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The Impact of Birth on Breastfeeding

Jul31

Just in time for the start of World Breastfeeding Week, here is part 3 of my CAPPA re-cap series!

…they want you to believe it’s their power, not yours…They stick needles into you so you won’t hear anything, you might as well be a dead pig, your legs are up in metal frames, they bend over you, technicians, mechanics, butchers, students, clumsy or sniggering, practicing on your body, they take your baby out with a fork like a pickle out of a jar.

–Margaret Atwood in her novel Surfacing (opening quote of Dr. Jack’s presentation at the 2012 CAPPA conference)

As I mentioned, my favorite part of the CAPPA conference was hearing Dr. Jack Newman speak about controversies in breastfeeding (see next post) and then about the impact of birth on breastfeeding (breakout session). He was an amazing speaker. Very straightforward and almost blunt as well as funny and fast-paced. I really feel glad to have had the chance to see him in person after years of being familiar with his materials.

The notion of the birth-breastfeeding continuum isn’t new to me, having actually published articles about it previously, however Dr. Newman’s phrasing, descriptions, and reminders was just so perfect that it left me feeling even more enthused about the inextricable link between birth and breastfeeding. It is a biologic continuum that nature does not see distinct events—baby is born and goes to breast, it is part of the same event. Drawing on Diane Wiessinger’s work, Dr. Newman explained

With animal births: following a normal birth, infant feeding just…happens. Following an interventionist birth, the mother rejects the baby and there is no nursing at all.

In some hospitals, separation of mother and baby is routine as a way to “prevent” postpartum mood disorders. Dr. Jack’s own theory was that perhaps human mothers turn this “rejection” against themselves and it shows up as a postpartum mood disorder.

Babies NEED and expect to be with their mothers after birth. It is of critical importance. As I shared via Facebook, Dr. Jack explained this:

Know how much an incubator costs now? $50,000. Why don’t we just give half of that money to the mother and put the baby skin to skin on mother’s chest?

And, this gem:

“Our hospital births break every rule in the mammalian list of mother-baby necessities.” –Dr. Newman

He also noted that if baby is put skin-to-skin on mother immediately after birth regardless of original intention, the pair will breastfeed. It is biologically programmed.

Why do hospital births break the rules?

Because, as Dr. Newman explained we have a big, big problem in that HCPs do not recognize the critical importance of breastfeeding. He also repeatedly emphasized (in a very funny way) that there are many people who don’t know squat about breastfeeding and breastmilk and don’t feel like they need to learn anything before they start doing studies and writing papers about it.

Dr. Newman also emphasized the important point that the burden of proof rests upon those who promote an intervention! He was speaking with regard to recommending formula supplementation, but I strongly believe it applies to any birth practice. So simple and yet so profound. One example that he shared that is familiar to birth advocates is that lying down for electronic fetal monitoring is a position of comfort for the care provider, NOT for the mother.

And, he made this excellent point: “All medical interventions, even when necessary, decrease the mother’s sense of control, and increase her sense of her ‘body not being up to the task.” Again, the burden of proof rests on those who promote the intervention, not vice versa.

As I’ve touched on several times before, IV fluids that are commonly administered during labor may increase the baby’s birth weight, leading the baby to be more likely to experience the dreaded 10% weight loss (“totally bogus, by the way”). Also as I’ve noted before, IV fluids lead to significant maternal fluid retention which contributes to edema in the nipples and areolas and then…the dreaded “flat nipples.” The more fluid a mother gets in labor, the more a baby “loses” after birth!

Including the same picture as in my other post, because it is in this picture that Dr. Jack is specifically talking about his next point:

I disagree strongly with this statement:

‘Typically, loss of = or >10% of birth weight in the first few days suggests dehydration and the need to consider supplementation.’

He goes on to note that what is necessary is NOT supplementation but to help the mother and baby breastfeed well. The real question when it comes to newborn weight loss is, “is the mother-baby breastfeeding well?”

Newman also addressed something birth advocates are familiar with, the fact that epidural anesthesia can cause maternal fever. This leads to an infant sepsis workup and antibiotics and usually means separation of mother and baby. Here we again experience the failure of many medical care providers to recognize the importance of breastfeeding as beyond just a feeding method. Breastfeeding protects the baby–this is what most hospitals do not understand.

Of interventions that undermine breastfeeding, Dr. Jack pointed to Demerol (meperidine) as the “worst of the lot,” with newborns experiencing sedation and many of them not sucking at all. He also pointed out that all interventions increase the risk of cesarean section, which leads to increased discomfort for mothers and less willingness to breastfeed and increased likelihood of mother-baby separation.

The importance of skin-to-skin contact

Babies easily find their way to the unwashed nipple. And, given baby’s inborn feeding behaviors and instincts, it seems clear that, “if the baby expresses his or her choice, the baby would choose the breast.” (with regard to breastfeeding as maternal “choice”)

Not putting baby skin to skin with the mother, “increases the risk of hypoglycaemia significantly…Isn’t skin to skin contact a less invasive preventative measure than giving formula?” Newman then points out that most often we see “skin to blankets” which keeps baby from showing they’re ready to feed, doesn’t stimulate milk supply, and leads to engorgement which is not normal.

And, at the end he emphasized that when it comes to birth and breastfeeding, all too often WE MESS IT UP by meddling with the biological processes and rhythms of the mother-baby relationship.

—

For more about controversies in breastfeeding, check out my next post.

Handouts from Dr. Newman are available here. One I’ve used recently is How to Know a Health Professional is not Supportive of Breastfeeding.

I’ve written about the birth-breastfeeding continuum and about some other systemic influences on breastfeeding in breastfeeding as an ecofeminist issue.

DVD Review: Birth as We Know It

Jul29

Birth as We Know It: Educational Edition. DVD directed and produced by filmmaker Elena Tonetti-Vladimirova. 2006, www.birthintobeing.com (40 minutes), $39.95.

Reviewed by Molly Remer, MSW, ICCE, Talk Birth

As a birth educator, I am always on the lookout for the “perfect” video to show in classes. Though not a film I would show in its entirety to the average class, Birth as We Know It is a gorgeous compilation and I’m delighted to have it amongst my educational resources.

The film is available in two versions—the feature film edition and the “educational edition.” The feature film contains almost 4 hours of total footage (a number of bonus features), including 11 births. The educational edition consists of two condensed versions of the feature film—a 40 minute presentation and a 25 minute version designed to show in groups. I chose to purchase the educational edition and this review is based on that edition. I have not seen the full length feature film.

The forty minute version of the film contains gentle, moving footage of 7 births. All the births occur in water—some in the ocean, but most at home. It also includes footage about birth trauma, cesarean section, and circumcision that is not included in the 25 minute presentation version (which also includes only 6 of the births). The DVD also contains instrumental versions of both.

The births included on this film are all exceptionally peaceful, beautiful, gentle, quiet, and calm births. Some of the birth footage is in slow motion, the sounds are muted, and there is instrumental music as the soundtrack as well as occasional voiceover commentary by the filmmaker. The film alternates between birth footage and spoken descriptions/interviews about conscious birth, emotional presence, limbic imprinting, etc. The voiceover commentary addresses things like toning and healing one’s own birth trauma.

The births are wonderfully undisturbed and unhindered—in most the only hands near mother’s perineum are her own and this is such a profound difference from the usual media representations of birth! A highlight is during “Tanya’s Birth” in which she speaks to her older child, smiles with extreme beauty and peace, then casually glances down again and as the camera follows her glance, we see the baby’s head has emerged between her legs and she is cradling it gently. I love for people to have a chance to see this powerful moment!

Though interesting, I find the voiceover content and non-birth portions of the film to be too abstract or “metaphysical” to appeal to the average birth consumer. It is even a bit too metaphysical for me and I find that the concepts she mentions are not well explained and do not seem immediately reasonable or easy to accept in stride. The instrumental version is one way to gloss over this element, but then you are unable to scene select to specific content the way you are able to do in the regular versions.

So, though I do not show the complete film in classes, there are several birth clips that I do show routinely. I find two of the births in particular to be potent educational tools and they have been very well received in classes and have had a profound impact. The births are so different from general media representations of birth that they leave couples stunned with amazement about what birth can be. Since the births are in water, they are a very gentle, non-messy, not very “graphic” way to expand people’s understanding of normal birth. People in my classes have said things like, “wow! You never see something like that!” or, “that was so beautiful, I’m just in shock.” I find men in particular are more receptive to this footage than to other, more detailed, videos I show and I have had a few request to borrow and view the whole video instead of just the clips I have chosen for class.

In conclusion, this is a lovely film and though I have some reservations about showing the entire educational edition, some of the birth footage has been a powerful addition to my work with birth.

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This review was previously published at Citizens for Midwifery.

Book Review: Birthwork

Jul27

Birthwork
By Jenny Blyth
Reprinted 2007
Softcover, 460 pages
ISBN: 0-9757610-0
www.birthwork.com
Reviewed by Molly Remer, MSW, ICCE, Talk Birth

From Australia, comes a gorgeous and unique book called Birthwork. It is such an amazing and compelling read that it took me a very long time to write my review—it is difficult to describe such a remarkable book. I have never read another book like this. It is truly extraordinary. Subtitled “a compassionate guide to being with birth,” Birthwork was written for all birthworkers–anyone who works directly with birthing women (midwives, doulas, nurses, childbirth educators, physicians…).

This book covers issues of a range and depth I’ve never before seen in a birth text. Subsections include titles like: touching vaginas, respect and relationship, dipping in and out of the birth milieu, group dynamics, conflict, birth culture, loving presence, birth is sacred, trauma release, letting down in the pelvis, and stresses and stretches of childbearing. This is just a sampling of the amazing, comprehensive range of topics explored in Birthwork. I particularly enjoyed sections on directed breathing and “dynamic anatomy in labour.” The book delves into a lot of the emotional and psychological elements of being in a caregiving field and also covers physical components as well.

The book includes lots of questions to ask yourself to increase self-awareness, understanding, and personal development and also exercises to try/explore. Some of the questions are difficult to answer and require you to take a deep look at your motives and ideas about doing birthwork.

The photographs are stunning and there is gorgeous cover art (front, back, and inside). Birthwork has a spiritual component that runs throughout—sort of an Eastern philosophy—that might not appeal to all readers.

The book includes sources and a glossary of fields of care, but no index and no resources sections. It is an expensive book, but so very worth it!

Birthwork is deep and intense. I usually read very quickly and this book took me several weeks to finish because it needs time and space to soak in and be absorbed. Truly a phenomenal read!

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

This review was previously published at Citizens for Midwifery.

CAPPA Re-Cap

Jul24

Yesterday I got home from Kansas City where I’d been attending the annual free birth conference hosted by CAPPA. While there I concluded that Desirre Andrews is officially a superhuman live-tweeter. You can catch up with all of her rapid-fire tweets about the conference at CAPPA’s Twitter account.

I also tried my hand at posting a few things that particularly grabbed my attention to my Talk Birth and Citizens for Midwifery Facebook pages which automatically feed into Twitter. I’m not very good at catching short snippets for live-tweets, but some thoughts that I grabbed to highlight are as follows. If they don’t have quotation marks, they aren’t necessarily direct quotes, just “essence” summaries as I tried to take notes and pay attention!

First I attended Laurel Wilson’s talk about Bridging the Nutrition Gap and next, I listened to Tracy Wilson-Peters speak passionately about the “accidental parent.”

Essence tweets from Laurel and Tracy’s talks:

Babies don’t need to be in nurseries–they need to be with their mothers. This MATTERS!

Science can do a lot, can do wonderful things. Mother’s body can do even more…

Prenatal diets high in hydrogenated oils predispose mamas to postpartum moods disorders.

And, then I attended a breakout session from Darla Burns about postpartum rituals and snagged this interesting tidbit:

In Holland, all pregnant women are required to buy a homebirth kit, “just in case.”

The second day, I found myself entranced by the most awesome Dr. Jack Newman. His presentations were the highlight of the conference for me. I loved him! I attended two–his general session on Controversies in Breastfeeding and then his breakout sessions, Impact of Birth Practice on Breastfeeding:

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If you ever get a chance to see this man, don’t miss it!

We have a big, big problem in that HCPs do not recognize the critical importance of breastfeeding.

There are many people who don’t know squat about breastfeeding and breastmilk and don’t feel like they need to learn anything before they start doing studies and writing papers about it. –Dr. Jack Newman

There is no such thing as “standard” breastmilk. It is a physiological fluid and varies from person to person. We DO NOT have to prove that breastfeeding is better than formula. Those comparison studies are unnecessary.

The burden of proof rests upon those who promote an intervention! –Dr. Newman

With animal births: following a normal birth, infant feeding just…happens. Following an interventionist birth, the mother rejects the baby and there is no nursing at all.

“Our hospital births break every rule in the mammalian list of mother-baby necessities.” –Dr. Newman

Lying down for electronic fetal monitoring is a position of comfort for the care provider, NOT for the mother.

Know how much an incubator costs now? $50,000. Why don’t we just give half of that money to the mother and put the baby skin to skin on mother’s chest? –Dr. Newman

Seriously, Dr. Newman’s talks were amazing. Be prepared to hear more about them soon!

The final day I heard Polly Perez speak about Building Bridges with an emphasis on communication and fear:

Luke: I don’t believe it. Yoda: that is why you fail.

“Use language that lets you share your heart openly.” –Polly Perez

Listening is *active*, not a passive activity. Listen with empathy, openness, and awareness.

We have taken the hearts and minds out of much of our work because we’re frightened of getting too close. But, close is where we need to be.

“We must give people the opportunity to challenge their fears. Not only will this change each person, it will change the political and medical climate in which they make these choices.” –Connie Pike, via Polly Perez

Polly shared the first home birth she attended – made her fear of it “melt away like butter in a pan.”

You do not have to be an OB to be knowledgeable about birth. –doctor working with Polly Perez

Follow up from same doc: “if you tell me a baby is going to come out, I’m a gonna believe you!”

Changing sick systems is not about subterfuge but bringing light to situations that need to be altered.

Since micro-blogging is simply not my gift and is unlikely ever to become so, I am also planning longer posts based on several of the conference sessions. They will be (links will be updated as the posts become live):

At the CAPPA conference I also made a large custom order of great gifts from Joy Belle jewelry.

And, I ate tons of sample honey sticks from Glorybee–yummy! (see prior post: Why Honey Sticks During Labor?)

Other treats involved getting to spend some quality visiting time with a Friends of Missouri Midwives friend from St. Louis. We spent a lot of time talking over the FoMM newsletter (of which I am editor) and I feel very enthused about our ideas for its future.

I also got to meet a Facebook friend who started out originally two years ago as a Talk Birth fan on FB (after finding my site via my all-time most viewed post: In-Utero Practice Breathing). We spent some good time together visiting and laughing and it was fun to make the friendship connection with someone who was previously only an internet friend!

Incorporating Prenatal Yoga into Childbirth Education Classes

Jun29

Incorporating Prenatal Yoga into Childbirth Education Classes

By Molly Remer, MSW, ICCE, ICPFE

Note: This is a preprint of an article published in the International Journal of Childbirth Education, Volume 27, Number 2 (April 2012)

The essence of yoga can be distilled into four key elements: breath, feeling, listening to the body, and letting go of judgment and expectation (YogaFit, 2010). When considering the essence of yoga, it is easy to see what a natural complement it is to conscious, active preparation for a healthy birth. Most birth educators would agree that paying attention to her breath and to her feelings, listening to her body, and letting go of preconceived expectations of what birth will be like are perhaps the most crucial messages to convey to the pregnant woman and her partner. Additionally, experts widely agree that exercise during pregnancy has beneficial effects for the cardiovascular and musculoskeletal systems and is associated with physical and psychological well-being. There is also some evidence that recreational exercise may reduce the incidence of premature labor and low birthweight babies (Hyatt & Cram, 2003).

Anyone involved with educating adult learners (in any context) is likely to be familiar with the concept that people are most likely to retain information that they have actually practiced (versus reading about, hearing about or seeing demonstrated). I have found that incorporating a few simple yoga poses into each class session is a beautiful way of illustrating and applying many important elements of childbirth preparation. In approximately 10 minutes of movement, important points can be underscored without having to actually say anything or “lecture” to clients. The hope is that as we move together through a carefully chosen series of poses, subtle emotional development and trust in birth occurs—again, in a more effective manner than by the childbirth educator saying during class: “Trust birth!”

One rationale for incorporating yoga into prenatal classes is as follows: First, people often learn and retain information more effectively by actually doing something. Practicing the yoga poses together allows experiential practice of pelvic floor exercises, pelvic rocks, tailor-sitting, leg cramp alleviation, and back pain coping techniques, to name a few, instead of just hearing me talking!

Second, and most important, Yoga in prenatal classes emphasizes that birth happens in the body. As childbirth educators we spend a significant amount of time talking and sharing information, but birth does not only happen in the mind. Birth happens most profoundly in the body. Not only does birth happen in the woman’s body, but supporting and being with a woman in labor is also an intensely physical process, so it is important for partners to try the yoga series.

People today spend much of their time “living in their heads”, and many of us do not feel comfortable with, or at home in, our bodies. Practicing poses in class helps couples out of their heads and into their bodies and begins a process of feeling comfortable with moving and using their bodies in positive ways. This may help them develop the trust and confidence that will contribute to a smooth and peaceful birth process.

Each pose is followed with a birth affirmation such as, “the magic and mystery of birth delight and amaze me” (Miller, 2003). Positive affirmations help plant positive seeds of confidence and trust in the wisdom of women’s bodies and of the beauty of birth. These cognitive adjustments may also send a welcoming message to the woman’s body and baby as they both prepare for birth.

Opening classes with a series of poses is an effective way to “frame” the class. Class can be opened with a brief check-in period asking how people are feeling, about recent prenatal appointments, and any questions can be addressed. A transition from “regular time” into “class time” occurs with a brief series of simple poses. This routine helps people transition from their normal days into feeling ready and excited for birth class information.

Each pose was chosen because it has specific birth- or pregnancy-related benefits. Begin with healthy sitting—seated crossed legged or tailor-style on the floor with spine straight. Do some neck rolls and shoulder rotations to help release tension. Move into a brief series that includes knee-rocking, leg stretches, Divine Mother Pose, Star Pose, pelvic rock, standing squat, Palm Tree Pose, Half Moon Pose, Triangle Pose and seated Mountain Pose. There is an additional short series of “birthing room yoga” poses described with photographs that is available as a free handout here.

The series is closed with a very brief meditation or visualization exercise. The series of poses and the affirmations are kept the same each week for retention purposes, but the meditation is varied. A quick visualization or relaxation exercise (under two minutes) is often more effective and more readily welcomed by couples than the longer visualization exercises often used in classes (which can seem esoteric to some people). A mindfulness meditation that is effective is:

Inhale and repeat silently: “I exist in the here and now….”

Exhale and repeat silently: “The present moment is all I have to be with…”
Continue inhaling and exhaling as you silently and simply repeat: “Here and now…present moment.”

A favorite resource for easily and smoothly incorporating yoga into classes is The Prenatal Yoga Deck by Olivia Miller, published by Chronicle Books in 2003. The poses listed above were selected from this deck. The deck contains 50 cards, so the educator can easily build a series for use in classes. Each pose card is accompanied by a lovely affirmation. The deck also includes six cards with simple meditations (the meditation above is adapted from one in the deck). The deck format, tidy box for holding the cards and sturdy card for each pose is an ideal format for transport to class as well as serving to provide subtle reminder cards as you lead couples through poses. Each card has a line drawing on the back illustrating the pose, so assessing whether you are doing the pose correctly is easy (sometimes just reading a description of the pose is more complicated than seeing it completed).

Occasionally the childbirth educator may get some eye-rolling or “weird, hippie exercise!” responses from pregnant couples. Regardless of how much or how little they appreciate the practice of yoga in classes, the poses used lay a physical foundation for a positive attitude toward birth and a sense of confidence as a birth-giving woman or supportive partner. Through the simple incorporation of yoga into birth classes, the expectant couple receives an irreplaceable, experiential grounding in the rhythm, focus, release, and conscious awareness so essential to the intensely embodied experience of birthing.

 Molly Remer, MSW, ICCE, ICPFE is a certified birth educator, writer, and activist. She is a professor of Human Services, an LLL Leader, editor of the Friends of Missouri Midwives newsletter, and a doctoral student at Ocean Seminary College. She has two wonderful sons and a toddler daughter and she blogs about birth, motherhood, and women’s issues at Talk Birth (http://talkbirth.me)

Suggested Resources for Birth Educators
The Prenatal Yoga Deck: 50 Poses and Meditations, Olivia H. Miller, ChronicleBooks, (2003)
YogaFit: PreNatal DVD, YogaFit (2009)
Yoga for Your Pregnancy DVD (2004)

All available via Amazon.com

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All photos of the author, January 2011, 37 weeks. (c) Karen Orozco, Portraits & Paws Photography

References

Hyatt, G.& Cram, C. (2003). Prenatal & postnatal exercise design. DSW Fitness, Tuscon Arizona (training manual for the ICEA Certified Prenatal Fitness Educator Program)

Miller, O. (2003). The prenatal yoga deck: 50 poses and meditations. Chronicle Books, San Francisco, CA.

Remer, M. (2007). Incorporating prenatal yoga into childbirth educationclasses. Midwifery Today, 4(84), 66.

Talk Birth. (2011). Retrieved from https://talkbirth.me/2010/03/10/birthing-room-yoga-handout/

YogaFit PreNatal/PostpartumSpecialty Program Manual. (2006). YogaFit Training Systems Worldwide, Inc. , www.yogafit.com.

Birth Culture

Jun13

Birth is cultural, the way eating is cultural. We don’t just eat what our bodies need to sustain us. If we only did that, there would be no reason for birthday cake. Birthday cake is part of our food culture. The place you are giving birth in has a local culture as well. It also partakes of our national birth culture. Not everything doctors do regarding birth makes the birth faster or physically easier for you or the baby. Some things are just cultural. For example, most hospitals do not offer enemas to birthing women anymore, yet a few years ago, most women who labored in hospitals were required to have an enema whether they wanted one or not. Enemas are sometimes helpful at birth, but not always…But they used to be part of the birthing culture… –Jan Mallack & Teresa Bailey in (p. 32)

I don’t feel like I have time to construct a big blog post about this subject, but I’ve been having big thoughts lately about birth culture and also how we think about and treat women’s bodies in pregnancy, labor, birth, and postpartum. So, this collection of quotes will have to do for now!

In the short book Birth on the Labyrinth Path by Sarah Whedon, I also marked this passage to share: “In the context of modern medicine, the childbearing year is often treated as a healthcare problem and we are alienated from the natural and holy processes of our reproductive bodies. Let us seek more and more ways to reframe pregnancy as a natural part of the human experience and to honor the holiness of this work that brings a pure and tiny spark of the divine into the messy, beautiful drama of life on Earth. Let us guard mothers, fathers, and babies as they grow families. Let us celebrate our sexy, dangerous, bloody, beautiful ability as people to make and love more people…” (emphasis mine)

Later on, Whedon makes these lovely observations about postpartum bodies:

A body that is curvier than it was before, maybe bearing stretch marks or scars from surgical procedures or tearing, maybe producing milk, is a body that bears the signs of delivering a human being into this world. We may mourn our smooth, skinny, unmarked maiden bodies, but at the same time we can celebrate the beauty of our storied, productive, and strong mama bodies….
—-
You may have seen images of new mothers as mama goddesses, resplendent in their fertility, effortlessly suckling a new babe while woodland creatures graze nearby. This is a lovely scene to aspire to, but my personal experience is that new mama goddesses are more likely to be found pinned to a couch by a ravenous infant, wearing pajamas and a messy ponytail, and surrounded by the remains of hastily grabbed snacks and partially read motherhood memoirs. Those mamas are no less goddesses. In fact, a careful Pagan theology of embodiment will recognize that the true mama goddess must include the range of experience of new motherhood, with all the sleepless nights, messy lochia, and milky-sweet sleeping babes.”

I also came across this quote from Sister MorningStar in the Spring 2011 issue of Midwifery Today: “Every mother has a culture. Every mother is a culture. She is born into an ocean of language, traditions and rituals around how she eats, sleeps, poops, makes love or births a baby.”

And, then from Ani DiFranco’s great introduction to Birth Matters: How What We Don’t Know About Nature, Bodies, and Surgery Can Hurt Us by Ina May Gaskin:
“The pains associated with menstruation and childbirth (even the emotional pain) are the price of having agency with the bloody, pulsing, volcanic divinity of creation, and they lie at the core of feminine wisdom. The literal experience of my body is your body your blood is my blood holds great insight into the way of things. A self-possessed woman in childbirth can be a powerful teacher for all (including herself) on the temporality, humility, and connectedness of life.”
I honestly believe that if modern birth culture rested in perspectives like this, our whole world would change!

Birthday!

May3

Today is my birthday and my mom sent me a guest post about my own birth!

Molly’s Birth Story (33 years later)
May 3, 2012

At the time of Molly’s birth in 1979, we lived in a 10 x 30, un-insulated building – a shack, really – and were completely off the grid. We used wood for cooking/heat, and kerosene and candles for light. We hauled in drinking water, and bathed in rain water. We had no phone, electricity, or plumbing and shared a vehicle. Many people were appalled at our decision to homebirth (fortunately, they couldn’t call us to yell about it!). Midwives were completely hidden and underground. I had two dear friends, both nurses, who agreed to attend the birth.

I was very close to term, and we were concerned that I would begin labor at home (with no phone or car) while Tom was away at work, so I spent those final days of pregnancy hanging around at the homes of neighbors and friends. Labor began while with neighbors, and continued to progress throughout the evening. It was a wild night – raging thunderstorms, torrential rain, and incessant lightning. It became apparent that this was true labor, so Tom had to leave me alone in our tiny home to go find a phone to call our support people. They arrived by midnight, and I continued to labor throughout the night, culminating in 2 hours of pushing and the arrival of a beautiful, sweet baby girl! I’ll never forget the surreal feeling of contractions punctuated by lightning and thunder. Towards the end, I was actually falling asleep between contractions and still remember the dreams I had…..

Unfortunately, I sustained a large tear, and was unable to push to release the placenta. We had to pack up, borrow a 4-wheel drive truck, and slip and slide through the mud to a doctor who had agreed to provide postpartum care if needed. I was curled up on the seat with baby Molly – this was before car seats were in use! I lamented having to go out in such horrible conditions. The tear was major, and took 42 stitches, making my days of postpartum recovery very difficult. Nothing daunted, I went on to have 3 more children at home – still off the grid, still with no indoor plumbing, but some of the time with a car and a phone for the last two.

This experience – having my first baby – was a transcendent transformation. I became a mother at that moment, and being a mother is still a defining element of my personality and identity. Molly grew to adulthood altogether too fast, and even though she stands before me now as a mother herself, I will never forget the infant, child, and teenager that she was. We’re inextricably linked, and while I marvel at our sameness, I also celebrate our differentness.

I had 2 favorite books that I read to prepare for a very rustic homebirth – Spiritual Midwifery, by Ina May Gaskin, and Special Delivery, by Rahima Baldwin. These books are still being recommended to birthing women, and while the climate of homebirth is certainly in transition, each woman must find her own path through the labyrinth of birth.

Who knew, when I was planning a homebirth all those years ago, that Molly would grow to be the birth advocate and authority that she has become? Perhaps my decision to homebirth had some sort of deep-seated and profound influence on her!

Happy birthday to an amazingly intelligent, witty, loquacious, creative, generous, intuitive, compassionate and productive daughter. I am incredibly proud of the woman you have become, and I love you beyond all reason.

Love,
Mom

She also uploaded a photo of me at 11 months–we think Alaina looks like me 🙂

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I also had this nursing picture already saved on my computer:

Happy Birth Day to both of us!

Present day…

Today we had to take Alaina to the pediatric dentist in St. Louis to have her front teeth looked at. I thought the four upper front teeth all had decay, but it turned out to be a pretty best case scenario—she only had one actual cavity (some pitting and staining on three others, but not decay) AND the dentist said, “would you like me to just fix it now instead of you having to drive all the way here again from Rolla?” So, not only was the problem more minor than we feared, it is already ALL FIXED! Yay! So, I was able to go on and enjoy the rest of my birthday rather than fretting about her teeth or planning the follow-up visit for the “big work.” We did have a horrible 15 minutes while I held her on my lap and she screamed and cried and they did the work, but that is a tiny blip as far as things go and it was SO much better than the anesthesia route we did with Z (ambulatory surgery clinic admission, etc. Boo on that, especially because most of the work then chipped off—that’s what $5000 or so gets you!). After we got home she was extra clingy and very needy and mama’s girl-ish though, which makes me feel bad because I know she must still be feeling traumatized by the betrayal of being taken somewhere to, essentially, be hurt, trapped, and helpless 😦

After the dentist, we went to my friend’s house who lives in the vicinity. Another friend joined us and we had a little party with a nice lunch and cupcakes. My friend’s kids had blown up balloons and hung them up all over and there was also a great sign hanging in the tree:

I cried when I saw the cute sign! I really miss seeing both these friends on a regular basis, but I also feel thankful that they still live close enough to be within reach!

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Recovered enough from tooth trauma to swing like a big girl!

On the way home we stopped at the pie shop for the Boston cream pie Mark ordered for us to enjoy with my parents:

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Couldn’t resist taking a picture of the sweaty, wild hair of a traveling baby!

My parents came over bearing gifts and my favorite dinner of beef stroganoff and we also ate the pie. I’m tired, but relieved. I was also feeling weird to be 33 now and said something along the lines of, what happened and is Alaina going to be 33 soon too?! My dad said, “this can never be a long time ago…” and then reminded me that it was a Laura Ingalls Wilder quote:  “…They could not be forgotten, she thought, because now is now. It can never be a long time ago...”

Later, I laid in bed nursing Alaina to sleep and thinking about how my parents remember me as a baby—their baby—but I don’t remember being their baby. And, how this intimacy with Alaina will someday soon be only my memory, not hers (at least not consciously). How strange, because it is so total and so real and so right now…it can never be a long time ago.

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:

Birth Pause…

Mar28

What was the moment like immediately following the birth of your baby?

Was the baby placed directly onto your chest by a caregiver? Was she pushed into your own waiting hands and gathered to your body? Was he put first into a warmer and then onto your chest? Did a midwife pass him to you after gently receiving him? Did you glimpse her body as she was held over a blue cloth in the operating room? Did you see her whole body, or just the top of her head as she rested upon you? Did she emerge onto a soft landing where you could gaze at her for a moment, integrating the transition from giving birth to mothering, and then scoop her up into your waiting arms? No matter how it unfolded, I’m sure it was unforgettable.

Waiting to inhale…

I greatly enjoyed reading a beautiful guest editorial in The Journal of Perinatal Education by Mary Esther Malloy, called “Waiting to Inhale: How to Unhurry the Moment of Birth,” in which she explores this precious post-birth moment. This moment when mother meets baby, earthside. Malloy notes that for many women, the moment of meeting is “hurried” by the immediate placement of the baby on mother’s chest. Many women are in a brief, transitional state almost like “birthshock” at this moment—it is the moment before the classic euphoria and “I did it!” hits. Mother often has her eyes closed and needs a second to breathe and re-focus on the world outside her deeply inner focus. Malloy began to observe at births that if baby was allowed to emerge gently onto the softness beneath the mother, the mother is able to take a brief pause to integrate the shift from birthing to mothering and then begins to gently explore baby’s body on her own time, her own terms, before gathering it into her arms and to her breast. This occurs in the space of only moments, but they are unhurried, timeless, liminal moments. She notes: “…just as we are now appreciating what occurs when we respect a baby’s ability to find its mother at birth, what I am seeing [with mothers] is heightening my respect for an understanding of our own abilities as women to find our babies at birth.” She suggests that this natural pause marks a center point of a sequence that transforms woman to mother; that finding our babies ourselves brings us forward into a new state of being physically, emotionally, psychologically, and mentally. Malloy refers to this transition point as a moment to inhale—to “exhale” the experience of giving birth and to “inhale” the sight of the new baby and the beginning of a new phase of life.

Malloy does make sure to mention that the moment of birth is “just fine” and “unforgettable” without this “birth pause” and that mother’s chest is most definitely baby’s intended destination, but that she is starting to acknowledge that having her own babies delivered straight to her chest, “feels a lot like an intervention to me. If intervention feels like too strong a word, at least, it now seems like an interruption to what I might have done if no one told me what to do.” She concludes with some thoughts regarding her own upcoming birth:

Exhale and then inhale. Exhale the magnitude of the experience of birth and then inhale the unfolding moments in which I am receiving this child. Life is not one big inhale, one big gulping in of experience. It is the symmetry of exhale and inhale. Just as we breathe this rhythm through our labors, present to one contraction at a time, we can also breathe through our transition to motherhood, finding that moment between states and passing through as slowly as we need…

Personal experiences with the birth pause

Since I recently wrote about two other  “stages” of the birth process that are not widely acknowledged, the rest and be thankful stage and the spontaneous birth reflex, I knew immediately upon reading this editorial that I wanted to explore the birth pause as well. I am curious to know of others’ experiences with it or reflections upon it. I think back to my own immediate post-birth moments with my babies. My first baby was born and immediately placed onto my chest. I remember feeling disoriented, unreal, and dazed almost. It was sort of surreal. He was crying, I touched his back, and then asked him if he wanted “nursies.” It was very spontaneous and gentle and natural feeling, though taking a step back I see that there was not much time for that inhale moment.

When my second son was born, I was on my hands and knees and the midwife passed him through my legs to me as I turned over. When my daughter was born, I pushed her out into my own hands in a kneeling position. What struck me upon reading the editorial was how after my second son’s birth and after the birth of my daughter, though I was holding them, I did not immediately put them up to my chest. I held them low, against my body, near the tops of my thighs. I think my eyes were closed both times, head tilted back and then tipped forward. Then, I looked down at them, explored them briefly, and then gathered them up in my arms and to my breast. Neither was born onto the surface in front of or behind me, but neither was placed immediately on my chest either. My daughter’s birth was the most undisturbed and instinctual, and I distinctly remember looking down at her as I held her low against my body, and then making the decision to lift her higher and into my arms against my breast. With my son, I felt like his umbilical cord was short and that I actually couldn’t lift him higher without tugging it uncomfortably (it wasn’t actually short though and I’m still unclear what this sensation was exactly).

I immediately thought of post-birth pictures of each baby, in this birth pause time:

Immediately after first baby's birth--straight to chest. Main view is of top of his head. Hands tentatively touch/explore.

Immediately after second son's birth. Notice how he's held low down and kind of only with one hand. My eyes are closed and I'm not looking at him yet. In pictures shortly after, I'm looking at him and smiling and I've moved him up to my breast.
(Didn't feel totally comfortable with full breasts shot on my blog, though feel bad to conform to social expectations of appropriateness!)

Immediately after last baby's birth. I know it is dark/hard to see, but note how I'm holding her kind of low down and actually kind of out/away from me (to look at) rather than against my chest.

I actually feel like I see in all of these pictures that birth pause to exhale the birth and then inhale the baby and the mothering of it.

What about you? What was the moment like following the birth of your baby? Did you take a brief pause, a moment to exhale and then inhale? I’d love to hear about it!