Tag Archive | childbirth

Pathways Article

I was happy to have an article and an accompanying sidebar in the winter issue of Pathways to Family Wellness (the magazine of ICPA). This was one of my most exciting publications to date as Pathways is a lovely, full color magazine and they laid my article out so nicely and professionally. I’m posting about it here, because the articles were based on two posts originally written here:

What to Expect When You Go to the Hospital for a Natural Birth (re-named in Pathways as “The Hospital ‘Birth Plan'” and available in an online version here)

and

Can I Really Expect to Have a Great Birth? (included as the sidebar in Pathways)

As long as I’m writing about writing, I wanted to share links to some of my recent books/film reviews also:

Multimedia Review: Baby’s First Gift

Book Review: Labor of Love

DVD Review: It’s My Body, My Baby, My Birth: A film About Natural Childbirth

Book Review: The Power of Women

Book Review: Fathers-To-Be Handbook

Book Review: Permission to Mother

Book Review: Dance of the Womb

Jan25

Dance of the Womb book cover

Book Review: Dance of the Womb: The Essential Guide to Belly Dance for Pregnancy and Birth
By Maha Al Musa, 2008
ISBN 978-0-646-48705-2
260 page hardcover book, $49.95 (AUS)
http://www.bellydanceforbirth.com

Reviewed by Molly Remer, MSW, ICCE

Some books simply feel good to hold in your hands. Dance of the Womb is one such book: it is beautiful, both in content and appearance. While priced a little higher than some birth books, I cannot emphasize enough what a high quality book it is—-it is not a traditional trade paperback, it is of textbook quality and size. Hardbound with a lovely cover and endpapers, Dance of the Womb is packed with full color, detailed, step-by-step instructional photographs leading the reader through a “belly dance for birth” journey.

Dance of the Womb is divided into several segments. The first section summarizes the benefits of belly dance and explores the physiology of birth. The next section walks the reader through a series of gentle warm-up exercises while the following sections progress through a variety of different specific belly dance movements. Nearing the conclusion of the text is a segment about labor movements with positions. Each section of the book is lavishly illustrated with very clear, easy to follow, step-by-step photographs.

The author’s own journey through pregnancy, birth, and mothering is skillfully interwoven throughout the text as well as her own feminine passage into understanding herself as a complete woman. Interspersed with the photographs and belly dance instructions, is the exploration of the author’s pregnancy and birth experiences, her relationship with her own mother and her parents’ culture. The book contains her personal birth stories as well as perspectives on belly dance for birth from three midwives.

The author, Maha Al Musa lives in Australia. Her interest in Middle Eastern Dance was sparked by her Palestinian/Lebanese roots and birthplace as well as her pilgrimage to explore her heritage and reconnect with her long-separated mother. Maha has also developed a Dance of the Womb step-by-step instructional belly dancing DVD (sold separately, review to follow) that includes a video of her own homebirth journey with her third child. She is also developing a one day foundation course in “bellydancebirth” for birth professionals with a plan to go international in 2011.

Dance of the Womb is a great introduction to not just the basic physical elements of prenatal belly dance, but also to the spiritual aspects of giving birth and life as a woman. It is written with an intimate tone that makes the reader feel as if the author has reached out across the miles to form a direct, personal connection. This book feels like a rich treasure to hold and is a gentle, nurturing, encouraging, and enriching voyage for pregnant women or the people who serve them.

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

Tips for Emotional Well-Being During Pregnancy

Jan22

I got a lot of wonderful responses to my question about emotional well-being during pregnancy (associated with my giveaway of the book Birth Space, Safe Place). So, courtesy of a lot of wise women, here are some top tips for supporting your emotional well-being during pregnancy and birth:

Peaceful Beginnings doula services shared “I think my best tip for emotional well-being during pregnancy (and life in general) is to let go of guilt. We can only do the best we can with the information we have at the time, no more, no less.”
Yasmel shared that her most helpful tip, “would be to find whatever gives you positive thoughts and use it, a lot. I loved the book Ina May’s Guide to Childbirth and whenever I started second guessing my homebirth decision, I would open it up and just read the birth stories in it.”
Heather appreciated a helpful tip from her sister: “I was having alot of people question my birthing choices and telling me that my baby and I were going to die. None of which happened. She told me that ‘you can’t expect people to agree with your choices or behave respectfully about them. All you can do is know that you are doing what’s right for you and your child and that is all the matters. Don’t let them change your mind with fear. It has no place in childbirth.’”
And I especially enjoyed Ahmie’s advice: “remember that cats purr while giving birth. Figure out what makes you ‘purr’ while you’re pregnant and find ways to do more of that as well as to bring those tools to the birth-space with you.”
One of the most simple and yet important tips was shared by bubbledumpster, “Trust yourself,” and echoed in several other comments, such as earthmothergypsy who said, “I think one of the best helps emotionally is to encourage mamas to trust in themselves, their bodies and their babies. By giving them support in a way that they don’t feel undermined they can build the above trust in themselves.” And inoakpark who said, ” learning to trust your body (and trusting the people who will be with you at your birth to hold that space), is vital for an emotionally secure pregnancy and birth.”
bee in the balm offered another elegantly simple tip “to breathe, just take the time to come back to center and be and breathe.”

Nicole d shared that her best tip is “meditation on good/safe birth… the normalcy and miraculous nature of it. So much of pregnancy stress is uncertainty and fear of the birth process. The more you can trust in the process of pregnancy and birth, the more joyful and peaceful pregnancy can be.”
For Lee-Ann, “emotional wellbeing came with knowledge, the more I read and the more I normalized the birth process in my mind, the more research I did, the more confident and at peace I became.”
Rebekah made an excellent point about honest during pregnancy: “I think being open and honest with yourself and talking to your baby openly helps. It benefits no one to ‘pretend’ like everything is perfect and is okay to have trials, doubts, and fears.”
Jessica benefited from midwifery care: “One of the things that helped me a lot was having a midwife that I knew and trusted implicitly. I knew that my body and my baby would know what to do, and that I had a wonderful woman who would let it all unfold!”
And whoz_your_doula pointed out the benefit of taking time for yourself: “For me that took the form of meditation and prayer. The early morning is my time for deep reflection before the house begins to stir.”
A similar tip was shared by Gentle Beginnings: “I feel it is very important for a woman’s emotional well being to take a few minutes each day to spend time alone. To sit quietly and think about the precious child growing inside them, to disconnect from the world, to envision how peaceful they want their birth to be, to take a stroll in nature and to connect with their inner self. I think we can all benefit from these simple suggestions, but feel it is especially important during pregnancy and childbirth.”

Helpful for birth educators as well as couples, Janet shared that her favorite tip is “teaching the mom and her partner to work together towards open and honest communication before hand. I find a lot of the mothers I teach think, ‘Oh, well we talked about it once and I think we are on the same page,’ only to be completely blind-sided afterwards. Keeping these lines of communication open before, during and after pregnancy makes for a much better emotional state for all.”
Jamie moved us back to the trust theme: “Trust yourself. Trust that your body knows how to be pregnant and how to give birth. Be positive in the changes your body is going through and how you are being prepared for motherhood in all facets of your being. Know that you can do this—you are doing it!”
And another excellent and simple tip was shared by Heather Richins: “My tip is to make sure you stay well fed and hydrated. It is hard to feel good emotionally if you don’t feel good physically.”
Deborah had more than one to share: “1) Eat well: increase protein and raw fruits & veggies, and drink lots of water. Decrease refined foods, white flour products and sugars. 2) Exercise: walk, swim, yoga, etc. 3) Talk: find someone you trust and be honest about how you are feeling.”
And finally, Kathy offered a comprehensive collection of tips: “to be conscious of their needs each day. This includes physical,emotional, and spiritual. For the physical; Eat well. Whole foods, including whole grains, fruits, vegetables. Protein intakes needs to be adequate for a pregnant woman on a daily basis. Eating often to keep your blood sugars level is especially important for warding off mood swings. For the emotional; Trust yourself and others who care about you. Surround yourself with positive people who support you in what your doing. Communicate your needs and wants. Be willing to be honest and vulnerable. Pregnancy can often ‘stir the pot.’ Being willing to work out your feeling and talk to someone you trust and bring about personal growth and sometimes, bring about healing the past. For the spiritual; It is just as important for the spirit to be fed, as it for the body. Fellowshipping with others of the same faith is uplifting to the spirit. Take time for reflections and meditations each day. Keep a journal.”

I appreciated all the responses and think that emotional well-being is such an important subject. I feel like, especially with a first baby, it is an often overlooked element of birth preparation—a lot of time and energy is spent on the physical health of the pregnant woman, but the emotions are assumed to kind of take care of themselves, to perhaps be no one’s business, or to be dismissed summarily as “crazy pregnancy hormones” and “mood swings of pregnancy!”

Cesarean Trivia

Jan20

Anyone who is even slightly familiar with the history of childbirth in the modern world has probably heard the legendary story of the pig-gelder Jacob Nufer and the first successful cesarean section (performed on his wife in 1500). Successful because both mother and child lived, which had never before been documented to happen with a cesarean—and took quite some time to happen again. For example, there was a 100% mortality rate for cesareans performed in Paris for 89 YEARS (1787–1876). I’ve read several excellent books about the history of birth and feel fairly well-versed in the associated facts. However, this month I finished reading a new book by pediatrician Mark Sloan and was surprised to learn something completely new about the history of the cesarean section. This was that, the well-known legacy of Jacob Nufer notwithstanding, the first well-documented successful cesarean section performed in the English-speaking world was performed by Dr. James Barry in Cape Town South Africa in 1826. James Barry was quite the character, small of stature and very big of opinion and personality. He was a British Army officer who clashed frequently with everyone over everything (including even fighting duels!). He even had public arguments with none other than Florence Nightingale! And…then…the conclusion to this already interesting tale is that after Dr. James Barry died—after his forty year medical and military career—it was discovered that he was actually a woman!

I found this extremely fascinating. (I also imagined Jill at Unnecesarean using her Photoshop talents to make some kind of image about this…) So, despite the dominance of males in the medical profession, the first successful cesarean in the English-speaking world was actually performed by a woman! A point the author brings out in this discussion is that, “Here in the early years of the twenty-first century we have reached a point of high medical irony that would not be lost on James Barry: it now can take more courage—or foolhardiness—not to do a cesarean than it takes to do one.” How true.

Some other non-related quotes from Birth Day that I shared via the CfM Facebook page are as follows:

“Birth is about radical, creative, life-affirming change. It is about adaptation on a nearly unbelievable scale.” –Mark Sloan, MD

The quote above is in regard to the physical adaptations required by the baby immediately after birth—I see it as about both mother and baby though and I enjoy that it comes from a man and a doctor no less!

“Rigid plans work best if you’re building a skyscraper; with something as mysteriously human as giving birth, it’s best, both literally and figuratively, to keep your knees bent.” –Mark Sloan, MD

The above quote is from the segment about what he would want to tell his daughter about giving birth. Though the book wasn’t as “alternative” as many of the birth books I enjoy, I found Birth Day to be a very engaging and entertaining read!

Heroin and Labor…

Jan8

I recently finished reading the new book Birth Space, Safe Place by Adela Stockton (watch for my full review and a giveaway on the CfM blog next week!). The author lives in Scotland and something in the book’s glossary jumped out and caught my eye. The word was “diamorphine” and the definition was: “a semi-synthetic opoid for labour—only adnimistered in Scotland; another name for heroin.”

The irony that giving heroin to women in labor is considered a medically acceptable practice, but that “letting” a woman labor without an IV or in water—as some of many examples—is considered unsafe or risky is so boggling my mind that I can’t even comment any further!

Birth Talk

Oct19

As I have referenced several times before I have a special interest in the language of birth. That is part of the reason my blog/business is so-named—because is it is a blog that “talks birth” (as in, “let’s get together and talk birth!”), but also because the way you talk about birth matters. I have also referenced before that it was originally going to be called Birth Talk, but when I went to get the gmail address, it was already taken (by a childbirth educator I coincidentally later came to know!). I’ve come to really “bond” with my Talk Birth name and now “birth talk” sounds slightly odd to me (though “talk birth” is really the odder phrasing).

A couple of months ago, I read an interesting article by Debra Bingham about Taking Birth Back. It it, she asks you to consider–when talking about birth–how your basic assumptions affect your discourse (the way you talk about birth):

1. Does your discourse include stories about the power of women?
2. Or do the stories shift the locus of control away from women and their bodies to other authority figures such as nurses, physicians, or machines?
3. Does your discourse assume that women are physiologically capable of giving birth and nourishing their own children?
4. Or does your discourse assume that women’s bodies are fundamentally flawed and in need of medical attention and intervention?

I am frequently attempting to shift the locus of control from “authority” figures back to women–it is shocking to me how ingrained the terminology is about medical care providers (even midwives!), “letting” someone do something, etc.

And, an enormous part of my life revolves around stories about the power of women, so I think I have that one down 😉

The prevailing social discourse about birth assumes a locus of control external to the woman and you rarely hear stories about the “power of women” amongst the general public or mainstream media. Ditto for the assumption of women’s bodies as fundamentally flawed, except replace “rarely” with “frequently.” These messages are so dominating that I think it is hard for women to really “hear” positive birth talk–it seems like a “joyful birth” must be a myth or impossible. Likewise, when a woman is striving to keep the birth talk around her positive, it can be very difficult to override the predominately negative messages coming at her from every side. I see this in my classes, “I believe birth is a natural event, etc., etc. BUT….” (followed by a “I trust my doctor’s judgment and if he wants me to have this GTT test or this extra ultrasound to check my fluid level, etc. I guess I will do it…” comment that contributes to the “climate of doubt” in her life). There are also the woman’s own “inner voices” to contend with—I hypothesize that the loudly-shouted cultural voices about birth contribute a good deal to the “negative voice” in her inner dialog.

I don’t know any way to “fix” this other than to continue “talking birth”–good, healthy, positive, normal, humanistic, natural, joyful birth–as widely and frequently as I can!

Birth as a Rite of Passage & ‘Digging Deeper’

Oct16

Childbirth is a powerful rite of passage. One of my favorite resources, The Pink Kit, has some great reflections on this rite of passage and the words we use to describe the powerful, indescribable act of giving birth:

Whatever the culture, when a woman surrenders to the process, accepts the intense sensations, works through each contraction, and digs deep within herself to achieve the end goal–giving birth–she is touched by the Unknown and Unknowable. Many traditional cultures send their young men into initiation rites where they, too, can learn to understand humbleness and achieve the self-control that women learn in childbirth.

All cultures believe that women become better and more generous through the process of giving birth. That is why some cultures use words such as ‘sacrifice,’ ‘suffering’ and ‘labour.’ These terms can seem overwhelming and to be avoided’ however, seen from a different viewpoint, childbirth helps us to become strong, resourceful and determined.

In a modern world, ‘getting through’ labour without numbing or dumbing the process can be a very powerful experience for a woman, and very challenging.

I like the concept of “digging deeper.” This how The Pink Kit explains it:

You might avoid the pain in labour by moving into a position which is comfortable for you (i.e. reduces the sensations), but it slows labour down and then you stay there for hours. Doing that will increase the likelihood of medical intervention because you will become tired, bored, or frightened, and labour doesn’t progress. Instead, consider remaining in positions that keep you open and the labour progressing, while using your skills to manage the sensations. This is ‘digging deeper’.

I have noticed an emphasis in other natural birth preparation books and explanations about finding positions that are “comfortable.” I very much like the concept of finding positions that help you feel “open”—these positions may certainly also comfortable (and that is great!), but if you remain mindful of “staying open,” it may lead you “dig deeper” and find positions that really help move the baby. In my classes, I encourage women to welcome labor “getting bigger” (not more “painful” or “difficult,” but make it “bigger” and be excited by that change!). I think this idea goes hand in hand with digging deeper.

Let labor begin on its own…

Oct9

One of my blog posts that gets the most hits and is a consistently searched for topic is one that I wrote called “how do I know I’m really in labor?” I revised it recently for participation in a blog carnival at Science and Sensibility about letting labor begin on its own. Let Labor Begin on Its Own is the first of Lamaze’s Six Healthy Birth Practices. Why is letting labor begin on its own so important? Well, the onset of labor is a complex biological system that has its own wisdom–when a woman’s body is pushed into labor on someone else’s timetable rather than her own, the whole biochemical “dance” of labor and birth is impacted. What may seem like a harmless “jump start,” actually has a cascading effect on the rest of the birth (and has an impact on the baby as well). A significant impact is that induced labors are often much more painful than spontaneous labors. If a woman is planning an unmedicated birth, the increased intensity of artificial induced contractions coupled with the lack of the biologically trigged endorphin release that helps birthing women naturally cope with pain, often leads directly into a request for medications. The woman is then sometimes left feeling like she “failed” in her “natural birth” plans and that she “wimped out” and “just couldn’t handle it.” However, she was dealing with something much different than a “natural” labor and so it makes sense that a “natural” birth then didn’t happen. Of course, the cascade of other interventions that accompany an induction, such as an IV and continuous monitoring also severely restrict a woman’s mobility (which also has a dramatic impact on her ability to cope).

I am saddened when I hear women blaming themselves for “not being able to handle it” (or, conversely being angry at “natural birth zealots” for misleading them…), when they were actually just missing significant pieces of their “pain coping pie” as well as dealing with a (probably) more difficult labor. We need to remember to look at the overall healthy birth climate of the birth setting and the use of the six healthy birth practices, rather than at personal “failure.”

There are a lot of excellent links on letting labor begin on its own in the rest of the blog carnival!

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

Sep9

I’ve been debating about whether to share this post or not. I’m concerned that it may come across as unnecessarily negative, pessimistic, or even “combative” or “anti-hospital.” However, I do think it is honest and I’ve decided to share it. There is a fairly “normal” course of events for women having a natural birth in a hospital setting. In order to be truly prepared to give birth in the hospital, it is important to be prepared for “what to expect” there and to know how to deal with hospital procedures. All hospital procedures/routines can be refused, but this requires being informed, being strong, and really paying attention to what is happening. I hope this list of “what to expect” with help you talk with your medical care provider in advance about hospital routines and your own personal choices, as well as help prevent unpleasant surprises upon actually showing up in the birthing room. This list is modified from material found in the book Woman-Centered Pregnancy and Birth. I am not saying that is how your specific hospital operates, but that many American hospitals function in this manner.

Expect to have at least some separation from the person who brought you to the hospital, whether this separation is due to filling out admission paperwork, parking the car, giving a urine sample, being examined in triage, etc.
Expect to remove all your clothing and put on a hospital gown that ties in the back.
Expect to have staff talk over you, not to you, and to have many different people walk into your room whenever they want without your permission and without introducing themselves.
Expect to have your cervix examined by a nurse upon admission and approximately every hour thereafter. Sometimes you may have multiple vaginal exams per hour by more than one person.
Expect to have an IV inserted into your arm, or at minimum a saline lock (sometimes called a Hep lock).
Expect to be denied food and drink (at best, expect clear liquids or ice).
Expect to give a urine sample and perhaps a blood sample.
Expect to have an ID bracelet attached to your arm.
Expect to have to sign a consent form for birth and for application of a fetal monitor that states that your doctor will be responsible for making the decisions about your care (not you).
Expect to have a fetal heart rate monitor attached around your belly—two round discs on straps that will often stay with you continuously until you give birth (or, at best, for 15 minutes out of each hour of your labor).
Expect to have your water manually broken at about 4 centimeters (or at least, strongly suggested that you allow it to be broken). After this point, expect to be encourage to have an electrode screwed into the baby’s scalp to measure the heartbeat and a tube places in your uterus to measure your contractions.
Expect to be offered pain medications repeatedly.
Expect to receive Pitocin at some point during your labor–“to speed things up.”
Expect to be encouraged (or even ordered) to remain in your bed through much of labor, especially pushing.
Expect to either have your legs put in stirrups or held at a 90 degree angle at the hips.
Expect to be told you are not pushing correctly.
Expect to hold your baby on your chest for a few minutes, before it is taken away to be dried, warmed, and checked over.
Expect the baby to have antibiotic eye ointment put into its eyes (without telling you first).
Expect to have your baby suctioned repeatedly.
Expect to be given a shot of Pitocin to make your uterus contract and deliver the placenta.
Expect not to be shown the placenta.
Expect your baby to be given a vitamin K injection.

I think it is important to note that what you can expect is often different than what you deserve and that what you can expect often reduces or eliminates your chances of getting what you deserve. In my classes, I’ve made a conscious decision to present what women deserve in birth and though I also talk about what they can expect and how to work with that, I think sometimes they are left surprised that what they actually experience in the hospital. At minimum, what you deserve are Six Healthy Birth Practices (as articulated by Lamaze):

Let Labor Begin on Its Own – Download PDF
Walk, Move & Change Positions – Download PDF
Have Continuous Support – Download PDF
Avoid Unnecessary Interventions – Download PDF
Get Upright & Follow Urges to Push – Download PDF
Keep Your Baby With You – Download PDF

As an example of what I mean about what you can expect clashing with what you deserve, consider the second healthy birth practice “Walk, Move Around, and Change Positions”—monitoring and IVs directly conflict with the smooth implementation of a practice based on freedom of movement throughout labor.

So, how do you work with or around these routine expectations and your desire for a natural birth?

Discuss in advance the type of nursing care you would like and request that your doctor put any modifications to the normal routines in your chart as “Doctor’s Orders” (if your doctor is unwilling to do so, seek a new medical care provider!)
Labor at home until labor is very well-established.
Go through the above list of “what to expect” and make a decision about how to handle each one on a case by case—you may choose to actively refuse something, you may be okay with accepting certain procedures or routines, and you can develop a coping plan for how specifically to work with any particular issue.
Take independent childbirth classes and learn a variety of techniques and pain coping practices so that your “toolbox” for working with labor is well stocked.
Hire a doula, or bring a knowledgeable, helpful, experienced friend with you. It can help to have a strong advocate with you (this may or may not be a role your husband or partner is willing to take on).
Another tactic is to “never ask permission to do what you want, but to go ahead and do it unless the hospital staff actively stops you.” (An example of this is of getting up and walking around during labor)
“Many people, if they can find no other way to get around a dangerous or unpleasant hospital policy, unobtrusively ignore it”—a good example of this is with regard to eating and drinking during labor. Restricting birthing women to ice chips or clear liquids is not evidence-based care. Bring light foods and drinks and quietly partake as you please.
Leave the hospital early, rather than remaining the full length of stay post-birth. This can minimize separation from baby and other routines you may wish to avoid.
For some additional ideas see my post, “Can I really expect to have a great birth?“

Finally, and most importantly, “birth is not a time in a woman’s life when she should have to FIGHT for anything,” so if you find that you feel you are preparing yourself for “hospital self-defense” I encourage you to explore your options in birth places and care providers, rather than preparing for a “battle” and hoping for the best. If you feel like you are going to have to fight for your rights in birth, STRONGLY consider the implications of birthing in that setting. Also, as The Pink Kit says, “hope is not a plan”—so if you find yourself saying “I hope I can get what I want” it is time to take another, serious look at your plans and choices for your baby’s birth.

Beautiful Homebirth Slideshow

Sep8

Today I was sent a link to a lovely homebirth slideshow (scroll down through the photos and story to get to the slideshow link—-the story is worth reading too. It has some good observations about why birth matters: “If you have scene the movie The Business of Being Born there is a seen where one of the OBs being interviewed states in so many words that the process of birth is unimportant that it’s the outcome that is important – a healthy baby and a healthy mom. And while he is correct that a healthy baby and a healthy mom are always the most important end result he is dead wrong about the process. The process matters – -immensely. Physically the birth process is extremely important for the long term health of the mother and the baby, emotionally and psychologically the birth process will affect a woman for the rest of her life.” Can I just say, Amen!)

I absolutely love the joyful expressions on the mother’s face immediately after birth. So beautiful! Plus, it brings that feeling from my own births back to me. On Labor Day, CAPPA posed the question:

“Happy ‘LABOR’ day from CAPPA. What I loved about labor was________________!”
My response was: The feeling of personal power at the end—the “I climbed my mountain,” I DID IT feeling. And that moment of ecstasy of holding my new baby and saying, “my baby, my baby, oh my baby” over and over 🙂 Brings tears to my eyes thinking about it!

Watching the slideshow above, also brought the memory of that same “my baby, my baby” rapture back to me.