Trying for a Natural Birth? The Three Things You Absolutely Must Know.

[Above:  Fill this space with a birthing woman who knows her power!]

 

I work with women who want a natural birth. They want to experience this fundamental human act.

They also want to take advantage of the safeguards of modern medicine, so most choose to give birth in the hospital.

There is great potential for conflict in holding these two desires at once. I’ve written about it here and here. How do you avail yourself of medicine without allowing it to turn your birth into a medical event?

Here are three things you absolutely must know in order to achieve a natural birth in the hospital.

1.  You can do hard things.

“Don’t be a hero. Get the epidural.”

Why do we discourage women this way?

Imagine talking to a mountain climber with such condescension: “Why would you do that to yourself? I’ll keep the ambulance close by for when you’re ready to quit.”

It’s ridiculous, isn’t it? One reason we may think of birth as different from other achievements of endurance is that birth is involuntary. It comes through you – you don’t choose to do it, and you can’t quit if it is longer and harder than you expected. Consequently it can look to outsiders like an affliction, rather than an opportunity for a transformative experience.

Another factor is that it happens to women. Many believe (unconsciously) that women are the weaker, more fragile sex and in need of protection from men. More than one woman has told me that she got an epidural not because she wanted it, but because her husband was uncomfortable seeing her in labor!

In fact, the rawness of birth itself can make onlookers uncomfortable, too. A medicated woman is a quiet, controllable patient in a bed.

Ladies, I don’t know how long your labor will last or if it will hurt. I don’t know what traumas and expectations may come up and challenge you during your birth. But I do know this: you can do hard things.

Think right now of one of your proudest accomplishments. How much grit did it take to achieve? How many times did you become afraid and want to quit, but instead you found the strength and determination – and sometimes the help – you needed to persevere?

Not only can you do hard things, you do not have to do this hard thing (labor) alone. Nature’s design for birth includes powerful feel good hormones, which I’ve written about in detail here and here. In short, a labor that is allowed to begin, proceed and conclude without interference, in an atmosphere of loving support, feels dramatically better than one that is chemically manipulated in any environment.

Believe in yourself strongly enough and you’ll silence the naysayers before they have a chance to doubt you!

2.  You are an authority.

Nothing in our culture of birth suggests that women are authorities on it. Isn’t that interesting?

Medicine can gather and interpret a great deal of objective data on you, your baby and your birth, but that’s not all there is to know. You have access to subjective ways of knowing – your feelings and your intuition – that are valid and important. You do not need to understand Friedman’s Curve to be an authority on your own birth.

Do you have an experience of just “knowing” something? Do you have an experience of Just Knowing something and not being believed by a doctor? Countless women have told me stories of Just Knowing something about their labors that was not reflected in the objective data, and yet they were proved right.

(If you’ve taken a class with me, you’ve heard some of these stories. One of my favorites is about Anna, who arrived at the birth center only to be told to go home again because her cervix as “only 3 cm.” But Anna knew her baby was coming, so she quietly locked herself in the bathroom there at the birth center. Her baby was born within the hour on the bathroom floor.)

It’s easier to remain tuned in to your knowingness if you shut out distractions. Darken the room, close your eyes, maybe play some environmental music. Have your birth companion keep the room quiet and free of non-essential personnel. If any interventions are proposed – which would undermine your natural birth but which might be good medicine – get the information you need, then ask for some time and space to consult your intuition.

Claim your authority in this way and you will be treated as one.

3.  Breathe and Relax.

What would happen if I told you that something was going to hurt more than anything you’d ever experienced in your life, no ones knows how long it will last, and some people don’t even survive it?

You’d probably be scared.

That’s what our culture tells mothers about birth. So most mothers are frightened of it.The trouble is that fear interferes with birth.

What happens when you are afraid? Your brain releases stress hormones. Your breathing becomes shallow and rapid. Your muscles tense. Blood flow is redirected to the limbs, so you can fight or take flight. You become reactive.

Stress hormones inhibit the release of both oxytocin, the hormone that causes labor surges, and endorphins, the feel good hormone. Muscle tension increases the workload of the uterus, which is already taxed. Reduction in blood flow to the uterus – which is not a defensive muscle system – weakens those muscles and may hurt the baby. The result is a slowed, less efficient, dramatically less comfortable labor and possible fetal distress.

But there’s good news! You can stop the physiological effects of fear by breathing deeply and consciously relaxing your muscles. Deep breathing overrides the shallow breathing of the stress response and short circuits it altogether. This restores the vital release of oxytocin and endorphins. Relaxing your muscles conserves all your energy for your birthing body and ensures blood flows appropriately to the uterus and baby. The result is a labor that flows more easily, comfortably and healthily.

It probably isn’t possible to eliminate all fear. You can, however, eliminate its harmful effects on you, your labor and your baby by consciously breathing deeply and relaxing your body.

Where You Lead, Others Will Follow

There are a lot of messages in our culture, both implicit and explicit, that can undermine a woman’s determination to have a natural birth. But you don’t have to argue with anyone about your choices to get what you want.

What you have to do is believe in yourself – own your strength, claim your authority – and have some simple breathing and relaxation skills to keep yourself in peace while you’re in labor. Where you lead, others will follow.

Love,

Allison

How about you? If you had a natural birth in the hospital, how did you stay committed to it? What helped you?

 

If you like this, you might also like this cheerful little article, in which I discuss a fresh way to think about birth.

If you like this a lot, I’ll teach you this and much, much more in my empowering new prenatal course, Becoming A Mother. The next telecourse begins September 30. Enroll now!

 

 

Can the Birth Plan. Pick the Right Provider.

Whether you have a C-section or any other procedure or medication in labor has little to do with your or your baby’s condition. 

What happens to you depends almost entirely on your caregiver’s practice style and philosophy.

– Henci Goer, The Thinking Woman’s Guide to Better Birth

 

What kind of birth do you want?  Are you hoping for a natural birth?  If so, just fill out the “Birth Preferences” form your OB gives you, and you’re covered, right?  Wrong.

The wide acceptance of birth plans has given a false sense of agency to mothers who give birth in hospitals.  Doctors and hospitals know that modern women are educated consumers of health care and desire some control over their care.  In particular, moms are alarmed by run-away C-section rates and want to protect themselves from unnecessary surgery.  Many of them, in fact, desire a completely natural birth.  In response, providers have become more willing to discuss a mother’s birth preferences.

I’m sure that doctors are sincere when they agree to do their best to comply with the mother’s preferences.  But unless the birth you desire is the kind of medicine they already practice, don’t count on it.  If you are looking for mother-baby-centered care, rather than care that is doctor-hospital-centered, the birth plan will cover you about as much as a hospital gown.  Instead, choose the right provider in the right environment for you, and then let them do their job.

 

It isn’t me, it’s you.  (Why you should break up with your OB).

It isn’t that doctors intend to deceive.  It’s that saying, “If you’re a hammer, everything looks like a nail.”  The way they practice reflects what they honestly see.  Doctors, in the words of Robbie Davis-Floyd, are socialized to look for pathology.  It’s why you’re giving birth in the hospital in the first place, right?  “In case” something goes wrong?  Well, what you look for, you tend to find.

Doctors don’t intervene to spite the mother or her birth plan.  They intervene because in their judgment something should be done.  But what you need to know is that another practitioner would look at the same scenario and decide that nothing needed to be done.  Or they would “intervene” in a non-medical way, such as suggesting a walk, a position change, or offering words of encouragement.

 

The Gilded Cage

The weight of the institution also plays a huge role in what happens during your birth.  Hospitals are institutions, in the dual sense of being the social authority and the physical structure.  Doctors are the officers of that institution.  We have been socialized from the earliest age to be patients within that institution:  we wait for them to see us; we slot ourselves into their organization; they wear special clothing and have special titles; we are awed by the physical structure itself, with all the people who support it and all the high-tech, expensive technology it contains and which the doctors know how to wield.  We pay dearly to be part of it.

So not only do doctors play their role as finders of pathology, we play ours, as patients.  When we park the car in the huge lot, walk the long distance into the double-doored atrium, consult the signs or the friendly receptionist for where to go and don the bare-bottom gown, we become smaller and smaller.  We begin asking permission.  We accept “no” for an answer (even if we know better).  We accept being told that something is “not allowed” (even when we know there’s no basis for it).  Surrounded by medicine and technology, unsure of ourselves and hypnotized by the institutional cues, we consent to the undoing of our own birth plans.

 

What To Do Instead.

You know this.  Every other time in your life you’ve hired someone for something important, you’ve done this.

Hire a birth attendant (midwife, family practice doctor, or obstetrician) who already practices the way you want to be treated.

Though this is simple advice, I know it may not necessarily be easy if no one within your insurance panel fits that bill.  If that’s the case, seriously consider paying out of pocket for a birth center or home birth midwife for these good reasons:

1. Care with these professionals is substantially less expensive than a hospital birth.  According to “Evidence-Based Maternity Care,” a report published by Childbirth Connection and the Milbank Foundation, out-of hospital vaginal birth averages $2,500, at least a portion of which is reimbursable under many insurance plans.  Compare that to an average of $7000 for a vaginal birth in hospital or $20,000 for a C-section, which may not be 100% covered.

2. It is just as safe as hospital birth – arguably safer, when you consider that interventions are much less likely to happen outside of the hospital.  Once interventions are introduced, more interventions become likely, including the C-section, which is not without risk.  According to the WHO, C-section rates above 10-15% actually increase rates of morbidity, or illness and dysfunction, rather than prevent it.  What a relief it would be to know you can trust your provider to intervene judiciously, rather than feel you have to be on your guard against unnecessary interventions.

3. Women vividly remember their births all their lives.  They particularly remember how they were treated during their births.  Ina May Gaskin says, “If a birthing woman doesn’t look like a goddess, someone isn’t treating her right.”

It’s time to can the birth plan and start putting our money were our values are.  When we choose maternity care providers whose practice aligns with our values, we tilt the economics of birth toward care that we want.  If enough families walk away from maternity care business-as-usual and put their money behind mother-baby-centered care, we incentivize change in the system.  We also put the responsibility for our care back where it belongs:  with us.  Parents, not patients.

The Prenatal Orientation Your OB Was Too Busy to Give You

When you visit the doctor’s office to confirm your pregnancy, you are full of joyful expectation.  Even if you don’t admit it to yourself, you are so taken by your new condition that you kind of expect everyone in the office to share your excitement.

 

You imagine your doctor is going to initiate you into your new status with a conversation about how to be pregnant correctly, what your birth options will be and how you can Guarantee the Best Possible Outcome.

 

Instead, it’s weirdly business as usual: the doctor is kind but clinically detached, the techs take your blood and urine efficiently and your next appointment is made for eight weeks later.  Eight weeks?  Can you really wait that long to see me again? Isn’t there anything I should know now?

 

So on your way to the car, you call me.  Yes, there are some things to know.  Here is the prenatal orientation your doctor was too busy to give you.

 

1.  Read only books & blogs that inspire you and make you feel strong.

This is the first step because I know that as soon as your pregnancy is confirmed you’ll start book shopping.  You are excited and hungry for information, and I love that about you!  But, seriously, be careful what you choose to read.  It will frame your whole experience of pregnancy and your feelings about birth.

Pregnancy media — like most things that people have opinions about — is a spectrum with pro-medicine at one end and pro-nature on the other.  The pro-medicine media treat pregnancy and labor like an illness that is cured by birth.  You’ll recognize this mindset because it talks about, well, medicine:  tests, procedures, symptoms, medical options, illnesses to watch for.

You may like this approach if you are already technology- and medically-minded.  Even if you like it, though, the danger with this approach is that it can make you feel like a ticking time bomb.  When you focus on what could go wrong, that’s what you tend to find.

The pro-nature media, on the other hand, reassures you by focusing on the fact that pregnancy and birth are natural and usually healthy processes.  Nature has been honing the design for millennia, and mothers and babies have thrived on the planet all along.  In fact, Pro-Nature leans in close to whisper, birth is actually awesome!  You’ll read stories of births as trials overcome and as peak experiences that mothers are so proud of.

Even if you like this approach, it can sometimes feel too spiritual and ungrounded (hippy-dippy) and, in some cases, lead to feelings of failure if your experience was not all you hoped it would be.

Only you know where you fall on the spectrum.  So, rather than tell you what books to read, I suggest that you read the first page or ten of any book.  If what you read makes you feel strong and healthy and like you’re up for this thing, then keep on reading.  But if it does not put it down.

If you’re in doubt, I do recommend you begin with a pro-nature reading list.  You can’t unread some of the scary stuff the pro-medicine people write about.  I have a great bibliography here, if you want some ideas.

Your reading will help you get to number two on the list:

2.  Decide how you want to give birth.

Once you know that, you can start making plans for it.  Those plans may very well involve finding a new birth attendant; i.e., you may have to fire your doctor.  The influence of your provider cannot be overstated, friends.  One of the most unequivocal statements in her classic, The Thinking Woman’s Guide to Better BirthHenci Goer states that “what happens to you during your birth has little to do with your or your baby’s condition.  What happens to you depends almost entirely on your caregiver’s practice style and philosophy.”  (Find her latest article on the arbitrariness on maternity care here).

You can write a birth plan and discuss it with your doctor and think everything is fine.  But your doctor and the staff who support him or her are human.  Humans like routine and when the pressure is on them – as it will be during your birth – they will only feel safe if they are doing what they always do.

You do not want to set yourself or your birth companion up for a fight on the day you meet your baby.  Instead, set yourself up for success by partnering with a provider who already practices the way you want to be treated.

The only way to know a provider’s practice style and philosophy is to interview him or her and to speak to mothers whose births they attended.  Ask the provider how often mothers like you give birth the way you want to give birth.  What are their rates of intervention (induction? augmentation? c-section?)

Ask mothers how they were treated by the provider.  How did their providers make them feel?  Were their preferences were respected?  If there were differences, how were they resolved?

3.  Hire a doula.

But only if you want to feel strong and loved and have a great birth.  The thing is, you were never meant to do this alone.

If you give birth in a hospital, you will be surrounded by people, yes.  But they are strangers and they do not love you.  Kind and well-meaning as they are, to them you are a patient and a clinical responsibility and they have other patients to attend.

Your beloved will be by your side, yes.  But this is as new to them as it is to you, and they may not know how to help you.

Enter the doula.  Doulas are women who provide continuous emotional and physical support to the mother and to the couple.  They know and trust birth and love and believe in birthing mothers.  And they make a difference.  The benefits of doula care during labor and birth are well-documented.  See the evidence here.

A doula is like an angel in the birthing room, reassuring you that you are strong and amazing and you can do this.  She is skilled in providing non-medical pain relief.  She can help your partner help you, too.  She can help you communicate with the staff, too, and ensure your preferences are remembered.

A doula is also a professional.  High-quality research has found that certified doulas have a more positive impact than doula-like care from hospital staff or someone from your social circle.

 

There you have it, mama: three fundamentals to orient you as you begin your pregnancy. And yes, being pregnant really is as amazing and wonderful as you feel it is. You are growing another human being! You are becoming a mother!  Enjoy every minute.

 

Love,

Allison

Optimal Cord Clamping the Culture of Medicine

Which cord seems right to clamp? The full one or the empty one?

Which cord seems right to clamp? The full one or the empty one?

Expectant parents are increasingly aware of the benefits of delaying the clamping and cutting of their newborn’s umbilical cord, and they are insisting on it for their births.  This is great news because there are no benefits  to early cord clamping without a specific medical indication.  Whereas, there are abundant benefits to delaying; in fact, the best term for it is “optimal cord clamping.”  The question becomes, how long do you wait? More importantly, how long do you wait if baby seems to be having difficulty taking his first breaths?  It turns out that, contrary to common practice, it is important to keep the cord open and baby attached to the placenta until baby is breathing well on her own.  The fact that this is not common practice tells us something important about the culture of medicine.

 

First, here is a very simple explanation of the physiology of newborn transition.  (For a detailed discussion of this transition, visit the brilliant Midwife Thinking.)  In the womb, one-third of the baby’s blood volume is outside of him, in the placenta and umbilical cord, so that baby can exchange nutrients and waste products with the mother, through the placenta.  When he his born, the placenta transfuses the entirety of the newborn’s blood volume, and stem cells from the umbilical cord, into him.  This blood is needed for the full, independent function of the baby’s organs – notably the lungs, which must now accomplish the gas exchange that the placenta was completing in utero.  After birth, you can see this transfusion in the pulsing of the umbilical cord.  It takes 2 – 10 minutes for complete transfusion.  As long as the cord pulses and baby is not held aloft, he is receiving this transfusion and continues to be oxygenated by it.  This means that he does not have to rely solely on breathing air to get the oxygen he requires.  If baby is not breathing well on his own, assistance can be given by the mother or by staff while baby remains in mother’s arms or beside her, attached to the placenta.

 

Now that you know something about the science of newborn transition at the time of birth, you can confidently insist on optimal cord clamping when your baby is born.  But I’d like to take this post a step further and let the issue of early cord clamping – a harmful intervention regularly practiced on babies – teach us something important about maternity care in general.   It teaches us something about the culture of medicine and the importance of your physician’s practice style and philosophy.  In The Thinking Woman’s Guide to Better Birth, Henci Goer says that “whether you have a c-section or any other procedure or medication during your labor has little to do with your or your baby’s condition.  What happens to you depends almost entirely on your caregiver’s practice style and philosophy.”

 

Doctors are human, like the rest of us.  Humans tend to like to feel in control.  This leads us to value predictability and routine over change, even if the change is an improvement.  In our busy lives, we don’t always make time to keep up with the latest wisdom – until we’re in trouble and searching for help.  (When was the last time you read a parenting book?  Compare that with how many you read when you were pregnant or a brand new parent.)  With those observations in mind, it’s easy to see how physicians would favor doing what they always do, even if their knowledge is outdated.  And if things go well for them – if these practices cause them no obvious trouble – they don’t go looking to change the formula that seems to work!

 

Furthermore, as medical anthropologist Robbie Davis-Floyd reminds us, “Doctors are socialized to find pathology.”  What we look for, we tend to find, and when we find it, our pre-existing belief is reinforced.  Because of their socialization in disease and intervention, physicians don’t necessarily believe that birth, just because it is “natural,” is necessarily “healthy.” Cancer is natural, too, they point out.  Many physicians have never not manipulated a birth, so it is outside their comfort zone.  (I’m reminded of the pre-Columbian map of a flat earth: beyond the horizon, “There be dragons.”)

 

Finally, medicine is a high-prestige profession.  Studies show that even the most well-informed patients can find themselves tongue-tied and uncomfortable when they try to question their doctor.  But question you must.  Despite a mountain of evidence, the American College of Obstetrics and Gynecology (ACOG) still refuses to admit that early cord clamping is a bad practice.  To do so would be to admit that they have been wrong and cast doubt on their authority.  This is a counter-cultural act!

 

If change will not come from within, it must come from without: from you parents.  Ask questions of your provider.  You are looking not only for answers that align with your own philosophy but for her comfort with having a conversation with you about your care!  If you sense arrogance, it really is best to find another provider.  But if she is open, cultivate the relationship.  She may be willing to step outside her comfort zone to accommodate your preferences.  By doing so she may discover a new way to practice and even adjust her philosophy to allow the idea that Nature’s design for birth and newborn transition is actually a good one.  Thus you pave the way for the mothers and babies who come after you.

How Do You Eat an Elephant?

The physical therapy notes that changed my life

 

As I did my physical therapy routine on the track three mornings ago, I thought about writing.  Between running a home with a husband and children, volunteering at my children’s schools, and my business teaching HypnoBirthing and life coaching, my days are completely full.  I am always doing!  But writing is important to me.  More than that, I feel I am a writer in the same way that I am a mother, a wife, a reader, a coach. . . it’s just who I am.  I feel sure that writing is how I’m meant to contribute.  But can I say I’m a writer if I don’t have a writing practice?  The discrepancy between what I wanted to do and what I was actually doing nagged at me, especially as this is something I help my coaching clients with every day!

My mind is always searching for patterns and meaning, so I tried to understand why I wasn’t making this thing I love a priority.  Why say yes to everything else but no to it?  Trying to answer my own question, I thought, “Maybe now is just not the time.  Maybe it would it be better to wait until the children have left home.  I don’t want to miss a thing with them, and I’ll have a lifetime to write once they’re grown!  Maybe I should focus on building up the practical skills required by my work and write when I ‘have more to say.’”  There may have been some truth in these conclusions, but they did not make me feel any better.  I returned my focus to running.

I love being able to run again.  Not only does it feel good to my body, it is excellent time to let my mind roam.  Such good ideas come effortlessly when I run, ideas I can’t force just sitting at the computer.  I missed it when I had to stop because of an injury in June.  I pulled my Achilles tendon.  I rested it for about a month, then, eager to believe I was “healed enough,” I tried running again. But, alas, it was too soon.  In my haste to not be injured anymore, I hurt it even more.

I am committed to spiritual growth, and as I mentioned, my mind is always searching for meaning.  So I took my injury as a sign from the Universe that I needed to learn to be okay with resting instead of constant movement that comes from juggling work and home life.  A naturopath once told me it was important to balance running with something slow like yoga.  While that seemed logical, I never took the advice.  Now it seemed I was being forced to slow down!  I spent the summer elevating my foot every chance I got.  I hardly even walked.  I read.  I watched web casts.  I played board games with my kids.  My husband did the housework and errands.  I noticed it was a really nice summer! The world did not fall apart because I sat down.

But unfortunately the pain in my foot remained.  Wanting to test it, I took the dog for a walk and within five minutes was hobbling home. This drove me to finally take my husband’s advice to go to see the physical therapist.  I had resisted because I had my existential theory of this injury and didn’t believe a Western medical practitioner could help me!  I went to my appointment with low expectations.  How silly I had been!  The physical therapist was very bright and professional and spoke with authority about my injury.  She taught me some stretches and exercises to strengthen the foot.  They were simple and few and so I did them.  Within a month the pain was gone.  G-O-N-E. Gone.

I was so impressed that I kept my follow up appointment with her, during which time she matter-of-factly gave me a plan for beginning to run again.  “Really?” I asked, incredulous.  It seemed so bold!  Though her exercises had strengthened my foot, I was nervous about re-injury.  To be completely honest, I was a little superstitious about whether or not I’d learned the Lesson the Universe Was Teaching Me about slowing down.  That was the lesson, right?

But as before, her plan was simple and unintimidating, so I did it.  First, there was a five-minute walk to warm up.  Then there were five minute increments of running and walking: the first week I would run for one minute, walk for four; the second week I would run for two minutes, walk for three, etc.  Then I’d end with a five-minute walk to cool down.  Once I could run comfortably for 20 minutes on a flat surface, I could re-integrate hills into my routine.

I am now doing three minutes of running with two minutes of walking and I feel great!  As I reflect on my accomplishment it occurs to me as obvious that I could apply the lessons of physical therapy to my writing practice:

Start small.

Do something every day.

It will add up.

You will get stronger.

My teacher Martha Beck says, “How you do anything is how you do everything.”  I felt the truth of that as I reflected on my attitude toward healing my foot and becoming a good writer.  I had put all my eggs in the metaphysical basket.  I believed that if I cleared away internal barriers, what I wanted – be it the healing of my foot or a thriving blog – would flow to me effortlessly.  Lovely theory!  And maybe true sometimes.  But when the magic is not happening, a little sweat, every day, might do the trick.  This is what Martha calls “turtle steps.”  How do you eat an elephant? One bite at a time.  I knew this intellectually.  But it took an injury and taking small but consistent actions to heal it for me to understand it.  That’s the real lesson!

It may not sound like much, but this is the third day in a row that I have made writing my priority, the number one item on my To Do list.  It feels really good, like a lifeline to the future.  But the truth is, it’s a lifeline to myself — to who I am now and who I will become.  I am a writer who writes.  And that’s enough.

What’s your experience with taking “turtle steps”?  Is there an area in your life that you’d like to build up but don’t know how to start? How do you overcome internal resistance?

 

Pain in Childbirth

Here is HypnoBirthing mom Sarah, laboring in water and in her husband’s arms. Notice how relaxed her face and hand are!

I’ve written about the fear of childbirth, which I believe has two main causes:  we question the safety of childbirth and we believe it’s going to hurt.  I’ve written about the safety of birth, and now I’d like to address the issue of pain.  Pain is real, but it can be avoided or at least diminished through simple, natural means.  Avoiding pain, rather than treating it symptomatically, not only leads to a more comfortable labor.  It also makes labor progress more quickly.

I do believe women who tell me that childbirth hurt.  I also know that mine, for the most part, did not.  I attribute my relatively comfortable labor partially to luck, but mostly to HypnoBirthing.  The foundation of HypnoBirthing is the replacement of fear with trust in the body’s ability to birth safely and comfortably.   Upon this foundation techniques for working with the body are taught, the most important being profound relaxation and deep breathing.  The result is a more comfortable labor – i.e. less pain, even no pain.

I have two children.  In both my labors I had a direct experience of how fear caused pain and an experience of how relaxation made the pain go away.  With my first child, labor began very gently in the early morning hours.  Mid-morning, I was crossing the dining room on my way to the kitchen when I felt a more powerful surge coming on.  The intensity frightened me and I braced myself for it against the wall and held my breath.  It crashed over me like a wave, painful and disorienting!  I panicked, sure I could not do it.  Then I remembered that I had learned HypnoBirthing.  It was time to put it into practice!  So I put on my HypnoBirthing relaxation CD, got comfortable on the sofa, called my husband to sit by me, and when I felt the next surge come on, instead of bracing myself for it, I relaxed into it.  I breathed.  It made all the difference!  Instead of a wave crashing over me, I felt myself riding a swell.  It was then that I knew I could do it, then that I recognized that fighting labor only made it hurt.

With my second child, an easy day-long labor kicked into high gear after I woke from an afternoon nap.  As we drove through 5 pm traffic my surges kept coming quickly and powerfully.  When we found ourselves stopped completely as three lanes of traffic merged into two to cross a bridge, it occurred to me that we might not make it to the birth center.  I did not want to have my baby on the side of the road!  While having that fearful thought, I had a very painful surge.  They’d been powerful, but not painful until then.  I quickly made the connection that my fearful thought had created tension within me that caused the pain.  I smiled and decided that, if my son wanted to be born at the side of the road, it would be okay.  When the next surge came, it was just as powerful as the previous one but there was no pain.  (We did make it to the birth center, incidentally, and my son was born soon after).

Why did relaxing and breathing make my pain go away?  Because breathing and relaxing are the antidote to fear – more specifically to the body’s response to fear, the well-known “fight or flight” response, has two specific effects on labor.

First, fear causes muscular tension in the body, and tension causes pain.  To understand this, recall that the uterus is a muscle system like others in the body, composed of two opposing muscles.  The inner layer of muscle runs in a circle, parallel to the floor, like latitude lines.  The outer layer of muscle runs longitudinally, perpendicular to the floor.  When you’re in labor, the longitudinal muscles pull up on the base of the uterus to thin and open the cervix and uterus so that baby can be born.  In order for this action to be accomplished, the latitudinal muscles of the uterus must relax.  If there is tension in the body, the latitudinal muscles will not relax and allow the longitudinal muscles to do their job.

To experience this for yourself, try this exercise.  Extend your right arm to the side so it is parallel to the floor.  Now flex your arm at the elbow.  Easy right?  As your bicep contracted, your tricep relaxed, and the movement was almost effortless.  Now extend your arm again.  This time please try to flex your arm at the elbow while keeping your tricep tense.  Much harder, isn’t it?  If the movement can be accomplished at all, it will be exhausting and painful.  The surging of the uterus – the flexing of the longitudinal muscles – is involuntary, so it will keep trying, even if the latitudinal muscles resist.  The result is exhaustion and pain.

The second effect fear has on labor is a hormonal one.  If the action of the uterus is involuntary, that means it is controlled not by intention but by hormones, namely the hormone oxytocin.  Oxytocin causes the uterine surges that result in birth.  But fear releases stress hormones called catecholamines, which slow down or stop altogether the release of the hormone oxytocin.

To understand this, it will help to remember that oxytocin is called the hormone of love and bonding.  It is responsible for sexual arousal and orgasm.  It is one of the hormones involved in the let-down reflex of breastfeeding.  It promotes bonding with your partner, with your children, with anyone you love.  It causes a feeling of connection, even oneness that feels heady and blissful.  It is now easy to see how much the release of oxytocin is influenced by the environment:  you cannot make love if you’re scared, or breastfeed your baby, or experience that sense of oneness with loved ones.  Catecholamines suppress the release of oxytocin, because they are released by a body that believes itself to be threatened.  In nature and human evolution, safety trumps reproduction.  Oxytocin will not release if you don’t feel safe, and no oxytocin means a slowed or stalled labor.

Free from fear, the muscles of the body relax and do not resist uterine surges. Oxytocin flows freely, not only achieving the birth of the baby but also preparing the mother to bond profoundly with her newborn.  In Nature’s perfect economy the hormone that got you pregnant, oxytocin, will birth your baby and facilitate your bonding.

But there’s more!  Equally good news is the body’s own natural response to physical exertion: endorphins.  “Endorphins” means “endogenous morphine”; i.e. morphine made by the body.  Endorphins are the most powerful pain reliever known to us, and they are Nature’s plan for the exertions of birth.  Furthermore, release of endorphins can be enhanced through meditation and relaxation.

This understanding is profound.  It suggests that by managing fear, relaxing, and entering a meditative mental space — in my case, this was facilitated by HypnoBirthing breathing and visualization techniques — during labor, mothers can have easier, faster and more comfortable birth without drugs.  That doesn’t necessarily mean that there will be no discomfort or circumstances that require medical intervention when giving birth.  No one can predict what course a mother’s birth will take.  However, how encouraging to know that Nature’s design is for efficiency and comfort during labor!

Please share your experience!  What helped you during labor?  Did you notice ways that stress and relaxation influenced the course or your labor or your level of comfort?

No, Ms. Wurtzel, Economic Parity Is Not the Only Feminist Value

 

The provoking magazine.

Do you believe that stay-home moms can be feminists?  Elizabeth Wurtzel, writing for the Atlantic magazine, says no – and vehemently – in her recently published essay, “1% Wives Are Helping Kill Feminism and Make the War on Women Possible.”   Though the title states she is writing about “the 1%,” the essay is in fact a broadside against all mothers who do not have a job that earns money.  Wurtzel argues that feminism is about economic independence and equality – that is, earnings parity with men – period.  Whereas, to stay home is to choose dependence and undermines the work of “real feminists” like herself to attain equality.  She makes some good points, but I think her definition of feminism is too narrow.  Wurtzel, a lawyer, best-selling author, and single-and-childless-by-choice, wants us, like her, to win at the game that men designed.  I, a stay-at-home mom and budding entrepreneur, want feminism to change the rules of the game.

Wurtzel’s essay reads like a repeated finger poke to the chest.  You can almost see the spit fly.  Now, I learned and in turn have taught my children to ignore this kind of blind hostility; engaging it only fuels it, and it says more about the attacker than the attacked.  But it was so absurd, it was kind of entertaining.  It is an epic rant. She calls stay home moms morons and idiots; they have done the “easy” and “obvious” and have no integrity.  She repeats her conviction that raising children is not work and implies more than once that staying home is really just a flimsy cover for a life of self-indulgence.  Her delight in heaping contempt on stay home mothers shows in her creativity at imagining their lives and thoughts. But that creativity was the key in helping me to get past her rage:  I realized she has no experience with the people she writes about; she had to invent them.  She doesn’t actually know any stay-home moms, or children for that matter.  Putting “the 1%” in the title doesn’t fool anyone.  Like the social conservatives who tried to create a straw-man “slut” out of Sandra Fluke during the arguments over access to contraception, so Wurtzel has created a straw-man in the grotesques she imagines.

In her attack on stay-home mothers, children are oddly absent.  In Wurtzel’s world children don’t seem really to exist.  If they did, she would be forced to acknowledge that they need care and that care has economic value.  “Being a mother isn’t really work,” she writes.  Rather, “something becomes a job when you are paid for it.”  So if I hired someone to come into my home and do the work that I do – the organizing, the cleaning, the shopping, the cooking, the myriad tasks of raising children – and paid her money, it would count as work?  But because my husband and I are married and treat our finances as joint – in other words, no money changes hands between us – the work I do for our family does not count?  Would Wurtzel apply the same logic to an entrepreneur who depends on a bank loan to live until her business gets off the ground?  What about farmers who work year-round just to break even?  Full-time volunteers with religious organizations or the PeaceCorps?  The exchange of money is only one signifier of work, hardly the one true validation of it.  Children do not raise themselves.  They need parents paying attention to and caring for them.  If Wurtzel knew any real children, she’d know that her refusal to acknowledge this basic fact does not make it go away.

Another fact of life with children that Wurtzel has no concept of is parental love.  Her essay reveals a great deal of discomfort with feelings generally.  She refers to emotions as “hullabaloo,” says that love makes us “idiots” and “fools,” that love is “foolishness.”  She has chosen not to marry – which, apart from foolishness, she equates with being “bossed around” – out of a sense of “integrity and independence,” implying that those who do marry lack these qualities.  The only emotion besides anger – the one emotion that our culture sanctions for the public sphere – that she admits is to feeling “betrayed” by women who are educated but still stay home.  I am a mother, and I know a tantrum when I see it.  The funny thing about tantrums is that they aren’t usually the mother’s fault, but a child will wait until she’s with her mother before she allows herself to melt down:  mothers are safe, and they love you, even when you’re acting hateful.  I know, Elizabeth.  I know.  Oh, honey, I’m angry with the conservatives, too.  I want economic and social parity with men, I do.  I want a family leave policy!  I’m furious, too, with the men who want to control women’s bodies with trans-vaginal ultrasounds and name-calling. It’s an outrage!  Shhh, honey, shhh.

Parents love their children in a way that people who do not have children just do not understand.  I know because once I did not have children, and I looked in bewilderment at parents.  “What’s so fascinating?” I wondered.  (Another favorite was to wonder what stay-home moms did all day.)  I was devoted to my career, and I loved my independence.  But then I had children.  It is a cliché, I know!  And I don’t expect Wurtzel to understand; how could she?  But the fact is that becoming a mother changed me in a fundamental and completely unexpected way.  The pull of my baby overwhelmed any pull my career still had, and I thanked my lucky stars that my husband’s salary could support us.  Call me foolish, if it makes you feel better, but do not question my integrity.  Being a mother is my truth.  It has made me a better person.  It inspires me. Feminism that tries to factor out the feelings of motherhood just does not work.  Maybe that’s why the feminist movement hasn’t made more progress.  “Equal” does not mean “same.”  It never has and it never will.

So, yes, Ms. Wurtzel, there is a war on women.  But after you calm down, I think you’ll see that, rather than ignore the financial and emotional realities of parenthood, real feminism accommodates them.  There is lip service enough given to the contributions of mothers – just ask Mitt Romney.  You’re right: it’s overcompensation and it’s condescending.  I want real progress, not a pat on the head.  I want feminism to represent my values, because I want the world to be a better place for my children.  My feminist values include taking care of the earth; improving the educational system; universal health care; ending poverty; the inalienable right to bodily integrity; family leave policies and work environments that make room for the needs of children.  It would be a hollow victory if we limited the mission of feminism strictly to economic equality and gave up our values in the process.

 

An Open Letter to Kate Pickert of Time Magazine from an Attachment Parenting Mom

The provocative magazine cover

“In a way, the arguments for and against attachment parenting

mirror questions about family and work that still divide America

 five decades after the advent of modern feminism.”

Dear Kate,

You don’t have kids, do you?

If you did you would know that there is no “battle that rages within the parenting community.”  The only place such a battle exists is in the media, who use it to sell magazines, and in the rhetoric of politicians, who use it to score political points.  Those of us with children are not battling one another.  We are doing the best they can with what we have within a society that would rather talk about us than offer meaningful support.  We are raising children in a world that is changing beneath our feet.  Old supports and certainties have fallen away and attachment parenting is actually a creative response to that.

Parenting methods aren’t developed in a vacuum by “crazy” (your word) parents who just feel like changing things up.  They are in part a reaction to experience.  In the case of Bill and Martha Sears, they experienced hardship and neglect in their childhoods.  It’s natural they would want better for their own children.  Even if their childhoods had been idylls, they still might have made some changes – every generation does to some extent.  But they and the so-called “devotees” of their approach are also reacting to the larger culture.

Attachment parenting strikes me as an unconscious attempt to counter the forces of detachment, fragmentation and insecurity of modern life.  Financial insecurity creates circumstances that can be harmful to family life.  Professionals are expected to move to further their careers, so they often live far from extended family and old friends who might help with the kids.  Parents’ willingness to hustle has not resulted in upward mobility, though; middle class incomes have remained stagnant since the 1970’s.  Maybe that’s why 80% of American families need two incomes to make ends meet?  Without trusted loved ones to care for our children and the shameful absence of parental leave policies, some parents feel backed into a corner:  it’s all work or all home.  Attachment parenting feels something like a new, rewarding career to women who choose all-home.

There is social insecurity as well.  Public institutions have lost authority.  Civic institutions are weakening.  Corporations are all that’s left standing, and they are better known for loyalty to shareholders than to employees – let alone the public interest – in the global economy.  As a result, people are questioning authority and convention in many areas of American life.  In response to the environmental and health consequences of industrialized food production, there has been a surge of support for organic, locally-sourced food and breastfeeding.  In response to the unsafe rise in Cesarian sections and conveyer-belt birth experiences, women are choosing homebirth in record numbers.  When faced with poor performing, unimaginative public schools, parents are embracing homeschooling.  There is also an increasing acceptance of wellness models of health, such as homeopathy and acupuncture, as well as of Eastern philosophies and practices, such as meditation and yoga.  Attachment parenting is consistent with these other trends in its quest for what is natural and for wholeness, connection and thoughtful living.

Attachment parenting is much bigger than feminism.  It is a creative response to insecure times and a rapidly changing world.  As a feminist I would like to see fewer articles criticizing how mothers mother and more conversations about how to help mothers – with parental leave policies, job sharing and investment in quality child care, for example.   In fact, as a feminist I would like to see less criticism of the choices other women make, full stop.  This is the principal reason that I threw away every other parenting book once I laid eyes on Dr. Sears’s The Baby Book.  In my haze of postpartum anxiety and vigilance his was the first voice that validated what I felt instinctively:  that this was not a time to be endured until I could get the baby on a predictable schedule and my life could return to “normal.”  It was an invitation to live more deeply, to learn from my baby as she learned from me, to allow myself to be transformed.  The practices he suggested – breastfeeding, sleep sharing, physical closeness – are not ends in themselves, but a gateway to a deep connection with my baby.

In this way, attachment parenting is more even than a response to insecure times.  It’s an affirmation of what we want:  connection, instead of separation, and cooperation – yes, even with our children – instead of competition and dominance.  To the question you imply, “Is staying home to raise children an authentic feminist choice,” I answer, “Why wouldn’t it be?”  Birth showed me my power in a way that society never would.  Motherhood has shown me my value and given me a sense of purpose that the world of paid work never could.  I’m helping to raise the next generation to live comfortably and creatively in a world that bears little resemblance to the one I grew up in.  What could be more feminist than that?

 

 

The Farm: Why You Can Trust Nature’s Design for Birth

 

Ina May on the Farm

Quick:  How many women out of one hundred do you believe could give birth safely at home?  What’s the first number that pops into your head?  Your answer to this question reflects how much you believe in the body’s natural ability to birth.

Before I was pregnant myself, I made the simple calculation that the national c-section rate accurately represented the dangers inherent to birth.  In other words, if our national c-section rate was 30%, only 70% of mothers could give birth safely without medicine.

When I became pregnant, this question of safety became an urgent one for me.  I figured educating myself would improve my chances for a safe birth, so I took a HypnoBirthing class.  It worked.  I gave birth safely, calmly and with a minimum of discomfort.  I knew I was physically no different from other healthy mothers, so I reasoned that HypnoBirthing had made the difference.  I became a HypnoBirthing Certified Educator to help other mothers have safe, satisfying births.

I have been studying birth ever since.  My reading has always sought to answer the first, fundamental question:  how safe is birth, really?  This the biggest source of fear about birth, which I wrote about in a recent blog post (http://www.wisdomchildbirth.com/why-we-dont-talk-about-birth-as-a-womens-issue/).   Can Nature’s design really be trusted?  How often does it need medical back up?

Attempts to answer this question coalesce around the topic of homebirth, because there is no medical intervention in a homebirth; if intervention is needed, the mother is transferred to hospital.  Unfortunately, there is not a clear answer in the scientific research to the question of the safety of homebirth.  The best we can say with confidence is that home birth has not been proven to be any less safe than hospital birth.  Feel better?  I didn’t think so!

Enter the book Spiritual Midwifery, by Ina May Gaskin.  Gaskin is a self-trained midwife who practices on the Farm, the commune in Tennessee she started with her husband, Stephen, in 1970.  (Read more about Ina May in the New York Times magazine’s recent article, http://www.nytimes.com/2012/05/27/magazine/ina-may-gaskin-and-the-battle-for-at-home-births.html?emc=tnt&tntemail1=y).  I read Spiritual Midwifery with passing interest, believing it a quaint relic of an age gone by:  there were black and white photos of long-haired hippies in 70s clothes (or none at all) and they talked about auras and said things like, “It was psychedelic!”  But one day I happened upon Appendix A in the back of the book, “Outcomes of 2,028 Pregnancies: 1970 – 2000.”  I snapped to attention.  Their groovy birth culture and midwifery model of care was nice, but did it actually make birth safer?

It seems so, but you be the judge.  Here are a few numbers from her most recent book, Birth Matters, in which 2,844 pregnancies, 1970-2010, are reviewed:

Births completed at home:     94.7%

Transports:     5.2%

Emergency transports:     1.7%

Cesarians:     1.4%

VBAC:     108 attempted; 106 completed.

Maternal mortality:     0

Neonatal mortality:      1.7 per thousand

Ninety-five percent of women gave birth safely at home! Only one percent of births were c-sections!  Only five percent of moms needed to be transferred, and only 1 percent was considered an “emergency.”  (This begs the question, should 92% of women, the national average, really be giving birth in hospital when only 1% are actually going to experience an emergency?)

These numbers are striking, but what makes them utterly compelling are the low death rates.  They lost no mothers – it should be said that in the US maternal death is so rare that it’s counted in the 100,000’s – so that is good but not unexpected in such a small population.   However, neonatal mortality is much more common, with numbers expressed in the 1000’s.  Neonatal deaths on the Farm were well below the national average of 8 per 1000 (as of 2005).  This tells me that the standard of care was a very high one: they did not sacrifice mothers and babies in the service of a principle.

Furthermore, births that are increasingly considered “automatic” c-sections were accomplished on the Farm.  3.5 percent of births were of breech presenting babies, 90% of whom were born at home.  All 17 sets of twins were born vaginally.  And to those women who have been pressured into an artificial induction, would you be surprised to learn that only 5% of mothers on the Farm were induced – and with castor oil instead of with drugs?

These numbers give me great confidence in the body’s ability to birth naturally. The only fault I can find with them is that there are so few!  That is the only rationale I can imagine for their relative obscurity in the conversation over the safety of homebirth.  The numbers may be few, but they are consistent over forty years.  At the very least this is proof of the viability of the midwifery model of care for low-risk mothers.

If you are now persuaded that birth is mostly quite safe but still feel a great deal of fear, I think I know why:  pain!  It’s the subject of my next blog post.

Are you persuaded?  Persuaded enough to consider birth at home?  Have you heard of Ina May and The Farm before?

Why We Don’t Talk About Birth As a Women’s Issue

The next generation: They deserve more humane maternity care.

Women’s bodies have been in the news lately.  Access to contraception – whether it should be a mandatory part of insurance coverage, who should pay for it, and what it says about women who take it – has dominated political talk the past week.

Also, two states have recently passed laws requiring ultrasounds – not the usual kind, run over the belly, but the trans-vaginal kind, which must be inserted into the most private part of a woman’s anatomy, while she is laying flat on her back with her feet in stirrups – before women can have abortions.  Twenty other states already have similar laws on the books, and seven other states have recently proposed them.

There’s another facet of women’s reproductive health that I’d like to bring into this discussion: birth.  It is well known that as our Cesarian-section rate has been rising, so has maternal mortality and morbidity (illness and injury) risen.  The US now ranks 40th in maternal mortality in the developed world.

This is important, and it gets people’s attention.  But I think it’s wrong to see maternity care as just a health issue.  It belongs in the same category as contraception and access to abortion as an issue of bodily integrity and autonomy that has health implications.  The longer I study birth, the more I see it first and foremost as a women’s issue.

This opinion is not shared by more people because of a widespread misunderstanding of the inherent dangers of birth.  As long as parents believe that birth is dangerous, they will fear it and give up control of it.  Ina May Gaskin recently said, “You can make a lot of money off scared women.”  Here are a few ways that mainstream culture communicates that birth is dangerous and encourages us willingly to surrender our autonomy and bodily integrity in birth.

  1. Obstetricians.  OB’s are specialists in the pathology of pregnancy and birth, and they attend about 90% of births in the US.  Like all doctors, OB’s are trained to look for pathology and that’s what they find, even when a midwife – who is trained in a different model of care – would not.  OB’s talk to one another, confirming one another’s biases.  They’ve been doing birth so long this way that their research also reflects and confirms this bias.  In Born in the USA Dr. Marsden Wagner writes, “Obstetricians have no idea what a non-medicalized birth is.  The entire modern published literature in obstetrics is based on observations of medicalized birth.”  There are many other voices talking about the safety of natural birth, but our culture is simply saturated with messages to the contrary.  Obstetricians are also implicated in the next two points.
  2. Routine Interventions.  A timely intervention can be life-saving to a mother or baby, but interventions performed on every laboring woman who comes in the door – from IV fluids to being made to give birth in a certain position – are called “routine.”  Routine interventions communicate to a mother that her body is not sufficient for the job.  This increases her fear, which increases her pain and feelings of dependency on the medical model.  More importantly, routine interventions introduce risk and frequently disrupt the natural flow of labor so profoundly that a “cascade of interventions” ensues, further endangering mothers and babies.
  3. Cesarian-Section Rates.  Before I had my own baby, I believed that if we had a c-section rate of 30% in America, it was because 30% of women and/or babies would die without it.  That made me afraid of birth.  But the World Health Organization has been studying c-sections as they affect maternal-fetal health for many years.  They determined and then recently reaffirmed that a c-section rate of 10-15% is optimal; c-section rates greater than 15% create adverse outcomes.  That is, more women and infants die in countries where there are section rates greater than 15%.  As noted above, that is true in the US, which is even scarier.
  4. Hospitals.  A surprisingly under-appreciated fact of birth is that the same hormone that causes sexual arousal and orgasm, oxytocin, is the prime mover of birth.  So in Nature’s elegant economy, the same hormone that got you pregnant will deliver your baby.  The trouble is that oxytocin is highly influenced by the environment.  It likes a dim, warm, hushed environment that the woman controls and where she is free from observation; i.e. the opposite of what she experiences in a hospital.  Furthermore, fear (see previous points) negatively affects the release of this vital hormone, causing labor to slow or stop altogether.  This makes sense if you remember how most mammal mothers give birth in nature, where predation is a daily threat.  If she senses a threat, her labor needs to stop so that she can move to a safer location or until the predator has moved on.  A human mother’s logical brain, which tells her that the hospital is a safe place, is not actually in charge of birth.  A more primitive part of her brain is, and it doesn’t like the atmosphere of a hospital – the bright lights and the constant noise  – or its messages to her – the machines whisper that her body will break down; the masks and gowns suggest that her bodily fluids are dangerous; the strangers clinically touching her during this most intimate act of opening dehumanize her; the fact that they are treating her like she is sick undermine her trust in her body.
  5. Media.  I’m referring both to entertainment and information media.  Film and television exploit the dramatic and comedic potential of birth.  It’s dramatic to have a doctor rush in and “save” a laboring woman.  It’s hilarious when a hapless father passes out when faced with the sight of a baby emerging from his wife’s vagina.  Folk tales would be nothing without dead mothers to force their children into the homes of wicked step-mothers or into the forest.  Even so-called reality television must create some drama for their viewers, so they focus on interventions and abnormalities, and find a way to leave the viewers in doubt about whether mom and baby will make it.  Most births happen in hospitals now, away from home, so this is the only window onto birth that most people see, and it isn’t real.  Information media also does not disabuse us of this misperception.  It trusts doctors implicitly.  Obstetricians are always consulted when birth is in the news; the news media therefore affirm their authority.  And how many times have you seen a headline like this one:  “Doctor delivers baby in airplane”?  Who is the star of that article?  The doctor who stood by while the mother’s body gave birth perfectly, or the mother?

These are just a few ways that fear is used to control women at precisely the time they are actually the most powerful!  Only when families – women and men – understand that birth is safe for the vast majority of low-risk mothers will they take their rightful place in the event:  no longer patients, but parents and empowered authorities.

Coming up:  Why You Can Trust Nature’s Design for Birth. 

Imagine!  How would it change how we perceive mothers and how mothers perceive themselves if every mother had a birth in which she felt empowered and honored?  How would it change the confidence with which we mother our children?  How would it change who we mothers are in the world?