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Becoming an Informed Birth Consumer (updated edition)

Sep3

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“Birth is life’s central mystery. No one can predict how a birth may manifest…Our dominant culture is anything but ‘natural’ so it is no surprise that childbirth, even with the most natural lifestyle lived by an individual family, sometimes needs intervention and medical assistance. This is not to say that any one mother’s efforts to have a natural childbirth are futile. Just that birth is bigger than one’s personal desires.” –Jeannine Parvati Baker (in The Goddess Celebrates: An Anthology of Women’s Rituals, p. 215)

It’s Labor Day and it is also the start of Empowered Birth Awareness Week! A blog carnival is in full swing at The Guggie Daily and I’ve been having some thoughts about birth as a consumer issue. Very often, it appears to me that responsibility for birth outcomes is placed on the mother—if only she’d “gotten educated” she would have made “better choices.” Many people have a tendency or overlook or minimize the impact of the context in which she makes her choices. In that way, I appreciate Baker’s observation about that birth is bigger than one’s personal desires. That doesn’t mean that we can’t take vital steps to alter the larger culture of birth in which we make our choices, however, and one of those ways is to remember to think about birth as a consumer issue.

Though it may not often seem so, birth is a consumer issue. When speaking about their experiences with labor and birth, it is very common to hear women say, “they won’t let you do that here” (such as regarding active birth–moving during labor). They seem to have forgotten that they are customers receiving a service, hiring a service provider not a “boss.” If you went to a grocery store and were told at the entrance that you couldn’t bring your list in with you, that the expert shopping professional would choose your items for you, would you continue to shop in that store? No! If you hired a plumber to fix your toilet and he refused and said he was just going to work on your shower instead, would you pay him, or hire him to work for you again? No! In birth as in the rest of life, YOU are the expert on your own life. In this case, the expert on your body, your labor, your birth, and your baby. The rest are “paid consultants,” not experts whose opinions, ideas, and preferences override your own.

There are several helpful ways to become an informed birth consumer:

  • Read great books such as Henci Goer and Amy Romano’s new book Optimal Care in Childbirth or Pushed by Jennifer Block.
  • Hire an Independent Childbirth Educator (someone who works independently and is hired by you, not by a hospital). Some organizations that certify childbirth educators are Childbirth and Postpartum Professionals Association (CAPPA), BirthWorks, Birthing From Within, Lamaze, and Childbirth International. Regardless of the certifying organization, it is important to take classes from an independent educator who does not teach in a hospital. (I’m sure there are lots of great educators who work in hospitals, but in order to make sure you are not getting a “co-opted” class that is based on “hospital obedience training” rather than informed choice, an independent educator is a good bet.)
  • Consider hiring a doula—a doula is an experienced non-medical labor support provider who offers her continuous emotional and physical presence during your labor and birth. Organizations that train doulas include CAPPA, DONA, and Birth Arts.
  • Join birth organizations specifically for consumers such as Citizens for Midwifery or Birth Network National or International Cesarean Awareness Network.
  • Check to see if you have a local birth network in your own community or even start your own (I recently co-founded one in my town!)
  • Talk to other women in your community. Ask them what they liked about their births and about their care providers. Ask them what they wish had been different. Pay attention to their experiences and how they feel about their births. If they are dissatisfied, scarred, unhappy, and disappointed, don’t do what they did.
  • Ask your provider questions. Ask lots of questions. Make sure your philosophies align. If it isn’t a match, switch care providers. This is not the time for misplaced loyalty. Your baby will only be born once, don’t dismiss concerns your may have over the care you receive or decide that you can make different choices “next time.”
  • Find a care provider that supports Lamaze’s Six Healthy Birth Practices and is willing to speak with you seriously about them:
  1. Let labor begin on its own
  2. Walk, move around and change positions throughout labor
  3. Bring a loved one, friend or doula for continuous support
  4. Avoid interventions that are not medically necessary
  5. Avoid giving birth on your back and follow your body’s urges to push
  6. Keep mother and baby together – It’s best for mother, baby and breastfeeding

These care practices are evidence-based and form an excellent backbone for a solid, mother and baby friendly birth plan.

Why “evidence-based care” though?

Because maternity care that is based on research and evidence for best practice is not just a nice idea or a bonus. It isn’t just about having a “good birth.” Evidence-based care is what mothers and babies deserve and what all birthing mothers should be able to expect! Here is a great summary of pregnancy and birthing practices that the evidence backs up:

20120903-142510.jpgRemember that birth is YOURS—it is not the exclusive territory of the doctor, the hospital, the nurse, the midwife, the doula, or the childbirth educator. These people are all paid consultants—hired by you to help you (and what helps you, helps your baby!).

“As long as birth- metaphorically or literally-remains an experience of passively handing over our minds and our bodies to male authority and technology, other kinds of social change can only minimally change our relationship to ourselves, to power, and to the world outside our bodies” – Adrienne Rich (Of Woman Born p185)
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Related posts:

Birth class handouts

Can I really expect to have a great birth? (updated edition)

What to Expect When You Go to the Hospital for a Natural Birth

Active Birth in the Hospital

The Illusion of Choice

Musings on Story, Experience, & Choice…

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This post is updated from a previous edition.

Woman Centered Pregnancy and Birth

Aug18

“Woman-centered childbirth recognizes the primary role of the mother, and allows labor to progress according to the mother’s natural rhythms.” —ALACE CBE training manual

Several years ago I wrote a popular and somewhat controversial post called What to Expect When You Go to the Hospital for a Natural Childbirth. The article took a look at what women can realistically expect from a “standard” hospital birth and included some thoughts on what they deserve, my conclusion being that what women can expect and what they deserve are often, sadly, very different things. The article was one of my widest-reaching pieces and it was republished on both the Unncesarean and on Navelgazing Midwife. I also converted it into an article that was published in Pathways magazine, laid out so beautifully and professionally I practically cried.

However, my idea for the post didn’t come from me alone, it was sparked by reading a similar list in the 1970’s book Woman-Centered Pregnancy and Birth, co-authored by Carol Downer. So, imagine my delight when I was contacted last month by her assistant, letting me know that they’d read and enjoyed my post and telling me this awesome news:

“We recently published the book in its entirety online at: www.womenshealthinwomenshands.org/BirthingOurBabies.html.“

That’s right, free online! Check it out!

For my conservative readers, do be aware that the book and website both come from a solidly feminist and pro-choice perspective!

“The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will have the power.” –Heather McCue

—

Previous thoughts on Why “Woman-Centered” Childbirth?

World Breastfeeding Week Post Round Up

Aug8

I ended up writing a lot of breastfeeding posts during WBW this year and decided to gather them all together in one post, plus extras, so that no one manages to miss out!

Other favorite posts about breastfeeding:

  • Breastfeeding as a Spiritual Practice: Reflections on the intimate, spiritual connection and meditative quality of being a breastfeeding mother as well as thoughts about parenting as a (rigorous) spiritual practice of its own.
  • Breastfeeding as an Ecofeminist Issue: Why does breastfeeding threaten both feminists and the patriarchy? Why is breastfeeding a core women’s issue? And, why aren’t we more concerned about systemic barriers?
  • The Birth-Breastfeeding Continuum: From a biological perspective birth and breastfeeding are not discreet events, but are inextricably linked. Healthy breastfeeding begins with healthy birth!
  • Ode to my nursling: What it is like to nurse my baby.
  • Nursing Johnny Depp: My “classic” essay on what it is like to nurse things other than my baby…
  • Listening Well Enough: What I learned from a dream about listening to breastfeeding mothers.
  • Listening to my baby…even when we disagreed! Personal story about how I learned to listen to my baby about what he needed with regard to breastfeeding even when I didn’t like what he was telling me.
  • Inseparable: Personal thoughts about being “in dependence” with our babies.

Other great resources:

Infographic for parents (and heck, providers too!) about the first few days of breastfeeding–newborn stomach sizes, number of diapers, etc.

Ban the Bags toolkit: Great rebuttals to common arguments about the assumed neutrality of distributing formula marketing materials via medical care settings/providers as well as evidence about the link between “free” formula distribution and reduced rates of successful breastfeeding.

Resources from the Breastfeeding Taskforce of Greater Los Angeles including:

Also, you can check Baby Friendly USA to see if your birthing facility is Baby Friendly.

CIMS sent out some good WBW information about how Birth Practices Affect Breastfeeding:

CIMS is proud that the WHO/UNICEF included recommendations in the Ten Steps of the Mother-Friendly Childbirth Initiative in the WHO/UNICEF’s Infant and young child feeding: A tool for assessing national practices, policies and programmes (2003).

The WHO and UNICEF recommend that to maximize the establishment of successful breastfeeding women in labor, regardless of birth setting, should have access to the following practices recommended in the MFCI:

  • Care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s culture, ethnicity and religion;
  • Birth companions of her choice who provide emotional and physical support throughout labor and delivery;
  • The freedom to walk, move about, and assume the positions of her choice during labor;
  • Care by staff trained in non-drug methods of pain relief and who do not promote the use of analgesic or anesthetic drugs unless required by a medical condition;
  • Care that minimizes routine practices and procedures that are not supported by scientific evidence including withholding nourishment, early rupture of  membranes, use of IVs,  routine electronic fetal monitoring, episiotomy and instrumental delivery;
  • Care that minimizes invasive procedures such as unnecessary acceleration or induction of labor and medically unnecessary cesarean sections.

And, so did Lamaze:

Valuable resources and information for expecting parents, like Lamaze’s Push for Your Baby, are aimed at giving expecting parents the tools to push for the best care practices for moms and babies, including those that support breastfeeding education and awareness.

Lamaze calls out the following top five breastfeeding barriers within the first 24 hours of birth to help expecting moms prepare for the best breastfeeding experience:

  1. Unnecessary birth interventions
  2. Separating mom and baby
  3. Use of pacifiers or other artificial nipples before breastfeeding is well established
  4. Supplementing breastmilk with formula
  5. Lack of postpartum breastfeeding support

Note: on August 15, Lamaze is hosting a free webinar called Moms, Babies, Milk and the Law: Legal and Ethical Issues When Teaching Breastfeeding

And, some other interesting posts not by me:

World Breastfeeding Week Sucks According to this Lactation Consultant

While I don’t really care for the title because I think it may cause people to not even read the article, I really appreciated this IBCLC’s thoughts about the correlation between the occurrence of WBW each year and the strategic release “breaking” news about some kind of breastfeeding related controversy. Call me a conspiracy theorist, but this does in fact happen every. single. year. During World Breastfeeding Week, something comes out that causes doubt about breastfeeding or breastfeeding advocates. Maybe it is about vitamin D and how “deficient” breastmilk is, or maybe it is a trumped up “mommy wars” tale or hyperbolic call to action about not letting those mean “breastfeeding Nazis” try to tell us how to raise our babies, or, like this year, a bizarre spin on the idea that formula should not be readily distributed in large “gift packs” via our medical care system, but should instead be reserved for cases in which it is actually needed (see above mentioned notion of those mythical, control-freak breastfeeding Nazis who are out to get us all). Anyway, the LC points out this:

I really hate World Breastfeeding Week because much of the media takes it as an opportunity to attack those who wish to support mothers who breastfeed rather than celebrate their efforts to improve infant feeding. Every year I hope I will not have to read more faux feminist manifestos that denigrate the value of women who enjoy their care-giving roles. I hope I won’t have to read more junk science fishing expeditions by journalists who deliberately exclude the wide body of solid research that does show that what infants are fed does matter. This year sets a new low with the addition of outrageously false claims that New York’s City’s Mayor has imposed a ban on formula that is going to deprive mothers of their rights. –Susan Burger

And, speaking of the bizarre spin of this year’s anti-WBW backlash conspiracy, Moxie wrote a great post exploring this issue: The illusion of choice, the free market, and your boobs

If you truly care about a woman’s right to choose what’s best for her and her baby, you will take the financial pressure out of the equation, and eliminate any actions that impede free choice. Putting formula samples right next to the baby’s head impedes free choice. Having to ask for formula (just like you have to ask for tylenol, or an extra chucks pad, or another container of orange juice) doesn’t impede free choice. It doesn’t change anything for women who cannot breastfeed–they can still get those formula samples easily by asking. It doesn’t change anything for women who don’t want to breastfeed–they can still get those formula samples easily by asking. It could change everything for women who want to breasfeed but don’t have correct information or are experiencing problems they can overcome if they’re given help, because they will be given EQUAL ACCESS to information that can help them breastfeed and formula samples. They ask for help or they ask for formula. Equal access. No privilege for formula.

I don’t want the decisions I make about how to parent my children made by the highest bidder. Especially since the highest bidder doesn’t care about me and only wants my money. (Let’s not forget that those formula samples are worth about $1.50. A woman who chooses to feed formula based on those samples has just been signed on to spend hundreds or thousands of dollars on formula once she leaves the hospital. She is never informed of that. Is THAT free choice?)

I don’t care how you feed your baby. But I want you to make a decision about it with all the information, all the support, and all the help you can get. Free choice. I do not want your choices narrowed by the huge financial incentives formula manufacturers pour into hospitals. [emphasis mine]

And, as I’ve already referenced in some of the posts linked to above, Dr. Newman has a helpful article about How to Know a Health Professional is not Supportive of Breastfeeding that directly connects to the issue of formula distribution by medical care professionals. One way to know right away is if the provider distributes material provided by a formula company—even if that material is labeled “breastfeeding information.”

Breastfeeding Class Resources

Aug3

I became certified as a breastfeeding educator in 2004 and accredited as a breastfeeding counselor in 2005, so I’ve been working with breastfeeding mothers for a long time. I lead a monthly support group and offer help/counseling via phone, email, text, Facebook message, Words with Friends messages, you name it. Recently, a nurse contacted me asking for ideas for teaching an early pregnancy breastfeeding class. I think this is a great idea, since mothers’ decisions about breastfeeding are often made before the baby is conceived and if not then, during the first trimester.

These are the initial ideas I suggested:

  • Focus on what the mothers themselves want—what do they need/want to know? What have they heard about breastfeeding? What are their fears? What misconceptions do they need cleared up? I’m very much about peer-to-peer support and allowing space for the women to talk to/connect with each other—the facilitator is then available to clear up misinformation and provide tips.
  • Focus on what mothers can do to prepare for successful breastfeeding—there is evidence that prenatal breast massage/colostrum expression helps with both milk supply AND with mother’s comfort with her own breasts. It also helps her think of herself as a breastfeeding mother BEFORE her baby is actually born!
  • Suggest good books to have on hand and encourage attending a breastfeeding support group (like LLL!) prior to baby’s birth.
  • Promote/discuss/encourage “baby led breastfeeding.” I love sharing with mothers about how smart their babies are and how mother’s chest after birth becomes baby’s new habitat! Check out the resources from Suzanne Colson: http://www.biologicalnurturing.com/
  • Discuss and emphasize all of the other great ways dads and other family members can be involved with baby other than giving a bottle. Dad/grandma can do EVERYTHING ELSE baby needs! That’s cool! Leave the feeding to mom and let dad have the other special and important jobs like baths and burping and tummy time and more.
  • DON’T talk about “myths” and try to dispel them in a myth-fact format, because evidence suggests that this actually helps the myths stick more!
  • Use Diane Wiessinger’s approach to language (http://www.motherchronicle.com/watchyourlanguage) i.e. breastfeeding isn’t a “special bond” it is a NORMAL bond. People want to be normal—special is for celebrities and “other people,” normal is what everyone wants. She also has handouts here: http://normalfed.com/Why.html

Since her email, a couple of other resources and bits have caught my eye. One is that the AAP has a resolution about the distribution of formula “gift bags” by pediatricians and hospitals. Apparently this came out in 2011, but it only came to my attention when I saw this image on Facebook!

In keeping with the 10 Steps and consistent with the AAP’s resolution, the hospital advocacy project from the Illinois State Breastfeeding Taskforce makes available the following useful documents for mothers to communicate with their hospitals:

The Task Force explains:

We encourage you to make the Breastfeeding Bill of rights and Hospital Experience Letters available to moms in your classes, practices, community events, breastfeeding fairs, “rock & rest” stations, etc.

Encourage moms to fill out the appropriate letter and mail back to the hospital where she delivered her baby.  Or collect the letters and mail them from your agency or task force.  Help moms make their voices heard!

We hope that this will show hospital administrators that lactation consultants, knowledgeable staff and breastfeeding friendly practices are valued by moms and families using their hospital services.

The Missouri Breastfeeding Coalition clued me into this Breastfeeding Plan for Mothers (pdf) from the MO Dept. of Health. The handout may be downloaded and printed as needed and is a, “list of requests that support breastfeeding for the postpartum stay. Similar to a birth plan and based on the 10 Steps for Breastfeeding.”

Also, make sure to check out this awesome resource, the WIC Sharing Gallery—free programs, curricula, brochures, and more from different WIC offices. I found this because I was back at the Illinois Breastfeeding Taskforce’s website downloading their Grandmother’s Tea curriculum for intergenerational support of breastfeeding.

Another great resource is the FREE online Tear-Sheet Toolkit from La Leche League.

And, finally, I already touched on this, but remember there are ample handouts/articles available from the incomparable Diane Wiessinger about birth and breastfeeding.

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.

—

This review was previously published at Citizens for Midwifery.

Conscious Agreement and Informed Consent

Jul28

This post is part 2 of my CAPPA Re-Cap series.

During their general sessions at the recent CAPPA conference, Laurel Wilson and Tracy Wilson Peters both advocated a process called “Conscious Agreement” in working with pregnant couples. The basic steps are as follows:

  • Separate yourself from external influences
  • Get quiet and pause
  • Listen in (including mentally checking in with your body and how it feels)
  • Choose and commit

I especially appreciated Tracy’s observations that this process of conscious agreement goes beyond informed consent and, as birth educators, we need to make sure to “marry the two every time,” rather than focusing solely on informed consent. Why? Because there are several things wrong with informed consent as it is practiced today:

  • It fails to address the importance of conscious decision-making
  • Informed consent is made with the mind or intellect (and ignores feeling and intuition)

And…

  • You can “consent” all day long and not feel good about it.

The last point is the crux of the issue to me. When I cover informed consent in my non-birth classes, I always emphasize that the corollary is informed refusal. If “consent” as it is practiced by your hospital means saying yes and there is no option of saying no, it does not qualify as consent! A choice without the option to refuse is NOT a choice at all (see The Illusion of Choice). My students have almost never heard of the notion of “informed refusal” and seem shocked to even consider the possibility! Since I’ve had a special interest in this topic for a long time, I really connected with the idea of conscious agreement, especially when paired, as Tracy suggests, with informed consent information.

Another handy tip offered by Tracy during her presentation was to use HALT before entering into any agreement (or confrontation). Check in to see if you are…

  • H–Hungry
  • A–Angry
  • L–Lonely
  • T–Tired

(Also, consider whether the person you are trying to communicate with is any of these things. This is especially good to remember with children.) And, she shared this little poster:

This little sign may have been made especially for me. I have a terrible problem with getting crabby and snappish and plain old hangry (hungry + angry)—and then having to apologize. You’d think I’d have it figured out by now! (though, I do think nursing exacerbates it)

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.

Women’s Retreat Recipe

Jul12

Quarterly, I get together with some of my friends and we have a women’s retreat. We had our summer retreat this past Sunday and I thought I’d share the outline and our activities as a “retreat recipe” that others may use if they wish to do so. Since my friends do not necessarily share specific religious beliefs, the retreats are spiritual in a somewhat generic “womanspirit” sort of way and you can obviously customize your own retreat to best suit the spiritual beliefs/backgrounds of your own friendship group.

Circle up—we stand in a circle, place our hands on eachother’s backs and hum together three times to raise the energy of the circle.

Invocation to directions. This time we used an invocation by Judith Laura:

We honor the East
Home of air
March wind
Morning’s song
Eagle’s flight
Aurora’s breath
Welcome East

We honor the South
Home of fire
Noon sun
Flame of change
Heat of passion
Pele’s power
Welcome South

We honor the West
Home of water
River’s flow
Font of feelings
World’s womb
Kwan Yin’s love
Welcome West

We honor the North
Home of Earth
Root of life
Shaded mystery
Ground of being
Gaia’s growth
Welcome North.

Light candle/opening quote

“I see the wise woman. And she sees me. She smiles

from shrines in thousands of places. She is buried

in the ground of every country. She flows in every

river and pulses in the oceans. The wise woman’s

robe flows down your back, centering you in the

ever-changing, ever-spiraling mystery.

Everywhere I look, the wise woman looks back.

And she smiles.”

–Susun Weed quoted in Birthing Ourselves Into Being

Check-in–we take turns “passing the rattle” and each woman has about two minutes to share what’s been on her mind.

Since we are close to summer solstice, I then chose to do this solstice prayer of healing from the United Nations as a responsive reading as a group:

A Prayer of Healing
From the United Nations Environmental Sabbath

We join with the earth and with each other.
To celebrate the seas.
To rejoice the sunlight.
To sing the song of the stars.

We join with the earth and with each other.
To recall our destiny.
To renew our spirits.
To reinvigorate our bodies.

We join with the earth and with each other.
To create the human community.
To promote justice and peace.
To remember our children.

We join together as many and diverse expressions of one loving mystery: for the healing of the earth and the renewal of all life. We join with the earth and with each other.
To bring new life to the land.
To restore the waters.
To refresh the air.

We join with the earth and with each other.
To renew the forests.
To care for the plants.
To protect the creatures.

Guided visualization/meditation/relaxation (for this particular retreat, I used a nice full body relaxation from the book Birthing Ourselves into Being. This one isn’t available online that I can find, but you can find others online, like this one for example.)

We followed the relaxation with a muse questions and journaling using one of the questions from Shiloh Sophia’s Museletter:

Your Muse would like to show you something you haven’t been able to see.

She wants to invite you to have a thought you haven’t had yet…isn’t that an enticing thought in and of itself?

A thought that has lingered on the edge of your consciousness for maybe even a few years, or months….tell her…

I want to know what it is I am not seeing.

Then automatic write whatever comes up until you have to put the pen down.

Immediately following this question, it began to rain. Blissful, blessed, healing, glorious rain for which we were in so much need.

Discuss responses/experiences to relaxation/journaling.

Listen to songs/perhaps drum (this time, went outside together and stood in the rain)

Closing circle: Sing Woman Am I (recording of my friends singing it together is here).

Closing quote and extinguish candle

“A circle! No sharp edges, no hierarchy, just a circle of women…We are mothers. We are the portals. The next generation comes through our bodies.” –Annie Lennox

and one of my all-time favorites:

“I believe that these circles of women around us weave invisible nets of love that carry us when we’re weak and sing with us when we’re strong.” –SARK, Succulent Wild Woman

When reading a 1988 back issue of SageWoman magazine, I fell in love with Womanrunes by Shekhinah Mountainwater (originally in her book Ariadne’s Thread, which I then purchased) and so I made copies of the images to share with my friends. We are going to make some sets of runes at our next retreat. (And, after much scouring of the interwebz, I found a pronunciation guide for the runes here).

I also made a handout packet for them of various moon wheels/circular calendars for tracking your cycles, or simply for planning and thinking in circles rather than in lines. In the packets were:

And, then it was time for a craft, so as we snacked and chatted, I showed everyone how to make a small, hardbound pocket journal. You can find instructions for a simple book here, or, to make it even more simple, use this kit from Blick Art Supplies.

It was a delightful afternoon of connection and celebration—my original vision for holding these retreats was to bring some blessingway spirit into our regular lives, rather than only centered on being pregnant and I think that purpose was achieved.

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This post is crossposted at Woodspriestess.

I See You: talking to mothers about their breastfeeding concerns…

Jul9

I’m helping to train two women right now to become breastfeeding counselors. As well as discussing how to help other women with the numerous issues that may be a part of the normal course of breastfeeding, we talk a lot about listening skills. As I’ve been working with them, I found a reminder list that I made 7 years ago when I took on this role myself. The list simply consists of ideas for how to talk to mothers about their breastfeeding questions in a way that promotes continued dialogue, demonstrates respect, and employs good active listening.

Photo from several years ago of a good friend and I nursing our babies while “seeing” each other.

Talking to mothers about their breastfeeding concerns…

“I hear you saying that….”

“You seem to be telling me that….”

“You seem to be feeling….”

“You sound…”

“How do you…”

“What are you observing that makes you think…”

“Tell me more about…”

“How would you like to see this resolved…”

“Many mothers have found…” **This is my all-time favorite and hands-down most useful. I use it all the time. It is so handy.**

“How would you feel about…”

“For some families it works well to…”

“There are some suggestions I can give you for… that have been helpful for other mothers…”

“It depends….”

“It sounds to me like you are doing a wonderful job as a mother”

“It sounds to me like your baby really responds to you”

“Your baby is so lucky that you want to/did give him the benefit of your milk”

With doctors/others’ opinions:

“How do you feel about those suggestions?”

“Some doctors take that approach, but research has shown….” (or, “we’ve noticed…” or, “reliable references indicate…” May also follow-up with, “Would you like me to send you a reference?”). **This is another one of my favorites, it doesn’t smack down the doctor and yet it gently and firmly provides you with a means of sharing alternate—correct—information.

Other good things to remember when listening to mothers:

Breastfeeding is not a by the book procedure—it is an intimate relationship with different dynamics from one nursing couple to the next. Individual mothers and babies respond differently to the same things. There are no hard and fast rules.

Our main message to each mother is how important she is to her baby and how breastfeeding can be a wonderful part of this. We want to help mothers feel good about being a mother, about meeting their babies’ needs in the way that feels best for them, and to trust their own instincts. We wish to leave mothers with a feeling of self-confidence and acceptance.

I See You

I often remind students in my human services classes that all people have a basic need to be both seen and heard. This doesn’t mean agreeing with everything someone else says and does, it means being present and witnessing them as they follow their own paths.

In a newsletter recently, I read an article called “I See You” by Sue Scott, a communication skills instructor. She explains that in South Africa, native peoples greet each other with an expression that literally means, “I see you.” The response is then, “I am here.” She observes, “what a powerful and beautiful gift it is to recognize another individuals in this way: ‘I see you.’ Acknowledgement, recognition, and respect all require focus on the other person…the word respect comes from the Latin word ‘respecere’ meaning ‘to look at again and again…’I see you’…seems to me to be the ultimate in respect.” Sue goes on to explain that when we truly SEE another mother—“when we truly hear her concerns—then we affirm her ability to mother her baby in her own best way.”

A little more than two years ago, I received the precious gift of being seen when a mother that I had previously helped with many breastfeeding questions called to ask me another question. We had become friends over the course of time since she’d had her first baby and I was in the process of my second miscarriage when she called with a question about her own pregnancy. I told her about the miscarriage, but said I felt like I could still talk with her about her question. We ended up then talking for a time about miscarriage and about cesarean birth, because we discover numerous surprising connections between the feelings and experiences of an unexpected outcome to our dreams for our pregnancies. She then said, “You know in that movie Avatar how they say, ‘I see you’?” I said yes, and she said, “I just wanted to let you know that I see you, Molly.” These words were such a gift to me. It was beautiful to hear them and I cried. I felt so seen. It was just what I needed and I hadn’t even known it. I will never forget that simple and yet extremely potent gift of acknowledgement from another woman.

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A previous post about Listening Well Enough.

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.