Centering for Birth

Oct28

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

Centering is a breath awareness strategy that I’ve adapted for use in birth classes based on the ten second centering process described in the short book Ten Zen Seconds. Using the breath as a “container” for a thought or affirmation is the basis of centering. A meditative technique, the purpose is to “center” and to become mindful of the present moment. The container is a 10 second long breath—a five second in-breath and a five second out-breath—that holds a thought. You think the first half of the phrase on the in breath and the second half on the out breath (Maisel, 2007). Use this technique once or twice to “greet” the contraction and then continue breathing with awareness throughout the remainder of the contraction.

Some suggestions of centering thoughts to use during birthing include:

(I am open) (to birth)

(I am ready) (for my baby)

(I welcome) (my labor)

(I am confident) (and strong)

(Right here) (right now)

(I am equal) (to this challenge)

(I embrace) (this moment)

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

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

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

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

References:

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

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

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

Birth Blessing

Oct23

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

Birth Blessing

by Natalie Evans

Close your eyes and breathe deep

Breathe in peace, breathe out pain

Imagine your feet

Toes curling into dirt

Think of yourself as rooted

Think of your place in the earth

How did you come to be here?

Through generations of women named

A maternal lineage

That brought you to this place

Think of their birth stories

What you know, what you believe to be true

Realize that their births carry deep wisdom

Some may carry the memory of joy and transcendence

Each birth is a powerful experience

Each birth traces down to you.

Just as you pass this knowledge on to your baby

Understand that your birth is your own

It will be different from all others

Like the swirls in your thumb

Your birth will have a unique pattern

Unfolding with each contraction

Rising and falling like a newborn’s chest

This birth belongs to you

This birth is an opening

This birth is the end and a beginning

May this blessing of birth come to you without fear

May this blessing of birth come to you with great understanding

My this blessing of birth make your heart soar

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

Blessings to you and your birth.

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Pain with a Purpose?

Oct22

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

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

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

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

So, what about pain?

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

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

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

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

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

I also love the description from Painless Childbirth:

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

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

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

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

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

Newborn Alaina, January 2011

Call for contributions: personal birth stories for new booklet on birthing positions

Oct18

I received an email this weekend from a woman who is writing a booklet about birthing positions (non-profit and free for distributing when finished!). She is seeking contributions of birth stories to use in the book. Below is her message:

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My name is Megan Layton. I have a strong interest in Women’s Health, current issues in obstetrics, as well as the cultural perceptions towards childbirth in general.

As well as being a Missouri native, a supporter of midwives and a woman’s right to an active role in childbirth, I am also a graduate student at the School of the Art Institute of Chicago. Currently I am working on a small, illustrated publication that focuses on birthing positions. The small book will be informative, fun, attractive, and free for distribution and copying. It is my intent to emphasize a woman’s choice during labor and childbirth, and not advocate for any particular position, provider, or setting, but merely convey the options available as well as the potential for birth to be a profound, empowering experience.

Part of the booklet will be first hand accounts of birth—oral histories from women who have had many different birthing experiences.

This is the reason I write to you: to ask that you share this with women who would be willing to share their personal stories, as well as any advice they could give to a woman who is about to experience childbirth for the first time.

Long or short, joyous or rational, funny or sad–any and all stories are welcome, and will be greatly appreciated. At the end of reviewing the narratives, I will ask those women whose stories best suit the publication for permission to use them. As well, I will send copies to all those who graciously allow me to reproduce their words.

All stories, narratives, and questions can be emailed via this link.

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It sounds like a wonderful project to me!

It also reminded me of my previous postings about how to use a hospital bed without lying down. I tell all my clients if they remember only ONE thing from my classes, it is see the hospital bed as a “platform” and a tool in their toolbox—NOT as a place to lie down!

And, here are links to my own birth stories (each which involved freedom of movement during labor as an integral piece!)

First son’s birth (at freestanding birth center): https://talkbirth.wordpress.com/2009/02/25/my-first-birth/

Second son’s birth (at home): https://talkbirth.wordpress.com/2009/02/25/my-second-birth/

Third son’s birth (miscarriage at home at 15 weeks): https://talkbirth.wordpress.com/2010/05/03/noahs-birth-story-warning-miscarriagebaby-loss/

Effectiveness of Childbirth Education?

Oct4

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

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

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

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

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

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

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

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

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

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

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

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

Book Review: Survivor Moms

Sep24

Book Review: Survivor Moms: Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse

By Mickey Sperlich & Julia Seng
Motherbaby Press, 2008
ISBN 978-1-89-044641-3
245 pages, softcover
http://www.midwiferytoday.com

Reviewed by Molly Remer, MSW, CCCE

Past sexual abuse is an unfortunately common experience for women. Anyone who works with women of childbearing age should be mindful and informed of the effects of an abuse history on the woman’s experience of pregnancy, birthing, and mothering. Indeed, I consider this awareness to be a fundamental professional responsibility. Enter Survivor Moms, published by Motherbaby Press. This book is an incredibly in-depth look at the experiences and need of survivors of sexual abuse during the childbearing year.

One of the best and most unique features of the book is the “tab” format used for much of the clinical, research-based, or fact-based content in the book. Rather than lengthy chapters reviewing research and analyzing the phenomenon, textboxes containing quick facts and reference material are printed in the margins of many of the pages. The bulk of the narrative information in the main body of the text is then in the voices of mothers themselves, interspersed with commentary by the authors linking concepts, explaining ideas, and clarifying essentials. This is a powerful format that makes information readily and quickly available for reference as well as making the overall book very readable and approachable.

As someone with no personal abuse history who is currently pregnant, I did find the book to be a very emotionally difficult, intense, and almost overwhelming read at times. This is not a criticism in any way—sexual abuse is not a light or cheerful topic and it can be one that many people prefer to avoid. This is all the more reason for birth professionals to make a specific effort to be educated and informed.

Written both for mothers themselves and for the professionals who work with them, Survivor Moms is an essential part of any birth professional’s library. As noted in the book’s introduction, “We need to understand the impact of childhood abuse on birthing and mothering deeply, from hearing women’s stories. We also need to understand it broadly—from looking at the impact on samples and populations, on the body and on the culture.” Survivor Moms offers an accessible way of hearing those critically important stories and developing the necessary understanding to care compassionately for birthing women.

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

Birth Waves

Sep18

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

–Sheila Kitzinger (Education and Counseling for Childbirth)

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

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

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

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

Humor and Labor

Sep16

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

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

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

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

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

“The Empowered Miscarriage” Book: Call for Contributions

Sep1

I already posted about this on my miscarriage blog, but I have more readers here and wanted to reach out to those followers as well.

I am currently compiling contributions for a book about miscarriage. I am especially interested in stories about natural miscarriages (i.e. miscarriages that begin and complete on their own timeline rather than a medical timeline) and on miscarriage at home, but I am happy to receive any miscarriage story contribution. I am seeking full stories about miscarriage—the nitty gritty physical reality as well as the emotional components. I have a big vision for this book—I want it to be a “what to expect when you’re having a miscarriage” guidebook that doesn’t only address the feelings involved with miscarriage, but answers practical questions like, “what should I eat?” and “how do I take care of myself?” and “how much blood is too much blood?” and “how to decide whether to have a D & C or whether to wait it out at home?” I feel like the best way to answer many of these questions is through the heartfelt stories of other women who have “been there.”

I welcome contributions from women who chose to go to the hospital at some point during the process even if they originally started out to have a natural miscarriage (I am particularly interested in the decision-making process about going). My primary interest is in the nitty gritty, physical coping stories rather than specific location of miscarriage-birth, though I do still have the special interest in home experiences—-at the root, I want real, complete stories from any setting.

I have a full survey of questions that I am developing to post online, but for now I am pleased to accept any contribution related to my primary theme of natural miscarriage (and/or the physical miscarriage experience regardless of setting). Stories can be emailed to me and I will respectfully and gratefully accept each one with my heart wide open.

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I was previously seeking suggestions for the title of this book, originally thinking of calling it simply, “Miscarriage at Home,” when a reader emailed me to suggest the title “The Empowered Miscarriage” (see comments on my other blog for her full explanation). I really like the connotations of the title—-particularly, that it suggests something about miscarriage that is very different than the normal coverage of miscarriage in books. So, I edited my original post to reflect this new title and focus.

Also, I still find myself signficantly displeased with the woefully inadequate word, “miscarriage.” I don’t like it. I don’t like, “miscarrying.” It isn’t enough. I also don’t like the euphemism “loss.” “Pregnancy loss” as a phrase is all right—side note: I feel like there is a range of experiences contained within the miscarriage experience and I think the three are almost separate experiences (emotionally, mentally, and physically)—the babyloss experience, the actual birth-miscarriage experience, and the experience of the loss of being pregnant. I have coped with my own strong, strong feelings about miscarriage as a birth event by referring to my own first miscarriage experience in writing as a miscarriage-birth or a birth-miscarriage. For me, this modifier makes an important point. However, it is cumbersome, not in popular use, and I want something else! Any ideas?

Childbirth and ‘Flow’ Experiences

Aug26

One of my areas of interest within childbirth education is about the importance of birth as an experience. I know this isn’t necessarily a popular approach—more popular is to focus on evidence-based care, because using the dreaded “experience” word implies something too esoteric or “woo-woo,” OR it implies that women value the “experience” over a healthy baby (the very notion of which is so insulting to mothers that I can hardly stand it). However, I tend to think that an overemphasis on evidence-based care simply isn’t enough to explore and describe all that birth means for women. Women deserve even more than evidence-based care! (I actually have an article brewing that addresses this subject.) All too often women’s plans for beautiful births are dismissed with comments such as, “all that really matters is a healthy baby,” or “birth is just one day in a woman’s life.” I believe that wanting a healthy baby is a given and that giving birth is also a transformative rite of passage and life experience that has value in and of itself.

In the textbook Childbirth Education: Practice, Research, & Theory the concept of birth as a peak, or “flow” experience is addressed several times:

The joy and personal growth that can result from successfully meeting challenging experiences has been described as ‘flow experiences’…such experiences are generally better understood in athletics than in childbirth because the public understands athletic events to be character building and an effort or a struggle that requires skill, practice, and concentration and is not without pain. As such, athletic accomplishments are widely recognized for both the product and process…Society focuses the celebration of birth almost totally on the product–the baby–and is rather neutral about the process as long as the mother emerges healthy.

The book also shares the research that when mothers were interviewed postpartum who had had epidurals, their comments following birth focused almost totally on the baby. Women who had relied on relaxation and other non-pharmaceutical coping methods talked about the baby AND about the emotional and psychological benefits of their birth experiences. Women in both groups expressed satisfaction with their birth experiences, but for those in the epidural group “the element of personal accomplishment or mastery was missing in their comments.”

I believe that starting out the parenting adventure with a sense of “personal accomplishment and mastery” is a tremendous gift and I wish all expectant couples had the opportunity to experience birth in this way. In my classes, I strive to emphasize that both process (giving birth) and product (healthy baby, healthy mom) are important, and indeed, are inextricably linked.