arizona (training manual for the ICEA Certified Prenatal Fitness Educator Program)

Miller, O. (2003). The prenatal yoga deck: 50 poses and meditations. Chronicle Books, San Francisco, CA.

Remer, M. (2007). Incorporating prenatal yoga into childbirth educationclasses. Midwifery Today, 4(84), 66.

Talk Birth. (2011). Retrieved from https://talkbirth.me/2010/03/10/birthing-room-yoga-handout/

YogaFit PreNatal/PostpartumSpecialty Program Manual. (2006). YogaFit Training Systems Worldwide, Inc. , www.yogafit.com.

Sharing Stories

May29

Mother-to-mother birthtelling is easy at blessingways!

In an excellent article by Rachel Reed in the Autumn 2011 issue of Midwifery Today, Sharing Stories, Reclaiming Birth Knowledge, she makes this important point: “Women not only learn practical information about pregnancy, birth, and motherhood through exchanging stories, but also gain emotional and social support…Through sharing stories, women created a sense of connection to other mothers and to the ‘universal nature of birthing’ …”

Despite the everyday miracle of birth and potent role in women’s lives and self-identity, “women’s birth stories are largely ignored in mainstream childbirth education programs. Instead, the approach consists of an ‘expert’ transmitting standardized information sanctioned by the maternity system. This approach does not adequately meet the needs of mothers, nor reinforce mothers’ expertise and knowledge. Building childbirth education around mother-to-mother story sharing would reinforce mothers as the experts in birth.”

What do you know about birth that other people don’t know?

As I read this article, I thought of several experiences in my own childbearing experiences that varied from “standardized information sanctioned by the maternity system” and that includes the alternative care system of which I was a part. Things that, for me, were not available from those systems around me—books, professionals, or media, but that nevertheless came through and are part of my own stories:

  • Being able to feel my babies practice breathing in the last 8-10 weeks of my pregnancies.
  • “Skipping” transition–no “freaking out” required to have a baby after all.
  • Tearing “up” into the labia/clitoral area instead of the more common or expected perineal tearing
  • Experiencing a spontaneous birth reflex
  • No bloody show/mucus/fluid until shortly before pushing
  • Long “strings” of post-birth mucus. So tough and sinuous that they are almost like membrane.
  • Experiencing a second trimester miscarriage clearly and potently as a birth event.

I’m curious to know what other women have experienced like this. What happened to you that you had never heard about before? What is a part of your story that isn’t a part of birth books? What do you know about birth that other people don’t know? How does your story enhance the collective culture of women?

The role of story in midwifery education

Reed goes on to explore the role of story in midwifery care and the education of midwives, explaining, “It is time for midwives, informed by being ‘with woman’ and experiencing birth in all its complexities, to reclaim their own unique birth knowledge. Sharing birth stories represents a rich source of knowledge and develops the ‘collective culture of women.’ Mothers are already doing this well, and childbirth education should reinforce this mother-to-mother expertise. Midwifery education also needs to embrace the power of storytelling as a means of developing woman-centered knowledge and practice.”

One of the most valuable elements of La Leche League for breastfeeding mothers is the mother-to-mother support and information sharing. This is irreplaceable. We need a means of providing this type of mother-to-mother support for birth as well. Not in swapping horror stories or “enlightening” others, but in authentic connection based on our own unique birth wisdom.

Birthtellers

In another article in the same issue of Midwifery Today KaRa Ananda shares the following gem in her article about Birthtellers: “…the stories women tell to each other privately–shape cultures, beliefs, choices and lives. Women used to learn about birth and motherhood through the stories of their mothers, sisters, grandmothers, midwives and friends. Today, that knowledge is transmitted primary through television, movies, peers and the internet. Now is the time for the Birthtellers to arise and once again share our inspirational birth stories–both within our communities and globally through new media technology.”

One of the midwife-authors that makes my heart sing with her lyrical, magical writing, is Sister MorningStar (author of Power of Women). She shared her daughter’s birth story in the autumn 2011 edition of Midwifery Today and it is just beautiful.

My own article on the value of sharing story also appeared in the same issue of Midwifery Today.

Strong Mothers (& Birth Network Resources)

May26

“Birth is not only about making babies. Birth is about making mothers – strong, competent, capable mothers who trust themselves and know their inner strength.” –Barbara Katz Rothman

This classic quote from Barbara Katz Rothman sums up the potent impact of the birth experience on women’s lives and it seemed like  perfect quote to kick off the website of the Rolla Birth Network that I founded with my birth advocate friends and colleagues. We believe that strong, healthy babies, vibrant families and resourceful communities begin with strong mothers. We chose Strong Mothers, Strong Babies, and Strong Community as our tagline because we believe that when women dig deep into their inner strength, everything else follows. We also chose this as our tagline because it reflects the conviction that women have already got it. They have the inner wisdom and the strength they need. While outside professionals and resources can be tremendously helpful, she’s already got what it takes within her, we may just be a part of helping her to access the strength she already possesses.

We agree with doula and birth educator Heather McCue who said: “The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will have the power.”

On a related note, Holly Kennedy raises this question in her guest editorial in the spring 2011 issue of The Journal of Perinatal Education:

What “matters” in birth is complex, extremely hard to quantify, and will vary from one person to the next…I found myself contemplating what matted most in my ability to support women in birth so they could emerge from the process as strong, healthy mothers. I believe we have collectively lost our way over time about this outcome—the strong mother. The mother’s experience of childbearing, which will affect her forever, can directly influence her future as a mother. How do we address this as a discipline?“

Yes, the strong mother. This is what is about. The strong mother who feels capable and competent in the mothering of her newborn and of her infant as it grows.

Another favorite quote about the strength of women:

“Women are strong, strong, terribly strong. We don’t know how strong until we are pushing out our babies. We are too often treated like babies having babies when we should be in training, like acolytes, novices to high priestesshood, like serious applicants for the space program.”

–Louise Erdrich, The Blue Jay’s Dance

It is also important to note that we believe that strength is found in all kinds of birth experiences from the triumphantly empowered to the extraordinarily taxing and even traumatic. (Previous post about Birth Strength and the quote above.)

So, speaking of birth networks. One of the things that I’ve been excited about working on now that I am not actively teaching birth classes is on projects for our local Birth Network. I’ve wanted to do something like this for ages, feeling excited about the potential and momentum created by bringing multiple people together to collaborate on projects that make a difference in our community. We have some great ideas planned and I feel rejuvenated and enthusiastic after every meeting.

Here are some resources on forming a birth network in your own community:

Tools, Tips and Resources for Birth Networks

Birth Network National Resources

Programs from Athens Birth Circle

Some time ago a follower of this page, Nora from Happy Within, posted to let me know that she hosts a virtual birth circle for mothers. She describes it thusly: “the birthcircle is a virtual community which is a sacred women´s circle about conscious pregnancy and birth and its free. You can get details here: http://happywithin.wordpress.com/your-birthcircle/.” You can also keep up with her work on Facebook.