I am a Midwife Campaign

May22

MANA has a great educational campaign going on right now called I am a Midwife. The campaign involves a series of short videos released once a week about a variety of topics. More than just a general education campaign, each video includes a variety of different women–midwives, mothers, public health activists, maternity care activists, authors—speaking out on important topics in maternity care. Each woman also identifies, “I am a Midwife.” This week’s video is about health disparities in maternity care, which is a very important and too-often ignored topic. It raises the concern that African American women and their babies are more likely to die than their Caucasian counterparts even when other variables are equalized (i.e. same socioeconomic status, same education, etc.) and moves into wider discussions about racism and the treatment of minority group members. It then focuses on the value and role of midwifery care in addressing these concerns.

As MANA states in relationship to this campaign: “For midwives, sharing is daring. We dare to challenge the status quo. We dare to speak up for women’s innate wisdom in pregnancy and birth. We dare to assert that there is a better way for our babies to be born. And we dare to insist that birth belongs to families.”

Absolutely! The I am a Midwife public education campaign is extremely powerful. I have to confess that when it originally launched, I didn’t personally make time to watch the videos right away, somehow assuming that they were “generic” videos with a “rah, midwives!” type of message. Don’t make the same mistake I did. These are quality videos with important messages, powerful voices, and essential education and information. You will definitely learn something from watching them!

The videos aren’t only of use to birth professionals, when I teach community organizing at the college level I show videos like this as examples of activism strategies. In fact, for the final exam in that course I show the Crisis in the Crib video about infant mortality and disparities from the Office of Minority Health’s A Healthy Baby Begins With You campaign. This MANA video could be an interesting follow-up addition to the video I already use. As a related side note, during this class I also show footage from The Doula Story, a project by the Georgia Campaign for Adolescent Teen Pregnancy Prevention (whose program director I heard speak at the CAPPA conference in NC in 2010—she was amazing!). So, people do not leave my class without having heard of doulas and midwives and their relationship to community health. Go me and my mad birth activist skills! ;-D

Is there really even such a thing as second stage?

Apr13

Is there a second stage in labor? Who says so? Who thought it up and why? How did they decide what it would be and when it would start? How it would be measured? When it would end? Is there really even such a thing as second stage? If there isn’t, might it not be important for midwives to know that? Is the Earth really flat? Well, it is in some places. Mothers that lie, sit, walk, stand, crawl, glide, stride, squat, climb stairs or hills, dance, sway, cry, throw up, chant or create positions and sounds never heard or seen before are moving their baby from the inside of them to the outside of them. That’s labor. It doesn’t have stages. One thing melts and overlaps another. It starts slowly and gets bigger. It changes a mother’s breathing from light to deep. Her sounds change as her body and baby mould and mimic each other on the journey from inside to outside. By the time the baby is low so is the mother, her breathing and her sounds and her body. –Sister MorningStar in “Midwifing Second Stage” in Midwifery Today, 98, Summer 2011

After having written recently about the rest and be thankful stage and the spontaneous birth reflex and then finally about the
birth pause, the above quote caught my eye in an issue of Midwifery Today from last year (I’m trying to catch up with my stack of magazines/journals). I explain to my birth class clients that birth looks different from the outside than it feels on the inside. Perhaps from the outside we can identify stages and phases of labor. From the inside, we are just doing it and the stages and phases meld into one continuous experiencing.

I love the final comment in this quote especially–we don’t really need tips, tricks, and vaginal checks to tell us where baby is positioned. When mother gets “low” baby likely is too! This reminds me of another article I read in MT recently. (I didn’t save the actual quote, just going from memory.) It was about a traditional midwife who was asked, “aren’t you going to check her?” when a mother felt like pushing. The midwife put the tip of a finger in and the other people laughed at her—“that isn’t checking her!” She said that all you needed to do was feel for the baby’s head—it the finger only goes in a tip, that means baby is close, if it goes in up to the knuckle, baby is pretty close, if you can’t reach the head, baby will be a while. Why would you need to try to reach the cervix or know what it is doing?

I love Sister MorningStar’s writing. It is so beautiful and expressive. Some time ago, I reviewed her book The Power of Women and I highly recommend it.

Doulas at Homebirths?

Apr5

What is a doula?

A doula provides non-medical labor support—all the good stuff like back rubs and encouraging words and suggestions for different positions to help with labor. She does not replace the father’s role, but “holds the space” for both mother and father as they take their own journeys/come into their new roles as parents. In my birth classes, I explain that I think one of the benefits of a doula is that it frees the dad up to JUST be the dad and to live his own experience/journey and not have the pressure of trying to remember all the birth “tricks” and book information.

But, why have a doula at a homebirth?

A lot of women planning homebirths do not feel as much of a need for a doula as do women in the hospital. The midwife is capable of providing many of the same functions as a doula, but she also has the monitoring tasks and baby tasks to take care of, while a doula is just there for YOU. Other things to consider when thinking about a doula for a homebirth are whether or not the midwife will be bringing an assistant and what her role will be if there is one–sometimes the assistant is available to fulfill some aspects of the doula role, other times she is observing or otherwise in training for other tasks. And, also consider how many people who want present at the birth–if you’re already having a midwife, an assistant, and say a mother or sister or friend there, adding a doula too may mean too much crowding.

A couple of months ago, I solicited feedback about doulas and homebirth for an article I was compiling for the Friends of Missouri Midwives newsletter. The full article is available here: Doulas and Homebirth. I had anticipated receiving a number of responses suggesting that doulas at homebirth are unnecessary, or redundant. After all, an emotional connection and secure trust is often the hallmark of what differentiates the midwifery model from the medical model. However, the responses I received were overwhelmingly in favor of hiring a doula for a homebirth. Personally, I very much valued the specific and customized postpartum care my doula provided to me after my last homebirth and I’ve concluded that a doula has the potential to offer something unique and precious to families, in whatever setting the birth takes place. I also think that the doula is the most likely member of the birth team to remain in contact with the family in the future. Perhaps it is because, even given the friendliness of the midwifery model, there is less of a “power differential” between mother and doula.

Personal experiences

The decision to hire a doula is a personal one, regardless of in which setting you give birth. My first baby was born at a birth center with the presence of a midwife, a doctor, my doula, a friend, my mother, and my husband. In hindsight, I felt like it had been too many people and that the doula hadn’t really been needed. For my second birth, at home, it was extremely important to me to have as few people present as possible. My husband, my mom, and my son greeted the arrival of my second son. My midwife arrived five minutes before his birth—just in time to catch! My midwife for his birth was so amazing, that I didn’t feel the need for any other professional care. I still miss her! My third baby was a second trimester miscarriage and he was born at home unassisted and just my husband present. Later, a friend who is a doula was very, very helpful to me with postpartum care/doula stuff. I really wished I had a doula there during his birth for emotional support and supportive physical care tasks (not medical support, but tea bringing and towel washing).

It is the little things that matter--here my doula puts warm socks on me following my baby's January birth (baby and I had special matching birth socks knitted by my mom)

And, finally, with my last baby, while I liked and respected my midwife I didn’t have the same warm bond with her and really wanted to hire a doula again, precisely because I was missing some of the emotional component I value so highly in midwifery care. It is really the little things that make doula care so special (see included photo!). When planning my last birth, I chose to hire the same doula as with my third birth, with the primary purpose being immediate postpartum help (“washing the bloody towels and bringing me tea” is how I define it).

Talk Birth in Labor…

And, speaking of my doula, I’ve been meaning to share this photo for a long time. When my doula had her own baby last April, amongst the wonderful photos that our mutual friend took at the birth, I was tickled to see this picture of my doula looking at my website while in labor:
I think this could be an advertisement for my blog 😉

You can read Summer’s intense birth story here and also be moved to tears by the stunning birth awesomeness of her video slideshow here:

The Midwife’s Role

Apr4

From midwife Elizabeth Davis’ non-midwifery-oriented book, The Women’s Wheel of Life she explores the archetype of the Midwife and shares this story:

I recently prepared a panel presentation on the topic of “Keeping Birth Normal” for a midwifery convention, and it dawned on me how insidiously the quest for standardization has permeated this sacred blood rite. Gearing midwifery practice to a reductionist, generic view of birth is but a travesty of our time-honored proficiencies, our ancient arts. There is no “normal” birth–each is individual and nonconforming. Childbirth opens an extraordinary spectrum of physical, emotional, and spiritual growth opportunities that is nothing less than extraordinary, which women should be supported in freely exploring. The Midwife must guard parameters of safety, yes, but she should also encourage women to play their edges, experience deep currents of emotion, discover their own ways of transformation, and chart new creative territory. This is “taming” based not on repression or control but on integration, being in synch and in surrender to one’s true self. Midwives must find ways to make the unseen visible and comprehensible, they must learn to recognize and validate gut instincts, heart feelings, or any other messages coming from the body, and they must translate these perceptions into tangible action and/or words.

I recently reviewed the book More Than a Midwife and the author, Mary Sommers, has a beautiful way of describing the role of a midwife:

Midwifery is about guiding women through the internal and external journeys of their everyday lives. The birth of our children may be without regard to a fixed date and time; the experience of birth is the expression of eternity. Women in labor have the ability to transcend time and space, to regain a deep appreciation of the nature of their internal selves…She…is immersed in a journey of recognizing a part of her that had remained a mystery until this moment…

We long to have our internal and external dimensions integrated. In birth, this naturally unfolds. You do not need to be a spiritual scholar or have a daily practice to gain spiritual growth. A woman only needs to go into the experience and the spiritual journey unfolds. Nevertheless, I have also found that women who live in harmony with nature in their daily existence can access the journey more readily.

Midwifery asks us to truly become at home with ourselves, with nature, and with women. Birth takes us out of our external experiences, our linear timing of progress, and our everyday rituals. In contrast, birth time is measured in a circular movement like the seasons. There are rhythms and patterns. If we let birth unfold with spontaneity and attuned to nature, we will end up appreciating the nature of our souls as well. For women in birth, there exists a duality of time and space. They are present in both the physical and the internal dimensions. Midwives are called to not only be medical providers, but emotional guides, allowing women to get in touch with their innermost selves, the place where the soul dwells.

Both of these passages are beautiful explorations of the multifaceted and relational role of a midwife. I keep thinking I’ll have more time to explore these quotes in a more fully developed post, but I just don’t have room to do it today after all. The piece I particularly like from Davis was about there being no normal birth. I feel the same about the birth profession’s obsession with, “evidence-based care.” I’ve often asked myself, is evidence-based care enough? Do we really need to quantify everything? I think it should be a given that women receive evidence-based care. It is a travesty that it is often, apparently, too much to expect or hope for. I think women deserve loving care, respectful care, humane care, personalized care, beautiful, life-celebrating care. I think evidence-based care sets the standard too low…at obvious rather than profound.

In the second passage, my eye was caught by the phrase, “I have also found that women who live in harmony with nature in their daily existence can access the journey more readily.” Is this true in your experience? I have conflicted feelings about it. Do I live in harmony with my daily existence? My birth experiences certainly reflected a “harmony” with body, instinct, mind, and surrender. But, in daily life, while I certainly live close to nature and view it as sacred and while I choose many practices of “natural parenting” my head is often in conflict with what really is. I often find myself arguing with reality and in a mental state that feels more scattered than harmonious–and, angry with myself for not being more skilled at “surrender.” Luckily, that part neatly shuts off during labor, freeing my body to do the work of birthing with relatively little interference or struggle.

Book Review: Into These Hands

Apr2

Into These Hands: Wisdom from Midwives
Geradine Simkins
Paperback, 300 pages
Published by Spirituality & Health Publisher, 2011
ISBN: 9780981870854
Wisdom from Midwives

Reviewed by Molly Remer, Talk Birth

Into These Hands is an amazing anthology of midwives’ retrospectives about their careers and midwifery journey. You won’t find birth stories here–this is book about women’s lives and journeys to midwifery. A book of midwife stories–how women are birthed as midwives, rather than about births they attended–Into These Hands is great reading for aspiring midwives or for currently practicing midwives who wish to feel a sense of solidarity with their sisters. There are many paths, many lessons, many voices and each midwife clearly loves women and has a passion for birth.

From the press release:

We are eager for you to meet some modern-day wise women, healers, revolutionaries, and reformers. Into These Hands, Wisdom from Midwives© is a comprehensive anthology of the life stories of 25 remarkable women who have dedicated their lives and careers to the path of social change through midwifery. These exemplary midwives are all over 50 years of age with 25-40 years in the field. Collectively, they have over 800 years of experience and have assisted in over 35,000 births.

The midwives whose voices are included in the anthology come from diverse backgrounds, training, experiences, and range of practice settings. Quite a few of the stories are from “bridge club” members–women who began as direct entry midwives and later became CNMs. These midwives have a foot in both worlds and insight into the politics of the profession. In general, Into These Hands is a good look at the politics of midwifery both past and present. Almost all of the midwives in the book have homebirth roots or orientation.

Since there are lots of voices represented, the tone or style of some stories is more compelling than others. Some within-story chronology jumps were a little confusing and there were a couple of stories in which I had to do some re-reading for clarity.

Into These Hands is likely to be of particular interest to midwifery activists, aspiring midwives, or current/retired midwives and may hold less appeal for general birth enthusiasts, doulas, or childbirth educators. The stories are rich, insightful, thought-provoking, and diverse and they brought tears to my eyes several times. This book is a treasury of women’s wisdom and a powerful legacy for the generations of women to follow.

An indicator of how much I like a book is how many page corners I turn down in order to come back to re-read those sections and write blog posts based on them/share quotes/etc. This is Into These Hands last night as I was finishing it...;-D

—

Disclosure: I was provided with a complimentary copy of the book for review purposes.

A Blessing…and more…

Mar30

Rue anemone
(next to the house)

A Blessing…

May Women all be treated

as rare and holy flowers

Petals strong and fragile

rise up sacred powers

Giving

Giving

Life its very breath.

–Sarah Blogg

I read this poem in an anthology of women’s prayers, blessings, and readings and it spoke to my heart and to the heart of birthwork, of women’s work, of why I do what I do, and care about what I care about. This is what I wish for women, not just in birth, but in life. I wish for baby girls around the world to be greeted with love and joy, “oh, good! It’s a girl! Another girl! We’re so blessed!” rather than viewed as second class citizens or as property or as burdens or as objects. I wish for the lives and bodies of women to be honored and respected and for their wisdom to be cultivated.

I’m happy to be reviewing a really great book right now called Into These Hands, Wisdom from Midwives. In the introduction is a great quote that makes me think of the above sentiments as well: “Every new member of the human family arrives on Earth through the body of a woman. Each day on our planet, the majority of babies emerge into the hands of a midwife. Since the dawn of time, midwives have been receiving the generations into their hands.” –Geraldine Simkins

Birth culture

For a dozen years now, birth and breastfeeding advocacy have been areas of intense and sustained interest to me. I feel like these are core, basic women’s issues and that women in our present day U.S. birth culture, as well as women around the world, experience significant amounts of devaluation, disempowerment, and even abuse in the medical birthplace. I agree with anthropologist Sheila Kitzinger who said that, “In any society, the way a woman gives birth and the kind of care given to her and the baby points as sharply as an arrowhead to the key values of the culture.” Our current birth culture does not value women and children. Though my focus is usually on the women, it also doesn’t much value men or fathers either. I also agree with Kitzinger’s assessment that, “Woman-to-woman help through the rites of passage that are important in every birth has significance not only for the individuals directly involved, but for the whole community. The task in which the women are engaged is political. It forms the warp and weft of society.”

A popular saying in the birth activist community is “peace on earth begins with birth.” Perhaps it really means, “respecting the birth-givers, eradicates patriarchy.”

Women’s voices & social discourse

In an article by Grassley and Eschiti in summer 2011 Journal of Perinatal Education, they state, “Women’s health research is grounded in women’s voices and experience…’What matters to people keeps getting told in their stories of their life.'” I’ve written before about the value of stories and story power. I would love for us to reach a cultural point in which the most common element found in most women’s birth stories is about their own power, rather than about times in which they experienced distress and victimization. How we talk about birth and about women matters. It matters a lot. Some time ago I read an interesting article by Debra Bingham about Taking Birth Back. It it she asks you to consider–when talking about birth–how your basic assumptions affect your discourse (the way you talk about birth):

1. Does your discourse include stories about the power of women?
2. Or do the stories shift the locus of control away from women and their bodies to other authority figures such as nurses, physicians, or machines?
3. Does your discourse assume that women are physiologically capable of giving birth and nourishing their own children?
4. Or does your discourse assume that women’s bodies are fundamentally flawed and in need of medical attention and intervention?

I frequently attempt to shift the locus of control from “authority” figures back to women–it is shocking to me how ingrained the terminology is about medical care providers (even midwives!), “letting” someone do something, etc.

As I’ve previously written, the prevailing social discourse about birth assumes a locus of control external to the woman and you rarely hear stories about the “power of women” amongst the general public or mainstream media. Ditto for the assumption of women’s bodies as fundamentally flawed, except replace “rarely” with “frequently.” These messages are so dominating that I think it is hard for women to really “hear” positive birth talk–it seems like a “joyful birth” must be a myth or impossible. Likewise, when a woman is striving to keep the birth talk around her positive, it can be very difficult to override the predominately negative messages coming at her from every side. I see this in my classes, “I believe birth is a natural event, etc., etc. BUT….” (followed by a “I trust my doctor’s judgment and if he wants me to have this GTT test or this extra ultrasound to check my fluid level, etc. I guess I will do it…” comment that contributes to the “climate of doubt” in her life). There are also the woman’s own “inner voices” to contend with—I hypothesize that the loudly-shouted cultural voices about birth contribute a good deal to the “negative voice” in her inner dialog.

Women’s stories have not been told. And without stories there is no articulation of experience. Without stories a woman is lost when she comes to make the important decisions of her life. She does not learn to value her struggles, to celebrate her strengths, to comprehend her pain. Without stories she cannot understand herself. Without stories she is alienated from those deeper experiences of self and world that have been called spiritual or religious. She is closed in silence. The expression of women’s spiritual quest is integrally related to the telling of women’s stories. If women’s stories are not told, the depth of women’s souls will not be known. (Carol Christ, p. 341, emphasis mine)

Yes. May we see and hear women. May we witness them in the act of living, of birthing, of struggling, of triumphing. In surrender and in self-doubt. In exultation and joy. May we hold that space for her story. May we listen well and wisely.

Book Review: More Than a Midwife

Mar21

More Than a Midwife: Stories of Grace, Glory, and Motherhood [Paperback]
by Mary Sommers
MavenMark Books (HenschelHAUS Publishing) (October 1, 2011), 148 pages
ISBN-13:978-1595981066

Reviewed by Molly Remer, Talk Birth

More Than a Midwife is a thoroughly delightful little volume by experienced and resourceful midwife, Mary Sommers. One of the things that makes the book particularly distinctive is the impressive diversity of Mary’s work experience. The book includes stories from her work as a midwife in urban Chicago as well as in Africa and Mexico. As always, glimpsing the dire situations facing birthing women cross-culturally is a sobering reminder of the immense challenges international midwives face with few physical resources—they accomplish an amazing level of care with only their heads, hands, and hearts.

Each story shared in the book is selected with care and has an important message to share. The stories are about unique women and their unique births and what Mary (and the reader) can learn from them. From empowering and exhilarating, to difficult and heartbreaking, particularly notable are the stories that remind us all to treat every woman with dignity and respect, regardless of her life’s circumstances or choices. Mary is clearly a midwife who loves women and birth and practices with sensitivity, respect, and positive regard.

More Than a Midwife is a slim paperback. It is nice size to hold easily and the stories are short and easy to read in small chunks of free time. It is occasionally erratic in the organization/flow of a story and in a few of them I had to re-read segments to understand chronology. However, this was a negligible issue in the context of this thoroughly enjoyable small book.

Mary Sommers has written a true gem of a book. I feel honored to have read More Than a Midwife and I highly recommend it to anyone interested in birth, homebirth, midwifery, or women’s health. Most excellent!

—

Disclosure: I was provided with a complimentary copy of the book for review purposes.

Virtual Screening of More Business of Being Born!

Mar5

How exciting! Tonight birth activists and pregnant women across the country have the chance to virtually attend a free screening of one of the More Business of Being Born films: “Special Deliveries: Celebrity Mothers Talk Straight on Birth” on The Huffington Post.

From the press release:

LOS ANGELES, CA – Executive Producer Ricki Lake and Filmmaker Abby Epstein present an online screening of Special Deliveries: Celebrity Mothers Talk Straight Talk on Birth from their highly influential four-part DVD series More Business of Being Born on Monday, March 5^th at 6:00pm PST on The Huffington Post. Lake, Epstein and special guests from the film including Kellie Martin will host a live Q&A chat following the film beginning at 7:10pm PST. Viewers are encouraged to ask questions and engage in conversation with Lake, Epstein, and Martin by directing messages via twitter to @rickilake with #mbobb as the hash tag.

More Business of Being Born, a follow up to their landmark documentary, The Business of Being Born, offers a practical look at birthing options as well as poignant celebrity birth stories from stars. The virtual screening will air on HuffingtonPost.com and MyBestBirth.com. BabyCenter will host the virtual screening on their Facebook fan page.

I’m also excited that the Classroom Edition of the film premieres today. I would definitely like to add it to my birth class library.

More about the episode of MBOBB airing during the screening tonight:

Special Deliveries: Celebrity Mothers Talk Straight on Birth

Featuring celebrity moms Laila Ali, Gisele Bundchen, Cindy Crawford, Alyson Hannigan, Melissa Joan Hart, Kellie Martin, Alanis Morissette, Christy Turlington-Burns and Kimberly Williams-Paisley, Special Deliveries is a collection of intimate birth stories from a diverse group of mothers. Whether they chose to deliver at a hospital, home or birthing center, these heartfelt and humorous testimonies speak to the lasting power of the birth experience. True inspiration for any mother-to-be, this group of women trusted their bodies and intuitions, taking responsibility for their birth decisions even when things didn’t go according to plan. None of these courageous women has ever spoken on the record in such compelling detail, and, on this DVD, the filmmakers weave together their passionate narratives as a celebration of the journey to motherhood that will leave viewers with a renewed sense of amazement about the power of women.
(Running Time: 74 min)

Enjoy!

Small Stone Birth Activism

Mar1

As someone who feels deeply, passionately, and intensely about the need to transform the birth culture in the US, I have often experienced an immobilizing feeling of not doing enough. Of not helping enough. Of not being enough to affect the kind of social change I want to see happen in the world. As a mother of small children, I often feel limited with regard to the kind of large-scale changes I’d like to make in the birth world. I have been a childbirth educator since 2005 and I’m also trained as a birth doula, a postpartum doula, a prenatal fitness education, a prenatal yoga teacher, a birth art facilitator, and a breastfeeding educator. I’ve accepted that birth doula work doesn’t fit into my life right now (and even without young children, I do not know that I actually possess the strength to lend witness to the hospital birth machine). I’ve happily taught independent birth classes, usually privately in homes one-on-one, for quite a few years which feels like smaller scale change than I envision. It is also becoming less easy to integrate into the rest of my life’s responsibilities. Rather than relying only on teaching independent classes as my primary outlet for change, I enjoy discovering alternate ways of educating others about birth.

While reading the book The Mother Trip by Ariel Gore, I came across this quote from civil rights activist Alice Walker: “It has become a common feeling, I believe, as we have watched our heroes failing over the years, that our own small stone of activism, which might not seem to measure up to the rugged boulders of heroism we have so admired, is a paltry offering toward the building of an edifice of hope. Many who believe this choose to withhold their offerings out of shame. This is the tragedy of our world.” Ariel adds her own thoughts to this: “Remember: as women, as mothers, we cannot not work. Put aside your ideas that your work should be something different or grander than it is. In each area of your life—in work, art, child-rearing, gardening, friendships, politics, love, and spirituality—do what you can do. That’s enough. Your small stone is enough.”

These quotes caused me to reflect on the myriad methods of “small stone” birth activism that can be engaged in as a passionate birth activist mother embroiled in a season of her life in which the needs of her own young family take precedence over “changing the world.” We can offer the small stones of:

Speaking positively about normal, natural birth, to whomever we are speaking with whenever the topic arises.
Birth advocacy bumper stickers.
Sharing our birth stories.
Creating little informational cards (inspired by Carla Hartley’s Trust Birth Initiative cards) to seed around our communities in creative locations. I am fond of using Vistaprint and ordering their horizontal premium cards for just the cost of shipping.
Creating bookmarks with inspiring information about birth and giving them to pregnant women, handing them out at health fairs, etc.
Buying subscriptions to enlightening magazines for doctors’ offices.
Buying gift subscriptions to enlightening magazines for our public libraries.
Talking to pregnant women—my most recent approach is simply to say, “I wish you a wonderful birth!”
Responding to “action alerts” from the organizations in our states promoting healthy, normal birth and midwifery.
Supporting healthy birth related organizations with your membership. I am a member of 11 birth-related organizations. I also maintain subscriptions to a variety of magazines and journals.
Volunteering—either for advocacy organizations or directly with pregnant women.
Showing up at events, fundraisers, and rallies. Maybe we are not able to plan these events by ourselves at this point in our lives (or maybe we can!), but we can certainly show up and be counted!
Talking to non-pregnant women and girls about birth.
Giving empowering books to pregnant friends (or to not pregnant friends!).
Buying memberships to supportive organizations for friends and family members.
Give back issues of inspiring, positive magazines to people as part of your baby shower gifts.
Making donations as you are able to local chapters, statewide organizations, or national organizations promoting birth, breastfeeding, doulas, midwives, etc.
Making your birth stories available online.
Blogging about birth and about issues in the birth world (in addition to writing my Talk Birth blog since 2007, I’ve also blogged for ICEA and maintained the CfM blog).
Being an online childbirth educator—visit message boards (especially “mainstream” message boards) and give accurate, evidence based information. This has the potential to reach many people, but also can be very time-consuming (and addictive in a way) and can replace the face- to-face good you could do, so be careful with this one.
Participating in online research (such as the Birth Survey transparency in maternity care project).
Writing letters to the editor of your local newspaper educating the public about birth options and midwifery care.

Despite my persistent feelings of wishing to do more, when I examine each of my offerings, I begin to acknowledge that maybe my own small stones of effort are enough after all…

What stones do you add to the pile?

—-

Molly Remer, MSW, ICCE, CCCE is a certified birth educator, writer, and activist who lives with her husband and children in central Missouri. She is the editor of the Friends of Missouri Midwives newsletter, a breastfeeding counselor, a professor of human services, and doctoral student in women’s spirituality. She blogs about birth, motherhood, and women’s issues at http://talkbirth.me.posts.

The first version of this article was published in Citizens for Midwifery News, March 2008. Revised version published in the Fall 2009 edition of the International Journal of Childbirth Education (ICEA’s publication).

The Rest and Be Thankful Stage

Feb26

During my first labor, I experienced what Sheila Kitzinger calls the “rest and be thankful stage” after reaching full dilation and before I pushed out my baby. The “rest and be thankful stage” is the lull in labor that some women experience after full dilation and before feeling the physiological urge to push. While commonly described in Kitzinger’s writings and in some other sources, mention of this stage is absent from many birth resources and many women have not heard of it. After writing recently about the spontaneous birth reflex, I received a comment stating the following: “I was particularly interested in the idea of resting after full dilation before pushing. This makes sense if you are only following your body’s urges to push, but never something I had seen (or remember seeing?) spelled out before.”

I always make sure to tell my birth class clients about the possibility of experiencing a lull like this, because it is during this resting phase that labor is sometimes described as having “stalled” or as requiring Pitocin to “kick it off again” or as requiring directed or coached pushing. Also, think of the frequency of remarks from mothers such as, “I just never felt the urge to push.” When exploring further, it is often revealed that what the mother actually experienced was no immediate pushing urge instantly following assessment of full dilation. Depending on the baby’s position, this can be extremely normal. The way I explain it to my clients is that the lull represents the conclusion of the physiological shift happening in the uterus—the transition between contractions that open the cervix and the contractions that push the baby down and out.

As I wrote in a previous post from several years ago:

Your uterus is a powerful muscle and will actually push your baby out without conscious or forced effort from you–-at some point following complete dilation your body will begin involuntarily pushing the baby out. Many women experience the unmistakable urge to push as an “uncontrollable urge”–-but, in order to feel that uncontrollable urge, you often have to wait a little while! Though some care providers and nurses encourage you to begin pushing as soon as you are fully dilated there is often a natural lull in labor before your body’s own pushing urge begins. Some people refer to this lull as the “rest and be thankful” stage. It gives your body a chance to relax and prepare to do a different type of work (in labor the muscles of your uterus are working to draw your cervix up and open. During pushing, the muscles of your uterus change functions and begin to push down instead of pull up). If you wait to push until you really need to, you will often find that your pushing stage is shorter and progresses more smoothly that pushing before you feel the urge.

In the book, Our Bodies, Ourselves: Pregnancy and Birth they share the following important point:

“Research suggests that the length of time before the baby is born is the same if you allow one hour of ‘passive descent’ of the baby (when you relax and don’t consciously try to push) or you start pushing immediately after you are fully dilated.”

via Waiting before pushing… « Talk Birth.

That’s right, the length of time between full dilation and baby’s birth is the same, whether the mother waited one hour before pushing, or started pushing without the urge immediately following full dilation. I know which one sounds easier and more peaceful to me!

In my own experience with my first baby, I found that I felt like I should be pushing after full dilation and thus began to do so before feeling the full urge. I ended up pushing for about an hour and fifteen minutes. I suspect if I’d just continued hanging out for 45 minutes to an hour, he may have flown out in 15 minutes. Prior to pushing though, I did experience a rest and be thankful stage of about 30 minutes in which I sat in a rocking chair, joked about feeling “trippy,” and talked about being an A++ birthing woman. I describe it in my son’s birth story:

After finding out that I was fully dilated, I started to feel very odd and I really think I had to go through a sort of emotional/psychological transition to adjust myself to the fact that I had “missed” the physical transition point…I sat in the rocking chair for a while and kept saying things like, “am I dreaming? Is this real?” I also made a joke about feeling “trippy” like in Spiritual Midwifery. We also joked about what an A+ + + laboring woman I was (a family joke–I was a 4.0 student throughout college and grad school and so we always say that I like to get an A+ + + on everything I do). Those pressure feelings I had been having for a while, got a little more intense and I started pushing kind of experimentally. I was on my knees with my head on the bed on my pillow again and during one of the little pushes my water broke with a giant, startling POP and sprayed across the room including all over my friend. At this point, the midwife left saying, “I think I should call the doctor.” via My First Birth « Talk Birth.

The blog Birth and Baby Wise has some great thoughts to share on resting and being thankful (note the blog is from an educator in London, thus the use of the term Syntocinon, rather than the U.S. based brand Pitocin):

… it seems that there is little appreciation for this well documented pause amongst health professionals working in the consultant-led units of hospitals. Any stop in action once the magic ’10 cm dilatation’ is reached is met with almost instant medical intervention to get the contractions back up and running, ie a syntocinon drip. Women experiencing this are already on a consultant-led unit, where a higher level of medical intervention can be anticipated, but it is strange that there seems to be such a rush to use a syntocinon drip to get the contractions going again, providing mother and baby are both coping well.

One reason the contractions may ease temporarily is in order to allow the baby’s head to get into a better position. If this is the case, then artificially speeding contractions up is hardly likely to have the benefit of a faster birth for the woman – if anything, a slower and more complicated birth as she tries to push out a baby that is not quite in the right position. In addition, she has to cope with stronger contractions that she might find difficult to deal with, necessitating further medical help in the shape of an epidural – which in turn makes pushing the baby out even harder…

…At this stage, the woman and her partner are incredibly vulnerable to this well meant ‘help’ from midwives and obstetricians and are unlikely to question the requirement for additional medical help. It is also unlikely that the calm and relaxed environment so important for a peaceful birth can survive the worries of the health professionals, which will affect most women and their partners. via Rest and be thankful – or panic and have a drip shoved in? | Birth and Baby Wise.

I agree. In my own personal experience with my first birth, I was very vulnerable to just the perceived expectation of it being “time to push.” With later babies, it was intensely important to me that I have very few people present at the birth, knowing how sensitive I am to the expectations of those around me. It is truly only my husband and my mother than I trust to not disrupt my “birth brain” and the freedom of my birth space.

I’d love to hear more from readers about their experiences with the rest and be thankful stage.

Did you experience this lull between full dilation and pushing out your baby?

Was the lull recognized and respected by your birth attendants?

If you pushed without feeling the urge, was the pushing stage fairly long?

With subsequent babies, I had no internal checks during labor, so I never really knew if I experienced the rest and be thankful stage with them. I just pushed when my body started pushing—I have no idea how long after full dilation that was. So, I also am curious to know if women find they experience this stage with all babies, with only the first one, or with only some of their babies?

I suspect I did experience it with Alaina, because I remembering feeling concerned that contractions were suddenly “far apart.” I started talking more and analyzing myself and the labor and this was probably part of a lull in the intensity of the contraction action while my body prepared for a powerful spontaneous birth reflex.