Guest Post: The Midwife as a Storyteller and Teacher by Patricia Harman

Oct18

The use of old-fashioned narrative to influence, and inform patients about health practices

As an author of memoirs, historical fiction and children’s literature, I am a storyteller, but I’m also a nurse-midwife, and I use storytelling as one of my primary teaching tools.

Storytelling is uniquely human. Anthropologists have argued that storytelling is pre-verbal, that pictographs on the inside of caves are in fact stories. Form the earliest days humankind has used narrative to record history, to entertain, to convey experience and to transfer information.

To convey information in narrative form is something no other species can do. It’s an evolutionary advantage and allows each individual to harbor more information than personal experience would allow.

Using stories to teach patients is not unique to midwives. All good providers use stories to illustrate how individuals can make better health choices.

We all know that many patients are non-traditional learners and even those in higher education love a good story. Research and statistics are boring for most people and easy to forget . Many patients, even if given a handout drop it in the trash as they leave our office. They don’t have time to read it or are non-readers.

On the other hand, if I tell a tale, in an amusing way, about a young woman who refused to take her birth control pills because she was worried they would make her fat…and now she’s pregnant…that’s a cautionary tale and brings a smile and a knowing nod from the fifteen-year-old here to discuss birth control: That’s not going to happen to her!

Using self-disclosure about your own life can humanize a professional relationship and help patients be more honest with you about their lives. For example, I might say with a smile, that I’ve gone to Weight Watchers for so long I could teach the class, even though I’ve never reached goal weight. The patient and I share a good laugh and now she feels comfortable telling me she can’t stand to look in the mirror, has tried four different TV diets and is terribly discouraged. A door for real communication has opened. She no longer feels alone and she knows she has me as a non-judgmental advocate.

Stories can accomplish what no other form of communication can do; they can get through to hearts with a message. I might tell a very stressed-out college student, sitting on the end of the exam table, about a patient of mine who had two jobs and was studying nursing full time. Last year she started getting a series of illnesses. Next thing she knew, she flunked two courses, lost her boyfriend and had a motor vehicle accident. The moral is clear: don’t take on more than is humanly possible. And the tale is more likely to induce lifestyle change than a lecture.

All health care providers, surgeons, nurses, physical therapists, family doctors or midwives must be teachers. If you missed that part in school, it’s not too late. With humor and love we can become part of the human story that will bring health and hope to our patients.

For the past twenty years, Patricia Harman has been a nurse-midwife on the faculty of The Ohio State University, Case Western Reserve University and most recently West Virginia University. In 1998 she went into private practice with her husband, Tom, an OB/Gyn, in Morgantown, West Virginia. Here they devoted their lives to caring for women and bringing babies into the world in a gentle way. Patricia Harman still lives with her husband, Thomas Harman, in Morgantown, West Virginia. She recently retired from her thirty-five years of midwifery so she could write more books for people like you!

My past reviews of Patsy’s books:

Past blog posts on the subject of story power:

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Talk Books: Pregnancy, Childbirth, and the Newborn

Mar29

Several months ago, I received an email from one of my former college students. His wife was newly pregnant and they had several specific questions. They asked for my help and recommendations with where to go for answers and without hesitation, I suggested a book: Pregnancy, Childbirth, and the Newborn. I was confident that not only would they find the answers they sought in the book, but also reliable, practical, helpful answers to questions they haven’t even thought to ask yet.

Co-authored by a foremost authority in childbirth and doula education, Penny Simkin, Pregnancy, Childbirth, and the Newborn was one of the first books I bought as a new childbirth educator in 2005. Now, newly revised and updated, the book has a companion website packed with resources to help you have a healthy pregnancy, a rewarding birth, and a nurturing postpartum.

One of the things I’ve always enjoyed about this book as a wonderful resource for childbirth educators are the line March 2016 119 drawings illustrating a variety of positions and concepts. This new fifth edition has lots of black and white photos as well. The fact that the book is co-authored by a world-renowned doula, a nurse/lactation consultant, a nurse/childbirth educator, a social worker, and a physical therapist, means it is an interdisciplinary resource benefiting from the skills and professional experience of each co-author. Childbirth educators and doulas as well as pregnant couples will want to check out the companion website which has a plethora of pdf handouts available on numerous topics including comfort techniques, nutrition, and parental leave.

Evidence-based, comprehensive, and encouraging, Pregnancy, Childbirth, and the Newborn is an ideal companion for both childbirth professionals and expectant parents.

—

Pregnancy, Childbirth, and Newborn is published by Meadowbrook Press, an award-winning publisher specializing in pregnancy & childbirth, baby names, parenting & childcare, and children’s books & poetry: Meadowbrook Press. Pregnancy, Childbirth, and the Newborn

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

Thursday Tidbits: Everyday Sheroism in Birth and Life

Feb18

Do you know how many days have gone by in which I’ve said: “well, I didn’t write my dissertation today?”

This past Monday I got to say: I *DID* WRITE MY DISSERTATION TODAY!!!!!!!!!

It may be a first draft rather than a final submission, depending on suggestions from the reviewers, but there is a huge qualitative difference between someone who is writing a dissertation and someone who has submitted a dissertation and who might need to make revisions. It is 187 pages and 88,000 words and involves one year of original research with 100 pages of collated research results. Five years of classes, study, and contemplation, with also doubling my amount of offspring during this time. I grew this dissertation project at the same time I was growing Tanner from a tiny newborn to a walking, talking toddler. And, I feel like I just pushed out the biggest baby of my life. I cannot even describe the energy expenditure this required of me. I feel so satisfied and very, very proud of myself.

At Red Tent last week, when we passed the rattle, we each had a moment to share something we needed to be “compassionately witnessed.” After making a good effort at doing daily dissertation work throughout December, I’ve been semi-half-hearted on it since, averaging one “good” day of intensive work on it per week. I was hoping to have it finished before we go on a trip this month, but I was feeling so strained and drained and tense that adding it to my to-do list felt almost cruel and possibly ridiculous. When it was my turn for compassionate witness, I shared with the circle that I had reached a point in which I could no longer distinguish whether finishing my dissertation was self-care or self-harm.

After making manifestation bracelets together at Red Tent.

Now, in hindsight, I recognize the “transition” stage. I’ve known for a while now that it is part of my personal process with big projects to have to be able to have a time and a place in which I am able to say, I don’t know if I can do this. And, to have that fear and self-doubt, and vulnerability simply witnessed. And, then, do that thing anyway. It is hard to find a space in which this is “allowed.” Very often well-meaning suggestions are to cut myself slack, to lower my expectations, or to give myself a break. I have discovered that just like these comments are not actually helpful to a woman in labor, they are not helpful to me in “labor” with other big projects either. In fact, I think there is a secret “dark” side to many popular self-care messages, primarily because what we sometimes might pass off as “self-care” is actually a “shadow comfort” (to borrow Jen Louden’s term) and is actually a meanings of inhibiting ourselves, holding ourselves back, or sabotaging ourselves (or those around us, when we offer the “out” of quitting or not following through…of letting ourselves down). When I was able to let out the fear and doubt, only for a few minutes, and have it simply received, it was as if something unlocked within me and suddenly I knew I had it in me after all. Only a few days later, after several focused bursts of intense writing, I submitted my completed project.

Anyway, a long story just to make this point: I felt SO good after submitting it. I may never have been so proud of myself. I was giddy, thrilled, exhilarated, excited, and exuberant. “What if I had QUIT?!” I yelled, “then I would never have gotten to feel like THIS!” When I lower expectations, sure, I might meet them, but when I keep my expectations high…and meet them. There is nothing that can replace that feeling. And, guess what, it keeps stretching me to reach just a little higher and a little higher. And yes, the self-harm shadow side of continuous life-stretching is that I can be trapped into “striving and striving and never arriving,” but the self-care amazing life side, is that I prove to myself that I can do incredible things and that I accomplish that which may have felt impossible for a time.

Bringing it back to birth, I read this post about ten things not to say to a woman in labor and the first reminded me of my own big “push” to finish the dissertation and how compassionate witness is infinitely more valuable than sympathetic shadow comfort enabling:

Scenario 1: If a woman is trying to make a rational and educated decision while in labor (a very difficult thing to do when in pain!) about whether or not to get an epidural (which is a big deal, by the way) by saying “you don’t have to be a hero” is playing to her emotions and vulnerability which isn’t fair. If she’s questioning this choice instead of immediately signing up for anesthesia, she likely has a reason for the hesitation. I guarantee she doesn’t want an unmedicated birth to become “a hero”. Maybe she was hoping for a natural birth, or wants to reduce the chance of further interventions like pitocin, or maybe she’s wanting the best start for her baby. I don’t know. But by saying “you don’t have to be a hero” to help her make a decision is basically blowing her off when she is in a very vulnerable position. It’s a low blow.

Source: 10 Things to NEVER Say to a Woman in Labor | Mother Rising

And, here’s the deal…women in labor and postpartum are heroes. They are incredible. They are amazing. We should never deny them that knowledge, particularly if all we are offering in return is a patronizing platitude masquerading as compassion. This “One Day Young” photo project captures that sheroism:

These goddesses headed to a WIC peer counselor’s office this week.

“In those first 24 hours, it’s like this warrior comes out in women,” says Jenny. “They gain this inner strength to protect the child and you can see it in the photos. “They’re like those heroic pictures of soldiers on the battlefield or the footballer after the match, still full of the adrenaline of achievement. This moment isn’t often captured in women, but what they’ve just achieved is just as important as that goal or that battle, and that moment deserves to be recorded and celebrated in the public arena.”

Source: Empowering Photo Project ‘One Day Young’ Reassures Women That Childbirth Is Nothing To Fear

At the same time, birth can be very hard work and the recovery can be intense and long-lasting. Culturally, while we may minimize, invalidate or deny women’s power, strength, and amazingness in birth, we also often minimize, invalidate, and deny their vulnerability after birth.

We don’t talk about postpartum pain — bleeding, stitches, not being able to stand upright, or easily walk around. We don’t talk about the struggles of early breastfeeding: cracked and bleeding nipples, mastitis, and worries about producing enough milk. We are only beginning to talk about postpartum depression and anxiety. And it almost seems as if new fathers and adoptive parents don’t matter at all. The rhetoric from those who don’t want change paint a rosy picture of motherhood, but the realities of these anti-family policies are much more grim. In a recent TED talk, I share a number of heart-wrenching personal stories from women who have suffered as a result of having to return to work too soon.

Source: Maternity Leave Policy Postpartum Pain – Susan Crowe

After submitting my dissertation, I was heard to say that I felt like I needed a long nap and maybe several large gifts. After the intensity and unpredictability of giving birth, a ceremony might be in order, either a sealing ceremony like I experienced, or a birth reclaiming ceremony as is described in this article:

“I wasn’t at the birth, but it was super quick and the mother felt traumatised. I came in on a Monday, and the baby looked a little pinched. I asked the mother about feeding and she said she thought it was going okay. I offered to change the baby’s nappy – I took it off and it was bone dry. I asked how long it had been on and it was over 12 hours. The maternal health nurse was due over that day, so we had a bit of time to suss what was going on, since I was a breastfeeding counsellor as well. From chatting, we realised her milk had not come in and the baby was clearly not getting anything.

The mother was super stressed and her baby was about a week old — and clearly not in fabulous shape. I talked about a birth reclaiming ceremony and we ran her a lovely warm bath. It was daytime, so we closed the curtains and played soft music. As she climbed into the bath, I saw her high, tense shoulders drop right down and she let out a big sigh. When she was ready, I stripped her baby, and placed the baby on her chest. We sat quietly, not saying a word. The mother started to cry, then sob, totally overwhelmed by the responsibility of being a parent and not doing a good enough job. All the while, looking at her sleeping baby, holding her.

As the mother eventually finished crying… her milk started to roll down her breasts. She looked at me, so surprised, and said, “Is that what its meant to look like?”

Source: Birth Reclaiming Ceremony – Could It Help You Heal? | BellyBelly

Finally, I like to share this link. I haven’t actually watched any of these, but for people who like TED Talks, this sounds like an interesting round-up!

11 TED Talks for Pregnancy and Birth — Tulsa Birth Doula, Bethanie Verduzco, CD(DONA) – Hello Sunshine Birth Services

What else is up with me this week:

The etsy shop is on limited inventory until March 1.
I’ve been working on the materials kits for both the Red Tent Initiation and Womanspirit Initiation courses that I have coming up. They’re beautiful and I’m so proud of both of them. Every time I pack up a kit, I feel so thrilled. Both trainings begin March 21st and still have spaces available for registration if you’re interested!

Tuesday Tidbits: Waterbirth & Healthy Babies

Jan26

“It takes force, mighty force, to restrain an instinctual animal in the moment of performing a bodily function, especially birth. Have we successfully used intellectual fear to overpower the instinctual fear of a birthing human, so she will now submit to actions that otherwise would make her bite and kick and run for the hills?”

–Sister Morningstar (in Midwifery Today)

via Tuesday Tidbits: Human Rights and Birth | Talk Birth

Tanner, our last baby, was my first waterbirth. I didn’t really consider water for my first baby. I did for the second and had a birth pool and supplies on hand, but he was born so quickly we had no time to use it. Alaina was born in the deep winter, so water didn’t appeal to me at all and I never considered having a waterbirth with her. With Tanner’s pregnancy, I was interested in trying things I’d never done before. I’d also read that water helps reduce or prevent tears and I really, really, really wanted to avoid tearing again and I thought it would be my last chance to try water and see if helped. He was born in the water and I did tear. I have no regrets about having opted for water with him, other than wishing I would have been able to get out of the pool a little earlier since he got pretty chilled from it. (In case you missed it: his birth story and birth video.)

So, I was interested to read this article about the safety of waterbirth. The conclusion was that water birth is safe, but that women actually had a higher, not lower, chance of tearing…

The findings revealed babies born in water, as well as their mothers, were no more likely to require a transfer or admission to a hospital. Moreover, the babies born in water did not receive a low Apgar score. This quick test is performed on a baby one minute after birth in order to determine how well the baby tolerated the birth, and five minutes after birth to tell doctors how well the baby is doing outside the womb.

Despite the positive, the researchers did find an 11 percent increase in perineal tearing, or vaginal tears among mothers who gave birth in water…

Source: Pregnancy And Water Birth: Giving Birth In Water Tub Poses No Risk To Mom Or Baby, Says Study

A commonly asked question about waterbirth is whether or not water slows down water (the consensus is that it often can if the woman gets in the birth pool “too soon”):

A woman should be encouraged to use the labor pool whenever she wants. However, if a mother chooses to get into the water in early labor, before her contractions are strong and close together, the water may relax her enough to slow or stop labor altogether. That is why some practitioners limit the use of the pool until labor patterns are established and the cervix is dilated to at least 5 centimeters.

Source: Does Water Slow Down Labor? | Talk Birth

I was 35 when Tanner was born, technically of “advanced maternal age.” Luckily, new research also indicated that us “advanced” types have a higher chance of living to “extreme old age” (maybe that should be “advanced, old age”?)

A Boston University School of Medicine study found that women who can still give birth naturally after age 33 have a higher chance of living to extreme old age than those who had their last child before age 30. But the report, published in the online version of the journal Menopause in April 2014 doesn’t imply that putting off pregnancy will add years to your life. “If you physically delay having children, that’s not going to help with longevity, Paola Sebastiani, a Boston University biostatistics professor and study co-author, told OZY. A woman with a natural ability to have children later in life suggests that her body – including her reproductive system – just happens to age at a slow pace. Some women’s biological clocks simply tick more slowly than most.

Source: Late Kids, Long Life? | Acumen | OZY

And, switching gears slightly, I enjoyed this post about that “a healthy baby is all that matters” refrain, that, while seemingly sensible on the surface, is actually an insidious phrase used to shut down women’s voices and deny their completely legitimate right to humane care in pregnancy and birth:

When a woman gives birth, a healthy baby is absolutely completely and utterly the most important thing. Got that? OK – do not adjust your wig, there’s more… It is not ALL that matters. Two things – just to repeat: a healthy baby is the most important thing, AND it is not all that matters. Women matter too. When we tell women that a healthy baby is all that matters we often silence them. We say, or at least we very strongly imply, that their feelings do not matter, and that even though the birth may have left them feeling hurt, shocked or even violated, they should not complain because their baby is healthy and this is the only important thing.

Source: A healthy baby is not ALL that matters – The Positive Birth Movement

This reminds me of the “birth and apples…” example I’ve used in teaching and activism for a long time:

It is not helpful because the expectation was not to not have a healthy baby–the expectation was to have a vaginal birth. It is comparing apples to oranges since there were two separate individual hopes: one the joy of a baby, the other her experience of bringing that baby into the world. The apple being the healthy baby we all want and usually bear, the orange being what we hope for in our trials and tribulations on the way there…

Source: Birth & Apples | Talk Birth

And, it also makes me remember that your baby’s birth is the beginning of a fresh new, lifelong relationship, one worthy of being treated with dignity and respect and honored as an important rite of passage. I explored a relational analogy in one of my most popular past posts…

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.”

Source: All That Matters is a Healthy Husband (or: why giving birth matters) | Talk Birth

In totally separate news, I have an upcoming free Womanspirit Wisdom mini class. Feel free to join!

Guest Post: Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health

Jan5

Leading Maternity Care Experts Release Issue Brief Encouraging Medicaid and Private Insurers to Cover Doula Care

WASHINGTON, D.C. – January 5, 2016 – At this time when most experts agree that not nearly enough women in this country receive high-quality maternity care, federal and state government agencies and health insurers should make doula care an option for more women by covering doula services. An issue brief released today by two leading maternity care advocates makes a powerful case for the health benefits of doula care for women and babies and the significant cost reductions that would result if more women used doulas – trained professionals who provide non-clinical emotional, physical and informational support before, during and after childbirth. The brief, Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health, is co-authored by Choices in Childbirth and Childbirth Connection, a program of the National Partnership for Women & Families.

In the brief, the authors summarize research showing that doula care reduces the likelihood of interventions such as cesarean birth and epidural while supporting shorter labor, spontaneous vaginal birth and other benefits to mom and baby. As the use of interventions decreases, so do associated costs, making coverage of doula care a cost-effective strategy for public and private insurers alike. The authors estimate that the reduction in cesarean births from the use of doula care could save Medicaid at least $646 million per year, and private insurers around $1.73 billion annually.

“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”

“Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”

The brief provides key recommendations to expand insurance coverage for doula care across the country:

Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
State legislatures should mandate private insurance coverage of doula services.

The issue brief and a new infographic illustrating the importance of coverage for doula care are available at http://Transform.ChildbirthConnection.org/Reports/Doula and www.choicesinchildbirth.org/our-work/advocacy-policy/doulacoverage.

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About Choices in Childbirth

Choices in Childbirth is a non-profit organization that works to ensure access to maternity care that is safe, healthy, equitable, and empowering. Our mission is to promote evidence-based, mother-friendly childbirth options through public education, advocacy, and innovative policy reform. Learn more at www.ChoicesinChildbirth.org.

About the National Partnership for Women & Families

The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and policies that help women and men meet the dual demands of work and family. Founded in 1918, Childbirth Connection became a core program of the National Partnership in 2014. Childbirth Connection programs serve as a voice for the needs and interests of childbearing women and families, and work to improve the quality and value of maternity care through consumer engagement and health system transformation. Learn more at http://Transform.ChildbirthConnection.org and www.NationalPartnership.org.

Thursday Tidbits: Recovering from Birth

Dec10

“Before I had children I always wondered whether their births would be, for me, like the ultimate in gym class failures. And I discovered instead…that I’d finally found my sport.”

–Joyce Maynard

People often use running a marathon as a metaphor for birth. Turns out that science has discovered that birth is actually more difficult…

“The researchers used MRI equipment typically used to diagnose sports injuries to explore the full scope of trauma that a woman’s body experiences during childbirth. The MRI images revealed that almost 25 percent of women had fluid in the pubic bone marrow or fractures that are similar to stress fractures that athletes often suffer. And 41 percent of women had pelvic muscle tears.

Also revealed by the study is the startling statistic that 15 percent of women never fully recover from the birth-related pelvic injuries.”

Science Says Childbirth Is Harder Than Running a Marathon – In The Loop Tips & Advice | mom.me

The same research was covered in this post as well:

Childbirth, as anyone who’s been through it knows, can feel very much like an extreme sport. And, it turns out, some childbirth-related injuries are surprisingly like sports injuries, including the very long time they need to heal.

The bottom line, Miller says, is: “if women don’t feel that their body is back to what they expected after six weeks, it’s not in their heads. Women do some self blame or feel like they’re not as robust as their sister or friend. But they may have one of these injuries not visible on clinical exam.”

Source: Childbirth As An Extreme Sport — And Why Its Injuries Can Take So Long To Heal | CommonHealth

I do have to admit that I perhaps would have re-titled the articles: “Science Reports Something Most Women Have Known Since the Beginning of Time,” but, oh well. Picky me.

I’ve written about birth and marathons in several past posts. Giving birth is the original “extreme sport.” One that tests your reserves, your endurance, your courage, and your stamina like nothing else. Truly, we have the comparison wrong. Running a marathon is kind of like giving birth, rather than vice versa! The first older blog post of mine isn’t related to childbirth/sports injury, but instead the emotional satisfaction of finishing your “marathon”:

She goes on to share: “I want that feeling of going beyond what you think is possible for laboring women. If you let go of control and allow the process to unfold, you are so proud of yourself. Then pride morphs into self-confidence and trust. What a perfect combination for parenting. When it comes down to it, you have to do this by yourself, be it labor or running. You might hear other laboring women around you or have the support of crowds in a race, but it’s still up to you. there’s a start and a finish and only you can see it through. Fortitude brings a new self-awareness and strength that feels overwhelming…I know one of my greatest challenges in the vocation of perinatal education is getting women to trust the process and her own capabilities before labor. My practice runs helped prepare me for the marathon, but there is no practice run for labor. Women must rely on their confidence and the legacy of the many women who have birthed before them…”

Source: Births & Marathons | Talk Birth

Women giving birth often experience a sort of post-race euphoria:

Those who push themselves to climb the last hill, cross the finish line, or conquer a challenging dance routine often report feelings of euphoria and increased self-esteem…women who experience natural birth often describe similar feelings of exaltation and increased self-esteem. These feelings of accomplishment, confidence, and strength have the potential to transform women’s lives. In many cultures, the runner who completes the long race is admired, but it is not acknowledged that the laboring woman may experience the same life-altering feelings… —Giving Birth with Confidence (by Lamaze International)

Source: Birth Feelings | Talk Birth

And, they can draw on those feelings for strength again and again:

“Whether it be the thick memory of enduring a non-medicated labor and finally pushing our third child into the world, despite feeling as though I hadn’t an ounce of energy left, or the meager sprint I managed as I neared the finish line of the marathon…, I hold tight to these images as proof that I can and will be able to rise to the occasion–again and again, if and when I need to-–because the ability to do so is in my very bones. Because I am a woman.”

Source: Woman Rising | Talk Birth

Mothering can also feel like a marathon:

“My body? I was ashamed to admit that, after two powerful homebirth experiences, I no longer felt intimately connected to my body. Pregnancy and giving birth were all about every little feeling in my body; mothering felt like a marathon of meeting everyone else’s needs and rarely my own…Most days, the question I asked was, ‘How are their bodies?’ My body was in the back seat, unattended, without a seatbelt.”

Source: Tuesday Tidbits: Birthing Bodies | Talk Birth

This article about recovering from a Cesarean Birth After Cesarean (CBAC) is packed with helpful information:

As we have discussed, everyone celebrates a VBAC but many CBAC mothers feel alone and unsupported, both in their physical and emotional recovery. This needs to change.

Source: The Well-Rounded Mama: Physical Recovery After CBAC

And, this article has some ideas to share about lowering back and pelvic pain during pregnancy: The Birthing Site – 5 Things you can do to Help Lower Back and Pelvic Pain in Pregnancy

All of these posts and topics remind me of the importance of planning wisely for postpartum:

My son’s birth was a joyous, empowering, triumphant experience, but postpartum was one of the most challenging and painful times in my life. I had not given myself permission to rest, heal, and discover. Instead, I felt intense internal pressure to “perform.” I wondered where my old life had gone and I no longer felt like a “real person.” A painful postpartum infection and a difficult healing process with a tear in an unusual location, left me feeling like an invalid—I had imagined caring for my new baby with my normal (high) energy level, not feeling wounded, weak, and depleted.

Source: Planning for Postpartum | Talk Birth

Closing the Bones…

Oct7

After my own postpartum sealing ceremony, November 2014.

I’m thrilled to have a guest post from Awen Clement on the Brigid’s Grove blog this month. She writes about Closing the Bones, a ceremony for postpartum women…

“After the birth of my son, I felt broken open”

Did you feel this way after the births of your children? Did you feel as though you had opened yourself body, mind and spirit to bring that new life into the world? Did it surprise you to feel this way?

We give so much when we birth our children, on every level, and then we keep on giving as we move on in our mothering. We feel exhausted, but that exhaustion somehow doesn’t seem to lift no matter how well we rest. We may feel as though something is missing, some part of ourselves that we were sure was there before. It probably isn’t something you would ever mention to anyone and even if you did many would simply point out that you’re a mother now, of course your tired and of course you feel different…

Read more here: Guest Post: Honouring the Bones of my Sisters – Brigid’s Grove

My own post about my postpartum sealing ceremony can be found here:

Ceremonial Bath and Sealing Ceremony | Talk Birth

Guest Post: How childhood stress can affect female fertility

Sep17

Related to my Tuesday Tidbits post from earlier this week, this guest post touches on the relationship between childhood stress and later female fertility.

How childhood stress can affect female fertility

“Early life events may impact later reproductive strategies.”

Can events you endured as a child really impact your ability to have children yourself? New research in the Journal of Psychosomatic Obstetrics & Gynecology examines the mechanism by which adverse experiences in childhood impact female fertility.

In their paper ‘Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics’, Marni B. Jacobs et al. explore the hypothesis that negative experiences in childhood can result in menstrual cycle irregularities, which consequently impact fertility. They relate their hypothesis to life-history theory, which talks of balancing the preservation of one’s health and the production of offspring that will survive to reproduce themselves, and theorise that “early life stressors may predispose an individual to adaptively suppress fertility when situations are less than optimal, leading to periods of fertility difficulties even following previous births.”

The study examined data from 774 women of reproductive age, 195 of whom were pregnant. It analysed fertility difficulties, menstrual cycle irregularities and adverse childhood experiences, through a mixture of in-person interviews and take-home questionnaires.

Following their research, the team came to the conclusion that those women who had experienced negative events at a young age – such as “abuse, neglect, household dysfunction or parental substance abuse” – were more likely to have faced fertility difficulties and abnormal absences of menstruation lasting three months or more, and also took a longer time to get pregnant. Their research also suggests that certain harmful events in childhood can potentially have a greater impact on fertility than others.

Adverse childhood event experiences, fertility difficulties and menstrual cycle characteristics by Marni B. Jacobs, Renee D. Boynton-Jarrett & Emily W. Harville published by Taylor & Francis.

* Read the full article online

Tuesday Tidbits: Parental Leave

Sep8

I’m teaching Introduction to Human Services right now. In this class, I emphasize systems theory and the complex, dynamic interplay between people and the environment. I cannot stop being a birth activist, nor can I stop being a social worker, so of course, one of the examples I use in class is adequate parental leave. Yes, parental leave. We talk about maternity leave more often in the U.S., but I consider it practically criminal that so many workplaces expect fathers to return to work within a few days after a baby’s birth. This isn’t fair to babies, mothers, fathers, or to workplaces or communities. As I explain to my students, we place people into abnormal situations and expect them to cope normally. When they don’t cope “normally,” we decide they have a disorder and need some medication or possibly parenting classes (or even removal of children). I also make sure to share this quote: It is no measure of health to be well adjusted to a profoundly sick society (Krishnamurti).

For Natasha Long, who was back three weeks after her third child, Jayden, was born in 2012, the worst part was missing out on bonding time with her son.

Long, who was 29 at the time, was determined to make sure Jayden got breast milk. But the factory where she worked, ACCO Office Supplies in Booneville, Mississippi, didn’t have a lactation room. So when she was on breaks, she had to run out to her truck. She sat in the cab, worried that someone might see her, and pumped, while tears rolled down her face and over the plastic suction cups attached to her breasts.

Long cried because she wanted to be holding her baby rather than sitting in the parking lot of a factory in her old Yukon Denali. But exhaustion clearly also played a role in her emotional state. Her job was simple—to place stickers with the company logo on the bottom right-hand corner of plastic binders and then box up the binders. But the shifts were long—from 6 a.m. to 6 p.m.—and she put in four or five a week. Because the factory was an hour’s drive from her home in Okalona, Mississippi, Long had only 10 hours left in the day to do everything else, including tend to her three children, spend time with Jayden’s father, and sleep. By the time she got back in the evening, her children, who were being looked after by her father during the day, were on their way to bed. To pump breast milk before leaving for work, she had to get up at 4 a.m.

After just a few days of this crazed schedule, Long began to develop strange symptoms, including a headache that never seemed to go away and a choking sensation that left her feeling breathless. She started biting her fingernails to the quick—something she’d never done before—and crying a lot. “I felt like I was alone,” says Long. “I wanted to fall off the face of the earth.” Long had never been depressed. But when she went to the doctor, he surmised that her physical symptoms were rooted in her mental state, which was itself rooted in her schedule. When her doctor said he thought she was depressed, Long worried that if child welfare authorities found out, they might take her children away. She had seen other people’s children put in foster care. But when her doctor prescribed her antidepressants, she took them.

Source: The Real War on Families: Why the U.S. Needs Paid Leave Now – In These Times

The issue here is not women’s inability to cope, it is that society’s expectations are disordered.

Here is another good article about the perils of no paid leave in the U.S.:

“I was in the car with my candidate with my brand new baby, a first-time mom, and I was driving to a fundraising meeting to shake somebody down for some cash,” Spradlin said. “I mean, I’m still bleeding. So I’m like, well, what pants do I fit into that are black, just in case I bleed through them. And these are not reasonable ways to behave. I mean, postpartum hemorrhage is a true and real cause of death of women.”

Spradlin is now a lactation consultant, a health-care professional who helps women having trouble breastfeeding. Too often, she said, “trouble breastfeeding” is really just a symptom of a deeper problem—a system that denies too many women the chance to heal and bond with their babies because they can’t afford to take more unpaid time off of work…

Source: Bleeding Wounds and Breastfeeding Hell: The Costs of No Paid Maternity Leave in America

I’ve mentioned several times before that in my ten years in breastfeeding support, I’ve more often marveled that a woman continues to breastfeed, than I’ve wondered why she doesn’t.

I feel like almost every woman I meet or every one I speak to online is seeking community. We’re looking for the “tribe,” we’re looking for the village. We don’t want to do this alone.

The truth is, creating a village sometimes just isn’t possible and there have been many times as a mom a “break” isn’t realistic. Balance, thriving, creating time for you — sometimes, those helpful tidbits tossed out to drowning moms just make me feel like yet another thing I’m failing at…

Source: To the Mom Without a Village – Babble

The problem I note with self-care advice to “ask for help,” is that most people are in similar situations–it is hard to ask for help when the people you ask, also need help!

As we muddle our way through our own home-based life, often “too busy” and “too chaotic” and “not enough time,” I absolutely loved this article about messy importance of the every-day, the real, and the complicated:

…Joy will be there waiting when we’ve adequately tidied our lives, is simply another disempowering cultural story. A story that has an entire generation of humans (and particularly mothers) feeling bad about ourselves, scrambling to “keep up,” and futilely spending billions in attempts to find solace…

Source: Revolution from Home » Blog Archive Life Is Meant to Be Messy (You’re Not Doing It Wrong)

Talk Books: Q & A with Jenny Kitzinger

Sep3

“These hands are big enough to save the world, and small enough to rock a child to sleep.”

–Zelda Brown

Childbirth education pioneer and feminist icon, Sheila Kitzinger has five daughters. After reading and reviewing Sheila’s passionate, beautiful, inspiring memoir: A Passion for Birth, published shortly before her death this spring, I did a short interview with her daughter, Jenny Kitzinger…

How has your own work been influenced by your mother?

I grew up knowing that the ‘personal was political’ – including issues such as birth, marriage and death – and believing that nothing was taboo or closed off for discussion.

My early work on AIDS, and then on child sexual abuse, as well as my most recent work on the treatment of patients in long-term coma, has all been fundamentally influenced by my mother’s approach to life and work.

What was it like to grow up with a birth activism “celebrity”?

To me my mother was just normal – so I took for granted her passion, determination and impact on the world, and the privilege we had as children of meeting lots of interesting people from the world of women’s rights, politics, and the arts.

I was struck by the focus on humanitarian work in Kitzinger’s memoir. Do you have any childhood memories of these experiences and their influence? Are you still involved in cause-oriented work as an adult?

We often had people staying who needed support – it was lovely to meet the different people who came into our home – and to see the practical support and nurture my mother offered them. Sheila was also clear that the personal was political and that alongside supporting individuals it was necessary to learn from them and work alongside them to tackle root causes of problems.

My sister Tess was centrally involved in support for refugees – a cause also close to my father’s heart (he came over to England as a refugee in 1939). I was involved in setting up one of the first incest survivors refuges. Polly was also active in disability rights, advocating for people with mental illness. Our oldest sister, Celia, is a leading campaigner for sexual equality and equal marriage.

Since my sister, Polly’s car crash in 2009, Celia and I have worked together to examine the treatment of people with catastrophic brain injuries, including rights at the end-of-life. Although we are both full professor, and publish academically, we are committed to making work accessible to families, health care practitioners and policy makers. That is why we designed an online support and information resource about the vegetative and minimally conscious state.

How many times did you hear birth stories around the dinner table?

We are a loud and talkative family. We would often discuss childbirth issues around the dinner table – alongside topics such as sex. This was fine at home, but I think when we went out to eat in restaurants I am not sure next door tables always enjoyed either the content of our lively debates, or the volume of the conversation as we became engrossed in family debate and everyone spoke at once!

What do you feel like is your mother’s most enduring legacy?

The transformation of assumptions about childbirth – alongside a broader contribution to respecting women’s experience and supporting their rights to have choice and control over their own healthcare decisions.