Personality and Birth

From Sheila Kitzinger’s book The Experience of Childbirth:

In a normal, straightforward labour a woman’s attitude of mind, her approach to the task that awaits her, and her preconceptions concerning the nature of the work that her body has to do, are more important than any sort of physical preparation she can make in advance. Whatever athletic exercises she may essay, however controlled her breathing, however complete her muscular relaxation, in the last resort the thing that matters most is essentially the kind of woman she is, and the sort of personality she has [emphasis mine]. That is why preparation for labour cannot rest in purely physical training and in mechanical techniques of control and release alone. Controlled muscular activity can assist her in making of her labour something she creates, rather than something she passively suffers, but her capacity for achieving this physical coordination is dependent upon her mind–upon her fearlessness and sense of security, her intelligence, her joy in the baby’s coming, her courage, her self-confidence, and the understanding she has of herself. The experience she has of childbirth is a function of her whole personality and ideally the preparation should involve increased self-knowledge and a growing towards maturity.

While there is a certain element of “blame the victim” in this quote that I find distasteful (i.e. “she had XYZ intervention, must be her bad personality…”), I recognize something here that speaks to me. I have observed in some of my clients a certain “quality” of personality (or perhaps determination) that makes me feel secure that they will be fine with or without me–they have something that comes from within that will guide them through birth. There are others who are more ambivilant, who say they want to “try” natural birth. Sometimes they blossom into confidence as the classes proceed, sometimes nothing really changes. I do not really take responsibility for any birth outcome, because birth classes are just a piece of a much more multifaceted puzzle of a woman’s experience. However, I feel like you can see that some women just “have it in them” and in others, that “it” has to be nurtured and grown. I’m not sure exactly what this “it” is, which is why Kitzinger’s quote caught my attention.

Birth & Apples

Mar10

What does birth have to do with apples? Well, I read two things this week that made me think of both apples and birth. First, in an Ode magazine editorial that was about “apples and entrepreneurs.” The editor introduced me to the word “pleonasms” –used to refer to words that contain unnecessary repetition. He was discussing apples, “after all, what’s an apple that grows without chemicals? It’s just an apple. If any kind of apple needs a modifier, it’s the kind that isn’t grown organically. Those we should call ‘chemical apples'” (instead of labeling the other an “organic apple”). Of course, I immediately thought of birth. I was considering how we have to use the terms “natural birth,” “normal birth,” “organic birth,” “physiological birth,” “unmedicated birth” and more. Taking a cue from this Ode editorial, what is a birth that isn’t interfered with? Just a birth. In theory, the other phrases we use are pleonasms like “organic apple.” (Same with “breastmilk,” actually. Our own species-specific milk should not need a modifier…)

Still related to apples and birth, but moving into another area, I have a particular interest in “good birth experiences” and how mothers tend to get very valid and real emotions dismissed with comments such as “at least you have a healthy baby.” Or, they face insinuations that they are “selfish” for caring about a good birth experience (the assumption being she somehow cares more about “the experience” than “the healthy baby”). I have already explored this subject in an article for the International Journal of Childbirth Education in Sept. 2008 and also in this post, but I loved this explanation in The Big Book of Birth when addressing disappointment over having a cesarean birth: “…in cases where a mother feels disappointment because the birth didn’t go as hoped, it is like saying to her, Well, at least you got a healthy baby and dismissing any other emotions or experience. It is not helpful because the expectation was not to not have a healthy baby–the expectation was to have a vaginal birth. It is comparing apples to oranges since there were two separate individual hopes: one the joy of a baby, the other her experience of bringing that baby into the world. The apple being the healthy baby we all want and usually bear, the orange being what we hope for in our trials and tribulations on the way there.” (Or, the orange being our “good birth experience.”)

Using the right ingredients…

Feb6

I seem to be able to relate just about everything I ever read to birth. Some time ago, I read a book called Things I Learned from Knitting and in it the author recounts a story about her attempt to make her friend’s delicious stroganoff:

“The recipe was for a fantastic mushroom stroganoff that I thought was one of the yummiest things I’d ever eaten. I hurried to the grocery store to buy all of the ingredients, but there was one problem: I couldn’t afford them. I decided to make do. I bought substitutes…It called for cream; I used milk. It called for portabella and shiitake mushrooms; I used regular button mushrooms. It called for butter; I used margarine. The wine? I substituted water. I painstakingly put together my version of the stroganoff and was absolutely devastated when it was a pale (and sort of gross) imitation of the glorious dinner I had eaten at my friend’s. I explained the outcome to my mum, telling her that I must not have the skill at cooking that my friend had. I proposed that I just needed practice making the dish…’Darling, practice all you want, but you can’t make a silk purse out of a sow’s ear.'”

How does this relate to birth? When women share their stories with me in person, online, or in articles, I am struck by how often they’ve tried to make do without the “right ingredients” and then blame themselves (or nature) when their birth didn’t turn out the way they had wished. They may have gone to a hospital with a 50% cesarean rate, chosen a physician unsupportive of natural birth, spent much of their labors on their backs in beds, labored while attached to any number of restrictive pieces of technology, taken powerful medications, and so on and then grieve the loss of the beautiful birth experience they had planned.

So, what are the right ingredients? Every woman is different and each birth is different and has its own lessons to impart. However, we do know that some things are the “right ingredients” for many women if they would like to have a normal (physiologically unfolding) birth:

Labor begins on its own (no induction, no pitocin)
Freedom of movement throughout labor (no restriction to bed)
Continuous labor support (from a doula, your husband/partner, or a supportive friend)
No routine interventions (any interventions should be based on the unique needs of you and your baby, not hospital protocol or “this is what we always do”)
Spontaneous pushing in upright or gravity-neutral positions (try squatting, kneeling, hands and knees, or side-lying)
No separation of mother and baby after birth with unlimited opportunities for breastfeeding (do not have the baby taken to the nursery and breastfeed early and often!)

Another wonderful ingredient is confidence in yourself and your body’s natural ability to birth your baby.

Please do not be afraid to seek out a care provider and a birth setting that recognizes the importance of the right ingredients and who will do everything possible to help you use those ingredients to “cook” up a healthy, rewarding, normal birth for you and your baby!

For more information about Six Care Practices that Promote Normal Birth, visit the Lamaze site.

What Does Coping Well Mean?

Jan7

“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

Occasionally, I hear people telling birth stories and emphasizing not making noise as an indicator, or “proof,” of how well they coped with birthing–“I didn’t make any noise at all,” or “she did really well, she only made noise towards the end…” Women also come to classes looking for ways to stay “in control” and to “relaxed.”

This has caused me to do some thinking. Though relaxation is very important and helpful, to me, the goal of “laboring well” is not necessarily “staying in control” or “staying relaxed” or “not making any noises.” Instead, I view “laboring well” as involving: listening to yourself; respecting your own needs and acting on them; working with your body; finding your rhythm; trusting your instincts; following your body’s urges/signals; accessing your inner wisdom; finding your unique way along the path; journeying with openness, curiosity, acceptance, excitement and joy; and responding to coping strategies that spontaneously arise from within.

I have been reading Penny Simkin’s The Labor Progress Handbook and she addresses this subject as well:

“Childbirth education programs first emerged in the 1940s, when much less was known about the powerful, multisensory ways in which women spontaneously cope with labor. Much has been learned since then, but older ideas have left their stamp on Western culture…Many people still think that ‘coping well’ means that the woman remains silent and does not move during contractions. Often, caregivers, partners, and the women themselves believe that women who are physically active and vocal are coping poorly, and may strive to help these women to be quiet. However, we now know that women with kinesthetic and vocal coping styles often find much more effective relief from pain and stress when they move and make sounds, than when they try to use the quiet, still techniques of early childbirth methods.”

During my own births I found movement and sound to be of tremendous importance. With my first baby, I felt more inhibited and primarily coped by humming. I spent a lot of time kneeling on the ground with my head on the bed. With my second, I was alone with my husband for most of the time and was much more vocal–“talking” myself through contractions. I also moved around a great deal and found it very important. Talking (well, really rhythmic word repetition) and moving, for me, are parts of “surrendering” to the power, process, and intensity of giving birth. This fits with my personality as well as in “normal” life I talk a lot (talk-to-think) and I also have a lot of physical energy that leads to my “buzzing” around the room a lot or stepping back-and-forth as I speak.

Edited to add that the Feminist Childbirth Studies blog linked to this post with an interesting and insightful further development/exploration of this subject in the post characteristics of a ‘good’ labor and birth experience?

I revisited this topic in a later post: The Power of Noise in Labor

Birth art sculpture depicting pushing the baby out. Roar, mama, roar!

Movement and pain

Jun14

A brief quote from Biance Lepori an Italian architect who specializes in the design of birth rooms:

“Even pain dissolves with movement; pain killers are a consequence of stillness.” (emphasis mine)

This architect specifically designs rooms that support physiological birth–birth that unfolds accords to the natural biological processes of the woman, on her own timeline, and under her own power.

I emphasize active, normal (physiological) birth in my classes. I feel like the use of movement is one of the single most important ways we have to embrace labor and its rhythms and also to support healthy, physiological birth. Though I teach a variety of positions for labor and birth, “birthing room” yoga poses, and encourage practicing them, I believe that the movements you need during labor come from within and arise spontaneously during labor, not from specific training and practice. The key is the FREEDOM to use movement in the way you need to (many women end up being denied the right to free movement during labor 😦 ). The benefit to practicing different positions and movements prior to birth is that you gain a “body memory” of how to move your body in labor supporting ways.

Lamaze: Pregnancy, Birth, & Beyond

Jun4

In addition to the Healthy Birth guides I posted about in my last post, I also received my first shipment of Lamaze’s new publication, Lamaze: Pregnancy, Birth & Beyond. This magazine is excellent! I was very favorably impressed. It is brief, but provides an excellent, positive, overall overview of pregnancy, birth, and early parenting. I found myself thinking that if I could give only ONE handout in class, this would probably be the one to choose, since it neatly touches all the important bases and in the tone of confidence, trust, and respect that Lamaze does so well. There is a particularly good article called “Position Statement” that reviews the pros and cons of 11 different positions for labor. It has great photo illustrations as well as clear, accurate information.

I was really pleased with this magazine. The articles are clearly written and easy to understand and takes a clear position on the normal, healthy nature of birth. I also appreciated the articles for new parents about taking care of yourself after the baby’s birth, safe sleeping, and breastfeeding. It is important to remember the continuum extends from pregnancy, through birth, and on to breastfeeding and newborn care! Childbirth educators can sign up to receive their own free shipments of these magazines here. It is published once a year, but shipped quarterly.

There is advertising for disposable diapers as Huggies is a sponsor of the magazine, but absolutely NO formula or bottle advertising, which, of course, is no less than I’d expect from Lamaze and their philosophy.

Speaking of Lamaze, I also really enjoy their basic guide, Giving Birth with Confidence.

Healthy Birth Guides

Jun3

I recently received a shipment of The 2008/2009 Guide to a Healthy Birth published and distributed free of charge by Choices in Childbirth in NYC. I ordered a stack of these nice little booklets for only the cost of shipping ($11 for 50 booklets). I really like the content and plan to distribute these in my birth classes and encourage other educators to do the same. The emphasis of the booklet is on being an informed consumer and it also touches on the politics of birth and the business of birth, which I really liked. The end of the booklet has an article by Dr. Harvey Karp about the 5 S’s. I particularly enjoyed the chapter called “The Purpose and Power of Pain in Labor.”

All in all, this is a fantastic and nearly free resource and I’m pleased to have them available! Check them out yourself! (You can also download the booklet for free as a pdf.)

I first learned of these booklets from the wonderful Passion for Birth blog.

Birth as a creative process

May30

I recently finished reading the book Rediscovering Birth and there was a section in it that I absolutely LOVED about birth as a creative process. The author quotes another writer, Dr. Michelle Harrison. She forms an analogy about women giving birth as like dancers on a stage and how just as routine interventions for the purpose of “just in case” would hinder the dancers in their creative process, so too, do routine obstetrical interventions hinder the woman’s capacity to give birth in her full strength and creative power:

“Birth is a creative process, not a surgical procedure. I picture dancers on a stage. Once, doing a pirouette, a woman sustained a cervical fracture as result of a fall; she is not paralyzed. We try to make the stage safer, to have the dancers better prepared. But can a dancer wear a collar around her neck, just in case she falls? The presence of the collar will inhibit her free motion. We cannot say to her, ‘this will be entirely natural except for the brace on your neck, just in case.’ It cannot be ‘as if’ it is not there because we know that creative movement and creative expression cannot exist with those constraints. The dancer cannot dance with the brace on. In the same way the birthing woman cannot ‘dance’ with a brace on. The straps around her abdomen, the wires coming from her vagina, change her birth.”

Do Epidurals Impact Breastfeeding?

May10

There was a question recently on a list I belong to about the impact of epidurals on breastfeeding. The person asking the question had been told by several hospital based childbirth educators that epidurals do not “cross the placenta’ and thus do not have an impact on the baby. Since this is an issue of concern, I thought I’d share some of my response/thoughts regarding this question here. I was happy to hear Linda J. Smith speak at the LLLI conference luncheon session about this very issue–the impact of birth practices on breastfeeding–and she covered a ton of material about the impact of epidurals on breastfeeding (she also wrote a book on the same topic with the late Mary Kroeger). There is some good information, though much less complete, on her sit e. The biggest problems with epidurals are the impact on the mother rather than the baby, though the medications used in epidurals DO cross the placenta and get to the baby, they are much less seriously impactful than IV or IM narcotics. An epidural refers to the means of medication delivery not what is actually being delivered into the body, so it is hard to say definitively that one has no effect, because different anesthesiologists use different “cocktails” of drugs in their epidurals. They usually use bupivacaine as the anesthetic, but there are opoids included as well, such as *morphine* or other related opoids like that.

All the books I have as a CBE say that medications used in epidurals do make it to the baby, but effects vary. Most effects are connected to what is happening to mom—i.e. mother gets a fever as a side effect of the meds and that stresses baby. Fluid overloading leads to more fluid in baby’s lungs, etc. The main breastfeeding impact on the mother’s side is excess fluid retention in the breasts due to the fluid “bolus” administered prior to an epidural. Baby is a little sleepy following birth and then can’t latch to severely swollen breasts (which are not “normally” engorged, but excessively so due to excess fluid), and so it goes. You often hear from mothers that their nipples are “too flat” for the baby to latch on to and as you probe further you find that the flatness has NOTHING to do with the mother’s true anatomy, but has to do with that excess fluid. Women are so programmed to look inward and blame themselves for problems that it is really unfortunate (like mothers who “aren’t making enough milk” when it is really a pump with bad suction).

Basically most breastfeeding problems that have to do with birth practices are not correctly attributed to the source—the birth practices—and are instead blamed on the mother (“flat nipples”), the baby (“lazy suck”), or breastfeeding (“sometimes it just doesn’t work out”).

Top Five Birth Plan…

Apr29

Birth plans are a topic often discussed in birth classes. There are SO many things that could be put onto a birth plan that sometimes it is difficult to sort out the most important. I encourage couples in my classes to complete two different “values clarification” exercises to help them include those things on their plan that are MOST important to them, rather than trying to cover everything on a one page birth plan. They often ask what I think is important to include. So, recently I started thinking that if I needed to create a birth plan for a birth in hospital that was as normal and natural as possible and could only include five elements, what would be most important to me, my baby, and a normal birth?

These are my top five after first going into the hospital as late in labor as possible (this isn’t included on my birth plan and doesn’t need to be on anyone’s birth plan–“I plan to labor at home as long as possible”–because it isn’t relevant by the time you get there and people are reading your plan. It belongs on your own personal plan, but not in your “official” plan):

No pitocin.
Minimal fetal monitoring and preferably with a Doppler only.
Freedom of movement throughout labor (stay out of bed, use it as an active tool rather than as a place to lie down. Stay upright during any necessary monitoring.)
Push with the urge in whatever position works best for me (NO coached, directed, or “cheerleader” style pushing).
Baby immediately to me. NO separation.