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Book Review: Painless Childbirth: An Empowering Journey Through Pregnancy and Birth

Book Review: Painless Childbirth: An Empowering Journey Through Pregnancy and Birth

By Giuditta Tornetta
Cumberland House, 2008
ISBN 978-1-58182-640-1
320 pages, softcover, $16.95

Reviewed by Molly Remer, MSW, CCCE

Written by a mother of two who is also a doula, childbirth educator, hypnotherapist, Painless Childbirth takes the pregnant mother on a physical, mental, and spiritual journey from conception through postpartum. The text is interspersed with personal stories from the author’s own pregnancies and births as well as those of her doula clients.

A lot of people are initially skeptical of the phrase “painless childbirth” and I really loved the author’s description of what painless childbirth means: “When I say painless, please understand, I don’t mean you will not feel anything. What you will feel is a lot of pressure; you will feel the might of creation move through you. Pain, however, is associated with something gone wrong. Childbirth is a lot of hard work, and the sensations that accompany it are very strong, but there is nothing wrong with labor.” The book has no rigid concept of what “painless” means and no suggestion that mothers who do not experience birth as painless have “failed.” Painless Childbirth is written in a gently nurturing tone throughout (you can “hear” the author’s doula skills coming through), but is also very assertive that painless childbirth is very reasonable, doable, and is, indeed, the birthing mother’s right.

The book contains a lot of ideas and concepts that are of use to doulas and childbirth educators. I particularly liked Tornetta’s characterization of the three phases of first stage labor according to the primary means of coping with each phase—distraction, concentration, and surrender.

After my own experiences with pregnancy loss, I have become more aware of the treatment of the subject in birth books. Painless Childbirth directly addresses childbearing losses in a short, but compassionately written segment about healing past grief. The book also has content about exploring and overcoming fears.

The book is holistic in its approach, addressing body, mind, and spirit. It contains a lot of spiritual content of a “new age” flavor (for example, lots of references to the law of attraction and the book is organized by month according to fetal development as well as associated body chakra). While I definitely agree that birth is a spiritual event, my practical, down-to-earth side stumbled a bit over some of the concepts and phrasing, and the esoteric content may not appeal to all audiences. That said, Painless Childbirth presents a positive, loving, welcoming approach to giving birth that is both refreshing and interesting.

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

Distraction, Concentration, Surrender

Apr26

In my childbirth classes when I cover “labor and birth 101,” I talk about the traditional stages of labor—early labor, active labor, transition, pushing, and third stage (placenta). I also talk about the “emotional signposts” of labor—excitement, seriousness, and self-doubt, as well as about the fear-tension-pain cycle and the excitement-power-progress cycle. Recently, I finished reading the book Painless Childbirth by Giuditta Tornetta and she elegantly described the three phases of first-stage labor in a three-word format that I found extremely accurate and helpful, as well as fresh and interesting. The first phase is distraction—during early labor, it is most helpful to continue to go about your normal life as if nothing is happening. Do not give your contractions any attention until they strongly request your attention! I tell my clients to just do what they would normally be doing—-if they would be sleeping, sleep. If they would be walking the dog, walk the dog. Watering the plants, eating dinner, etc., etc. Just keep up the normal routine until you need to give the birthing energy more attention. Without distraction as a tool, labor can become very long and exhausting—if you think of yourself as in labor from the second you feel anything, you are much more likely to experience a 24 hour labor than if you do not think of yourself as in labor until you are completely absorbed by its sensations.

The second phase is concentration—contactions have now become what Ina May Gaskin would term “an interesting sensation requiring my complete attention.” This phase corresponds to the Bradley Method’s emotional signpost of “seriousness.” I tell my clients that this is when she stops laughing at your jokes and stops even seeming aware that you’re talking. (She IS still aware however, and we will address this in a later post about undisturbed birth, prompted by another new book I am reading called Optimal Birth.)

The third phase is surrender and this corresponds with the transition portion of active labor and the “self-doubt” signpost. I think the concept of surrender during labor is one of the most profound and transformative elements of giving birth. If you can embrace the notion of “surrendering” to birth rather than staying in “control” of it, I think this can revolutionize your perception of what is happening in your body and your life. While hard to express in words, the experience of surrendering to my own body’s power was a transformative experience in my life (particularly since I am a “controlling” sort of person in “real life”—maybe this is why this term and experience holds such meaning to me). With surrender comes “flow”—there is such value and beauty and strength to be found in letting go and just letting it happen; letting “the might of creation come through you.” This was the most profound truth I discovered in each of my birth experiences.

New Training!

Apr12

This year, I completed several new trainings that I am very excited about.

Prenatal Yoga Training

This weekend I fulfilled a 7 year old dream and attended a prenatal yoga teacher training in St. Louis. I have wanted to teach prenatal yoga since I was pregnant with my first baby, but a training opportunity just never opened up for me until now. I felt like this was perfect timing. The training was through YogaFit and was pretty basic, but it was just what I needed to feel like I can move forward with this dream. YogaFit is a very “fitness” oriented type of program vs. any kind of holistic-mind/body connection stuff, but I can add those elements in myself. I think I will be able to offer something fairly unique—not just yoga and not just childbirth education but yoga-childbirth-education. There are several other programs like that, of course, but none in the local area! At the training, I also learned some really cool partner yoga stuff that I didn’t know how to do before.

Birth Art Training

In February, I completed something else that I’ve been dreaming about for some time—I took Birthing from Within‘s online course, “How to Lead the Birth Art Process.” Aside from a few minor complaints about the sometimes-frustrating “Zen” underlay and occasional contradictions within the course, I really LOVED this class. I found the online course format to be an ideal format for me—real-person interaction through message board, chat, phone call, and email; written information; writing journals/essay responses; hands-on personal practice with the assignments; and real-life application with other people/clients in birth art sessions. I felt like I got more out of actual use out of this workshop than most of the other classes and workshops I’ve attended—I think this was because the course was spread out over 5 weeks, not just a weekend, which allowed plenty of time to really assimilate and USE the information. It was very affordable too and I was able to attend right from the comfort of my own chair! The class is marketed as suitable for beginners, but personally I found my past background in childbirth education to be very important and I cannot imagine having taken the class with no prior birth class teaching experience—I think the people who had little experience were kind of disadvantaged in this course. Birthing from Within is my all-time favorite birth preparation book/resource and it was so exciting for me to have a little taste of direct training with them. Hopefully at some point in the not-too-distant future, I will take further training with BfW.

Childbirth Educator Certification

In March of this year, I was pleased to earn my childbirth educator certification with CAPPA. Since I am already certified with other organizations, I enrolled in the dual certification program option. I am very excited to be “throwing my hat in” with CAPPA. The organization is very friendly and stable and I really connect with the CAPPA Vision. The program information itself was pretty basic and I didn’t really learn anything new from it, but that makes sense because it isn’t specifically designed for people who already have CBE teaching experience—I think it is a great program for someone starting out in this field.

Comparing CBE Programs:

I get a lot of inquiries from people seeking information about different childbirth education programs and thought I would provide a super-quick mention of the things I enjoyed most about each of my certification programs/organizations. Keep in mind that I certified with ALACE first, hence, I had the most direct experience with their full training program, vs. the other organization’s “accelerated” options (which I SO deeply value and I am SO grateful that ICEA and CAPPA make that option available to people—I’m very, very grateful!). In sequential order:

ALACE (now IBWP)—phenomenally in-depth training program with a wonderful woman-oriented, holistic, midwifery-model. Very homebirth friendly. When I finished this program, I felt like I’d earned another master’s degree—this time in birth. At the present time, however, I do not get a “stable” or professional feeling from the organization and that is very disappointing 😦

ICEA—very professional. Lots of really good information on how to teach and on the principles of adult education in general. I learned the most about the “how” from ICEA (and the “how” is very, very important). They also have several great teaching manuals that are super-affordable. I enjoy the International Journal of Childbirth Education as well. Very professional. The training information assumes educators will be teaching a “mainstream” population, probably in a hospital, but their position papers are very sound and I can really get behind their mission as well. Their certification exam was the most difficult of the three programs and I feel like I really earned my certificate!

CAPPA—I am really pleased with my association with CAPPA. As I noted, they are very friendly and I feel like they will be around for a long time to come. I just get a lovely, warm feeling of “sisterhood” from CAPPA and that is very important to me. I feel connected to the organization and the people and it is a very supportive atmosphere. I recommend them for training, especially for people who are just starting out. I’m excited about the free conferences CAPPA offers as well and I’m going to my first one this July! I also enjoy the CAPPA Quarterly and and I am proud to write the book/film reviews column.

Thoughts About “Let”

Mar28

“The effort to separate the physical experience of childbirth from the mental, emotional, and spiritual aspects of this event has served to disempower and violate women.” –Mary Rucklos Hampton

Related to my recent birth consumer post, I wanted to write a little bit more about the word “let.” One of my strongest birth-related pet peeves is the use of the word “let” when applied to birthing women. Women and providers and even doulas and CBEs often use terminology like “well, they let me get up for a while and walk around” or “my doctor is going to let me go to 41 weeks” or “the nurse let her get off the monitor for about 30 minutes” or “my husband won’t let me have a homebirth.” I do not like this phrase because of the “victim” mentality I feel like it conveys—-that women are passive and things are being “done to” them and they have no power of their own. I feel like it removes autonomy and empowerment and women’s control over their own bodies and births.

I often remind people that birth is not a time in a woman’s life when she should have to fight for anything. I also like to gently remind clients that no one can “let” them do anything. With colleagues, I occasionally have to clarify or explain my perception of the term as disempowering. Though in the end, sometimes I need to let (!) it go and realize that some people are perfectly satisfied with the term. And, I also have to acknowledge that the word DOES accurately describe many women’s experiences-—they are “let” or “not let” to do things even if I think it should be different and think they should have more power and control during their own births!

Becoming an Informed Birth Consumer

Mar26

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’s The Thinking Woman’s Guide to a Better Birth 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, Bradley, 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.
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.
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:

Remember 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!).

New Post…

Mar20

I spent quite some time writing a new post yesterday and then it disappeared without a trace! I like to make a post here at least once a week, so I’m going to have to just link to the other post I wrote yesterday as part of the Women’s History Month blog carnival from Birth Activist. Birth Activist was the very first birth blog I ever started reading and the blog that sparked my own interest in blogging (a couple of years later).

In addition to teaching the Young Parents classes, which is a new venture for me, I also start teaching my second college class next week. This one is at a college branch about an hour from me, so I’m going to be doing a lot of driving in addition to all the preparation work. I think blogging is going to have to slip down my list of priorities for a while and so I may not be making new posts for a little while—I hope my readers don’t abandon me! Have no fear, I’ve managed to work birth activism into my class in a very appropriate way—I’m going to show them the Reducing Infant Mortality film and possibily The Doula Story as well, during my section of the class on teen pregnancy.

Resource Rack

Mar15

I was pleased as can be when my husband brought home a plastic brochure rack that was getting thrown away at work. As a semi-compulsive gatherer and sharer of information, I have boxes of pamphlets, magazines, brochures, etc. that I put together in packets for my birth class clients. How much more efficient and attractive to organize them this way! I took a picture of it because I’m so happy.

Young Parents Program Prenatal Classes

Mar12

I am getting ready to teach a series of classes for a local Young Parents program. I have had to rework my class outlines a bit to meet some of the program’s requirements/needs. I decided to upload some of the activities here in case they may help someone else avoid reinventing the wheel by typing up their own similar activities.

Birth BINGO–this is a Bingo card with birth terminology. You can enter the terms into one of a variety of bingo card makers online in order to randomize the cards so that they are not all in the same order (which would then make everyone always win together).

Bingo Definitions–this is the list of definitions that goes with the card above. You can cut them apart and draw terms at random to read aloud. Participants yell out the answer and get to put a candy (Smarties, M & M’s, that sort of thing) onto the appropriate square on their card.

Labor Rehearsal–this is a labor walk-through. It is a little more conventional/conservative than I really like. In most of my classes I like to use the Labor Stations from the Transition to Parenthood site. I print them out as cards, not full pages, and hand them over to the parents to practice. The cards walk them through a whole labor early labor through pushing and it is a god opportunity to review and integrate everything they’ve learned and experimented with in class. I do not include the patterned breathing suggestions because I do not teach patterned breathing techniques. There are LOTS of good games and handouts for classes on this site. I really appreciate it!

Communicating with Baby Prenatally–I was specifically asked to include a component of this in this series of classes. This exercise is modified from one in the Nurturing Parents prenatal curriculum. It isn’t my favorite exercise, but I’m going to try it out. I also have another one from ICEA that I am going to use called Sensory Imaging: The Baby Inside You.

Birth Violence

Mar6

“‘Old wives’ tales,’ says the Oxford dictionary, are ‘trivial stories, such as are told by garrulous old women.’ It is significant that no one ever talks about ‘old husbands’ tales’ or ‘old doctors’ tales.’ Women are blamed instead. It is implied that there is poison in their speech and that the only safe thing to do is remain silent. The experiences that women share with other women are thus rejected and trivialized…In reality, it is not other women who instill and fuel anxiety in most pregnant women, but the medical system itself.” This quote from the 1980’s book, Giving Birth, by Sheila Kitzinger, remains strikingly relevant today. When women in the United States today enter the hospital to give birth, many experience some form of institutional violence. They may not explicitly define it as violence, but listening to their stories provides a disheartening picture of maternity care today.

What kinds of violence occur in the birth place? Here are a few possible examples of “normative abuse” women may experience when giving birth in U.S. hospital setting

• Restriction of movement
• Restriction of nourishment
• Domination by those in positions of authority—must obey even when it is against her own best interests.
• Routine, forced interventions such as IVs
• Repeated, possibly painful, vaginal examinations by many different people
• Denial of option for VBAC (vaginal birth after cesarean)
• At the most extreme example of overriding patient rights, a forced cesarean section
• Vaginal cutting (episiotomy)
• Abusive language
• Separation from family/restriction of companionship
• Lack of respectful treatment
• Voice and wishes disregarded/unheard
• Emotional manipulation using baby as a “card” to force compliance (“you want a healthy baby don’t you?” No mother doesn’t. It is degrading and dehumanizing to suggest that she doesn’t.)
• Forced separation of mother and baby
• Administration of medications without consent
• Cord traction and interference with third stage (placenta) that may lead to hemorrhage.

The emotional treatment of women in labor is the most significant factor contributing to their satisfaction with their birth experiences (emotional factors of highest importance include having good support from caregivers and being treated with respect). According to Kitzinger, “We are only now discovering the long-term destructive effect on human beings and families of treating women as if they were merely containers, to be opened and relieved of their contents; and of concentrating attention on a bag of muscle and a birth canal, rather than relating to, and caring for, the person to whom they belong. The violence which is a common element in childbirth today leaves many women feeling that birth has been a kind of rape. This sort of experience is not easily forgotten. It can shatter a woman’s self-confidence, make her doubt her ability to mother her baby, destroy joy in the expression of her sexuality, and attack her very sense of self–the roots of her identity. It is psychologically mutilating.”

And, as Mary Rucklos Hampton says, “The effort to separate the physical experience of childbirth from the mental, emotional, and spiritual aspects of this event has served to disempower and violate women.”

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Molly Remer, MSW, ICCE is a certified childbirth educator and activist who blogs about birth at https://talkbirth.wordpress.com and midwifery at http://cfmidwifery.blogspot.com.

Note: In 2009, I wrote an article about birth violence for International Women’s Day, but it appears to have never been published. So, I decided to post it here (and on the CFM blog in honor of this year’s International Women’s Day on March 8th). I also read two relevant articles recently: How childbirth caused my PTSD and Birth Trauma: An Introduction.

Book Review: L’Mazeltov

Mar5

L’Mazeltov: Your Personal Guide to Jewish Childbirth Education
By Pamela Nadav
L’Mazeltov, Inc. 2008
Softcover, 248 pages, $18.00
ISBN: 978-097786610-6
www.lmazeltov.org

Reviewed by Molly Remer, MSW, ICCE

The title of the new Jewish childbirth education book L’Mazeltov combines “two important Jewish symbolic expressions—L’Chaim (To Life) and Mazel Tov (Good Fortune).” The first half of the book consists of basic childbirth education and preparation. The second half is about “Jewish Life Cycle Education.” The strength of this book is the fusion of the two.

The childbirth education section was very conventional and conservative. I was surprised by some of the advice offered such as, “Always follow your doctor’s advice in all matters related to your pregnancy, labor and delivery” and in the section about anesthesia, “All of these modern technologies are designed to assist you in having the best possible birthing experience, and are considered to be relatively safe.” Personally, I feel like an important piece of childbirth education is encouraging pregnant couples to be informed birth consumers. There was no element of this perspective within L’Mazeltov.

The book includes some population-specific pregnancy information such as a short section on Jewish genetic diseases and testing.

There is a nice recipe section at the end of L’Mazeltov. I was inspired to make some delicious Challah bread for my family! There is no index, resource list, or glossary of terms (as a non-Jewish reader, many words were unfamiliar to me—-the author does a good job defining many within the body of the text, however).

Despite my wish for a more creative and evidence-based approach to the birth education portion, this book is a one-of-a-kind contribution to birth literature, covering both the “oys and joys” of preparing for parenthood. What a resource for Jewish couples expecting their first baby! “There is such a special sweetness in being able to participate in creation.”

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Disclosure: I was provided with a complimentary copy of this book for review purposes.

Review first published in The CAPPA Quarterly, January 2010.