House of Babies

Mar19

During my classes, we talk about how media portrayals of birth impact our perceptions and expectations as well as contribute to our fears about birth. Often media portrayals of birth have a tense, “emergency” atmosphere, with lots of rushing around and communicate that birth is a dangerous, medical event requiring rescuing by medical teams. Usually, when I bring this up, people in my classes nod in agreement and have lots of examples to share. However, in the last two classes, women have responded, “well, on House of Babies, I saw…” or “in House of Babies…” or “House of Babies isn’t like that.” Well, cool! I think I need to see House of Babies! (I don’t get any TV channels though, so alas, I can’t see it. Someone in my current class offered to show me a recording of it though, so I’m excited to see it).

I’m encouraged to know that there are shows like this with positive, affirming messages reaching women and showing them what birth can be like in a supportive, midwifery model of care atmosphere.

“Balanced” Information?

Mar15

Occasionally I read that someone is planning to take a hospital sponsored birth class because they feel they will get more “balanced” information. This usually seems to be said with regard to medications “versus” natural birth. There is an excellent discussion about this issue in the book Mother’s Intention: How Belief Shapes Birth.

“Let us look at [the word] ‘balanced’ first…’to make two parts exactly equal.’ What if the two parts are not equal? What if a parent will be making decisions that will affect her and her baby with both short and long term consequences? Is it fair to distort reality so that the information she has to choose from seems ‘equal,’ even though it really isn’t? Why would a parent want information that appears balanced, but isn’t factual?”

From my perspective, independent classes are better able to provide you with truly helpful, accurate, and factual information (even though they might not feel “balanced” towards all interventions/options), because the educator is working for you and not for an institution.

Climate of Confidence, Climate of Doubt

Mar14

Recently I finished reading (and reviewing) the new book Our Bodies, Ourselves: Pregnancy & Birth. In the opening chapter, they identify a concept that I have *felt* for some time, but hadn’t really put a finger on. The authors refer to it as a “climate of confidence” and a “climate of doubt.” I love this way of articulating the messages swirling around pregnant women in our society.

A Climate of Doubt comes from “The media’s preference for portraying emergency situations, and doctors saving babies, sends a message that birth is fraught with danger. Other factors, including the way doctors are trained, financial incentives in the health care system, and a rushed, risk-averse society, also contribute to the popular perception that childbirth is an unbearably painful, risky process to be ‘managed’ in a hospital with the use of many tests, drugs, and procedures. In such an environment, the high-tech medical care that is essential for a small proportion of mothers and babies has become the norm for almost everyone…[a] ‘climate of doubt’ that increases women’s anxiety and fear.”

A Climate of Confidence “reinforces women’s strengths and abilities and minimizes fear. Some of the factors that nourish a climate of confidence include high-quality prenatal care; healthy food and time to rest and exercise; a safe work and home environment; childbearing leave; clear, accurate information about pregnancy and birth; encouragement, love and support from those close to you; and skilled and compassionate health care providers.”

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I encourage my birth class clients to consider ways in which they can create a climate of confidence in their lives as they prepare for their births and their babies.

Pain Acronym

Mar14

Continuing with my musings about pain and birth, I came across a following acronym in the fall 2007 issue of the International Journal of Childbirth Education (the publication of ICEA):

P (purposeful)

A (anticipated)

I (intermittent)

N (normal)

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I was previously unfamiliar with the acronym, but I kind of like it. There are so many fears surrounding pain in birth–often of the unknown–and then stories abound about “excruciating pain,” and “you’re gonna need that epidural!” as well as media portrayals of birth as a scary, emergency event with lots of screaming and stress. This little acronym acknowledges that many women experience birth as painful, but also offers the perspective that it is manageable and doable.

Words for Pain

Mar8

I recently purchased a new educational DVD about natural birth called It’s My Body, My Baby, My Birth. A childbirth educator interviewed during the film briefly discusses pain and says that we need more words for pain, because it is ridiculous that we have only one word that is used to describe a hangnail, a broken leg, being hit by a car, and labor. I had already been musing about pain during labor and how we perceive it, talk about it, and so forth and this comment was additional food for thought for me. I’m thinking that there are many other words used to describe women’s experiences of labor and birth other than pain–a word that is limited in scope and that for some women may well not even apply to the experiences in birth (I’m thinking of the intriguing “comfortable, easy birthing” philosophy of programs such as Hypnobabies).

I reflected on my own birth experiences and how I would describe them, especially my second birth, which was very quick. I would describe it as:

Powerful

Intense

Triumphant

Empowering

Major (this is a word I kept repeating during labor…”This is MAJOR!”)

Beautiful

Special

Amazing

Awesome

If someone then asked me, “yes, but was it painful.” I would have to think a minute and then say, “oh yeah. I guess it was painful.” However, pain is very far from my dominant interpretation, impression, or experience of this birth. It does not make my “top ten” list of descriptors. I’m interested by that. I’m also interested to know about the other words women use to describe their births and where “pain” falls on their lists (feel free to leave a comment sharing your words for your birth experiences! If pain is at the top of your personal list, that is okay! I’m fascinated by women’s experiences of all kinds.)

I have heard people scoff at this kind of language to describe birth–triumphant, empowering, etc.–saying that it is just natural birth “rhetoric” trying to lie to women or that if giving birth is so wonderful why do we use “euphemisms” to describe it, but the words I chose above are truthfully my experience. Why would describe my births as painful, if that truly is NOT the best word to describe them? If I had to pick the best word, I’d probably say triumphant. Or, I might choose intense (particularly with that second, fast labor and birth).

As I said, I’ve been reflecting a great deal about pain and the word pain and how to address the issue of pain during birth classes. I hope to share some more of these thoughts soon.

Benefits of Active Birth

Feb29

From Janet Balaskas’ classic book, Active Birth:

“When birth is active–

There is less need for drugs.
Discomfort and pain are less.
The uterus functions better, so artificial stimulants are not usually necessary.
Labors are shorter.
The supply of oxygen to the baby is improved.
There is less need for forceps or vacuum extraction.
The secretion of hormones that regulate the whole process is not disrupted.”

Make sure to talk to your care provider about your plan for an active birth. You may have to introduce your attendant to the concept and be assertive about your right to have an active, normal birth.

Overused & Underused Procedures

Feb22

My previous post about a good experience and a healthy baby as well as reading a relevant section in the wonderful new Our Bodies, Ourselves: Pregnancy & Birth book I’m reviewing made me want to post about this topic. There are a multitude of common procedures that are overused in hospitals and that when used routinely actually harm mothers and babies. I also thought about the multitude of evidence based, helpful procedures that are underused in many birth environments despite research indicating that they contribute to better outcomes for both mother and baby. (The use of the terms “overused” and “underused” and the examples below are taken from the OBOS book.)

Overused Procedures–these techniques are often used routinely (instead of appropriately based on true level of need in which case they can be truly helpful and sometimes even save lives) despite clear evidence that overuse is harmful:

Induction of labor
Episiotomy
Epidurals
Cesarean sections

Underused Procedures that have been shown to improve birth outcomes as well as to improve women’s satisfaction with their birth experiences include:

Continuous one-on-one support from a skilled caregiver during labor (a doula is a professional labor support provider who offers this one-to-one support).
Changing positions during labor (especially positions using gravity).
Laboring out of bed.
Walking during labor.
Comfort measures such as water, massage, and birth balls.

To increase your likelihood of satisfaction with your birth experience and of having a normal birth as well as a healthy mother and baby, choose a birth setting and care provider that supports and USES these underused procedures and only rarely, and appropriately, uses the overused procedures listed above.

Birth Experience or Healthy Baby?

Feb20

As you may have read in many blogs in the birth world, ACOG issued a press release this month opposing the choice of homebirth for women. One of the quotes towards the end of the release, “Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby,” is a sentiment that I see expressed fairly frequently and I’d like to explore it a little. I do not think these two things are mutually exclusive by any means. I say, why not BOTH? A “good experience”/process of giving birth AND healthy baby–these two things can, should, and do go together. Many of the elements that make up a good experience are also things that are best for the baby–as I said, the two concepts are not mutually exclusive, instead they reinforce and contribute to each other! Most of the time, taking good care of a mother in birth (i.e. contributing to her “good birth experience”) is the very best thing you can do to take care of her baby. Babies do not need to be “rescued” from their mother’s bodies–healthy mothers help lead to healthy babies! Women and babies BOTH deserve a good birth experience.

I also question whether ANY mother actually considers this a choice, or makes this choice. Erica Lyon, quoted in the book Pushed, speaks eloquently on this topic:

“…The goal is to have a healthy baby. ‘This phrase is used over and over and over to shut down women’s requests,’ she [Erica Lyon] says. ‘The context needs to be that the goal is a healthy mom. Because mothers never make decisions without thinking about that healthy baby. And to suggest otherwise is insulting and degrading and disrespectful’…What’s best for women is best for babies. and what’s best for women and babies is minimally invasive births that are physically, emotionally, and socially supported. This is not the kind of experience that most women have. In the age of evidence based medicine, women need to know that standard American maternity care is not primarily driven by their health and well-being or by the health and well-being of their babies. Care is constrained and determined by liability and financial considerations, by a provider’s licensing regulations and malpractice insurer. The evidence often has nothing to do with it.” (emphasis mine)

Satisfaction with Your Birth Experience

Feb16

There are four factors that research have found to make the greatest contribution to your degree of satisfaction with your birth experience (experience or not of pain isn’t one of them!):

Having good support from caregivers.
Having a high quality relationship with caregivers.
Being involved with decision making about care.
Having better than expected experiences (or having high expectations).

According to additional research, pain relief only becomes important in relationship to level of satisfaction when expectations are NOT met (so, if you planned for a epidural and didn’t have time to get one, or you expected to cope differently with pain than you did, and so forth).

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When reflecting on these things based on my personal experiences, they seem completely appropriate (including the experience or not of pain–my sense of satisfaction with my own birth experiences has nothing to do with how much or how little pain I experienced or how I interpreted my sensations as painful or not. With both my babies, I had a high level of satisfaction with my birth experiences and in both I had a high quality relationship with my caregivers (family practice physician with the first baby and midwife with the second). During both labors I had very excellent support from my husband (the professional caregivers had little involvement with either of my births). He was so present for me and so able to provide what I needed that I had a sense of us being like one person during labor. Decision making about care also came into play with my satisfaction level. with my second baby particularly, I was completely in control. No one else made decisions about my care. So, it was much more than “involvement in” decision making, but for me, an important component of satisfaction was total control of decision making.

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Finally, I totally identify with the “better than expected experiences.” With my first baby, I was stunned and very pleasantly surprised to arrive at the birth center fully dilated. I had expected to labor for an additional 10 hours or so at the birth center (I was in labor for about 11 when we got there). With my second baby, I was again stunned and also pleasantly surprised to be in labor for a total of 2 hours. While I felt a bit “run over by a truck” by the speed and the intensity of the second labor, I was delighted to have such a quick birth. It was great.

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I also started thinking about what else, personally, would be on my list of things contributing to satisfaction with my birth experiences and I think location is a big one for me. Being in an environment of my choosing and in which I felt safe, comfortable, and respected was very important to my feelings of satisfaction. My second baby was born at home and that was very satisfying to me. I’m sure there are other things that were important, but I can’t think of anything specific right now.

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How about you? What contributed to your feelings of satisfaction (or not) with your birth experience(s)?

Waiting before pushing…

Feb16

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

I’m reviewing a copy of the wonderful new pregnancy book from Our Bodies, Ourselves and they shared the following about this issue:

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