Spontaneous Birth Reflex

Feb24

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

– Ina May Gaskin (via Birth Smart)

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

Flicked forward hips?

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

Shortly following a spontaneous birth reflex!

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

via Alaina’s Complete Birth Story « Talk Birth.

Birth without pushing?

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

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

Trusting the urge

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

Personal experiences in birthing without pushing:

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

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

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

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

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

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

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

Why isn’t it encouraged?

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

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

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

—

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

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All That Matters is a Healthy Husband (or: why giving birth matters)

Feb10

It is your wedding day. You have been planning this day since you got engaged nine months ago. You are happy, excited, and a little nervous. When you get to the church, you are told that it is necessary to switch your wedding to the courthouse instead—it is disappointing, but the minister’s assistant reminds you that the courthouse is probably a safer location for your wedding because there are more people on staff there to handle any problems that might arise. When you arrive, you are told that your minister isn’t going to be there for the ceremony after all, but there is a perfectly good justice of the peace available instead.

You ask when the ceremony can begin and the clerk tells you not until your fiancé’s heart rate has been monitored for twenty minutes—“We need a baseline strip on him, hon. After all, you do want a healthy husband out of all this, don’t you?!” she says.

You are asked to change out of your wedding gown and into a blue robe. When you express your dismay, you are reminded that your dress could get messy during the wedding and also, “Why does it really matter what you’re wearing? In the end you’ll have your husband and you’ll be married and that’s really what counts.”

Next, the clerk starts an IV in your hand because, as she explains, you might get dehydrated while you wait for your fiancé.

“I have my favorite juice here, I’ll drink that instead,” you reply.

“No, no dear. No juice. You could aspirate it and die if you end up needing surgery.”

“SURGERY!” you exclaim, “Why would I need surgery? I’m just getting married!”

The clerk gives you a knowing glance, “Honey, about forty percent of women who get married here need surgery before their marriages are finalized. This is an excellent courthouse! We do everything possible to make sure you have a healthy husband when you leave here. Isn’t that what you want?”

“Yes,” you reply weakly.

Finally, the other clerk signals that your fiancé is ready. You turn to look at him and see that he has a monitor strapped to his chest to monitor his heart rate and that he has an electrode on his scalp. You smile at him and prepare to say your vows—you’ve waited for this moment for so long! But, as you begin to speak, the clerk tells you to stop making so much noise. You start to cry in confusion and embarrassment and she tells you that you really need to get control over yourself.

She calls over several other clerks who stand near you and they all begin chanting loudly, “Say I DO! Say I DO!”

“Wait,” you protest, “What about our vows?”

“No time for that—you’ve got to get married as quickly as possible. Husbands can only bear to stand at the altar for a short time before they start showing signs of distress—you wouldn’t want anything to happen to your husband would you? Now, say ‘I DO,’ say ‘I DO’!!”

So, you say the words, feeling a sense of dismay at it not being like you had planned, but excited to finally be married to your beloved. You turn to your new husband and reach out for him eager for your first married kiss, but the clerk grabs his arm and tugs him away after her.

“Wait!” you call, “I want to see my husband!”

“Sorry,” is the reply, “He needs to be taken to the new husbands’ lounge for observation.”

“Observation of what?”

“Weddings are stressful for husbands; we need to make sure he is all right. Now wait here, while the other clerk brings you a wheelchair to take you to your waiting room.”

Instead of leaving for your honeymoon, you end up staying at the courthouse for three days. You keep asking to see your husband, but the clerk tells you he needs to gain some weight before he can leave and that he also needs some more blood drawn. She also lets you know that he has finally stopped complaining about his spinal tap.

Spinal tap?! Your dismay shows on your face and she tells you, “Come on! You’ll be married for the rest of your life! A few hours of separation isn’t going to hurt either one of you. You’ll have plenty of time with him after you get home and will probably just get fed up with him then! What really matters now is that your husband is healthy.”

“Yes, of course…”

Finally, you get to go home, but you feel distant and sad. Your wedding was nothing like you’d dreamed of and you feel disappointed and betrayed. You enjoy being married and snuggling with your new husband, but you keep thinking about your wedding day and all of your ruined plans to make it special. When you try to tell your mother how you feel, she tells you that you should be grateful, at least your husband is nice and healthy.

When you tell your best friend about your disappointment, she tells you it is time to get over it—“Your wedding is just one day of your entire life. It is the marriage that really matters in the end. You only get married once, but in the end, you’re married and you’ve got a healthy husband and that’s really what counts, not how you get there!”

You tell another friend about your ruined plans and she reminds you that you are lucky your husband is healthy and that it is selfish of you to keep thinking about your wedding. It is over and you’ve got your nice healthy husband to keep you busy now.

“Yes, but I feel like I missed out,” you venture.

“On what? Weddings are SO overrated. It isn’t like you get a medal for having a beautiful wedding or anything. People have weddings every day.”

You stop sharing your feelings, but you can’t shake the memories. What you expected to be a beautiful day filled with love and celebration was not and you feel a real sense of grief at the loss of your dreams. You know you shouldn’t feel this way. You know that what really matters is your healthy, happy husband, but you keep wondering if your wedding really had to be that way. Yes, you love your husband and you are so happy that he is healthy, but you also wonder if that really is all that matters. Don’t you matter too? Doesn’t your relationship matter? What about respect, dignity, love, and self worth? Don’t those matter too? Wasn’t this a special life transition for your family? Wasn’t it the beginning of a special relationship together and couldn’t that relationship have been celebrated, honored, and treated as worthy of care and respect?

————————————————————————————————————

Notes: I originally wrote this essay in 2007. It was retained for publication by Mothering magazine, but did not end up making it in before the print publication ceased. It was then retained for publication by Midwifery Today, but has not yet appeared. I decided it is FINALLY time for it to see the light of day!

I was inspired to write this essay after reflecting upon the similarities between weddings and births—both mark the beginning of a new form of relationship and a change to the family structure and to individual roles in society. Yet, in our culture, one of these transitions is celebrated as a milestone of adult life and the value of honoring the first steps in life as new partners in a relationship is a given. The other is institutionalized and mechanized and the partners’ individuality is minimized or ignored. Much preparation, energy, time, and finances are invested in planning a lavish wedding and you are expected to expect things to go beautifully, perfectly, and as planned. If they didn’t and your wedding was ruined, most people would say, “It is awful that your wedding was ruined! Wow!” and not call into question your love of your husband or your commitment to your new role as his wife. The wedding ceremony is respected as having value in its own right. This is not true of birth, which is widely viewed as unimportant in terms of how it happens, as long as the result is a “healthy baby.”

Molly Remer, MSW, ICCE is a certified birth educator, writer, and activist. She is a breastfeeding counselor, editor of the Friends of Missouri Midwives newsletter, and a professor of Human Services. Molly has two wonderful sons and one delightful daughter and lives in central Missouri. She blogs about birth, motherhood, and women’s issues at http://talkbirth.me and is the author of the miscarriage memoir Footprints on My Heart.

Alaina’s Birth Story–Baba Style!

Jan28

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

Alaina’s Birth Story

Baba’s version

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

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

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

Baba meets Alaina!

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

—-

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

Birth Quotes of the Month

Nov26

As always, while these quotes are obviously not my own words, I do appreciate a link back to my site if you re-post them because I have a significant amount of legwork invested in finding and typing the quotes. Most are not recycled from other pages (I give credit if they are), but are typed up when they catch my eye in the books/magazines/journals I’m reading.

“The first few months after a baby comes can be a lot like floating in a jar of honey—very sweet and golden, but very sticky too.” –American College of Nurse-Midwives

“Your children love you. Be the trampoline for their rocketing and the cupped palms for their returning.” –Shae Savoy (in We’Moon 2011 datebook)

“There is nobody, out the other side of that sort of strong birth, who is not better prepared to meet the absolutely remarkable challenges of parenthood. When the power and trust is transferred to the mother, when she delivers her child, rather than ‘is delivered’ when she chooses, rather than ‘is allowed’, no matter what sort of technical birth she has, she is stronger, fiercer, and better. After a trip like that, you would kill for that child, and you know you can.” —The Yarn Harlot

Why do birth work? “I do it, because nothing else… nothing else, compares to watching a woman move mountains with her own self, to watching her rise to a challenge and meet the moment with all she has, and that experience is only enhanced when she is supported by those who care for her, respect her, and want her to be empowered by the journey.” –The Yarn Harlot

“We must act to keep the knowledge and the powers of women alive.” – Lynn Andrews

“Birth Freedom is inevitable. The natural progression is for people to move from tyranny to liberty. The agents of the status quo, however, rarely yield power without a fight.” –Senator John Loudon (ret.) in Midwifery Today e-news

“If I didn’t define myself for myself, I would be crunched into other people’s fantasies for me and eaten alive.” – Audre Lorde

“We have barely tapped the power that is ours. We are more than we know.” –Charlene Spretnak

“Woman is a glorious possibility; the future of the world is hers.” – Matilda Gage

“In everyone’s life, at some time, our inner fire goes out. It is then burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit.” ~Albert Schweitzer

“There is a sacredness in tears. They are messengers of overwhelming grief…and unspeakable love.” –Washington Irving

“Don’t you dare, for one more second, surround yourself with people who are not aware of the greatness that you are.” (Roots of She by Amanda Oaks, via @ROAR! Empowering Women to Give Voice to Their Truth)

“We all start out knowing magic. We are born with whirlwinds, forest fires, and comets inside us. We are born able to sing to birds and read the clouds and see our destiny in grains of sand. But then we get the magic educated right out of our souls.” -Robert R. McGammon

“It’s hard to describe if you’ve never been there, but to watch a woman access her full power as a woman to give birth is awe-inspiring, and I never get tired of being witness to it. It’s an honor to watch that transformation take place.” ~ Julie Bates, CNM

“The emerging woman..will be strong-minded, strong-hearted, strong-souled, and strong-bodied…strength and beauty must go together.” ~Louisa May Alcott

“We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them.” –Elizabeth Davis, CPM

“The women in labor must have NO STRESS placed upon her. She must be free to move about, walk, rock, go to the bathroom by herself, lie on her side or back, squat or kneel, or anything she finds comfortable, without fear of being scolded or embarrassed. Nor is there any need for her to be either ‘quiet’ or ‘good.’ What is a ‘good’ patient? One who does whatever she is told—who masks all the stresses she is feeling? Why can she not cry, or laugh, or complain?” –Grantly Dick Read, Childbirth without Fear

“The purpose of life is not to maintain personal comfort; it’s to grow the soul.” –Christina Baldwin

“Everyone who interacts with a pregnant woman is, in some way, her ‘teacher.’ Telling birth stories, sharing resources, imparting obstetrical information, giving advice or warnings—these are all direct or indirect ways of teaching about birth and parenting. Whether you currently identify yourself as a ‘childbirth teacher,’ or you are a midwife, doctor, doula, yoga teacher, nurse, therapist, breastfeeding counselor, or you are simply a woman or man who cares about the power of the childbearing year, you already hold the power of mentoring within you.” –Pam England

“The purpose of our lives is to give birth to the best which is within us.” –Marianne Williamson

“There is no single formula for motherhood and writing that suits us all. Instead, there are many paths on this literary journey, all leading to the same destination, each equally valuable.” – Elif Shafak

“Remember our heritage is our power; we can know ourselves and our capacities by seeing that other women have been strong.” – Judy Chicago

“Scientific medicine has never been shy to dismiss if not denigrate any perceived threat to its values or power.” –from the book Breakthrough: How the 10 Greatest Discoveries in Medicine Saved Millions and Saved the World

“Midwives often forget that our beliefs in [mom’s] abilities can alter her accomplishments. It is important to check our hearts and push through any lack of belief that may inhibit her strengths. This may sound silly or ethereal, but I guarantee it can make a difference for a laboring mom and family.” ~ Carol Gautschi (Midwifery Today)

“Hormones have a kind of crazy rhythm that you can trust. Behind them is internal intelligence; try listening instead of controlling. When hormones are ‘raging,’ they exaggerate what’s already going on internally as a signal for us to pay attention and learn from it.” –Camille Maurine (Meditation Secrets for Women)

“Since the release of adrenaline is highly contagious, the main preoccupation of an authentic midwife, after the paradigm shift, will be to maintain her own level of adrenaline as low as possible when she is close to a labouring woman. Midwives of the future will also need to train themselves to remain silent, since language is the most powerful stimulant of the neocortex. The silent knitting session will be a necessary step towards an understanding of what authentic midwifery is. We present it as the symbol of a vital new phase in the history of childbirth and midwifery.” –Michel Odent (in Midwifery Today)

“Sons branch out, but one woman leads to another.” –Margaret Atwood (quoted in Sacred Circles)

“We can no longer sit back and debate whether maternity care is evidence-based. We have seen that over and over again, in most cases, it is not…” –Connie Livingston

“If the first woman God ever made was strong enough to turn the world upside down all alone, together women ought to be able to turn it rightside up again.” –Sojourner Truth

“The intrinsic intelligence of women’s bodies can be sabotaged when they’re put into clinical settings, surrounded by strangers, and attached to machines that limit their freedom to move. They then risk falling victim to the powerful forces of fear, loneliness, doubt , and distrust, all of which increase pain. Their hopes for a normal birth disappear as quickly as the fluid in an IV bottle.” ~Peggy Vincent

“The problem is not that obstetricians are surgeons. They are. The problem is that society has invested surgeons with control over normal childbirth.” –Michael Klein, MD (in The Journal of Perinatal Education)

“Perhaps the greatest gift that women can give their daughters is to take precious care of their own lives—to develop their natural talents and to honor the opportunities that come their way. By so doing, they become vital models for their children as well as full women in their own right.” ~ Evelyn Bassoff

“When one woman puts her experiences into words, another woman who has kept silent, afraid of what others will think, can find validation. And when the second woman says aloud, ‘yes, that was my experience too,’ the first woman loses some of her fear.” –Carol Christ

“Befriend fear, embrace struggle, trust nature, the process, and a baby’s wisdom.” –WYSH (Wear Your Spirit for Humanity see also https://talkbirth.wordpress.com/2011/05/25/birth-altar-wisdom/)

“Thousands of women today have had their babies born under modern humanitarian conditions–they are the first to disclaim any knowledge of the beauties of childbirth…” –Grantly Dick Read, Childbirth without Fear

“I am not free while any woman is unfree, even when her shackles are very different from my own.” –Audre Lorde

“Not only do I trust my body, I am in awe of all it can do. I don’t know if I will ever be able to accomplish anything as marvelous as birthing and nursing two babies. That is more amazing to me than running a marathon or climbing a mountain. I have created and nurtured life; nothing tops that. ” ~ Corbin Lewars (via Midwifery Today)

“Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women—half of all people—that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.” –Marsden Wagner

“I am sure that if the mothers of various nations could meet, there would be no more wars.” – E. M. Forster

“The strength that is displayed in labor and birth is something that no one can EVER take from you in your life. Elixir of courage.” –Desirre Andrews

Birth and the Women’s Health Agenda

Nov13

Ready to be on the agenda, dangit!

In the Fall issue of The Journal of Perinatal Education (Lamaze), there was a guest editorial by perinatologist Michael Klein called “Many Women and Providers are Unprepared for an Evidence-Based Conversation About Birth.” In it he notes:

Childbirth is not on the women’s health agenda in most Western countries…It never has been. Osteoporosis is. Breast health is; violence against women is. Why not childbirth? Because women, understandably, do not want to be judged only by their reproductive capacities. Women are multipotential people. Among many potentialities, they can rise to the top of the academic and corporate world. Giving birth is just one of many things women can do. But now is the time to add childbirth to the women’s health agenda; it is because of the lack of informed decision making that birth should be added to that agenda, lack of information, misinformation, and even disinformation. The time is now.

…What really matters is attitudes and beliefs, which are much more difficult to change than putting away the scissors and hanging some plants. These are systemic issues. (emphasis mine) It is all about anxiety and fear. The doctors are afraid…The women are afraid…Society is afraid and averse to risk.

So how can you make a revolution when so few individuals are unhappy with current maternity care practices? The most unhappy and well-informed women select midwives, if available. The most fearful women select obstetricians. Providers are not going to initiate the revolution to make childbirth a normal rather than high-risk, industrialized activity…Women are going to have to take the lead…

The problem is not that obstetricians are surgeons. They are. The problem is that society has invested surgeons with control over normal childbirth.

I keep wanting to write an article called, “is evidence-based care enough?” because we see this phrase used so often in birth advocacy work. It is kind of the companion phrase to the, “women just need to educate themselves” line of thought, that, quite frankly, is also just not enough. And, I think the reason it isn’t enough—all of our education, all of our books, and all of our evidence—is because it isn’t information itself that really needs to change, it is women’s feelings and beliefs about birth (and the medical system’s feelings and beliefs about it too, in addition to their practices) and changing those sometimes feel like an insurmountable task. As I’ve written before, much of the time it isn’t that we actually want women to know more, we want them to act differently. And, a choice made in a context of fear is not an informed choice at all.

Guest Post: More Business of Being Born Mini-Review

Nov9

In conjunction with the More Business of Being Born giveaway I’m currently hosting, I’m also pleased to share this mini-review of the first installment (Down on the Farm) guest posted by my friend and colleague, doula Summer:

More Business of Being Born

Down on the Farm: Conversations with Legendary Midwife Ina May

Reviewed by Summer Thorp-Lancaster

http://peacefulbeginnings.wordpress.com
http://summerdoula.wordpress.com

The first installation of More Business of Being Born, Down on the Farm: Conversations with Legendary Midwife Ina May, is infused with loving scenes of midwifery care, loads of vital information and even a few jokes (such as a gift referencing Ina May’s infamous “sphincter law”). We are given an up close view of the well-known Farm in Tennessee, whose Midwives boast an exemplary track record of Midwife attended, out-of-hospital births. This record includes a less than 2% cesarean section rate in over 2500 births. Throughout the interviews, Ina May’s (and the other Midwives featured) reverence and respect for the Midwifery Model of Care is ever-present. Her passion for the safety and overall well-being of the motherbaby is palpable and stirring.

It would be impossible to cover the many aspects of birth, or even just Midwife attended out-of-hospital birth, in a full length film, let alone an episode, but this piece successfully touches on many topics and will (hopefully) lead to further discussion amongst viewers. As an activist, I found myself left with a renewed sense of action or purpose, a desire to do more and help more so that all mamas and babies have the opportunity to experience birth as the positive, loving and intimate experience it was meant to be as well as a deeper understanding of the crisis surrounding our medical model of birth. I would recommend this film to everyone, as the state of maternity care affects us all.

Birth Fear

Nov1

“…if you want to know where a woman’s true power lies, look to those primal experiences we’ve been taught to fear…the very same experiences the culture has taught us to distance ourselves from as much as possible, often by medicalizing them so that we are barely conscious of them anymore. Labor and birth rank right up there as experiences that put women in touch with their feminine power…” -Christiane Northrup

Since it was just Halloween, I wanted to re-post some things about fear and birth that I shared on another blog a couple of years ago. I encounter a lot of women who are very scared of birth, particularly of the pain of birth. Grantly Dick-Read’s Fear-Tension-Pain cycle has influenced the teachings of most natural birth educators and most people readily connect to the idea that fear leads to elevated tension in body which leads to increased pain (more about fear-tension-pain in a linked post below).

One of my favorite birth books, Birthing from Within, has several sections about coping with fear. The author’s idea is that by naming fears and looking them in the eye rather than denying they exist, you shift your thinking from frozen, fear-based, thoughts to more fluid, adaptable coping-mechanisms. There is a useful handout based on her ideas available at the Transition to Parenthood site.

I also think of this quote from Jennifer Block:

Why is it that the very things that cause birth related morbidity rates to rise are seen as the ‘safe’ way to go? Why aren’t women and their doctors terrified of the chemicals that are dripped into their spines and veins—the same substances that have been shown to lead to more c-sections? Why aren’t they worried about the harm these drugs might be doing to the future health of their children, as some studies are indicating might be the case? Why aren’t they afraid of picking up drug-resistant staphylococcus infections in the hospital? And why, of all things, aren’t women terrified of being cut open?

I actually was afraid of these things, which is part of why I didn’t go to a hospital to have my babies!

I hope some day all women will be able to greet birth with confidence and joy, instead of fear and anxiety. This does NOT mean denying the possibility of interventions or that cesareans can save lives. And, it also doesn’t mean just encouraging women to “trust birth.” Indeed, I read a relevant quote in the textbook Childbirth Education: Research, Practice, & Theory: “…if women trust their ability to give birth, cesarean birth is not viewed as a failure but as a sophisticated intervention in response to their bodies’ protection of the baby.”

Here are some more good quotes from Childbirth without Fear:

A well–prepared woman, not ignorant of the processes of birth, is still subject to all the common interventions of the hospital environment, much of which places her under unnecessary stress and disrupts the neuromuscular harmony of her labor.

–

It is for this reason that thousands of women across the country are staying home to give birth…Women are choosing midwives as attendants, and choosing birth centers and birthing rooms, in order to regain the peaceful freedom to ‘flow with’ their own labors without the stress of disruption and intervention. Pictures on the wall and drapes on the window do not mask the fact that a woman is less free to be completely herself in the hospital environment, even in a birthing room. The possibility of her being disturbed is still there.

–

The women in labor must have NO STRESS placed upon her. She must be free to move about, walk, rock, go to the bathroom by herself, lie on her side or back, squat or kneel, or anything she finds comfortable, without fear of being scolded or embarrassed. Nor is there any need for her to be either ‘quiet’ or ‘good.’ What is a ‘good’ patient? One who does whatever she is told—who masks all the stresses she is feeling? Why can she not cry, or laugh, or complain?

–

When a woman in labor knows that she will not be disturbed, that her questions will be answered honestly and every consideration given her, then she will be better able to relax and give birth with her body’s neuromuscular perfection intact. The presence of her loving husband and/or a supportive attendant will add to her feelings of security and peace, so she can center upon the task at hand.

Childbirth without Fear was originally written in the 1940′s. The quotes above are just as relevant and true today.

Fathers, Fear, and Birth
Fear-Tension-Pain or Excitement-Power-Progress?
Cesarean Birth in a Culture of Fear Handout
Worry is the Work of Pregnancy

The Value of Sharing Story

Oct12

“..no matter what her experience in birth was, every mother knows something other people don’t know.”—Pam England

“Stories are medicine…They have such power; they do not require that we do, be, act anything—we need only listen. The remedies for repair or reclamation of any lost psychic drive are contained in stories.” –Clarissa Pinkola Estes

Every woman who has given birth knows something about birth that other people don’t know. She has something unique and powerful to offer.

As birth professionals, we are often cautioned against sharing our personal stories. We must remember that it is her birth and her story, not ours. In doula and childbirth educator trainings, trainees are taught to keep their own stories to themselves and to present evidence-based information so that women can make their own informed choices. As a breastfeeding counselor too, I must remind myself to keep my own personal experiences out of the helping relationship. My formal education is in clinical social work and in that field as well we are indoctrinated to guard against inappropriate self-disclosure in a client-helper setting. In each environment, we are taught how to be good listeners without clouding the exchange with our own “baggage.” The messages are powerful—keep your own stories out of it. Recently, I have been wondering how this caution might impact our real-life connections with women?

Nine months after I experienced a powerful miscarriage at home at 15 weeks, a good friend found out at 13 weeks that her baby died. As I had, she decided to let nature take its course and to let her body let go of the pregnancy on its own timetable, rather than a medical timetable. When she emailed me for support, it was extremely difficult to separate our experiences. I kept sharing bits and pieces of my own loss experiences and then apologizing and feeling guilty for having violated the “no stories” rule. I kept telling her, “I know this isn’t about me, but I felt this way…” I told her about choosing to take pictures of the baby and to have a ceremony for him at home. That I wished I had gotten his footprints and handprints. The kinds of personal sharing that may have been frowned upon in my varied collection of professional trainings. After several apologies of this sort, I began to reflect and remembered that what I hungered for most in the aftermath of my own miscarriage was other women’s voices and stories. Real stories. The nitty gritty, how-much-blood-is-normal and did-you-feel-like-you-were-going-to-die, type of stories. Just as many women enjoy and benefit from reading other women’s birth stories, I craved real, deep, miscarriage-birth stories. These stories told me the most about what I needed to know and more than organization websites or “coping with loss” books ever could.

I had a similar realization the following month when considering the effectiveness of childbirth classes and trying to pin down what truly had reached me as a first time mother. The question I was trying to answer as I considered my own childbirth education practice was how do women really learn about birth? What did I, personally, retain and carry with me into my own birth journey? The answer, for me, was again, story.

On this blog, I have a narrative about my experiences during my first pregnancy with being able to feel my baby practicing breathing while in-utero. More than any other post on the site, this post receives more comments on an ongoing basis from women saying, “thank you for sharing”–that the story has validated their own current experience. In this example, rather than getting what they need from books, experts, or classes, women have found what they needed from story and, indeed, most of them reference that it was the only place they were able to find the information they were seeking.

And finally, as breastfeeding counselor, during monthly support meetings, I cannot count the number of times I’ve seen mothers’ faces fill with relief when another mother validates her story with a similar one.

So, what is special about story as a medium and what can it offer to women that traditional forms of education cannot? Stories are validating. They can communicate that you are not alone, not crazy, and not weird. Stories are instructive without being directive or prescriptive. It is very easy to take what works from stories and leave the rest because stories communicate personal experiences and lessons learned, rather than expert direction, recommendations, or advice. Stories can also provide a point of identification and clarification as a way of sharing information that is open to possibility, rather than advice-giving.

Cautions in sharing stories while also listening to another’s experience include:

Are you so busy in your own story that you can’t see the person in front of you?
Does the story contain bad, inaccurate, or misleading information?
Is the story so long and involved that it is distracting from the other person’s point?
Does the story communicate that you are the only right person and that everyone else should do things exactly like you?
Is the story really advice or a “to do” disguised as a story?
Does the story redirect attention to you and away from the person in need of help/listening?
Does the story keep the focus in the past and not in the here and now present moment?
Is there a subtext of, “you should…”?

Several of these self-awareness questions are much bigger concerns during a person-to-person direct dialogue rather than in written form such as blog. In reading stories, the reader has the power to engage or disengage with the story, while in person there is a possibility of becoming stuck in an unwelcome story. Some things to keep in mind while sharing stories in person are:

Sensitivity to whether your story is welcome, helpful, or contributing to the other person’s process.
Being mindful of personal motives—are you telling a story to bolster your own self-image, as a means of pointing out others’ flaws and failings, or to secretly give advice?
Asking yourself whether the story is one that will move us forward (returning to the here and now question above).

While my training and professional background might suggest otherwise, my personal lived experience is that stories have had more power in my own childbearing life than most other single influences. The sharing of story in an appropriate way is, indeed, intimately intertwined with good listening and warm connection. As the authors of the book, Sacred Circles, remind us “…in listening you become an opening for that other person…Indeed, nothing comes close to an evening spent spellbound by the stories of women’s inner lives.”

Molly Remer, MSW, ICCE, CCCE is a certified birth educator, writer, and activist who lives in central Missouri with her husband and children. She is an LLL Leader, a professor of Human Services, and the editor of the Friends of Missouri Midwives newsletter. She blogs about birth, women, and motherhood at https://talkbirth.wordpress.com.

This is a preprint of The Value of Sharing Story, an article by Molly Remer, MSW, ICCE, published in Midwifery Today, Issue 99, Autumn 2011. Copyright © 2011 Midwifery Today. Midwifery Today’s website is located at: http://www.midwiferytoday.com/

Rebirth: What We Don’t Say

Oct2

A new self did emerge. This is what women do not tell each other. I want to say it here: You will die when you become a mother and it will hurt and it will be confusing and you will be someone you never imagined and then, you will be reborn. Truthfully, I have never wanted to be the woman I was before I had children. I loved that woman and I loved that life but I don’t want it again. My daughters have made me more daring, more human, more compassionate. Their births have brought me closer to the earth and they have helped me pare my life down to its essentials. Writing, quick prayers, good food, a few close friends, many deep breaths, love, plants, dancing, music, teaching-these are the ingredients of my/this new self. I waited for this new self in the dark, in the bittersweet water of letting go, in the heavy heartbeat of learning to be a mother, against the isolation, I grew and emerged laughing and crying and here I am, sisters and brothers. Rebirth: What We Don’t Say | The Sage Mama.

One of my favorite songs to listen to after my miscarriage experiences had a refrain of, “it is dark, dark, dark inside.” While previously not connecting to “darkness” as a place of growth or healing, during these experiences I learned that it is in the darkness that new things take root and grow.

As I’ve shared before, one of my favorite quotes about postpartum comes from Naomi Wolf, A mother is not born when a baby is born; a mother is forged, made. The quote I shared above from this “Rebirth” article touches that place in me—that motherhood results in a total life overhaul and a new, enriched identity. (This article also made me think of first postpartum journey which I wrote about here.)

In a previous post, I wrote the following about the idea that giving birth and mothering leaves permanent marks:

I’ve also come to realize that despite the many amazing and wonderful, profound and magical things about birth, the experience of giving birth is very likely to take some kind of toll on a woman—whether her body, mind, or emotions. There is usually some type of “price” to be paid for each and every birth and sometimes the price is very high. This is, I guess, what qualifies, birth as such an intense, initiatory rite for women. It is most definitely a transformative event and transformation does not usually come without some degree of challenge. Sometimes to be triumphed over or overcome, but something that also leaves permanent marks. Sometimes those marks are literal and sometimes they are emotional and sometimes they are truly beautiful, but we all earn some of them, somewhere along the line. And, I also think that by glossing over the marks, the figurative or literal scars birth can leave on us, and talking about only the “sunny side” we can deny or hide the full impact of our journeys.

During Pam England’s presentation about birth stories at the ICAN conference, she said that the place “where you were the most wounded—the place where the meat was chewed off your bones, becomes the seat of your most powerful medicine and the place where you can reach someone where no one else can.”

(I’m experimenting with PressThis for this short post)

Active Birth in the Hospital

Aug31

One of the inspiring images in ICAN of Atlanta's "Laboring on the Monitors" slideshow.

The vast majority of my birth class clients are women desiring a natural birth in a hospital setting. My classes are based on active birth and include a lot of resources for using your body during labor and working with gravity to help birth your baby. Sometimes I feel like active birth and hospital birth are incompatible—i.e. the woman’s need for activity runs smack dab into the hospital’s need for passivity (i.e. “lie still and be monitored”). So, I was delighted to discover this awesome series of photos from ICAN of Atlanta of VBAC mothers laboring on the monitors. It IS possible to remain active and upright, even while experiencing continuous fetal monitoring.

In my own classes, we talk about how to use a hospital bed without lying down—the idea that a hospital bed can become a tool you can use while actively birthing your baby. Here is a pdf handout on the subject:How to Use a Hospital Bed without Lying Down. In this handout, I offer these tips for using the bed as an active assistant, rather than a place to be “tied down”:

While being monitored and/or receiving IV fluids that limit mobility, try:

Sitting on a birth ball and leaning on bed
Sitting on bed
Sitting on bed and lean over ball (also on bed)
Kneeling on bed
Hands and knees on bed
Standing up and leaning on bed
Leaning back of bed up and resting against it on your knees
Bringing a beanbag chair, putting it on the bed and draping over it (can also make “nest” with pillows)
Partner sitting on bed and woman leaning on him/supported squats with him
Partner sitting behind woman on bed (with back leaned up as far as it will go)

While giving birth, try:

Hands and knees on bed
Kneeling with one leg up (on bed like a platform or “stage”)
Holding onto raised back of bed and squatting or kneeling
Squatting using squat bar

While most of the above tips can be used during monitoring, additional ideas for coping with a simultaneous need for monitoring AND activity include:

Kneel on bed and rotate hips
Sit on edge of bed and rock or rotate hips
Sit on ball or chair right next to bed (partner can hold monitor in place if need be)

If something truly requires being motionless, it can be helpful to have some breath awareness techniques available in your “bag of tricks.” One of my favorites is: Centering for Birth

Some time ago, a blog reader posed the question, can I really expect to have a great birth in a hospital setting? I definitely think it is possible! I also think there is a lot you can do in preparation for that great hospital birth! When planning a natural birth in the hospital, it is important to consider becoming an informed birth consumer. I always tell my clients that an excellent foundation for a simple, effective, evidence-based birth plan is to base it on Lamaze’s Six Healthy Birth Practices. My own pdf handout summarizing the practices is also available: Six Healthy Birth Practices. Don’t forget there is also a great video series of the birth practices in action! You might also want to get a copy of the book Homebirth in the Hospital. And, check out this post from Giving Birth with Confidence: Six Tips for Gentle but Effective Hospital Negotiations.

Before you go in to the hospital to birth your baby, make sure you have some ideas about this very popular question, how do I know if I’m really in labor?

And, finally, be prepared for the hospital routines you may encounter by reading my post: What to Expect When You Go to the Hospital for a Natural Childbirth.

For some other general ideas about active birth, read my post about Moving During Labor (written for a blog carnival in 2009).

Best wishes for a beautiful, healthy, active hospital birth! You can do it!