Yesterday, I read a brilliant article in Pathways for Family Wellness magazine
by Charles Eisenstein called "Don't Should on Us". Eisenstein writes on the reasons he feels the environmentalist movement is falling short and why, if they don't change their approach, will continue to do so. His writing made me think of all the work so many of us are doing to promote evidence based childbirth
, and some of the things that I hear again and again are frustrating birth professionals of all types.
It is very often on Facebook groups, mothering circles, and in private conversations with those who share information with women and those who call themselves birth advocates/activists that I read or hear that they just do not understand why a particular woman isn't open to receiving information or why is she going ahead with that choice when she knows what a risk that is to her birth plan. I read and hear how they wish that women would accept responsibility for their births and understand that they can take direct action to affect the health and safety of their birth despite what their care provider or others might be suggesting they do. The question on so many lips is - "Why would she just blindly accept that?"
I personally know how sad it can make you feel when someone experiences the direct negative impact of non-evidence based practices, and especially so when you are their friend, family member, or a hired birth professional. Particularly when you have talked with them about what they want in birth and what the evidence about birth actually tells us. It is frustrating and can make some advocates feel like they work so hard and yet seem to fall short too often. I know since experiencing unnecessary c-section I feel so very protective of mothers in regards to avoiding the interventions that could lead to surgical birth.
As Stephanie Dawn
, the Sacred Birth Founder/Mentor, has described it, we are ushering in a New Paradigm of birth and driving out a deeply patriarchal and established Old Paradigm. That process is not going to be easy and it will be long. But, what we can find comfort in is that what we are espousing is the true nature of birth and in modern times combined with our greater understanding of birth and modern medical possibilities is safer for more women than ever before. We can find comfort that this is the Truth despite ridiculously high cesarean, induction, and preterm birth rates that we are experiencing in our external reality. Why? Because as Eisenstein shares in his article, it is our human nature (our spiritual nature) to gravitate toward what can be accomplished with simplicity in ways that utilize our true inner abundance of resources.
When we approach people with the energy of wanting what is truly in their best and highest interest, they will instinctively trust us. Sometimes, to be sure, a person must experience something in order to realize that isn't what they actually wanted. But the message will stay with them until the time comes for it to sprout. When we act from the knowledge that a person's "selfish" interest is actually toward simplicity, closeness to nature, and closeness to community, then our urgings lose any judgementality and assume the force of a trusted friend's support. - Charles Eisenstein, "Don't Should on Us", Pathways to Family Wellness, Issue 35/Fall 2012
This must become our approach. Let's look at this from the inner want of most every mentally healthy mother and many of those with compromised mental health - a healthy baby and a healthy birth, in that order. Our instinctive nature as mothers is to protect both our child and ourselves. Whatever gets us to a healthy baby will ultimately be okay. That is why a healthy birth will come secondly. Very few women would say that they would sacrifice that baby's life to experience a natural childbirth if it came down to it. The choices women make are instinctive whether one chooses to birth in the hospital via elective surgery or whether one chooses to freebirth
. I truly do believe that both of those choices at the opposite ends of the birthing spectrum come from the same root instinctive source - protection of the birthing environment and the assurance of a healthy baby. It is the pressures that they feel from society that directs how and where they feel giving birth is appropriate.
Eisenstein directs us that our "selfish" interest (or our instinct to self preserve and thrive - K.B.H)
lends itself to choices that are simple, close to nature, and close to community. In thinking of these three tendencies in the face of our current situation with mainstream birthing practices, it reveals how our scope of work as evidence-based birthing advocates much be much broader to amend and appeal to the women we encounter through our work.Toward Simplicity
This one is simple. As the female of the species our instinctive nature is going to ask us to prepare for the simplest means to getting our babes earthside. In terms of what is simple, preparing for a nonintervention vaginal birth in a location that is comfortable and safe would be optimal. Evidence tells us that avoiding intervention unless medically necessary is the safest way to give birth. So, as we should expect evidence supports our best and highest interest. However, from childhood humans presenting as females are taught by mainstream culture to not trust their body. We might get too fat. Our hair might be too frizzy. We need cosmetics. We must be ashamed of our menstruation. We must be careful how we express our sexuality and with whom. You need multiple diagnostic tests to confirm you are healthy enough to sustain a pregnancy without intervention and the baby has no anomalies. What if labor doesn't happen by your due date? What if you don't dilate? What if your baby gets stuck? Are your breasts too small to breastfeed? It is easy to see how this mistrust could turn into the thought that it might be easier to have a medically managed birth.Closeness to Nature
Again evidence supports our self preservation toward a closeness to nature or what is natural. In mainstream American culture, it can appear that we have lost this desire. It is, however, basic to who we are as a living being. What we can accomplish with the greatest simplicity is that which can be done with our natural ability. Evidence supports less intervention in birth. Pain medication as a routine is intervention that can be a source of complication in an otherwise healthy birth. We must see that as truth. However, I personally have accepted pain medication in labor and I as a doula have seen it help along a complicated labor. I know it has its place. What I also know personally and as a doula, is that when we are experiencing a variation of normal birth, unmedicated (which we are all capable of doing), and are supported fully by those around us - never suffering (this is the key), we will heal faster and our children will initiate their first instinctual functions and bonding sooner and with greater ease. My HBA2C was my easiest birth yet, despite it being a 34 hour active labor + pushing with a week of prodromal labor prior. It is what is normal, natural, and physiological. However, in our mainstream culture the vast majority of images of women giving birth in film and on television show a woman not coping and unsupported. Pregnant women are bombarded with horror stories complicated deliveries that when examined were often high intervention or a woman being neglected rather than supported. The meds are there, why wouldn't you take them? So, it is easy to see how our mainstream system sets women up for dis-empowerment.
.Closeness to Community
We are built to live in community. We are a social being. Our instinct is also to protect our place in whatever social group we belong to. The pictures and sculptures are many of the births of old. Women surrounded by women, in birthing ritual ( See Wisdom of the Elders - On Becoming a Mother by Liz Cheney).
Birth was a sacred dance. Experienced women counseled expecting mothers on what to expect of birth. What has changed in our culture is that birth is expected to be manipulated. It is no less so that experienced women counsel expecting mothers. However, beginning with our grandmothers fewer women have experienced birth as a rite of passage. In fact, many of our grandmothers do not remember giving birth at all because they did so in twilight sleep
. At some point in time, we (women) thought that in order to gain equality in our society women should be less aware of what they experience in childbirth. What resulted was actually the severe abuse of birthing women. As twilight sleep fell out of vogue, medicine sought to replace it with more palatable alternatives. Birth was looked at more like an injury to be avoided despite the physical capability of women to give birth without permanent injury when support in the right environment. Our back story has changed, and to dare to step back in time to retrieve some of the positive past related to birth is a scary venture. Not only are you stepping outside of societal norms, but you may have to disagree with medical professionals who in our culture are held in regard as those with authority over our decisions. Who are we to question how it has been done for our sisters, mothers, grandmothers, and for some of us great grandmothers? Those of us thinking of unmedicated birth are warned against it repeatedly. If the result of us stepping outside of these norms is anything less than perfect who is going to be blamed? Even when the results are normal, there is risk. We hear of mothers having their children taken from them for refusing c-sections.
It is not only the birthing women, but those who help them by giving them options who suffer in our society. The most recent one to hit the natural birth community hard was the undercover investigation and arrest of Brenda Capps in California.
A "lay" midwife who offered to support women in making their own choices as described here
. Even within the movement itself, communities are turning against their midwives and mothers who go beyond what the community is or have been told to be comfortable with to make their own choices. No, it is very easy to see how the risk of fighting through what should be a glorious life event - the birth of your child - could seem unappealing. It is easy to see how the risk to our place among our community places too much fear behind the choices that actually help us birth in evidence based ways.Our charge as advocates is bigger than sharing information, and being midwives, OBs, and doulas.
What we are doing is changing a paradigm. Releasing old ways that do not serve us anymore. We must work in a larger realm than sharing evidence based practices and then supporting those who find the capacity to choose those options.
The shortcomings of many childbirth education programs and well meaning information sharing is that we give information, offer support, but then we leave out how to go against our instinctual nature to protect ourselves in the world that is presenting itself to us to actually make the choice to act of this new information. We teach coping strategies, but we neglect to share how to actually release fears. We tell women that homebirth is safe, but we do not offer tools to help them protect their choice from their well-meaning community who have yet to understand it. We tell women that their "body is not a lemon", yet we don't share with them ways to learn to once again love and trust their female body.
To simply share evidence based options is not enough. Sharing facts is not enough. For some all they hear is as Eisenstein writes - "You should
do better... On the most obvious level, this approach backfires simply because people can always sense judgementality, and they naturally respond to it with hostility... Alternatively, some people are temperamentally inclined to buy into guilt and shame. The message works on such people, but it cannot spread beyond them." How are we going to actually change this old paradigm into one that gives the space for us to act on the Truth of who we are as women? How will our efforts help to bring balance to our society? Going back to Eisenstein's comment on how it is sometimes necessary for us to experience something to know that it isn't what we want, we can see that this is going to take time. Some women, such as myself, will have to have one birthing experience in this old paradigm to even realize it is wrong and cannot serve them in their goals. As advocates we need to fill our bags with tools to help mothers heal and find the empowered position they need to make the choices that protect birth and regain our society's reverence for it. But, most of all in this work we must find our patience.If you haven't already, and would like to know more about tools you can share with women to do just this, I highly suggest you check into the work of Stephanie Dawn. You may also find her on Facebook. Her work has totally changed my perspective on how best to support women as we usher in the paradigm of Birth Heaven.
I have been so happy with the responses to my birth story with Gweneth
and inspired by them to continue head on into my work with VBAC support and advocacy. I want to blog here more regularly and would like to begin by addressing this awesome comment to my birth story."I have so much respect for the women, families and birth attendants who take responsibility for being fully informed, managing risk using non-clinical methods and excellent preparation and accepting the consequences - the divine & sublime as well as the occasional less than perfect outcome." from L
What does it mean to be prepared for labor and birth? What does it mean to be prepared to accept the consequences of our choices?
I'm not sure if it is ever possible to be prepared for a bad outcome. It is fact that the reason we prepare at all is to hopefully avoid a bad outcome. The fact also is that no matter how much we prepare for birth, some of us will experience a "less than perfect" outcome.
When I was preparing for the birth of my second daughter, I spent all the time I could steeped in information on natural birth and homebirth after cesarean. We took Bradley Method classes. I chose for my birth team women who had also experienced VBAC. But, what I was lacking was the deep inner work that was needed to prepare me emotionally and mentally to actually do the work. It was one thing to have the book knowledge and another to apply it.
Looking back on my second pregnancy, while I felt like I did do so much that was great toward creating a situation conducive to a beautiful HBAC experience (it ultimately ended in another c-section), there was so much else I could have done. Not that I can do anything about that now, and not that I have regrets. I have learned that being well prepared for birth is a marriage between facts and connecting with the feelings of our innermost selves. How do we reach the point of empowerment? Because giving birth is not about bravery. In giving birth, it should not feel like we are going to war or fighting for our rights. A reliance on bravery in labor can fail us. It isn't only about physical strength. A woman who has a low pain threshold is just as equipped physically to give birth as a woman with a high threshold. It most certainly isn't knowing a lot about birth. You can know a lot but not have the wherewithal to do anything about it. How many times do we say 'I can't' or doubt that something is possible for us?
Let's look into the couple that create this marriage which allows us to become empowered pregnant and birthing women. It is a melding of masculine and feminine energies that when one is let to affect the other empowerment is born.
Many times for women knowing what you want out of pregnancy, labor, and birth comes intuitively, if you are in touch with that inner voice and not guided by fear. I truly believe that if more women were able to acknowledge their inner knowing, feel supported, and we weren't living in a fear based culture, that we would see more women asking for natural options in birth. I remember knowing from the moment I decided to try to become a mother that I wanted to give birth naturally. What wasn't in place for me during my first pregnancy and birth was the book knowledge and unfortunately the network connections to make my dreams happen. I simply knew I wanted to birth naturally. I wasn't afraid of pain, and I felt I could do it. So, when we were told at 38 weeks by our OB group (I unsuccessfully tried to find a midwife in our city despite the fact that they were there.) that it was too risky to birth my baby vaginally because of her size. I agreed to a c-section having not felt the first pang of labor. Ignorance was not bliss for me in this situation. It was heartache. I didn't know enough. I didn't even know that I didn't know. I signed the consent form in tears.
I could write a whole other post about the importance of making evidence based birth information transparent in our communities for all women, so I'm going to focus here on how the individual obtains the information they need to make informed choices. It isn't complicated if you are already looking for the information and can determine if what you are reading is a reliable source. There are countless books and internet sites out there about birth, and of course not all of them are trustworthy despite their appearance to be so. To obtain solid information take the following steps (click on the highlighted words for links to help you further):
- Choose a care provider and birth setting (birth team) that is comfortable with helping women access their options in childbirth.
- Explore your options and the risks and benefits of those choices.
- When talking about options/decisions with your care provider always use your BRAIN - Benefits, Risk, Alternatives, Intuition, Nothing/Not Now
- Take a childbirth education class of your choosing independent from the hospital classes you may find.
- Gather enough information that you can be solidly comfortable with the birthing options you choose both acknowledging the benefits of them and being prepared to handle the risks as well.
The key piece missing out of so many birth dreams is the acceptance of the feminine part of birth. Yes, it is so
common for women today to give birth totally out of touch with the feminine energy that they need to maintain their safety, their dignity, and the appropriate emotional responses in their experience. The breadth of our society so often seems to negate this feminine presence as a bunch of "hooey" or "softness" to the point that in important life situations both women and men can be stripped of just what they need to be truly powerful.
How do we regain this connection with the feminine? By acknowledging our need for self care and self love. My Sacred Birth Mentor, Stephanie Dawn
, reconnected me with this missing piece of my self when she said, "How can we expect to effectively serve others when our own well is dry?" Learning to love ourselves or relearning this can take some time and gentle patience, but having this in place will give you the strength to go wherever birth may take you. It will also give you the peace you need as a mother. Take the following steps:
- Connect with yourself deeply. Journal, pray, meditate, contemplate... whatever is appropriate for you. Do it daily or as often as you can. Don't be afraid to go there and love yourself through whatever may come up. It may become necessary to process with another person be it a close and wise friend or a spiritual counselor or therapist. Afford yourself that.
- Take care of your body. Eat good, quality food as much as possible. Move your body through natural forms of exercise (yoga, walking, hiking, swimming) and learn how amazing it is. While pregnant, explore just how much your pelvis can open and move.
- Be in your beauty. Have maternity pictures taken. Dress in colors that inspire you. Acknowledge your gorgeous parts. Acknowledge how amazing your body is. Don't allow shame in. Watch videos of beautiful birthing mothers.
- Be in your sexuality. Sexual expression created your baby. Embrace the healthy and positive nature of sexuality and express it confidently. Discard the shame and perversions placed on it by a fearful society and one that has forgotten how to revere and respect their sexual partners and objects of desire. Birth will ask you to let go and allow your body to be used in a mutual benefit of yourself and another.
- Build a fortress. Listen to your intuition. You are developing a mother's knowing. Create a space around you that is positive and nurturing. Anything that is not can be dealt with more fully after your birth if you so choose to take it up again.
By doing this work, you ensure that all parts of your birth plans are in place. You give yourself the freedom to birth without restraint so that regardless of what comes up during the process, you can approach it with a solid framework that is true to all parts of you. A framework that respect you the birthing mother and your desires for your birth and your baby.
Childbirth in the United States was once in a very dire place. The outcomes for mothers and babies were poor to dismal (like in our part of the country - rural Appalachia). However, it did not remain that way. Pioneers in the care of women and children such as midwife and founder of the Frontier Nursing Service, Mary Breckinridge
worked hard to change that. Improvements in care included above all an approach that centered upon education of the women, their families, and their caregivers.
Using this approach, Breckinridge achieved better outcomes in her service than the physicians of the day were achieving in the hospitals.
The reality of childbirth improved for women in the US for a time. There have been dips and surges in the safety of childbirth and the outcomes of birth for mothers and babies, but what is concerning at the present is that the US and Canada both are "low on the list of optimal perinatal and maternal outcomes" when it comes to industrialized countries and even some developing countries
(Klein, The Journal of Perinatal Education,
20(4), 185-187, 2011).
Many attribute this change and poor outcomes for mothers and babies to the high rates of surgical birth (c-section) in the US - 34% or 1 in 3 women. But, a recent study conducted in Canada by Dr. Michael C. Klein, MD, CCFP, FAAP revealed that "a substantial number of women, even late in pregnancy, were uninformed about the risks and benefits of key procedures and approaches that might be used in birth." Dr. Klein wrote an editorial about his findings and his recommendations to address those findings in the most recent edition of The Journal of Perinatal Education
cited above. He also stated that, "Only 30% of the women had attended childbirth education classes; books and the Internet were their main sources of information."
Looking at the sources of information women are accessing during pregnancy and the fact that so many remain uninformed show a possible lack of finding truly useful or reliable information from the books they choose and the websites women visit and a disconnect between women and their care providers when it comes to patient education. There are many great books and websites for pregnancy and birth, but there are also many inaccurate information sources. We also have seen a reduction in the number of care providers offering complete childbirth education either through their private practice or the birthing facility. Many "childbirth classes" meet only a few times and include basically what to expect when it comes to hospital routine and policy as well as a tour of the maternity ward. These are important classes for women to take so that they can be prepared and anticipate certain experiences during their birth, but there is also a great need to have complete childbirth education including pregnancy nutrition/exercise, stages of labor, comfort techniques for labor including both natural and medical coping strategies, possible medical interventions that might be necessary and the risks and benefits of each, breastfeeding, postpartum, newborn procedures, and early newborn parenting. In order to cover all of these topics, it is imperative that women and their support persons meet with their educator over an extended period. Many childbirth educators who are certified through the various organizations in the numerous styles of education have a required amount of hours or equivalent of those hours that they must meet in order to label their classes as - Lamaze, Bradley, Hypnobirthing, Brio, CAPPA, ICEA, etc... This hourly requirement ensures that educators and the women they serve have the necessary time to cover all of these important topics that allow women to have the ability to act on the information they receive.
Another very disconcerting aspect of Dr. Klein's study revealed that obstetricians younger than forty "were less favorable to birth plans, less likely to acknowledge the importance of the woman's role in her own birth experience, and more likely to view cesarean surgery as 'just another way to have a baby'. They were also more likely to believe that women who had cesarean surgery 'did not miss an important life event.'" Physicians also had misinformed beliefs on cesarean surgery being "as safe or safer for mothers and babies as vaginal birth" - 20%. "Half of OBs were not supportive of doulas, and 70-80% of providers felt that home birth was unsafe. Epidural analgesia was another area where many providers, especially obstetricians, felt that the procedure did not interfere with labor or increase the frequency of instrumental birth (Klein)." This is despite the scientific evidence showing the contrary on all of the four points above. Klein points out however, that it is important to recognize that 20% of the OBs in the study had attitudes that aligned with midwives. So, we see that though a minority there are OBs who feel otherwise about routine intervention and the risks involved in normal birth. Klein found that women who were attending midwives for their care were less favorable to the use of technology and more supportive of women's roles in their birth experiences, possibly illustrating the difference between the obstetric and midwifery model of maternity care.
The following photo is linked to an interview with Julie Daniels, CNM of Frontier University describing the difference between the obstetric and midwifery models of care. This post is continued after the jump.
Dr. Klein questions "how informed decision making can take place when so many women approaching their first birth are ill-informed and so many care providers think they know, but what they believe is not evidence-based." Many organizations invested in childbirth education are making strides to empower women with scientifically based information, such as Lamaze International and their Six Healthy Birth Practices campaign
. But, Dr. Klein also asks, "how can you make a revolution when so few individuals are unhappy with current maternity care practices?" Dr. Klein believes that "The most unhappy and well-informed women select midwives, if available. The most fearful women select obstetricians." This may be so, but we must figure in the cultural norms and the fact that so many women are ill-informed. (I was one of those ill-informed women during my first pregnancy.) The famous quote from Diane Korte and Roberta Scaer, "If you don't know your options, you don't have any", says it all. Interjecting my personal experience here, I can't tell you how many times I get confused with being a midwife when I tell people that I am a doula. This is even after I describe what it is that I do and that it involves no medical or clinical responsibilities. There is so much misinformation that many don't understand what a midwife even does. This information is residual from the smear campaign of midwives in this country throughout the early 1900s, taking midwives from the primary maternity caregiver to almost non-existent.
Not that OBs are not great birth attendants. We need OBs and their services very much. OBs are trained surgeons and are trained to manage high-risk situations. In many situations, they are the best possible care provider. We need cesarean surgery to be available when it is medically necessary, but we also need to know that just like open heart surgery it is not physiologically normal and should be reserved for emergencies and true medical necessity and not used as a prophylactic. In a systematic review, there were 33 areas were c-section was found to cause more risk than vaginal birth and 4 areas where vaginal birth was found more risky than c-section.
Surgery is never a walk in the park. We can be thankful that c-section is a relatively safe major abdominal surgery, but we need to recognize it as surgery.
But, the real issue to address here is women having access to the information they need to make informed decisions and then the support they need to access their options. The beginning is the recognizing of a need for information. It is the recognizing that women deserve better. It is understanding that childbirth is a normal bodily function of the female body, and should not be treated as an illness, but as a very special time in which extra attention must be paid to health, safety, comfort, and proper support. What raises this recognition - education. It is so important for educators to reach both women and their care providers, for we are all working toward the same things - as positive outcomes as possible in individual situations, and satisfaction and dare I say pure joy in the experience of giving birth.
We are so excited to have this resource - free teleconferencing! As rural women, it's amazing what technology can do to link us together and make information available. In celebration of Empowered Birth Awareness Week
, we are offering a FREE Teleconference titled - Why Take a Childbirth Class? and What is a Doula? Register by emailing firstname.lastname@example.org
to receive the call in # and access code along with some helpful links. Share this with friends and other expecting mamas you know who may be interested. This is for women and birth professionals everywhere! Can't wait to meet you on the call!