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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.

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.

Book Review: Understanding Pregnancy and Childbirth: Your Complete Guide

Sep6

Book Review: Understanding Pregnancy and Childbirth: Your Complete Guide

By Linda Ayertey, CCCE
Resolve Medical Services, 2008
ISBN 978-9988-1-2163-1
152 pages, softcover

http://www.resolvegh.com

Reviewed by Molly Remer, MSW, CCCE

Written in simple, straightforward language, Understanding Pregnancy and Childbirth is a basic guide intended primarily for first-time mothers. It would be appropriate for clients with low literacy levels. With sections covering each trimester of pregnancy, physical changes, labor, comfort measures, and postpartum, the book is a handy, portable size that makes it easy for reference.

Published in Ghana by a midwife working in a small maternity hospital that she founded with her husband (an OB), the book contains some country-specific phrases and suggestions that may be mildly confusing to readers based in the U.S. I noted a higher than average number of minor errors in the text as well as some incorrect information (such as calling all morning sickness “hyperemesis gravidarum” and the advice to shave your pubic hair regularly because otherwise it, “may cause you to have an unpleasant odour”).

Overall, the information provided by Understanding Pregnancy and Childbirth is very basic as well as conventional. There is a nice illustrated section of positions for labor. However, the only “delivery” position described is the standard semi-sitting position and episiotomies are discussed without criticism (as are other interventions like IVs). The illustrations in the book (aside from cover image) are all of women, couples, and babies of color, which is a welcome change from many similar books on the market.

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

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.

Honesty in Birth Preparation

Aug19

Some time ago I came to the disheartening conclusion that what many independent birth educators like myself teach women in birth classes isn’t actually what they can expect, it is what they deserve. And, in our birth culture there can be a dramatic difference between the two. I then wrote an article exploring what many women can expect from a traditional hospital-based “natural” birth—it was published in Pathways magazine and has also made the rounds multiple times as a blog post. So, what then do women deserve? In my mind, they deserve: humane care; respectful, individualized treatment; freedom of movement and choice in a woman-honoring environment; informed consent; the Six Healthy Birth Practices; and the recognition that birth is a significant rite of passage and transformative life event. With this conviction, I therefore refuse to start teaching only what can be expected, because women deserve so very much more than that—but, how to professionally handle the dichotomy in class?

Published in the 80’s, the book Childbirth with Insight by Elizabeth Noble has some thoughts on the subject offer the birth educators of today. In the section addressing the issue of being honest with childbirth education clients about common obstetric practices, she says:

“…instructors in the community cannot afford to discuss obstetric practices in ways that will aggravate local hospitals and obstetricians if they wish to fill their classes. One childbirth educator comments, ‘Imagine if we told couples how it really was…perhaps we’d lose fewer teachers from our group.’ No wonder many of these dedicated and enthusiastic teachers suffer ‘childbirth preparation burnout.’ They are caught in a triple bind. If they describe accurately how birth is managed in some hospitals, couples would become very fearful. If expectant parents anticipate a warm and flexible birth environment and find that such is not the case in the hospital they use, their disappointment is inevitable and bitter. If the instructors advocate childbirth without drugs or anesthesia and these are needed, parents may harbor feelings of guilt and failure.”

The author concludes this segment of the discussion with a very potent and powerful message to birth educators:

“Each instructor must teach what she knows in her bones to be true. A dynamic teacher is constantly changing, becoming more self-aware. At the same time, couples must be warned that almost all hospitals and doctors have expectations based on the mechanical model of birth.” [emphasis mine]

This is such a difficult line to walk—to encourage confidence, trust, and joy in childbearing, while being straightforward about the challenges couples may face when seeking a natural birth experience in a hospital. I always encourage couples to “assume good intent” from hospital staff—they offer medication because they feel like they are helping and also simply because it is the primary “tool” in their medical-model oriented helping toolbox. I also remind them that routines are powerful and if the majority of births occurring at a specific hospital are induced, medicated, heavily intervened with, etc. it can be difficult to buck the trend. Again, not out of some sketchy motive from hospital staff, but simply because of routine or “this is what we always do” or “this is what mothers want from us.”

The very firey, bold, honest, and passionate 1990’s manifesto on VBAC, Open Season even more bluntly addresses the issue of transparency in maternity care and also the effectiveness of childbirth education in this quote:

“If childbirth classes really ‘worked,’ more women would be having babies without interference. More women would be recognizing the complete naturalness of birth and would remain at home, delivering their infants with feelings of confidence and trust. More and more, midwives would be demanded. The names of those hospitals and doctors who treated women and babies with anything less than absolute respect would be public knowledge, and childbirth classes would be the first place these names would be discussed. ‘You’re seeing What’s-His-Face? He’s a pig! In my opinion, of course,’ I tell people who come to my classes. I then proceed to give them the names of people who have used Pig-face. They can always ask Dr. P. for the names of people who have used him and been satisfied with their births, for balance.”

While I’m not personally to the point of taking the “Dr. Pig-face” approach from Open Season, I’ve decided that honesty is the best policy and I’ve started to be very upfront about my challenge with the couples in my classes. Lately, I say, “here’s where I’m wrestling with something. I’m teaching you what you deserve, but it isn’t necessarily what you can expect…” and we proceed to explore choices, talk about communication skills, talk about evidence-based care, making sure the care provider’s words and actions thus far are matching, etc. However, my basic dilemma remains—I am not changing a broken system by teaching individual couples how to navigate it more satisfactorily, I’m actually supporting the broken system (right?!). While one-on-one change efforts have value and are personally rewarding, what I know in my bones to be true is that what we actually need is widespread maternity care reform and systemic change on a global level…

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(I originally posted some content from this post on the ICEA blog.)

Childbirth Educator as Midwife…

Aug14

“Expectant mothers need to be mothered; their hearts need to be infused with love, confidence, and determination. I now see myself as ‘midwife’ to the gestation and birth of women as mothers.”

–Pam England

This is a beautiful quote that really speaks to how I wish to work with women and what I would like to accomplish.

As I’ve noted before, I have a big binder of back issues of  the International Journal of Childbirth Education and they are a real treasure. Here are several quotes that relate to the sentiment above:

From the Sept. 1999 issue in an article called The Challenge of Change: Making Mother-Friendly Care a Reality in Childbirth Education by Mayri Sagady comes a discussion of educator as “banker” or “midwife”:

[the concept of]..traditional education as ‘banking.’ This is where the role of the teacher is to ‘make deposits of information’ into the student’s mind. The student’s job is simply to ‘store the deposits’…the teacher as midwife [is explained as] ‘Midwife-teachers are the opposite of banker teachers. While the bankers deposit knowledge in the learner’s head, the midwives draw it out. They assist the students in giving birth to their own ideas, in making their own tacit knowledge explicit and elaborating it’…Within the field of childbirth education today, there are surely both ‘bankers’ and ‘midwife-teachers’

Then in the December 1999 issue in an article by Celeste Phillips called Family-Centered Maternity Care: Past, Present, & Future, she offers three challenges for 21st century birthing educators:

+”Help men and women understand that birth itself has the potential to change lives for the better.”

+”Give women a sense of fulfillment and tremendous accomplishment.”

+”Give new parents a strong connection to the very essence of life.”

These are formidable—and exciting—tasks! I think it is important to examine our own birth education programs to see how well we are meeting these challenges and also to strive to serve our clients as midwife-teachers rather than as of bankers of information.

And circling back around to my opening quote,  I am reminded of another good one, this one from Midwifery Today’s founder/editor, Jan Tritten:

“You will have ideas, options and paths to ponder, but you will also have a sense of possible directions to take as you consider midwifery, childbirth education, or being a doula or an activist. Your path may be circular or straight, but meanwhile you can serve motherbaby while on the path, with a destination clearly in mind.” She also says, “I use the word midwife to refer to all birth practitioners. Whether you are a mother, doula, educator, or understanding doctor or nurse you are doing midwifery when you care for motherbaby.” (emphasis mine)

And What’s This? More Birth Quotes!

Aug9

I decided to split my most recent Facebook quote sharing into two posts, because it was becoming overwhelmingly long. These are the quotes I’ve shared on the Citizens for Midwifery Facebook page since April. While I realize that I don’t “own” these quotes—other people said them, not me!—I do have quite a bit of legwork invested in seeking and sharing these quotes (I mostly get them from my own reading) and if you re-post one or more of them on your own Facebook page, blog post, or book, I really appreciate acknowledgement and/or link back to this site or to my FB page, that this is where you originally got the quote!

‎”When a woman births without drugs…she learns that she is strong and powerful…She learns to trust herself, even in the face of powerful authority figures. Once she realizes her own strength and power, she will have a different attitude for the rest of her life, about pain, illness, disease, fatigue, and difficult situations.” –Polly Perez

“It is a curious commentary on our society that we tolerate all degrees of explicitness in our literature and mass media as regards sex and violence, but the normal act of breastfeeding is taboo.” – American Academy of Pediatrics (via Baby Bloom Doula Service)

“The way a society views a pregnant and birthing woman, reflects how that society views women as a whole. If women are considered weak in their most powerful moments, what does that mean?” –Marcie Macari

“Attempting to fulfill an idea of the ‘perfect’ mother can only prove soul-destroying, as no such person exists.” –Adela Stockton

“In the sheltered simplicity of the first days after a baby is born, one sees again the magical closed circle, the miraculous sense of two people existing only for each other.” –Anne Morrow Lindbergh

Giving birth is an experience carried not only into the first days of motherhood but also throughout life, having far-reaching effects on the mother’s self-esteem and confidence.” –Gayle Peterson

‎”I think one of the best things we could do would be to help women/parents/families discover their own birth power, from within themselves. And to let them know it’s always been there, they just needed to tap into it.” –John H. Kennell, MD

“As doulas, midwives, nurses, and doctors, it’s important to never underestimate how deeply entrusted we are with someone’s most vulnerable, raw, authentic self. We witness their heroic journeys, see them emerge with their babies, hearts wide open…” –Lesley Everest (MotherWit Doula)

“…advocates of home birth have never suggested that *all* women should give birth at home, only that it is a reasonable choice for some women. Given that rather modest claim, the force and vehemence with which home birth is opposed by ACOG seems out of all proportion.” –Elizabeth Armstrong (Princeton University)

“Few healthy, low-risk mothers require technology-intensive care…Yet…the typical childbirth experience has been transformed into a morass of wires, tubes, machines and medications that leave healthy women immobilized, vulnerable to high levels of surgery and burdened with physical and emotional health concerns…” –Maureen Corry (quoted in Lamaze International‘s journal)

“At a time when Mother Nature prescribes awe and ecstasy, we have injections, examinations, and [cord] clamping… Instead of body heat and skin to skin contact, we have separation…Where time should stand still for those eternal moments of first contact as mother and baby fall deeply in love, we have haste to deliver  the placenta and clean up for the next ‘case.'” –Sarah Buckley

“Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be?” – Marianne Williamson

“…celebrate ourselves for our courage to birth. The real question becomes not, ‘Have you done your breathing exercises?’ but rather, ‘Can you love yourself no matter how you birth, where you birth, or what the outcome?'” –Claudia Panuthos

“Whenever a woman has a problem, I believe that she herself can find the answer, provided she is given adequate information and support. I firmly believe in women’s strength and resourcefulness; I’ve witnessed these time and again. Women care about the continuation and continuity of life; they are intrigued by relationships, how things fit together.” –Elizabeth Davis

“Deep relaxation, surrender, letting go: when midwives are asked to disclose the secret of giving birth with relative ease, these are the words we choose. More than metaphors for coping, these responses are based on physiological imperatives…” –Elizabeth Davis

“The greatest joy is to become a mother; the second greatest is to be a midwife.” –Norwegian Proverb

‎”Brick walls eventually crumble precisely because people keep busting their heads against them.” –Barbara Wilson-Clay (IBCLC)

“Some midwives pull women up the hill and say I will get you through this. Other midwives walk behind quietly and gently say, ‘I believe in you.'” -Patricia M. Couch (via Wellpregnancy Childbirth Educator Trainings and Childbirth Classes)

‎”In our own world today, motherhood is rarely sufficiently honored. One day each year, there are brunches and corsages and little gifts of love. But the rest of the time? As a culture, we do not respect the great gift of mothering. Women’s work in raising the next generation is taken for granted. Yet it is a vital service to humanity, one that deserves to be acknowledged continually.” –Patricia Monaghan

‎”Becoming a mother does not need to rob you of your selfhood. Stay away from martyrdom. Martyrs never make good mothers; what is gained in giving is taken away in guilt.” –Gayle Peterson

“The midwife cannot be skilled without being caring. She cannot be truly caring without being skilled.” –Sheila Kitzinger

“The two most beautiful sights I have witnessed in my life are a full blown ship at sail and the round-bellied pregnant female.” –Benjamin Franklin

“When you have a baby, your own creative training begins. Because of your child, you are now finding new powers and performing amazing feats.” –Elaine Martin

“…in a time lacking in truth and uncertainty and filled with anguish and despair, no woman should be shamefaced in attempting to give back to the world, through her work, a portion of its lost heart.” –Louise Bogan

“If the baby’s body is a joy and a delight in the mother’s arms, that same body will become a joy and a delight to its owner later on.” –English & Pearson

“Even if I am simply one more woman laying one more brick in the foundation of a new and more humane world, it is enough to make me rise eagerly from my bed each morning and face the challenge of breaking the historic silence that has held women captive for so long.” –Judy Chicago

“Children are the power and the beauty of the future. Like tiny falcons we can release their hearts and minds, and send them soaring, gathering the air to their wings…” –Skip Berry

“Mama exhorted her children at every opportunity to ‘jump at de sun.’ We might  not land on the sun, but at least we would get off the ground.”- Zora  Neale Hurston (via Literary Mama)

“That they can strengthen through the empowerment of others is essential wisdom often gathered by women. “—Mary Field Belenky (via Applaud Women)

“Since beliefs affect physiologic functions, how women and men discuss the process of pregnancy and birth can have a negative or positive effect on the women that are involved in the discussion. Our words are powerful and either reinforce or undermine the power of women and their bodies.” –Debra Bingham (I was inspired to share this quote today by a conversation with Kerry Tuschhoff 🙂

“Learn to respect this sacred moment of birth, as fragile, as fleeting, as elusive as dawn.” ~ Frederick Leboyer (via From Womb to Cradle Doula Services)

‎”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)

“Birth is women’s business; it is the business of our bodies. And our bodies are indeed wondrous, from our monthly cycles to the awesome power inherent in the act of giving birth.” –Sarah Buckley

“When a man is truly ‘present’ for the birth of his child and allows himself to be touched by the mystery unfolding before his eyes, he will have an unquestionable experience that can catapult him into the next phase of his development as a mature human being. His encounter with the power of birth…can connect him to his partner and his child in ways that sustain him for the rest of his life.” –John Franklin

“When he becomes a father, a man leaves behind his life as a single individual and expands into a more inclusive role. He becomes a link in an unbroken chain. And in doing so, he himself undergoes a birth process–the birth of himself as a father.” –John Franklin (FatherBirth)

‎”We are volcanoes. When we women offer our experience as our truth, all the maps change. There are new mountains. That’s what I want to hear–to hear you erupting. You Mount St. Helenses who don’t know the power in you–I want to hear you…If we don’t tell our truth, who will?” –Ursula K. Le Guin

“For most people, modern life meanders along a path of ups and downs, by and large devoid of high-voltage experiences that have the power to alter our lives in significant ways…The birth of a child is one of those significant experiences.” –John & Cher Franklin (FatherBirth)

“Pregnancy and labor are periods of vulnerability. This vulnerability is not weakness, but softness, which later contributes to adjustment to motherhood. Feeling dependent may open you to your need for help, and the ability to accept help from others can increase your strength and endurance for labor. Each of us must come to terms with our own feminine strength and our need for protection.” –Gayle Peterson (An Easier Childbirth)

“Labor is also teamwork. It is a mother and baby learning together how to push and how to be born, how to yield and separate from the union of pregnancy. You are not in control nor are you out of control during labor. The best way to approach labor is with an attitude of learning rather than controlling.” –Gayle Peterson (An Easier Childbirth)

“Midwifery calls upon you to be the best you can be: the best advocate, guide, healer, counselor, mother, comrade, and confidant of the women seeking your care.”— Anne Frye

“The birth of a baby is the birth of family. Myriad births take place at once: Women become mothers, husbands become fathers, daughters become sisters, and sons become brothers. One birth ripples through generations, creating subtle shifts and rearrangements in the family web.” –Gayle Peterson

“The family’s trust in the midwife and the midwife’s trust in the competence of the family members are the basis of caring that has the power of magic.” ~ Mary C. Howell (from Midwifery Today e-news)

“Birth is not a cerebral event; it is a visceral-holistic process which requires all of your self–body, heart, emotion, mind, spirit.” –Baraka Bethany Elihu (Birthing Ourselves into Being)

“Fear is completely intertwined with what we experience as labor pain…And it is the fear in our physicians and nurses as much as the fear within ourselves.” –Suzanne Arms (Immaculate Deception II)

“There is no place for ideology in birthing. Each birth has its own story and we must respond to what the baby tells us.” –Spinning Babies.com (via Kelly Caldwell)

I do think there is a place for ideologies/philosophies about birth and as guides for humane care/practice and as guides for making prenatal care and birth care decisions (before the birth), but in the actual moment, release of attachment is often necessary.

“To be pregnant is to be vitally alive, thoroughly woman, and undoubtedly inhabited.” ~Anne Buchanan (via CAPPA)

“Your doc/friend/mother-in-law may be saying, ‘Don’t be a hero, get the epidural!’ But this isn’t about heroics, this is about protecting your body…” –Jennifer Block (via @Spirited Doula Services)

“Giving birth in ecstasy: This is our birthright and our body’s intent. Mother Nature, in her wisdom, prescribes birthing hormones that take us outside (ec) our usual state (stasis), so that we can be transformed on every level as we enter motherhood.” –Sarah Buckley

“The mystery of life and birth is a profound invitation to be authentic as you trust and tremble your way through labor’s Gates of doubt and fear. It is possible that you will become more intuitive during labor than at any other time…Allow your body to guide you in your breathing, in your unique movement, in knowing …what to do…even when you don’t know what to do.” –Pam England (The Labyrinth of Birth)

“Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience and the passion to reach for the stars to change the world.” ~ Harriet Tubman (via Midwifery Today e-news)

“Midwives can create a spirit of beauty at a birth or they can desecrate it. They can create a sacred space around a birthing woman that drives out fear & inspires the mother’s belief in herself, which ultimately determines the outcome of the birth. Midwives can be a channel of Grace in ways they never imagined & in doing so they create a spirit of reverence. Reverence in these days and times is not a common thing.” Caroline Wise, Birthing with Reverence (Midwifery Today)

Re: “advice” for someone who is pregnant: “…if you know that you are pregnant and if you know when you conceived your baby and you think that everything’s okay, doctors can probably do nothing for you. Women need to realize that the role of medicine in pregnancy is very limited…What’s important is for a mom-to-be to be happy, to eat well, to adapt her lifestyle to her pregnancy, to do whatever she likes to do…I think that’s what we have to explain to women. They have to realize that doctors have very limited power.” –Michel Odent (in Optimal Birth)

Birth Quotes Update

Aug9

Time for my semi-regular re-sharing of birth quotes I’ve shared on my Talk Birth Facebook page in the last several months (there are also a few grief/miscarriage quotes mixed in as well as some activism quotes too). While I realize that I don’t “own” these quotes—other people said them, not me!—I do have quite a bit of legwork invested in seeking and sharing these quotes (I mostly get them from my own reading) and if you re-post one or more of them on your own Facebook page, blog post, or book, I really appreciate acknowledgement and/or link back to this site or to my FB page, that this is where you originally got the quote!

“…in not disturbing the laboring woman you’re not handing over all control to her…it’s not a question of handing control to the laboring woman, it’s a question of *not controlling* her…while she’s in labor and giving birth physiologically, she’s going to seem well and truly out of control–totally wild!–so the issue of control seems a pretty irrelevant one really.” –Sylvie Donna (Optimal Birth)

“I see my body as an instrument, rather than an ornament.” ~Alanis Morissette, quoted in Reader’s Digest, March 2000 via Denver Doula

‎”Expectant mothers need to be mothered; their hearts need to be infused with love, confidence, and determination. I now see myself as ‘midwife’ to the gestation and birth of women as mothers.” –Pam England (Birthing from Within)

‎[re: “surrender” during labor] “…She may refer to this as the feeling of surrender; but this kind of surrender is a gift, not something she herself did with her mind. At this point the body truly takes over and the thinking mind recedes into the background. This may be how women historically and presently, are able to labor without mental suffering and without pain medication.” –Pam England (Labyrinth of Birth)

This feels true from my personal experiences–I feel like the most important thing anyone can know about birth is to welcome that surrender (to let go of control) and also about the value of *freedom* in enabling the surrender to happen (freedom in the physical space–i.e. no one “letting” you drink or not drink or labor in bed or out of bed).

“[re: ecstatic birth] This exquisite hormonal orchestration unfolds optimally when birth is undisturbed, enhancing safety for both mother and baby. Science is also increasingly discovering what we realise as mothers – that our way of birth affects us life-long, both mother and baby, and that an ecstatic birth —
a birth that takes us beyond our self — is the gift of a life-time.” –Sarah Buckley

“When you don’t follow your nature there is a hole in the universe where you were supposed to be.” –Dane Rudhyar (via Marian Thompson, LLL Founder)

‎”Birth is what women do. Women are privileged to stand in such power! Birth stretches a woman’s limits in every sense. To allow such stretching of one’s limits is the challenge of pregnancy, birth, and parenting. The challenge is to be fully present and to allow the process because of inner trust. How can women find their power, claim it, and stand firm in it throughout?” –Elizabeth Noble

(Her answer: “vertical birth”–thus, to quite literally STAND in one’s birth power!)

‎”…it is not easy for women to lay claim to our life-giving power. How are we to reclaim that which has been declared fearful, polluting and yet unimportant? How are women to name as sacred the actual physical birth, which comes with no sacred ritual…?” –Elizabeth Dodson Gray

‎”A woman’s path to power is more like engaging life’s energies in a swirling movement filling us up, out, into wholeness.” –Lois Stovall

“The body has its own way of knowing, a knowing that has little to do with logic, and much to do with truth, little to do with control, and much to do with acceptance…” –Marilyn Sewell (via Mothering Magazine‘s pregnancy e-newsletters)

“…much of what passes for childbirth education and preparation today actually increases women’s fears by giving them too much concrete information to hang their anxiety on, and too many names for all the bad things they already fear will happen. In the course of trying to calm the higher brain by giving it lots of data, we can end up defeating our purpose by feeding our fears.” –Suzanne Arms (Immaculate Deception II)

“We take for granted in the United States that childbirth is a multi-million dollar industry. It’s as simple as that–women’s bodies and the act of creation are intertwined with the economy. What if our relationship with body and womb and birth was in every sense of the word FREE? What if we didn’t need managed care? Literally or figuratively?” –Baraka Bethany Elihu (Birthing Ourselves into Being)

Reader responded with a question about, “how do we teach our children about birth?” and this was my short answer:

I think by talking about is as something that is a “normal” as can be–i.e. not scary and dangerous–and by not “hiding” birth from them like it is a secret. My kids have seen all kinds of natural birth videos, pictures in books, etc. When …my older son was only 3 1/2 he drew me a picture with the baby attached to the mom with an umbilical cord (both with big smiles on their faces) and the placenta in bowl next to them (which of course couldn’t actually be there unless the baby was not still attached to the mom with the cord). 🙂

“I am starting to see that a woman’s strength in birth is also in the letting go and allowing herself to tumble fearlessly with the current, never losing sight of the belief that, when the energy of the tide is through, she will find herself upright again on the shore.” –Maria (at the blog A Mom is Born)

“Because parents are transients in the maternity care system, there is little cumulative birth experience over successive generations of mothers. Women giving birth don’t make the same mistakes as their mothers or grandmothers–they make new ones.” –Elizabeth Noble (Childbirth with Insight)

‎”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 (Lamaze International)

“Fathers’ sharing in the birth experience can be a stimulus for men’s freedom to nurture, and a sign of changing relationships between men and women. In the same way, women’s freedom to give birth at home is a political decision, an assertion of determination to reclaim the experience of birth. Birth at home is about changing society.” –Sheila Kitzinger

(Emphasis mine.) Posted in honor of Independence Day!

I’ve noted that many women (including myself) cite “freedom” as one of the main reasons they choose out-of-hospital birth…

‎”Labor is not a time to judge ourselves but a period for reflecting on our movement through life at a given moment. It is not possible to control labor, it is only possible to follow the process and to meet whatever it may offer.” –Gayle Peterson (An Easier Childbirth)

“There is an urgent need for childbirth education for doctors and nurses so that, instead of superimposing a medical perception of birth, professional helpers listen to, learn from, and respect women’s experiences. Only in this way shall we be able to humanize the culture of birth.” –Sheila Kitzinger (forward in An …Easier Childbirth by Gayle Peterson)

The book was written in 1993 and I think we still haven’t figured that out yet…:(

‎”The absolute miracle of a birth and the emergence of a new human being into the world catapults both mother and father into the realm of awe and wonder. They are flooded with non-ordinary feelings and energies that support a deep connection not only with the newborn and each other, but also with the mystery and power of life itself.” –John & Cher Franklin

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‎”A strong woman knows she has strength enough for the journey, but a woman of strength knows it is in the journey where she will become strong.”

“A strong woman isn’t afraid of anything, but a woman of strength shows courage in the midst of her fear.” (from the same “Woman of Strength” poem as above quote, author unknown, many internet versions floating around)

“When I dare to be powerful–to use my strength in the service of my vision–then it becomes less and less important whether I am afraid.” –Audre Lorde

“Despite hundreds of years of negative programming, labor and birth can be a soul-stirring experience!” —Christiane Northrup, MD

“The labor and birth experience itself is a microcosmic slice of what fathering asks of a man.” –John Franklin (FatherBirth)

‎”…an experience of the phenomenal capacity of our birthing body can give us an enduring sense of our own power as women. Birth is the beginning of life; the beginning of mothering, and of fathering. We all deserve a good beginning.” –Sarah J. Buckley

“Birth privacy is important because it fosters FREEDOM and that sense of freedom is fundamental to birthing unhindered and with joy.” –Molly Remer (my contribution to the book/DVD giveaway on Orgasmic Birth: The Best Kept Secret (fan page))

“Cautious, careful people, always casting about to preserve their reputation and social standing, never can bring about a reform.” Susan B. Anthony

“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.” –Giuditta Tornetta

Love this –the “might of creation.” How true!

“Day by day, month by month, year by year we are confronted with all that we do not know, that we do not understand, that we do not grasp. Sometimes we are humbled by this knowledge and say: God, it is too wonderful for me to comprehend but I know this universe is more grand and more beautiful than I ever could have imagined and I give thanks for the blessing of being here and seeing, hearing, experiencing, and sensing all that is so wonderful around and in me…” –Susan L. Suchocki

“Life is full and overflowing with the new. But it is necessary to empty out the old to make room for the new to enter.” —Eileen Caddy

“Once the baby is born, your life will change forever. It will change in so many ways, and until you get there you simply can’t be told. The joys, the sorrows, the excitement, the fear, the frustrations–in fact, I think all the adjectives in the world couldn’t describe what is in store for you.” –Giuditta Tornetta

‎”I love to think that the day you’re born, you’re given to the world as a birthday present.” –Leo Buscaglia (shared on my second son’s fourth birthday)

“Wherever women gather together failure is impossible.” –Susan B. Anthony

“I believe with all my heart that women’s birth noises are often the seat of their power. It’s like a primal birth song, meeting the pain with sound, singing their babies forth. I’ve had my eardrums roared out on
occasions, but I love it. Every time. Never let anyone tell you not to make noise in labor. Roar your babies out, Mamas. Roar.” –Louisa Wales

“…The motherhood mosaic has pieces that are dark and dull, but it’s a work that shines.” –Carol Weston

“Women’s bodies have near-perfect knowledge of childbirth; it’s when their brains get involved that things can go wrong.” –Peggy Vincent (via Sweet Miracles

“A child strips away our illusions that we are perfect, that we have it all figured out, that we are all grown up. In fact, we grow up with our children if we are willing to remain open to their innate goodness as well as our own.” –Peggy O’Mara

“The suckling relationship is one of the sources of real sweetness that we have in human existence…The suckling baby can teach adults about the expression of sweet love and gratitude in a way no words can.”
–Ina May Gaskin

“Unfortunately, birthing woman has not only lost touch with her body and with her ancient female lineage. She has also lost her voice to speak up, to question intervention, to ask for support, to demand respect for the work of giving birth and caring for her infant. When she finds that voice, she will regain a vital part of her creativity and power as a woman.” –Suzanne Arms (Immaculate Deception II)

“Pregnancy is a time of being in touch with the power of creation itself.” –Rahima Baldwin & Terra Richardson

“We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop.” –Mother Teresa

‎”Childbirth calls into question our very existence, requiring an expectant couple to confront not only new life but death, pain, fear, and, most of all, change.” –Elizabeth Noble (quoting a new mother)

“Hope is the thing with feathers, That perches in the soul, And sings the tune without the words, And never stops at all…” –Emily Dickinson

‎”We may tell ourselves that birth is a natural and safe process and recall our childbirth teacher’s emphasis that a woman’s body is designed for giving birth, but our own bodies may hold a different truth. It is essential to honor body memory, as it wields far more influence than the intellect during labor.” –Gayle Peterson (in An Easier Childbirth re: working through birth memories in preparation for future births)

“If a community values its children, it must cherish its mothers.” -John Bowlby

“Just as a tree grows best when anchored firmly in the earth, so can a pregnant mother feel strong and capable when supported by a sisterhood of nurturing friends.” -April Lussier

“Planning for birth is like getting ready for an athletic event…You can’t predict exactly what is going to happen; the events of the game will unfold according to their own particular logic, and not necessarily
according to your plan.” –Adrienne Lieberman

“If we don’t take care of mothers, they can’t take care of their babies.” –Jeanne Driscoll

“And I also know how important it is in life not necessarily to be strong but to feel strong, to measure yourself at least once, to find yourself at least once in the most ancient of human conditions, facing blind, deaf stone alone, with nothing to help you but your own hands and your own head…” –Christopher McCandless

‎”When you are drawing up your list of life’s miracles, you might place near the top the first moment your baby smiles at you.” –Bob Greene

I have crystal clear memories of my second baby’s first smile (the day of birth–looking into my eyes) and of my first baby’s first laugh. Less clear memories of the FIRST smile for my firstborn and first laugh for my second. I guess it is good that they each get one of the special, miracle moments!

“Midwives do NOT empower women. Only women can empower themselves. If you’ve been empowered through birth, thank your midwife for holding the space – but know that it was surely YOU that created and walked the journey” -Pamela Hines (via Barbara Herrera)

“Though we have lost a petal, we are still flowers, lush and full together in a garden of hope.” -Angie M. Yingst

‎”Once her endorphins have kicked in, a woman may actually enjoy labor or may even find it an ecstatic experience. I have many times told the story of one of my clients who was crying and desperate in early labor, only to be smiling and dancing around the room at nine centimeters’ dilation.”–Elizabeth Davis

“Life shrinks or expands in proportion to one’s courage.” –Anais Nin

“Giving birth requires an honest surrendering of your body and soul. You need to be in a relaxed state of love. Love has a way of overpowering fear. The more energy-draining feelings you can unload, the more room you will have for bliss and simplicity. Birth can be an unfolding and emergence like something you’ve never experienced before.” –Lynn Griesemer

“Labor is like mothering: you prepare and do the best you can, but finally, most of it is out of your hands. Birth is a great mystery. Yet we live in a rational, scientific world that doesn’t allow for mystery…” –Jennifer Louden

‎”Although the popularly desired outcome is ‘Healthy mother, healthy baby,’ I think there is room in that equation for ‘Happy, non-traumatized, empowered and elated mother and baby.’” –Ashley Booth Youn

[in reference to before she had her baby] “…I thought the only thing that was important…was to have a healthy baby. Now I recognize that while this is the primary goal, it is not the only goal. Birth is such an emotional experience; it can give or take away so much more than I ever realized…it will change you in such a wonderful and powerful way. It gave me more strength than I ever imagined. Since then, whenever I become overwhelmed, all I have do to is say, ‘I had a baby in my home!’ I am instantly empowered.”–Jody Niekamp (in Journey into Motherhood)

‎”10% of births needfully culminate in intervention. Self-esteem depends on salvaging the most important truth from your experience: Birth cannot be controlled. It is a mystery.” –Karen Fisk

“As doulas, midwives, nurses, and doctors, it’s important to never underestimate how deeply entrusted we are with someone’s most vulnerable, raw, authentic self. We witness their heroic journeys, see them emerge with their babies, hearts wide open…” –Lesley Everest (MotherWit Doula)

“Not every woman experiences unaided, natural childbirth, yet many women hope for it. To strive for birth as a peak experience—to withstand this ‘trial by fire’–a woman must learn what labor pain is and be prepared to accept and work with it. And she must also prepare for the unexpected.” –Karen Fisk

‎”It is so easy to close down to risk, to protect ourselves against change and growth. But no baby bird emerges without first destroying the perfect egg sheltering it. We must risk being raw and fresh and awkward. For without such openness, life will not penetrate us anew. Unless we are open, we will not be filled.” –Patricia Monaghan

“A Life may last for just a moment…. but a memory can make that moment last forever…” (Unknown)

“Birth is an experience that demonstrates that life is not merely function and utility, but form and beauty.” –Christopher Largen

“Birth matters. It brings us into being, on many levels.” –Ananda Lowe

‎”The way a society views a pregnant and birthing woman, reflects how that society views women as a whole. If women are considered weak in their most powerful moments, what does that mean?” –Marcie Macari

“Shrouding information about birth in silence hides the fact that labor and birthing pain is a positive key to transformation. Preparation for and expectation of that pain leads to self-awareness. Thus, birth becomes not only a passage for your child, but a passage for you into instinctual and effective parenting.” –Karen Fisk

What To Do When Newly Pregnant and Wanting a Natural Birth…

Aug4

Last month, a friend of my younger sister’s emailed to ask some questions about natural birth. She is newly pregnant and very interested in her birth choices (yay! How exciting!). I shared a couple of ideas with her and thought I would share them with my blog as well:

It can be hard to know where to start—there is SO much information out there. I would suggest getting a good, informative book—though I haven’t yet read it myself, Your Best Birth is a new book that is supposed to be good and very “balanced” at helping you make the choices that are right for you. I also have a suggested reading list here.  Mothering Magazine’s Having a Baby, Naturally is also quite good. Speaking of Mothering Magazine, their discussion boards are PACKED with good information and they all come from a natural/holistic perspective (a lot of other message boards have more of an “epidural soon!” culture). You can join a “due date club” there, etc. There is a whole forum just for birth stuff (and a subforum for homebirth), etc. Good resource, as is their entire website. Other good guides include Lamaze’s book Giving Birth with Confidence. One of my favorites as a really good “basic”/intro guide for pregnancy and birth is Pregnancy, Childbirth, and Newborn by Penny Simkin. A brand new edition is out, so think about checking it out!

Particularly if you plan to have your baby in a hospital, a doula would be a really good addition to your birth “team.” Doulas provide non-medical labor support and are there just to support YOU and what you want. It is really good to have continuous labor support. And, she does not replace your partner—he has his own “journey” to take into becoming a father and having a doula there frees him of a lot of the pressure of trying to be your “doula”—he can just be there with you, loving you, rather than trying to remember all kinds of stuff from books!

I would also suggest finding a good independent childbirth educator to take birth classes from when you get closer to your due date (one who doesn’t work in a hospital—it doesn’t matter if you plan to give birth in a hospital, an educator who works for herself instead of for somewhere else, is better able to give you complete information instead of just teaching about the “rules” of that particular location). Read more about “why independent classes” here.

Most of all, spend time celebrating your changing body and marveling at its inherent wisdom. Take time each day to “tune in,” draw inward and connect with your baby. Honor your natural rhythms—eating when you’re hungry, resting when you’re tired. Be gentle and loving with yourself. Know that you already have everything you need within you and strive to create a birth environment that encourages that inner wisdom to blossom and fully respects your right to freedom in birth.