There are several cultures where childbirth is understood to be a rite of passage. Beliefs surrounding this transformation are important because they inform the way in which women give birth.
The first culture that jumps to mind would be the Kung of the Kalahari Desert, where young men and women practice rituals that bring them into adulthood. The most significant right of passage for the Kung men is to hunt and kill their first large animal. For women, the right of passage is giving birth. The Kung is a very subtle tribe who don’t honor bragging. For example if a young man comes back from a hunt and boasts about making the big kill they will be ignored. Instead they will quietly start passing out meat, indicating that they accomplished this feat. For women to gain the same kind of honor, they go off on their own to give birth in the bush without saying anything to anyone. Once the child is born, they very quietly come back and start nursing their baby under a tree. At this point everyone notices and comes by to congratulate her. She is then honored for her stoicism and her warrior like abilities in her right of passage.
Another great example is Japan. Most births still take place in the hospital, however there are maternity homes with live-in midwives where women go for pre-natal care and birth. The Japanese and the midwives who work in these maternity homes have a specific saying about labor pain; they call it “metamorphic”. They say that going through labor is a metamorphosis because it changes the woman into a mother the way that crawling out of the cocoon changes the caterpillar into a butterfly. They adhere to an old story that states if you help the caterpillar out of its cocoon it will die. It has to emerge by itself in order to survive and to be strong.
Japanese midwives approach birth with great patience. They believe that the struggle and pain of labor helps the mother to grow and transform herself. The mother must look deep down inside herself and find out who she is. The baby also needs the struggle of being born; the work is what transforms both the mother and the baby into separate beings with the power and the strength to go on and to be the mother-baby pair that they need to be.
The babies muscles will get exercised during birth which will prepare the baby to be ready to breastfeed. This will also enable the baby to be aware of the smells and hormones needed to latch on. If it’s born by cesarean section for example or if there are drugs at birth the baby’s consciousness will be reduced as well as the flow of necessary hormones.
The mother’s metamorphosis releases massive doses of oxytocin while she’s in early labor. Late in labor a flush of adrenaline gets her on a high and gives her the power and strength to push the baby out. Right after this stage comes another flush – the biggest flush of oxytocin she’ll ever get in her entire life. This will transform her and the moment of suffering, pain and pushing. If you watch women’s faces at this moment there’s a suffusion of joy and ecstasy in their expression. Then the milk lets down, the prolactin comes and the hormones all work together to make the caterpillar turn into the most beautiful butterfly.
This excerpt is part of a video interview with Robbie Davis-Floyd and is being re-published with permission from Mindful Mama.
Do you wonder how comfortable your husband will be with your doula? Good news: this week we brought back Micky Jones, an LLL Leader, doula, lactation trainer, conference speaker, IBCLC, Hypnobabies instructor, and author to guide you through her doula “cheat sheet” for Dads.
“I’m just not sure if he’s going to be able to handle it. That’s one of the reasons we wanted to hire a doula.” If I had a nickel for every mom who said this during an interview for doula services, well, I would have a lot of nickels. Moms often wonder if their birth partner will truly be able to fulfill the role set before them in childbirth classes or birthing books. So much to remember. So much pressure for someone who is also deeply invested in the well-being of this special baby and mother.
The presence of a doula can free a father (or other close emotional support people) to experience and enjoy the birth without needing to be a perfect “birth partner”. I suggest that the partner also must be free to be present, vulnerable and primal. One dad might get in the birth tub with his partner and catch the baby while another might sit in a chair in the other side of the room and just try not to loose his lunch. Both can benefit from the encouragement of a doula’s support. It is the right of the couple to determine the level and type of involvement he should give. Insisting that all fathers participate in a certain way is just as judgmental as assuming all women should birth in a particular way.
Obstetrician, Michel Odent has suggested that the influence of the father’s participation during the birth is far more complex than we have considered. In a Midwifery Today article from 1999 entitled, Is the Participation of the Father at Birth Dangerous, Odent raises questions including’ “Does the participation of the father aid or hinder the birth?” and, “Can all men cope with the strong emotional reactions they may have while participating in the birth?”. Most of us would say, “Of course!”
But after witnessing the interactions between many couples during birth and postpartum, I believe we have put fathers in a position they were never meant to be in.
Make no mistake, I believe in women AND men attending childbirth classes. The father/birth partner needs to gain information, understand how the mother plans to labor and discuss options during pregnancy in order to be very connected and in agreement concerning plans for the birthing. Information given ranges from anatomy to the stages of labor to the smorgasbord of interventions and choices available today. That’s a lot of information to tuck into one’s brain cells. Not to mention that this is a pretty big day for dad too as he rides his own roller coaster of birth.
So, how can a doula help dad? Here are just five of the ways the support of a doula can free dad to offer support in a way that is comfortable and effective.
Doulas live, breathe, eat and sleep all that stuff from childbirth class you (dads) can’t remember. Doulas who have been through training and certification have a basis of information about pregnancy, birth and newborns that is more than most men know or want to know about birth. While a really smart doula knows her main job is to just “hold the space” (provide emotional and physical support to mom) and assist her in gathering information from her care providers. A doula has a knowledge base of “birthy stuff” that takes the pressure off dad (and mom) to remember it all.
Doulas give dads a teammate. Birth is often compared to a marathon. It is important to keep the birthing mother hydrated, fueled and even rested periodically during her birthing event. Same goes for dad. Dads need to eat, drink, stretch, take naps and refresh themselves during labors that last more than a few hours. A doula gives dad someone to tag to come in the ring when he needs to bow out for a break. Dads often feel tremendous relief leaving mom with the support of someone who he knows will not leave her side and will support her choices.
Doulas allow dads to perform super-human feats they could never achieve on their own. Okay, perhaps I’m overstating a bit but have you ever tried to be there for a mom to lean on while simultaneously providing counter pressure to her hips? It’s pretty much impossible. With a doula, one person can be there for mom to lean on while another person can provide massage, counter pressure, hold warmth or cool on her back while she sways. A doula/dad team are able to put into practice a lot more of the techniques and tips learned in childbirth classes.
Doulas help dad know what she really means when she asks, “Do you think it might be time to go to the hospital?” Babies often like to get things started in the middle of the night. When mom rolls over for the 5th time to nudge you and whisper, “Honey, I think my contractions are getting closer together!”, you will want a doula to call so you can gauge whether or not to get up or attempt to close your eyes and pray there won’t be a 6th nudge. While a doula can’t tell a mom that she is definitely in her birthing time, she can offer her professional opinion as to what mom’s current signs might indicate. A doula can help get past those, “Holy macaroni, this is it!” feelings and relax knowing that someone experienced with birth is supporting them as a couple.
Doulas let dads relax and enjoy the birth of their baby. In Hypnobabies, the childbirth class I teach, birth partners are given a special CD that helps them feel relaxed and confident during the birth. Occasionally, dads are resistant to listening to this. It’s as if they don’t feel as if they have the right to be relaxed and confident during the birth. Having the continuous support of someone who knows and understands birth, can help dad relax and let the process unfold. Dad is free to get in sync with his partner, be there for her without worrying and experience his emotions.
It’s important that mom AND dad have the support they need during labor and birth. And trust me, with the help of a doula you will both be able to handle it!
Resources
Odent, Michel, (1999). Is the Participation of the Father at Birth Dangerous? Midwifery Today, Issue 51, Autumn.
Micky, a team member with 9 Months & Beyond, LLC http://ninemonthsandbeyond.com/ (hyperlink) in Nashville, Tennessee, has experience as a breastfeeding mother, LLL Leader, lactation trainer, conference speaker, and IBCLC. Her mother-baby experience includes a degree in child development and family studies, teaching as a Hypnobabies Childbirth Hypnosis Instructor, being a certified birth doula with two organizations and DONA Approved Birth Doula Trainer. She also trains for the COPE Program with Commonsense Childbirth based on the JJ Way developed by Jennie Joseph, LM.
Author of, Keep the Fires Burning: Conquering Stress and Burnout as a Mother-Baby Professional (available at www.ibreastfeeding.com ), Micky is passionate about encouraging other professionals to understand that who they are is more important than the work they do. Learning to value themselves is a vital part of being able to serve women and babies for years to come. Micky is also the wife of 14 years to her amazing hubby KC and the mother of three energetic school-age kiddos. She wanted to become a doula as soon as she found out what the word meant and had a doula for two of her three births.
This week we are delighted to introduce Cole Deelah, who shares an insightful story of birth from her point of view as a Doula. Cole has over 10 years of birthing experience and has created her own independent childbirth curriculum.
Lynnette and Doug, you are a wonderfully delightful couple! Your beautiful daughter is so lucky to have such amazing parents. Your journey began long before your daughter’s birth day and, on that journey, you made so many amazing choices.
You chose to take an independent childbirth class, to hire a doula, to attend the play “Birth”, to interview midwives, and to change your care from a hospital-based midwife to a birth center midwife.
Saturday, January 29, 2011: Doug and I went to Laura’s house on the eve that my labor began. Laura and some of her friends were planning on running the Houston half-marathon the next day, so we “carbo-loaded” for dinner by having spaghetti and meat sauce, bread, salad, Girl Scout cookies, and ice cream.
Little did I know that this would be the last full meal I ate before my baby was born. Good thing it was full of carbohydrates for the long, hard work ahead.
When we lay down to sleep around 10:30, I felt my baby moving inside me rather wildly. The movements were huge and you could see their impression from the outside. Doug fell asleep with his hands on my belly, feeling our little girl dance. He was in awe of the miracle inside me, and so was I.
I feel asleep with a smile on my face.
Sunday, January 30, 2011: I woke suddenly at 3:00 in the morning and waddled as quickly as possible to the restroom, but my underwear was completely soaked by the time I got there. Then I sat on the toilet and felt a gush of fluid. Is this my water breaking? The fluid was clear and odorless and my heart started racing as I contemplated the possibility that my water had broken, but I still wasn’t sure.
I had read that only 1 in 10 women start labor with their water breaking and was not expecting my labor to start this way. I changed clothes and went back to bed. 30-minutes later, the same exact thing happened. Now, I was 99% sure that my water truly had broken. I lay in bed after this, feeling surprised.
I tried to go back to sleep. I knew this was important because labor could last a long time. But then I started feeling very mild contractions. I remember that they were only about 20 seconds long, but would happen every 5 to 10 minutes.
I read through some material from the childbirth class we had taken with Cole Deelah (my doula), just to try to figure out what was going on. I then realized I really needed to rest, even if I just lay there and couldn’t sleep. At 6:00am I called my midwife and told her what was happening. She advised me to let her know when my contractions lasted longer (at least 1 min) and were 5 min apart consistently.
Early on, you called to let me know that your water had broken in the early hours of the morning. You were patiently waiting for your contractions to begin and, in the mean time, you went for a walk and carried on as normal.
Doug and I went to the Stevenson park at 8:00 am to go for a walk. It was a drizzly, dreary looking day. I contemplated how appropriate it was that the marathon was going on that day and I considered how I had run a marathon 7 years ago and how if I could do that, then surely I could handle whatever lay ahead of me for labor and birth.
Sometime after 10:00am, I went to the birth center to check my vitals. My blood pressure and the baby’s heartbeat were fine. My midwife gave me an herbal tincture of Cottonwood bark extract to take every hour with a little orange juice to try to speed up labor since my contractions still had not gotten any longer or intense.
In the afternoon, you went to visit your midwife, who prescribed Cotton Root Bark to hopefully establish some contractions. Around 3 in the afternoon, you called to find out my thoughts on it. I reminded you to let your body start labor when it was ready, to not worry, and to take the cotton root if you felt comfortable with it.
I began taking the herbs immediately, knowing that there is some random “time limit” in which doctors and nurses want the baby to be born in after the water breaks. Jackie told me she was comfortable with a long amount of time as long as mom and baby are doing fine, but that her referring physician has a real issue if a woman goes past 24 hours after the water breaking and the baby is still not born.
Into the evening, my contractions still had not changed and I notified my midwife. She suggested I take some Castor oil. I was starting to become emotionally drained and I doubted that I should take the Castor oil. This conversation with Cole was pivotal in the progression of my labor.
Around 6:30pm, you called discouraged and worried. You were still not feeling much in the way of labor and talked about the use of castor oil. We also talked about the fact that, though your midwife was comfortable waiting on labor, her back-up OB wasn’t. I knew, in my heart, that your body was in protection mode. I encouraged you to go on a date with Doug, forget about what your body ‘should be doing’, and allow it to start in it’s own time.
She assured me that many women have given birth to completely healthy babies even DAYS after their water had broken. She explained to me the risks, but also reassured me: I was not Group B strep positive, so infection from that was not an issue, I was healthy, I was staying very sanitary, and I was not running a fever. All good things were on my side.
So, we completely cut off communication with our family and friends for awhile. We took a walk, held hands and played cards. And you know what? By the end of our card game, my contractions were actually requiring my attention. I began sitting on the birthing ball and holding onto Doug during contractions. After a few “big” ones, I was certain I wanted to make the car ride before it became more intense, so we headed to the birth center.
At 10pm that evening, I received the call that you were heading to the birthing center, your labor pattern was well established and you were in good spirits, but really working at labor.I arrived at the birth center within 40 minutes and found you in the bathroom, nauseous, and working through a strong labor pattern about 4-5 minutes apart.
You came from the bathroom and sat on the ball, rocking through contractions, moving your hips in a figure 8, and grasping the hands of whoever was nearest to you. Doug held your hands most often, praying with you, brushing the hair back from your eyes, and whispering strength and encouragement to you.
I had a ton of nausea at the beginning of active labor, making frequent trips to the bathroom with diarrhea and vomiting (really, really glad I had not taken castor oil…these issues would have probably been worse). I also had a lot of uncontrollable shaking in my legs and sometimes arms throughout the remainder of labor.
It was more annoying than anything, especially between contractions when I was trying to rest. I was able to drink water and Gatorade but did not have an appetite.
It was not long before you were active again, moving through your contractions and beginning to vocalize in deep hums and open ‘aaah’s. You asked for Doug to play for you and he brought out his guitar, weaving beautiful melodies throughout the room. You both sand a duet – Lynnette in the melody of birth, and Doug, in the melody of praise.
The first day ended with Doug playing his guitar and singing to me while I labored.
Monday, January 31, 2011: I labored in all sorts of positions: side lying, sitting on a birthing ball with my arms draped over the footboard of the bed, a modified sort of hands and knees position on the bed with my arms resting on a stack of pillows, standing, squatting, birth stool (which was uncomfortable to me so that didn’t last long), and in the water mainly on my hands and knees.
I remember thinking how important it was to me to be able to constantly change positions. I would get in a position during a contraction and then rest in sidelying or stand and sway between contractions. My body knew what it needed and I was constantly reassured by my midwife and doula that I was helping the baby get in the optimal position.
When the contractions truly began to come on you with insistence, you walked for a short bit, tried sitting on bed, but ultimately moved back to the ball after a short trip to the bathroom. You asked for a bath, which we drew for you, and soon you were lowering your beautifully ripe belly into the warm waters of the birthing pool.
You stayed in frog squat/kneel mostly, although sometimes you moved to all fours. Blissfully, you and Doug were both able to rest for short periods, and your body continued working toward the moment of birth.
Cole Deelah is the mother of 5 beautiful, home schooled children and the wife of one feisty entrepreneur. She resides and works in the Houston area as a birth doula, childbirth educator, and midwife apprentice. She has over 10 years experience in the birth field and has written an independent childbirth curriculum and head’s up a local cooperative of doulas. Cole has authored articles in such publications as Midwifery Today, the International Doula magazine, and others. She has plans to become a practicing midwife and travel the world with her husband and children, supplying basic life skills and maternal and neonatal healthcare to underdeveloped and developing countries.
As any pregnant women with a burgeoning belly can attest, there are a preponderance of frightening birth stories out there, and little apparent reluctance in sharing them. Birth is perhaps the one unequivocal commonality we all share; everyone on earth today was born. It is a completely normal physiological process with generations of proof of efficacy and yet many, if not most couples in our culture today approach their births with some degree of fear. And yet, the mere word- BIRTH- seems to have the power to conjure fear in western women. Men, too.
So where does it come from? In previous generations, women had a healthy reverence for the intensity of birth. Compared to women today, they were much more familiar with the sights, sounds and smells of labor, but had a very limited understanding of why some women survived child labor and others did not. First time mothers also struggled to grasp how something that looked so intense, would feel.
With technological advances, antibacterial soap and more prevalent hand washing, the possibility of death has become as remote as our direct experiences with childbirth. Very few people actually experience a birth other than their own, but we are inundated with conflicting and scary representations of birth. Thus, we fear what we think we know. Our collective understanding has shifted from a very real concern for life and safety to a second-hand anxiety.
A woman has merely to suspect pregnancy, and suddenly find herself overwhelmed with information — from ‘reality’ birth on numerous television programs and its more humorous Hollywood caricature, to an endless stream of products and contraptions marketed to parturient women claiming to ease, soothe, simplify, (read: correct) her birthing process. Taken separately, each of these influences has the potential to undermine a woman’s confidence in her inherent capabilities; the cumulative effect can corrode it entirely. It is in the absence of this confidence that fear absolutely thrives!
But, how do we heal this pervasive cultural influence?
The simplest answer is that the antidote to fear is faith. It matters not wherein the faith is placed; be it a Most High entity, or basic physiological science, it simply boils down to how deeply a woman believes in her ability to give birth to her child. Whether she borrows her faith from a greater spiritual practice and views her experience as merely an extension of this greater understanding, or whether she simply studies the facts of the body’s process in labor and the statistical likelihood of safe delivery and is duly assuaged by belief in her own body’s capabilities, a woman coming to the experience with a trust fortified in fundamental understanding is much more likely to have a successful birth. She’ll enjoy her birth more.
Happy birthing is completely subjective, but it’s probably safe to say that not spending the entire experience in terror is more pleasurable — and more conducive to surrender, which is critical. Armed with a fundamental belief that birth can be achieved or that whatever takes place will lend to a higher purpose, a woman can more fully give herself to the process. This is the shift of faith. The entire spectrum of variables — prenatal care model, childbirth education methodology, labor support, etc — cannot overcome the significance of the role that sheer faith plays in the labor experience.
So perhaps the most important preparation for birthing is bolstering faith; cultivating a sense of independent, sustainable trust. Of course, we must also embrace fear as part of the gift, in that it teaches us how to better connect to and prepare for the process and we can also participate in a paradigm supportive of birth (choosing the best support team possible) – but these things cannot supplant a woman’s core beliefs. Only she has the power to choose faith.
In time, each woman empowered by her a pleasurable birth experience contributes to a shift in the collective consciousness — gradually reframing fear. Every woman within herself, and all women within their communities. Men, too.
Piper Sunshine Lovemore is a Certified Doula, Organic Birth participant and consultant, Lamaze Certified Childbirth Educator, Placenta Encapsulation provider and all-around natural childbirth advocate. Her core belief is that an informed experience is empowering, no matter the particular outcome. To that end, her goal is to educate and support families through their birth experience primarily through reconnecting them with their own embodied wisdom. Piper believes deeply in the importance of community and the richness of a diverse support network. She strives to nurture her community by organizing and attending activities with her family in her free time. She and her partner, Chaz, live in Hawaii with their three children: Che’ Pax, Plum and Rocket, and they look forward to expanding their family further. Take a moment to be inspired by Orgasmic Birth. Watch the trailer… www.orgasmicbirth.com.
This week, Mother’s Advocate speaks with Sarah Proechel, a Certified Professional Midwife working in Guatemala on Fulbright Scholarship. In this inspiring interview, Sarah discusses her perspective on hospital interventions in Guatemala, preservation of Mayan culture, and her own endeavor to open a midwifery school in the Guatemala highlands.
MA: There are a lot of women in the United States who become involved in the birthing community because they feel compelled in a in some larger way – as though supporting mothers through the birthing process is a part of their life purpose or destiny.
SP: For me that’s very true. I had things like this happen to me when I was very young but it was never confirmed. It was a big struggle for me to own that calling as an adult – until recently. If I had had somebody saying “oh yeah you’re supposed to be a midwife and that’s why you’re having all these dreams and these feelings”, I think it would have made a difference in my life.
Things are different here in Guatemala. Most women who become midwives are aware of their calling from a very young age. One of the typical stories you hear is that a woman was born “in the caul,” which means with the bag of waters intact at birth and that is sign of destiny, that she will be a midwife. She grows up with that story and that begins to live into it as life presents its opportunities. She may also or alternatively experience a series of dreams involving babies, pregnant women, dolls, or coins. There are many things associated with pregnancy and birth that show up in dreams that can point to a calling. She is therefore validated and called “comadrona” before she has any experience or training whatsoever. I find this so beautiful and life-affirming. A boy who is born in the caul is said to be a “curandero”, or healer.
There was a doctor in the room at the first birth I attended here, and he wanted to break the bag of water. I asked the mother if she wanted the bag broken and she said “no”. Eventually the doctor was asked to leave. That day, the baby was a boy and he was born in the bag – so it was meant to be. What if we had intervened? It would have literally changed the course of that boy’s life.
MA: You are working with a group of midwives and activists from Guatemala and the United States to open a midwifery school. Tell us about your vision for this school.
SP: Our vision is to have a training center/midwifery school that will serve the local women who are chosen as midwives — and also provide a unique educational opportunity for student midwives from the United States, Canada and beyond. The philosophy of the school is one of leadership and collaboration – this is not a top down model. It is the vision of Ester Pop Tuch who is a traditional midwife from San Pedro – a really competent midwife who has attended hundreds of births. Jumping off from Ester’s original vision many talented people have joined the project and it is becoming a truly visionary model that has the potential to really shift the discourse and the direction of midwifery in developing countries, beginning here in Guatemala, where home birth is still the norm.
The school curriculum will combine the midwifery model of care with Mayan healing traditions – herbal medicine, spiritual cleansings, spiritual guides and birth wisdom. We can really help this community by training the midwives in the midwifery model of care and emergency medicine so that the midwives know how to handle complications and when to transport to the hospital. They Mayans have a rich tradition of midwifery and home birth, which has been eroded away. There’s a long history of discrimination and abuse and colonialism and war; and midwives during the war were picked off because they were community leaders, so they were the targets. We want to scoop that tradition back up into a container where it can be passed on to future generations, ideally in a way that is healthier, stronger, and more sustainable than it has been.
MA: How will this project improve birth outcomes and lower intervention rates in Guatemala?
SP: I came here to research high maternal mortality rates in Guatemala. On the surface it looks like women are having their babies at home and that’s why they’re dying. There is a relationship there, but it’s much more complicated then it would appear on the surface. Here’s what I’ve seen:
People in this area, on the whole, prefer home birth. It’s culturally expected – anyone who comes to the clinic to visit me for a prenatal is expecting to have a baby at home. They don’t have any desire to go to the hospital and deal with the scene there or be operated on. You don’t see people who are like “oh just cut me open, that will be easier.” They really value home birth; they really value their midwives.
However, women are being told that they must visit the health post during their pregnancy – which is outside of the midwives sphere of influence. Theoretically that could be OK, except for the fact that the health centers uphold a medical model of care. Women who go to the health post – I’ve seen this over and over – are much more likely to be told, for one reason or another, that they need to go to the hospital for the birth. They reasons given are things U.S. midwives would balk at, like being over 40 weeks, being diagnosed with a “narrow pelvis,” or a baby that’s too big, being told that the baby won’t come out because the cervix is posterior or because the baby is posterior, to name a few. All of these things are utterly absurd and the sad part is that most of them do not seem to make it out of the hospital without a c-section.
When mothers end up at the hospital, they have to be alone – no partners, no midwives allowed. No support person. Absolutely none. That’s hospital policy across the board. This is problematic on many levels. There was this really fantastic study that was done my Nicole Berry, which correlates high death rates to a fear of going to the hospital (among other things) – women don’t want to go even if they know they need to go. They wait too long, so it’s a last-ditch effort going to the hospital, and then it’s too late. I have definitely seen this playing out but I have also seen almost the opposite. I have seen many women that are easily convinced that they should go to the hospital even though the reasons given to them are bogus. They just don’t seem to have enough knowledge about their own bodies and normal birth to know otherwise and often times the midwives don’t know any better either. It’s not that different than in the U.S. actually, where women are given umpteen reasons why they need a c-section and they don’t really protest.
There are also situations where the midwife doesn’t know her stuff, but this environment makes it especially challenging for a midwife who might say “this is outside of my parameters, we should go to the hospital”—because then the family has a big discussion about whether to go or not, knowing that they will be treated very badly once they get there. Then the question becomes, at what point is it worth it to go?
I have also experienced the loss of a beautiful baby boy due to the utter incompetence of the health care system I dutifully referred the family to. Instead of being treated, the situation was dismissed (by the local health post doctor) as a result of the evil eye. A few days later the baby died. I am still grieving over the recent loss of this baby, my first as a midwife, and dumbfounded at the whole situation. Healthy women with healthy pregnancies are being told there is something wrong and a sick baby, who needs urgent attention, is dismissed. It makes no sense.
On a more positive note, I have attended some really triumphant home births, where women have had their babies at home with me and a “comadrona” attending, against all pressure to go to the hospital. The depth of gratitude I have received from the women and their husbands, often the most from their husbands, makes everything I am doing worthwhile. I can really, really feel how deeply important it is to these people to have their babies at home with their families and their midwives. It’s deep stuff.
For me, I care deeply about woman and babies surviving the birth process. But the point I want to get across is that birth, and life, for that matter, is not just about survival. All of life is here to be cherished. Birth is one of life’s most exquisite experiences, or I should say it can be. For some women, maintaining their dignity and freedom is more important than staying alive. Others are willing to sacrifice the home birth and endure the hospital experience in favor of what they believe is their safety. They should not have to make that choice. They can have their babies in safety, dignity, and freedom, all at the same time.
The goal of the midwifery school is not only to equip midwives with knowledge; it is to elevate the status of midwives so that we can improve birth outcomes and lower intervention rates. Ideally, we would like to offer a comprehensive three-year midwifery education to younger midwives just starting out so that there can be a group of professionally trained midwives who are well-steeped in the midwifery model of care as well as their own culture. These midwives would fill a huge void in the community between birth with a traditional midwife, or “comadrona,” who has minimal training, and a c-section in the hospital. These women could serve as bridge builders with a valuable knowledge base of normal birth and the ability to communicate in both the indigenous communities and the medical world. We hope our students will be the leaders of the future of midwifery in Guatemala.
MA: You have described this project as a dream-come-true. It is inspiring to hear. Tell us about that.
SP: The more this project develops the more I have deep faith in the process and what will be the product. It feels to me like there is a spiritual force that has created an energetic blueprint of what it wants to create. Each of us holds a piece of the manifestation of that blueprint and have joined the effort because we are somehow aligned with it. For myself I feel like I’m just following instructions. I just feel like I trust everything that shows up and the more I do that the more I see results that blow my mind. Every meeting is productive, every action moves us forward. Every door knocked on is opened. It’s crazy and awesome.
Sarah Proechel is a Certified Professional Midwife from the U.S. She has had a private home birth practice in western Massachusetts since 2005 and is currently working in Guatemala as a 2010-2011 Fulbright fellow. Her project, a cultural exchange with traditional midwives in San Marcos La Laguna, Guatemala, has rapidly evolved into a joint initiative to create an international professional midwifery school. Sarah holds a bachelor’s degree from Goddard College in Health Arts and Sciences with a focus on Mayan midwifery and herbal medicine and is currently enrolled in a Master of Midwifery program at Midwives College of Utah. She is author of Voices of Maya Midwives: Oral Histories of Practicing Midwives from the Mam Region of Guatemala, Lulu press, 2005. When she’s not in Guatemala, she lives in the Hudson Valley of New York State with her husband, two young children, and one teenager.
Michel Odent, MD, is known as the French obstetrician who introduced the concept of birthing pools and home-like birthing rooms to hospitals. He has published 21 books over his career, including The Scientification of Love, The Farmer and the Obstetrician, and The Cesarean. This week, Dr. Odent shares his personal insight about creating an ideal birth environment.
The best advice for an easy birth is for the parents to have nobody around except for an experienced mother figure, a midwife and a doula. We have to re-discover what is simple. Privacy matters during labor.
During the twentieth century, many schools of childbirth were based on theories that today are unacceptable. We make things so complicated. I learned this with my very fist experience of childbirth as a medical student in 1953. At that time, a midwife had nothing to “do”. She was spending her life knitting – knitting while waiting for the baby, knitting while there was no woman in labor – she had nothing else to “do”, and in that respect I realized the value of this tradition and attitude.
At Cambridge University, some scientist explored the physiological responses to repetitive tasks. As an example of a repetitive task, they studied knitting. When you are doing a repetitive task like knitting you reduce your level of adrenaline and that’s the key for an easy birth – when the level of adrenaline of the midwife is low, it’s contagious. This helps the woman in labor to be in a state of relaxation and the birth is easier.
And today, I’m still learning what is simple. I have been attending homebirths accompanied by a doula. Yes, I am a doctor, but this doula is the mother of four children. I generally stay in the kitchen keeping the man busy, the baby’s father. Finding topics of conversation, different things to do – leaving the two women together in another part of the house.
The doula does most of the work. She has an incredible capacity to remain silent – to keep her mouth closed – and that’s how I’m re-learning again what is simple. I have come to understand – again and again – that the best possible environment for an easy birth is when there is nobody around the parents but an experienced midwife, doula, and experienced mother figure who can remain silent.
How did you ensure birth went according to your plan?
Choosing the care providers who will be present and support you through your pregnancy, labor and delivery is key to achieving the birth you desire. This week, Deb Flashenberg, a Mother’s Advocate Blog veteran, joins us to clarify the difference between obstetricians, midwives, labor and delivery nurses, and doulas.
As a doula and Lamaze certified childbirth educator, I’m often asked:
“What is the difference between a midwife and a doula? “
“Does my obstetrician work with my midwife?”
“Why would I choose a midwife over an obstetrician?”
“Isn’t a nurse like a doula?”
I finally realized that the best way to educate the women I work with was to create a comprehensive resource that covers what each does, how each might help her through pregnancy, labor and birth, and then attempt to demystify the world of birth professionals.
First, it’s important to understand the definitions of these terms, what each profession is ultimately responsible for.
Obstetrician (OB/GYN): A physician (doctor) who delivers babies, and is in the practice of obstetrics — the art and science of managing pregnancy, labor, delivery and the puerperium (the time immediately after birth).
You will see your OB/GYN or members of his/her practice throughout pregnancy, although exactly who your care provider will be at delivery ultimately depends on who is on call during your labor. During labor, the obstetrician will come in and out to check on your progress and, as the definition above states, “manage” your labor. Obstetrics is also a surgical field, so in the case of a cesarean, your OB/GYN would perform the procedure.
Midwife: A midwife is a trained professional with special expertise in supporting women through a healthy pregnancy and birth. Midwives also work with each woman and her family to identify unique physical, social and emotional needs. When the care required is outside of a midwife’s scope of practice or expertise, the woman is then referred to other health care providers for additional consultation or care. Midwives operate from The Midwives Model of Care, which emphasizes the fact that pregnancy and birth are normal life processes. Midwives statistically have lower rates of interventions, and provide the mother with individualized education, counseling, prenatal care and postpartum support, as well as continuous hands-on assistance during labor and delivery.
Midwives, like doctors, may work in a group that rotates who is on call and who will see you for your prenatal visits. Some midwives work alongside doctors in their practices, while some work individually or outside of the hospital setting. There are different types of midwives: direct entry midwifes, certified professional midwives, and certified nurse midwives. Depending on their credentials and training, some midwives work in hospitals while others solely attend home births.
Labor and Delivery Nurse: Nurses in this field provide care to women who are in labor, women who have recently delivered, and women who may be having complications with labor. They also work with doctors to develop a plan that aids in the safe delivery of healthy babies.
Labor Support Doula: A trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth. Some doulas also provide emotional and practical support during the postpartum period.
Unless a doula has additional training, she is not a medical professional, and will not perform medical procedures on the laboring mother or deliver the baby. However, she most likely will be one of the most consistent elements of the labor experience. She does not change shifts and only deals with one client at a time. A doula will also labor with a woman at home, before the transition to a hospital or birth center is made.
Now, back to the original questions:
What is the difference between a doula and a midwife?
As described above, the doula acts as emotional, physical and informational support for the mother. While the midwife may offer many of those same qualities, it is the midwife who will actually deliver your baby and perform necessary medical examinations throughout your pregnancy, labor, delivery and postpartum period. Midwives are also available to work with a woman outside of pregnancy, and can perform “well woman” yearly exams throughout a woman’s life, as well.
Does my obstetrician work with my midwife?
Yes, sometimes a practice has both obstetricians and midwives. But if your current OB/GYN does not work with midwives, you cannot have both as care providers. If a midwifery practice does not have an obstetrician as part of the group, there will be an outside doctor who backs up that group.
Why would I choose a midwife over an obstetrician?
Choosing your care provider is a very personal choice. It requires a long, hard look at the model of care you would like for your pregnancy and delivery. While both professions try to offer the best care they can to women, the path in which that support is offered differs. The model of care that midwives subscribe to reflects the idea that pregnancy and birth is a natural physiological process that should be inherently trusted, while the medical model focuses on the pathologic potential of pregnancy and birth. They both have the same desired outcome, but use different routes to get there.
You should also consider the style of care you personally prefer. Midwives will tend to be more present during labor; moreover, they will be more holistically based, and allow more space for the labor to unfold naturally before moving to medical interventions. Obstetricians are not as likely to give you as much personal care and time, and may move to medical interventions more quickly.
Isn’t a nurse like a doula?
Many labor and delivery nurses (L & D nurses) I have worked with are wonderful, and can offer a lot of helpful advice for the laboring mom. However, I would not advise depending on your L & D nurse to provide the same comfort and assistance as a labor support doula. The L & D nurse often has several women they are monitoring at the same time, and cannot offer consistent support since they work in shifts and breaks. You may also find it appealing to choose your labor support doula, and have the opportunity to previously discuss your birthing preferences with this person.
I hope that laying out this cast of characters makes it easier for you to make decisions about your birth — including the model of support you will receive, and who you would like to be present. After all, it is your birth.
Debra Flashenberg CD (DONA), LCCE is a graduate of the Boston Conservatory of Music. She spent most of her life performing, and was introduced to yoga through a choreographer in 1997. Soon after embarking on the path as a yoga teacher, she founded the Prenatal Yoga Center in New York City, where she continues to instruct prenatal yoga and train prenatal yoga teachers. Debra decided to also take her skills and passion for supporting normal birth outside of the yoga room, so she became a certified labor support doula with DONA and a certified childbirth educator with Lamaze International. For more information, please visit the Prenatal Yoga Center online.
For many women, labor and birth can give rise to strong emotions — from common fears about the unknowns of labor to the re-emergence of traumatic wounds from the past. What are the common and more difficult emotions you have worked with in the context of birth? How did you — or your caregivers help you — navigate through this challenging experience?
To join the discussion, simply write in the comment field below.
And… stay tuned next week (January 17th) for a guest post by Mickey Sperlich, author of “Survivor Moms: Women’s Stories of Birthing, Mothering and Healing After Sexual Abuse.”
With optimal labor support, women can birth with a sense of pride, confidence and fulfillment. This week, Penny Simkin, inspirational author, childbirth educator, birth counselor and co-founder of DONA, joins the Mother’s Advocate blog to discuss the value of love, encouragement and support during labor.
MA: Can you speak to the importance of having supportive loved ones present during labor?
PS: Women need to feel safe during labor, and in today’s maternity care climate, the hospital is a rather strange place for most people — full of machinery and beeping machines. But also, there isn’t much continuity of care. She may not have a doctor that she knows, or may not have a midwife that she knows if she’s having a hospital birth — the nurses come and go. And so, there’s not continuity. Having her loved one nearby gives her that continuity.
MA: What roles can familial labor support play?
PS: The role that the partner, the father or loved one would play really depends on how the two of them perceive his or her role, but also how comfortable he (or she) is. It can be anything. From being a companion who is assisting her with every breath she takes — in terms of being present and being in the rhythm of her breathing. To sitting by and encouraging maybe a doula or someone else to do most of the labor support. But as far as I’m concerned, a woman who is alone in labor feels alone. Even with a partner who isn’t very present for her. She’s very unlikely to feel very fulfilled in her birth experience.
MA: How does labor support affect birth outcomes?
PS: The importance of labor support can’t be overestimated. We have studies of doula support — many of them — like 17 of them. Randomized control trials comparing women — the outcomes of women who have a doula with them with women who have no doula but usual care. In a nutshell, all the studies have found benefit — benefit in shorter labors, less requirement for pain medications, more satisfaction with the birth, and in some cases, better newborn outcomes. Some have also found less postpartum depression six weeks later, and better breastfeeding incidence. And, it seems strange that some of those postpartum outcomes would be improved by having a doula present during the birth, or having excellent labor support during the birth. But I think what we find is that a woman has great emotional needs during labor. If those are not met, she’s depleted. She may become depressed — we’ve found that there’s more depression in women who have not had adequate labor support. So this can have ramifications that go far beyond the birth experience. When she feels well supported, valued, respected, cared for, nurtured, guided — she feels empowered. And after a birth like that, she’ll say, “I did it.” She knows that she has that strength. I would hope for every woman, however she chooses to give birth, that she comes out of it feeling the sense of power, capability — accomplishment.
MA: Your DVD, “Comfort Measures For Childbirth” offers more than 40 ways a laboring woman and her partner can work together to achieve a comfortable birth. Can you one of these measures with us?
PS: I’ll show you an easy but very appealing hand massage. This is something that might be particularly useful if a woman has been gripping the sheets, or her partner’s ears (laughs), or the side of the bed in the need to fight through the contractions — it isn’t a good way to use her energy. So, her partner or her doula might say, “May I massage your hand?” — because she’s getting something out of this squeezing of her hands together. So, have her relax her arm. Place your two thumbs above her wrist and the rest of your fingers below, in (clasping) her palm. Put pressure on her palm, and increase pressure until she says it’s enough. Now, do a friction rub over the top of her hand, maintaining pressure on the palm and stroking firmly over the top of her hand. Many women will say that when you do that, the tension just kind of — you can feel it going away right up your arm. And so, that’s something that could be done during contractions or between, but I always look — if a woman is gripping, there is a purpose for that. There’s stimulation of her palms, but (with this massage) I can do it for her and she can relax.
MA: Any words of wisdom for expectant mothers?
PS: The birth of a baby is a lot more than the birth of a baby. It’s the birth of a mother, father, grandparents, siblings, etc. When a woman approaches birth, I think she probably has very little idea of how important that’s going to be to her, in her development as a human being. But the birth experience brings the woman to some of the deepest, most profound physical sensations and emotions that she’ll ever have. It’s a mix of joy, anticipation, excitement, pain, exposure, vulnerability. And, I think in going through that rite of passage and coming out on the other side, a woman is transformed. She’ll never be the same. And of course, we’re all hoping for every woman that she will have a satisfying, fulfilling birth experience that she can look back on with great joy, but also one that will give her a sense that — well, some women have said, “I can do anything after having a baby.” So that’s what I hope that we can look forward to for many women, and that’s what I see as part of my role is — to be a part in preparing her for that.
Penny Simkin, PT, is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates that she has prepared more than 10,000 women, couples and siblings for childbirth, and has assisted hundreds of women and couples through childbirth as a doula. She is the author of many books and articles on birth for parents and professionals, co-founder of DONA International, and member of the editorial staff of the journal, “Birth.” Today, her practice consists of childbirth education, birth counseling and labor support, combined with a busy schedule of conferences and workshops. Penny is married, the mother of four, and grandmother of eight.
This interview, originally video-taped for Mindful Mama, was transcribed and re-purposed with permission from Mindful Mama.
Who was on your labor support team? What comfort measures did your loved one(s) and/or doula provide?
You have done everything possible to ensure a smooth, healthy pregnancy — but what about labor and birth? Mary Oscategui, baby planner, birthing options advocate and mother herself, joins us this week to share ways pregnant women can cope with the stresses of an approaching birth. She encourages mothers to acknowledge their fears — for the health and well-being of both themselves and their babies.
As a health practitioner, baby planner and single mom, I understand the challenges and stressors that can affect an expectant mom in preparation for birth — trust me, I’ve been there! Your baby is soon to arrive and the excitement is present, but along with that excitement can come many different emotions — some easy to cope with, and some not. You may be feeling anxious and stressed with a lot of questions and uncertainties weighing on your mind. Will I feel pain? How long will my labor last? Will my baby be OK? What if he/she is not breathing? What if the cord is wrapped around his/her neck? What if I have complications? Will I be able to handle motherhood?
As an expectant mom, your first reaction may be to hide these uncomfortable feelings — you may feel ashamed or embarrassed to share them. Giving birth is our natural birthright, however, that does not mean we also don’t have the freedom to experience some fears or doubts. Suppressing such feelings of anxiety and stress can not only take a toll on your body, but on your baby as well. It’s important to be aware of your fears, anxieties and stressors — and to address them. Doing so will only improve the health of you and your baby, and the outcome of your birth.
How do stress and anxiety affect a pregnant woman and her baby?
When an expectant mom feels anxious and stressed, her nervous system causes physiological changes in her body. Adrenaline and the stress hormone, cortisol, release into her bloodstream, causing her body to react in a fight-or-flight response. As a result, her digestive system slows down, which prevents essential nutrients from being absorbed into her body and passed on to her baby. Her muscles become very tense, making it difficult to think clearly and relax. These physiological changes can lead to premature labor, or even complications during labor.
Babies exposed to a variety of stress hormones, toxins and malnutrition inside the womb may develop a host of problems during their fetal growth and after they are born. Their bodies have to undergo certain biological changes in order to cope with a high-stress environment. In October of 2009, The UK Times reported new research that shows exactly how stress can harm a baby’s development, and how that stress can lead to long-term problems.
According to research by Vivette Glover, a professor of perinatal psychobiology, maternal anxiety affects the placenta by reducing the activity of the main barrier enzyme that hinders the hormone cortisol from reaching the fetus. The babies of women who were stressed during pregnancy had lower birth weights, lower IQs, slower cognitive development, and more anxiety than those born to the other women in the study.
How can women cope, and prevent stress and anxiety?
When I was pregnant, I found a few things essential to my (and my baby’s) well-being.
Acceptance
I had to accept and feel comfortable with my feelings, and not to try to resist them. It is perfectly normal to have some doubts or fears surrounding labor, especially if you are a first-time parent. Once you allow and invite your feelings to be present, you will be able to take the steps you need to take care of yourself and your baby, while reducing — if not eliminating — stress all together.
Support
I sought support. This could be through an expectant mom’s group, a childbirth education class, or a qualified professional — such as a birth doula. By working with a birth doula, or attending a birth education class or expectant mom’s group, you can prevent or reduce stress levels dramatically. Birth doulas are trained to provide expectant moms emotional and physical support in preparation for labor, and are also present during labor for support. Childbirth education classes are designed to inform expectant mothers of their options for labor and birth, and prepare them for the journey. An expectant mom’s group can also be another great resource, as you will be able to relate to and share all the uncertainties and fears you are going through with other women who are going through the same process.
Sleep and Relaxation
I made it a priority to rest. It is so important to make sure you are getting as much sleep as your body needs, as well as taking some down time throughout the day. Your body repairs itself during sleep, and also works to restore any imbalances that are occurring. When you compromise sleep, you become more susceptible to stress, as your immune system has to work harder to maintain proper levels of functioning throughout the day. Also consider taking some down time through a yoga or meditation class, a brisk walk, bubble bath, or even by lightening your workload.
Nutrition
I found that nutrition played a very powerful role in both coping with and the prevention of stress while I was pregnant. Caffeine, sugar and processed foods can trigger stress, so it is best to avoid them. Eat whole, fresh organic foods: fruits, vegetables, protein, and healthy fats that are easy to digest, and contain bio-available nutrients that are especially high in B vitamins and minerals. Exposure to sunshine for a few minutes of day will help your body absorb these nutrients. Of course, be sure to consult your midwife, doctor or nutritionist for your specific dietary needs.
Should you seek medical help?
If you have tried everything and find yourself helpless or depressed, it’s always best to seek medical attention. There are many professionals who are dedicated and committed to supporting you through your journey, and can provide you and your little one on board with the necessary help.
Mary Oscategui, CBP [IABPP], CPT, is the founder and CEO of The International Academy of Baby Planner Professionals (IABPP). She is an international business consultant and educator specializing in maternal health, fitness and going green. She is also the founder of TheBabyPlanner.com, EcoFit Mom and Physical Awakening. Mary is a writer, speaker, coach, author and birthing options advocate. She enjoys empowering, educating and supporting expectant and new parents to know all their options, so they may confidently make the best decisions for themselves and their baby in the most objective, healthy, safe way. Through IABPP, Mary introduced a new approach to the baby planning industry by focusing on the needs of her clients through parental education and emotional support.
How did you cope with the stresses of anticipating labor? Did you utilize a support group or birth professional? What tips do you have for other expectant moms?
There are several cultures where childbirth is understood to be a rite of passage. Beliefs surrounding this transformation are important because they inform the way in which women give birth.
