Birth Art: The Mandala Journey

This week, Mother’s Advocate welcomes doula and artist Amy Swagman. She began making mandalas to prepare for the birth of her third daughter. Creating these pieces helped her to envision (and ultimately create) her ideal birth as well as meditate to prepare for labor.  Since her daughter’s arrival the mandala project has broadened to draw from other women’s experiences of their births. Through her art she hopes to change the climate of birth from fear to empowerment and convey feminine energy. 

I like to say that my first daughter Haven, made me a mother which was as earth-shattering as any experience could be.  My second daughter Lyric made me a doula and birth activist, and my third daughter Seren made me an artist.  Each pregnancy and birth, all different in their own ways, gave me immeasurable gifts.

When I became pregnant with Seren, I was surprised to find that even though we had planned for her I was feeling overwhelmed and unprepared.  I did not expect that to happen with my third!  I felt very trapped, helpless, and disconnected to my little babe.  I took it out on my husband, who is so wonderful and patient. It was a very stressful few months.

We were planning a much-wanted home birth but I felt like my emotions, fears, and anxiety were getting in the way.  Counseling didn’t help.  Talking to friends about it didn’t help.  I needed something else to center me.

I remembered going to a talk called “OPENING to the Art of Birth” presented by friend and fellow doula Alahna Roach.  In it she described the functions of the right and left brain.  They are as follows:

Left Brain	Right Brain
logical / rational	intuitive
sequential	random
analytical	holistic
objective	subjective
structured	fluid (especially with time)

Alahna said that the state of mind you’re in when you’re doing something creative (right brain) is the same state you’re in when laboring and birthing.  Time flies by without you sensing it as acutely.  You are very porous and intuitive.  You aren’t as easily able to answer questions or communicate logically.

To illustrate this she had us do a blind contour drawing.  Without looking at the paper we had to draw all the lines, cracks, details in our opposite hand.  After a few minutes of this Alahna came up to me and said, “Amy, what year is it?”  I had absolutely no idea.  The only thing running through my head was “Uhhhh, I should know the answer to this question!”  Anyone who has given birth or attends a lot of births has seen this written all over a laboring mama’s face.

So I decided to create a small mandala (image within a circle) every day during the last few months of my pregnancy to help me center, process, and prepare for my home birth.  Each one would take anywhere from an hour to four hours, though I hardly noticed.

I loved it.  I craved it.  There was so much solace in taking time for myself, doing something creative, getting lost in symmetry, turning off any worrisome thoughts.  I created images based on what was going on in my head that day.

For example, this one was created to help me connect and envision my baby:

This one was done to help me embrace my “mommy body”:

  As you can see, this image played out almost exactly in Seren’s birth!

Creating artwork, getting into that free, meditative mindset, helped me have the beautiful, peaceful, gentle home birth I had wanted for so long.  To read Seren’s birth story please visit my doula website here.

How to create your own birth art:

Quieting the “Inner Critic” -

Oftentimes I hear people say, “Oh I’m not an artist” or “I don’t know how to straight line.”   Well that’s ok, that’s what rulers are for!  The most important thing is to get involved in the creative process, not have a perfect-looking finished product.  Birth art can be a powerful and surprising tool.  You may discover aspects of your creativity that you haven’t tapped into or even realized yet!

Getting into the Groove –

Sometimes starting out with a right-brained exercise (like the contour line exercise I mentioned before) can be a great way to start.  Another one that I’ve found helpful is to start inside a pre-existing shape or pattern.  Coloring books are great for this, and starting inside a shape like a circle or triangle can make things flow.  You can divide up the shape into pie segments or concentric circles (like a bulls eye) and repeat your design around the circle keeping things symmetrical.  You’d be surprised at how easily the image takes shape!

For an example of this technique and symmetry you can visit my album here.

Creating Birth Art –

Some materials to get you started:

•  Pastels – These are great because they are very tactile and can easily be smeared

•  Watercolors – A great way to explore wet medium, covers areas well.  You can draw with a pen or pencil and use the watercolors to fill in areas

•  Polymer Clay (like Sculpey) – a great 3D medium as you don’t need a kiln to harden it, just your oven.

A valuable resource is Pam England’s amazing book Birthing From Within and the accompanying workbook.  In their pages you’ll find many prompts to help you process what kind of birth experience you want or work through any past birth trauma or preconceptions.

Examples from Birthing From Within:

•  Create a birth “power figure”.  What symbolizes strength for you?  What are the attributes that this figure possesses?

•  What do you know about birth already?  What have people told you?  What was the first birth story you ever heard?  What images come to mind?

•  How do you see your baby inside your womb?  What do they see, taste, hear?  Draw your reactions.

Whether pre-conception, pregnancy, birth, or beyond, art is a powerful tool for any woman in the childbearing year.  Tap into that creativity, you may be surprised what you learn about yourself!

I would love to see what you create and add it to my birth art gallery!  If you wish to be a part of it please email me at amy@birthingbody.org with the following:

•  Photos of your piece

•  A brief description about it (optional)

•  A photo of you (optional)

•  A short bio of you (optional)

Author, Amy Swagman

Amy Swagman resides in Denver, CO,  with her husband Kyle and three beautiful girls.  She is a birth doula and  graduated with a BFA in Illustration in 2005.

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Motherhood: The Psychological Experience

This week we are thrilled to feature Diana Lynn Barnes, Psy. D, with an excerpt from her book The Journey to Parenthood: Myths, Reality and What Really Matters where she discusses the importance of recognizing the psychological experience mothers go through during pregnancy and birth.

Most women would not dream of going through nine months of pregnancy without the requisite prenatal care – regular doctors’ appointments, special vitamins, a well-balanced diet, and diagnostic tests to check on the health of the baby. Yet they do not devote nearly the same amount of time or attention, if any, to the psychological aspects of impending motherhood. They fail to recognize how this profound role they are about to assume will alter their lives forever.

Typically, when a woman plans for life after pregnancy, she considers only her work and childcare arrangements. By the last trimester, she has probably already lined up a nanny or selected a day-care center, or at least thought about it. She also may have arranged for a more flexible work schedule in order to meet the demands of her new family life, which is just around the corner. But women generally do not take the time to reflect on the journey to motherhood, although they seem to have plenty of time to attend prenatal Pilates classes and register for the latest baby paraphernalia. They do not stop to ask themselves, “Am I ready to become a mother? What are my biggest fears regarding motherhood? What might it be like to stay at home alone with a newborn all day during those first few months? How can I begin to integrate and prioritize my different roles? And what does my relationship with my own mother have to do with any of this?

Today much has been made of the “supermom” phenomenon, the pressure for a woman to achieve perfection in each of her roles – mother, wife and professional. As a result, many women approach motherhood n overdrive, believing they must “accomplish” something at every point along the path to parenthood. The ideal pregnancy is one in which a woman exercises such control over her body that she does not need to wear maternity clothes until her eighth month. The gold standard for labor and delivery is a quick, easy, epidural-free birth. And the model for new motherhood is a woman who immediately bonds with her newborn, has no difficulties breastfeeding and knows exactly how to interpret every one of her baby’s coos and cries. During the first few months postpartum, the perfect new mom nurtures her child in such a way that he is the first kid on the block to roll over, walk, talk and hum along with Bach’s Prelude in D Minor. This accomplishment-focused mother is so busy trying to achieve what she considers to be the essential goals of motherhood, that it is no wonder she is left with no time to contemplate what being a mother means in the context of her own personal universe. And that self-analysis can be crucial as a woman attempts to navigate the postpartum period and life with an infant.

Throughout the transition to motherhood, a woman may ponder the question, “Who am I?” as she tries to incorporate the unfamiliar role of mother into her identity. An expectant mother’s changing view of herself is just one of the many things that can affect her adjustment during this transition. Others include the degree to which she desires to become a mom, her earliest childhood experiences with her own mother, her general reflections of family life, and her relationship with her husband or partner. The extent to which she buys into societal expectations regarding motherhood also influences how she will experience the shift to her colossal new role.

Mothers and daughters

Pregnancy and birth can trigger a flood of memories for an expectant mother about her own upbringing and, in the process, reveal a wealth of information about her relationship with her own mother. All of a sudden, a woman may recall how supportive her own mother was, what her mother sacrificed for her, or how her mother attended every one of her sporting events. A new or expectant mother may also face painful or sad memories, instances when her on mom somehow failed her, constantly criticized her or disappointed her. A woman uses these experiences, both positive and negative, to start to define what type of mother she would like to be. She determines how she wants to be like her own mother and how she would like to be different. This evaluation becomes part of the foundation for her ideas about motherhood.

Excerpted from The Journey to Parenthood: Myths, Reality and What Really Matters (2007). Oxford: Radcliffe Publishing pgs. 27-29

Author, Diana Lynn Barnes, Psy.D

Diana Lynn Barnes, is an internationally recognized expert on the assessment and treatment of women’s mental health, particularly around concerns pertaining to the reproductive years. She is the past president of Postpartum Support International and currently sits on the President’s Advisory Council for that organization. She is also a member of the Los Angeles County Mental Health Task Force.

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The Benefits of Natural Labor

Dr. Linda F. Palmer is an author and speaker specializing in nutrition of pregnancy, lactation, and childhood, and in infant health and bonding.  She joins the Mother’s Advocate blog this week to discuss the many benefits of natural labor.  

Natural labor is not simply something for mothers to endure; the process provides key mental and physical benefits for mother and baby. When not interfered with, natural labor helps to protect the fetal brain, prepare his lungs, and build his immune system. When uninterrupted, hormonal interplays provide imprinting and attachment between mother and baby, protect mother’s mood, and initiate instinctual parenting behaviors.

Oxytocin and the Mother

Oxytocin is a feel-good, bonding hormone that acts throughout our lives in response to togetherness and especially to skin-to-skin contact. Oxytocin’s strongest employ by far is during and immediately after birth. Its release during labor provides the contractions needed to expel the baby. As mother’s body feels the vaginal passage of the child, further oxytocin surges are stimulated and much higher levels now remain in the brain.[1]

This exceptionally high brain oxytocin just after birth provides for a powerful imprinting between mother and newborn as they smell each other and gaze into each others eyes. Remaining quite high in the brain for an hour or more after birth, oxytocin provides mother and baby with feelings of trust, calm, and well being, while also causing a little impairment in memory so they forget some of the discomfort experienced. When not impaired, this hormonal high also sets the stage for successful initiation of breastfeeding. The first nursing attempts then lead to continued oxytocin release. When occurring shortly after birth, this serves to help shrink the uterus, preventing hemorrhage.

This entire oxytocin experience acts in mother’s brain to initiate affectionate maternal behaviors,[2,3] helping first attempts at nursing to feel quite natural and teaching mom to want nothing more than to hold her baby and respond to his cries. While brain changes occur during pregnancy and in response to later physical contact, especially nursing, this post-birth window created by natural labor leads to some valuable reorganizing of receptors in mother’s oxytocin and stress responding portions of her brain.

High oxytocin in the female brain has also been shown to promote preference for whatever male is present during its surges,[4] (one good reason for dad to hang around after the birth).

Interrupting the Body’s Plan  

Pitocin is an imitation oxytocin used to induce or enhance labor. This synthetic agent does not cross mother’s blood-brain-barrier and hence artificially induced mothers miss out on a large part of oxytocin’s bonding, calming, mood elevating and amnesic benefits. If anesthesia is used during labor, there is no maternal oxytocin response to the vaginal passage, hence the mother misses the rest of her opportunity for the beneficial brain effects, and her maternal behaviors are not naturally switched on.[5] Cesarean section without labor fails to produce any of this extraordinary oxytocin experience, while labor before C-section provides a portion.

When a baby is born highly drugged, he is less able to partake from the oxytocin-provided benefits of calming, bonding, and drive to breastfeed.

Preventing mothers from these potent oxytocin surges in their brains can lead to increased risks of postpartum depression and poor bonding.[6-9] It has been found that the oxytocin levels secreted during nursing remain low for at least two days following a C-section, with a notable increase in mother’s anxiety level and decrease in her breastfeeding success.[10,11]

Many other hormonal interplays occur during labor, and most are affected by interventions in the natural process. Endorphins, the body’s own natural pain reducers, increase steadily throughout natural labor, however, use of Pitocin prevents their increase.[12] Maternal stress during labor, generally caused by a lack of continual, compassionate maternal support, causes heightened release of stress hormones. This alters mother’s stress handling for some time and raises inflammatory factors associated with the development of postpartum depression.[13]

Protecting the Baby

Mother’s oxytocin crosses the placenta into the fetal brain during labor, silencing the brain so the child is less stressed by the birth process. In addition, the brain is made to be less vulnerable to damage from periods of reduced oxygen or blood sugar. Even if Pitocin can enter the fetal brain as well, any natural regulation of appropriate levels would be absent. It is known that excess uterine stimulation typically seen with Pitocin use creates dangerous episodes of oxygen depletion in the fetal brain. Maternal protection of the fetal brain is not bestowed by Cesarean delivery without labor.[14,15] Mother’s body also supplies very important sugar to baby’s brain during labor. This provision is often impaired, however, when mothers are restricted from food and liquid intake during the birth process.

Baby receives certain antibodies from mother during the last term weeks in the womb but the majority of this transfer occurs during labor.[16] The lack of antibody transfer may be one factor in the reality that infants born via low-risk elective cesareans have a tripled death rate in the first month of life, versus vaginal births,[17] though the lower success in breastfeeding after Cesarean is likely a larger factor.

The hormonal changes of natural labor help to quickly clear fluids from the fetal lungs through a process of absorbing fluids out of the lungs, along with some mechanical clearing from the contractions themselves. When labor is artificially induced, infants suffer from breathing distress more than twice as often as with spontaneous labor.[18] In Cesarean section without labor, an infant is 4 times as likely to suffer respiratory distress.[19-20] This impact on the lungs is evidently long lasting as babies born via C-section are shown to suffer from allergies twice as often as those delivered vaginally.[21]

Striving for the Healthiest Outcome

All is not lost if the birth process does not go entirely as planned, yet birth choices affect a momentous first chance for attachment and breastfeeding success. Natural delivery determines a major cornerstone in preventing infant illness, while boosting mother’s parenting satisfaction. A child is born seeded with specific potential (nature), yet parenting choices (nurture) will greatly influence whether these latent abilities will come to fruition.

1. K.M. Kendrick et al., “Cerebrospinal fluid and plasma concentrations of oxytocin and vasopressin during parturition and vaginocervical stimulation in the sheep,” Brain Res Bull 26, no. 5 (May 1991): 803-7.
2. G. González –Mariscal et al., “Importance of mother/young contact at parturition and across lactation for the expression of maternal behavior in rabbits,” Dev Psychobiol 32, no. 2 (Mar 1998): 101-11.
3. J.A. Russell et al., “Brain preparations for maternity–adaptive changes in behavioral and neuroendocrine systems during pregnancy and lactation, an overview,” Prog Brain Res (2001): 133-38.
4. T.R. Insel and T.J. Hulihan, “A gender-specific mechanism for pair bonding: oxytocin and partner preference formation in monogamous voles,” Behav Neurosci 109, no. 4 (Aug 1995): 782–9.
5. F. Lévy et al., “Intracerebral oxytocin is important for the onset of maternal behavior in inexperienced ewes delivered under peridural anesthesia,” Behav Neurosci 106, no. 2 (Apr 1992): 427-32.
6. J.E. Swain et al., “Maternal brain response to own baby-cry is affected by cesarean section delivery,” J Child Psychol Psychiatry 49, no. 10 (Oct 2008): 1042-52.
7. H.J. Rowe-Murray and J.R. Fisher, “Operative intervention in delivery is associated with compromised early mother-infant interaction,” BJOG 108, no. 10 (Oct 2001): 1068-75.
8. K.D. Scott et al., “The obstetrical and postpartum benefits of continuous support during childbirth,” J Womens Health Gend Based Med 8, no. 10 (Dec 1999): 1257-64.
9. I.D. Neumann, “Stimuli and consequences of dendritic release of oxytocin within the brain,” Biochem Soc Trans 35, Pt. 5 (Nov 2007): 1252-7.
10. E. Nissen et al., “Different patterns of oxytocin, prolactin but not cortisol release during breastfeeding in women delivered by caesarean section or by the vaginal route,” Early Hum Dev (Sweden) 45, nos. 1–2 (Jul 1996): 103–18.
11. E. Nissen et al., “Oxytocin, prolactin, milk production and their relationship with personality traits in women after vaginal delivery or Cesarean section,” J Psychosom Obstet Gynaecol (Sweden) 19, no. 1 (Mar 1998): 49–58.
12. A.R. Genazzani et al., “Lack of beta-endorphin plasma level rise in oxytocin-induced labor,” Gynecol Obstet Invest 19, no. 3 (1985):130-4.
13. K. Kendall-Tackett, “A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health,” Int Breastfeed J 2 (Mar 30, 2007): 6.
14. R. Tyzio et al., “Maternal oxytocin triggers a transient inhibitory switch in GABA signaling in the fetal brain during delivery,” Science 314, no. 5806 (Dec 2006): 1788-92.
15. R. Khazipov et al., “Effects of oxytocin on GABA signalling in the foetal brain during delivery,” Prog Brain Res 170 (2008): 243-57.
16. S. Agrawal et al., “Comparative study of immunoglobulin G and immunoglobulin M among neonates in caesarean section and vaginal delivery,” J Indian Med Assoc 94, no. 2 (Feb 1996): 43–4.
17. M.F. MacDorman, “Infant and neonatal mortality for primary cesarean and vaginal births to women with ‘no indicated risk,’ United States, 1998-2001 birth cohorts,” Birth 33, no. 3 (Sep 2006): 175-82.
18. J. Lee et al., “Evidence to support that spontaneous preterm labor is adaptive in nature: neonatal RDS is more common in “indicated” than in “spontaneous” preterm birth,” J Perinat Med 37, no. 1 (2009): 53-8.
19. A. Ramachandrappa and L. Jain, “Elective cesarean section: its impact on neonatal respiratory outcome,” Clin Perinatol 35, no. 2 (Jun 2008)::373-93, vii.
20. S. Farchi et al., “Neonatal respiratory morbidity and mode of delivery in a population-based study of low-risk pregnancies,” Acta Obstet Gynecol Scand 88, no. 6 (2009): 729-32.
21. M. Pistiner et al., “Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy,” J Allergy Clin Immunol 122, no. 2 (Aug 2008): 274-9.

Dr. Linda Folden Palmer is an author and speaker specializing in nutrition of pregnancy, lactation, and childhood, and in infant health and bonding. She is dedicated to raising awareness about how powerfully early parenting and healthcare choices can influence a child’s mental and physical outcomes.

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Ani DiFranco on Birth and Motherhood

Ani DiFranco has written hundreds of songs, played thousands of shows and is no doubt an icon for strong and fearless women. This is why we are thrilled to share her thoughts on birth, motherhood and strength in this interview:

MA: Tell us about your decision to have a home birth.

Ani: Birthing is a very unique and profound event, and my choice to have a home birth was not because I’m independent (or something), it’s because essentially I’m an animal and I’m very affected by my environment. I’ve always got my feelers out and I know that the animal in me is very easily intimidated – I know this from making twenty records in awkward situations where I don’t feel comfortable, and then you have to sing and then there’s that moment when you’re not really in your own skin.  I didn’t want to give birth to my baby like I had given birth to some of my records thinking “help I’m alone among strangers in this alien environment”. The hospital environment would have been really counter-productive to me.

In retrospect I think that my midwife actually had a perception of me that I was very independent and knew how I wanted to birth because that’s my M.O., but having babies was something I had never done before and I had no idea how I wanted to do any of it.  I’m really happy that I did it at home, even though it was long and extremely challenging for me. In retrospect I think I would want more guidance.  No matter who you are, giving birth is going to kick your ass – in one way or another.

MA: So how did you get through it?

Ani: You know I think that I went into it with a lot of expectations about the power and the beauty and the transformation, and then when the labor really picked up, I was just scared and in pain. Then of course it was powerful and beautiful and transformative.

I think that one of the things that hurt the most afterwards was not my broken tailbone but my ego. I thought birth would be easy for me somehow and the fact that birth was (really) hard made me feel like “maybe I’m not as strong as I thought. Maybe I’m weak”. So, I had to go through an ego recovery process and address those feelings and my misconception of my role as a woman and myself as a part of nature.

MA: What’s it like to be a mama?  

Ani: It’s really something the way the babies teach us to nurture – to be nurturing and to transfer that sort of love and respect and caring to everybody’s babies. We’re all somebody’s baby and I think that everything we need to know about being mindful mamas our babies will teach us eventually, whether we want it or not.

Ani DiFranco has written hundreds of songs, played thousands of shows, captured the imaginations of legions of followers, and jammed with folkies, orchestras, rappers, rock and roll hall-of-famers, jazz musicians, poets, pop superstars, storytellers and a martial arts legend. Ani started her own music label Righteous Babe Records and because of this decision she’s been called “fiercely independent” (Rolling Stone), “inspirational” (All Music Guide), and “the ultimate do-it-yourself songwriter” (The New York Times).

This interview has been republished with permission from Mindful Mama

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Oxytocin: The Love & Birth Hormone

This week, Elizabeth Davis  – midwife, women’s health care specialist, educator, consultant and co-author of Orgasmic Birth: Your Guide to a Safe, Satisfying, and Pleasurable Birth Experience answers your questions on sex during pregnancy.

The number one priority in preparing for birth is to understand the physiology of birth and to know in advance that wherever you will be the most physically and emotionally comfortable is where you should labor.

There is a powerful player in birth called oxytocin, otherwise known as the “love hormone” because it is the hormone that we release with sexual activity. Even more, this is the hormone we release at the mere thought of sexual activity. Just thinking about a lover and becoming aroused, that’s oxytocin.  New mothers, just hearing a baby cry – even if it’s not their own – will let down their milk, and that’s oxytocin.

Never in a woman’s life is oxytocin higher than in pregnancy and during labor, as well as the moments immediately after birth (when it’s at it’s all-time peak).  Therefore if you think of birth as a sexual event, then you begin to understand how important the setting and the set of people around you really are.  It’s not too far afield to say “imagine yourself having sex with a room full of strangers parading in and out of your room.” Could you change positions spontaneously? Could you move and groan and moan and do the things that are natural in birth if you’re being observed?

In fact, we have plenty of research that makes clear that if women feel observed by relative strangers in the room, even by the fetal monitor and not least of all themselves (“Am I doing all-right? Am I doing it right?”), her labor will be affected. Think of what that does to sexuality – all it takes is a few minutes of “Oh my god am I doing it right?” and the orgasm is shot.

Birth is very similar, women become frightened or over-analytical or anxious about their progress.  They start releasing adrenaline and high levels of adrenaline stop oxytocin production and that turns the experience into a whole different event where there can be quite a lot of pain and anxiety, not a lot of oxygen to the baby, and we see a cascade of interventions that is leading all too often to cesarean births.

A renowned expert on women’s issues, Elizabeth Davis has been a midwife, women’s health care specialist, educator and consultant for over 30 years. She is internationally active in promoting motherbaby-centered birth and is widely sought after for her expertise in midwifery education and organizational development.

She served as a representative to the Midwives Alliance of North America for five years and as President of the Midwifery Education Accreditation Council for the United States. She holds a degree in Holistic Maternity Care from Antioch University, and is certified by the North American Registry of Midwives.

Her mission is to help women embrace an integrated view of birth, sexuality, family and ecology. She travels widely, lecturing and presenting workshops on women’s health, sexuality, intuition, and midwifery. She can design a workshop or keynote to meet your group’s needs–references on request.

This interview was originally filmed for Mindful Mama Magazine and has been transcribed with permission from Mindful Mama Magazine.

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Vaginal Birth After Cesarean: Saying ‘No’ To Interventions

This week we are thrilled to feature Desirre Andrews (midwife assistant & ICAN President) of Preparing for Birth as she discusses how to say no to interventions after a previous experience with cesarean birth.

Let me begin by saying I am a VBAC and Cesarean mother of 4 boys. Officially I am designated as a 2VBA2C mother. I too, have walked this path out just like countless other women. Many VBAC hopeful mothers are in a club they did not ask to be a part of regardless of why or how the cesarean occurred.  The first or last birth leaves not only a uterine scar but different possibilities for any subsequent future pregnancy and birth. It can be a very sobering, shocking, even overwhelming realization that there may never be a vaginal birth in the future or again.  The option at birthing versus repeat surgical delivery can be determined by accessibility and cultural expectations, needs and desires.

Why would there be an issue of VBAC access by hospitals and providers? VBAC is not a procedure that requires specific training or skill, unlike surgery. In a nutshell, it is the usual extension of pregnancy and labor to push out a baby vaginally. In essence, it IS the biological norm and expectation. The uterus does have incredible resiliency in healing, like other muscles in the human body. It is also widely recognized by and large to be a safe, reasonable option for women and babies by the National Institute of Health  (NIH) and the American College of Obstetricians and Gynecologists (ACOG) as evidenced in 2010 statements all backed up by years of evidence.

Some issues in access availability are language in the previous practice guideline statements stating immediately available anesthesia is needed (this idea knocks out vast number of rural facilities from offering access), physician liability concerns (cost of liability insurance, thought of being sued), lack of true informed consent between mother and physician comparing repeat surgical risk and VBAC risk, physician fear and desire for making labor and birth a zero risk venture (life is not risk free, either is labor and birth and can never be), and overall physician/hospital culture (what pressures, protocols and practices are widespread in an area).

Yes even with all of these, some changes are being made toward more access, albeit very slowly in most area. Women are compelling providers and hospitals to offer access through determination, evidence, self-advocacy, exercising options, rights and open communication. It is possible. Another point to look at is women are more and more choosing alternate places to birth whether at free standing birth center or in the privacy of their own home (with a midwife or unattended) when access is declined in the hospital environment.  Women are increasingly saying no to those who refuse to give options and choice.

The culture in which a childbearing woman lives (family, friends, co-workers, faith community) affects decision making for the positive or negative. When some or all of those in these cultural areas are supportive of VBAC, she is more likely to choose going for it. When it is the opposite and she is told to just do the “easy” thing (for whom, surely not the one undergoing surgery), ask “Why would you WANT to labor? How lucky you are to be able to get out of it.” or “What does it matter anyway? All you want is an EXPERIENCE, A healthy baby is all that matter anyway….”  All of these negate the woman herself. It is more than okay to want the vaginal birth. It is good to look at what is the healthiest birth avenue. That goes a long way to seeing how the best experience is also the healthiest experience for both mom and baby.

I asked a recent VBAC mother, Katie Z. how her culture affected her decision to go for a VBAC. She stated “Friends and family were extremely supportive, especially after seeing what I went through with (my) cesarean and subsequent PTSD. The community (at large) most was surprised it was no longer once a cesarean, always a cesarean.”

She was able to more readily and easily pursue the desire and need to have a healthier experience because she was fully supported by those in her life. Conversely, some women are willing to buck the trend within their culture and have a VBAC. With lack of support, fear mongering and too often misguided advisement, it is much more a challenge to gestate peacefully and prepare for birth. It is possible, but much more difficult when those a woman cares most about are not be in her corner. I will share that with my fourth son; very few in my world shared my point of view. Thankfully my husband and certified nurse-midwife did. That was really all I needed. Frankly, it can be a dangerous thing to tell a determined woman “no”. She is very likely going to find a way.

Bottom line, there are options though to exercise them it may require much effort, research, relocation, financial planning, meeting with administrators, changing providers and more.

For more information on VBAC www.ican-online.org and www.prepforbirth.com

Desirre Andrews, CCCE, LCCE, CLD, CLE, Midwife Assistant & ICAN President. Preparing For Birth, LLC – http://www.prepforbirth.com.

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Choose Wisely: How to Select a Care Provider

Choosing the right care provider is critical to having your best birth.  This week we are so excited to feature writer Meagan Church who discusses the importance of aligning your birth ideals with your care provider.

Shortly after I discovered I was pregnant with my first, I met with my family doctor. He had stopped doing obstetric care a few months prior, so I knew he wouldn’t be my care provider for my pregnancy. Even still, I felt compelled to meet with him. I believe that meeting shaped my journey to finding the right provider for me and set the course for a more desirable birth experience.

During the visit, I asked if he had any recommendations for a care provider. Since my husband and I wanted to wait to share the pregnancy news until after the first trimester, I couldn’t turn to family or friends for advice. My doctor simply asked, “What kind of provider do you want?” I hesitated for a moment, not knowing how to respond. Basically I wanted someone who would be covered by my insurance. What else was there to know? He then said he sometimes recommended a certain OB/GYN, but I should first consider that he takes a very patriarchal approach. Then he asked if I’d ever considered a midwife. My doctor said his wife had an at-home birth with a midwife, so perhaps I should consider whether a midwife would more closely match my desires. Essentially what he was asking me to consider is what my birth philosophy was.

Before that conversation, I had never thought of there being such a thing as a birth philosophy. But in the days and weeks after that appointment, I soon learned that practices and philosophies definitely do exist. I needed to understand my thoughts on birth and find a provider who matched those, and not base my choice solely on my HMO. Thankfully my research led me to a great midwifery practice.

As I’ve talked to more and more moms, I’ve come to realize that many women enter pregnancy with the same misconception that I did, not realizing that differences other than personality quirks separate providers from one another. It’s not until much further along in the pregnancy and sometimes even after a traumatic birth experience that some women have realized their birth philosophy and their provider’s did not align. Unfortunately, I have a good friend whose story is precisely that.

From the outset, my friend’s provider showed signs of being very keen on intervention, which concerned me since I knew my friend wanted a natural birth. Throughout her low-risk pregnancy, she had more than five ultrasounds. During one of those, the doctor felt the baby looked too big and that a c-section should be considered. This was a few weeks prior to her due date. My friend called me, asking for advice. I told her to seek a second opinion. She did not want to do that so late in the pregnancy, but after doing her own research and soul-searching, she knew she could not consent to her OB’s assessment. So she sought a second opinion. She took her research and second opinion back to her doctor and said she did not feel a c-section was necessary at that time. The doctor permitted her to wait. Spontaneous labor finally did occur, but it came with the stress of timelines and interventions that my friend had hoped to avoid.

Now, of course every labor is different, but with more research and introspection up front, those last few weeks and even labor could’ve been less stressful and more empowering. So what can you do to avoid a similar situation? First of all, don’t look to an insurance company as the main way of choosing a provider (as I nearly did). Instead, understand how you hope to experience labor (with or without drugs, for instance) and how active a role you want to take in the process—the difference between a team effort and a patriarchal provider. It is not necessary to go as far as to create a birth plan in the first month, but even a general idea of how you feel toward birth can help. The more you ask questions up front and interview providers before making a choice, the better understanding you will have of not only the provider’s philosophy, but also your own. If things go south even at the very end, seek a second opinion. Unless the baby is crowning, it’s not too late.

A midwife once said to me, “You never forget having your baby, so it should be the best experience ever.” And it all starts with a first-trimester decision that could have lasting impact beyond the delivery room. Choose wisely.

Meagan Church is a writer, a reader, a black coffee drinker; a runner, a golfer and a lover of nature; a wife, a mother and a wanna be world changer. Meagan is currently working on a book about the realities of birth, babies and beyond. To learn more, visit www.Unexpectant.com. She also writes about her experiences of motherhood outside of clichés and inside the reality of it all at www.DefiningMotherhood.com.

Did you feel supported by your care provider? Who made up your labor support team?

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Working Mom’s Pregnancy

Is it possible to be a bread winner and a bread baker too? Majorie Greenfield, M.D. shares her bold and honest assessment of working pregnancy — how to live a balanced life, while honoring both personal and professional aspirations.

MA: What advice do you give to mothers who are returning to work soon after having a baby?

MG: It’s hard! It’s hard to go back to work right after you have a baby—especially in the beginning – and different people go back at different times.  I stayed home for seven-weeks when I had my son 20-years ago, but a lot of people can still only get six-weeks of maternity leave (or even less than that).

Mothers need enough time to bond with their baby at home and to establish breastfeeding if that’s what they choose to do.  But everyone is different. Going back to work for some people is really satisfying.  I have had lots of people say “I’m just not a newborn person” or “I was so happy to have adult conversations again.”  I think for some of us, work is such a big part of our lives that the adjustment to being a mom is actually pretty hard.

When I went back to work, people said to me “you’re going to be so sad – your heart’s going to be broken going back to work”. I didn’t feel that way.  I missed him, but I was really still very glad to be at work.

Most women in the United States have living situations that are incredibly good compared to what women around the world experience – or what women over the centuries have experienced. We have a lot of luxuries in our lives and I personally believe that happiness has much more to do with our attitude than it does with the circumstances.  We have a lot of power now that we didn’t have before (for the most part).  We have the power to create our own lives. It may not be perfect every minute along the way, but we’re making choices!

MA: How can moms ensure a successful transition back to work?

MG: Part of where people get stuck is not asking for help, or expecting that they’re going to do every “mom” thing that their own mother did, PLUS every “work” thing that everybody else at work does – as if that is somehow humanly possible.  It’s crazy.

One of the things that came out in the interviews I did for The Working Woman’s Pregnancy Book was that a lot of moms still want to be that primary parent. They assumed that they would be the same kind of mom their mother was, or that they would be the primary parent — that they would always take their child to the doctor, or be the one to interact with school or day care.  Granted, some dad’s don’t contribute as much as they could, but sometimes it was the mom becoming the expert so quickly that dad got left out of that learning curve. If mom is jumping in there too often,  then the dad can begin to feel left behind.  You really have to let him become the expert too.

MA: Do you have any recommendations for ways to find that balance?

MG: The last chapter in my book is all about balance.  We conducted free-form interviews and looked for common trends.  “Taking time for myself” as a general theme came up over and over again.  Solutions to this common parenting delimma may look different for each mom – one interviewee said that she likes to “take a bath”, another recommended “yoga stretches while the coffee is brewing in the morning.”

Things like this, where you’re just carving out a little bit of time for yourself, can go a long way.  Sometimes moms don’t feel like they deserve that.  They feel that everything should be for the children, which leads them to feel deprived.

I like to challenge people to think about what kind of role model you want to be as a mom and as an adult.  Are adults people who deprive themselves of things in order to do for everybody else and are miserable all the time?  Or do you want to show your kids an adult who has a balanced life and who feels good – even if that means that you work full time and you get a babysitter on Saturday?

Marjorie Greenfield is a board-certified obstetrician-gynecologist and fellow of the American College of Obstetrics and Gynecology (ACOG). She has practiced and taught obstetrics and gynecology since 1987, and is currently associate professor on the full-time faculty at Case Western Reserve University School of Medicine. Her writing career started in 2000, when she became director of obstetrics and gynecology for the Dr. Spock Company, a health and parenting multimedia enterprise. In 2002, drspock.com was one of only five Internet health sites nominated for a Webby Award, the oscars of cyberspace. While working with the Dr. Spock team, Marjorie wrote Dr. Spock’s Pregnancy Guide, published in 2003 by Simon and Schuster and subsequently translated into Bulgarian, Romanian, Lithuanian, Estonian, Russian, Italian, Chinese, and for the UK edition, the Queen’s English. Marjorie practices general obstetrics and gynecology with a specialty of pediatric and adolescent gynecology, but loves obstetrics and have a large adult OB practice.

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Pssst: The Baby is Not Coming Out of Your Butt

How do you make birth education enriching and funny? Karen Brody, playwright of BIRTH and founder of BOLD – a global movement to make maternity care mother-friendly — talks about “butt humor!” Through the genius combination of truth and laughter, Karen’s message of facing fears and connecting to your intuition is loud and clear.

If you’re a mom with young kids, any mention of bodily parts and their sounds (butt farts and mouth burps for example) has the potential to produce roars of laughter that could be heard on a boat off the Swahili coast of Lamu. In 2005, when I wrote my play “Birth”, a portrait of how low-risk mothers are giving birth in America today, the cesarean rate was 25% and rising. Not hugely uplifting material to present to an audience. I needed a laugh desperately. And that’s when I met a mother who gave me playwright mana-from-heaven: butt humor. If it could work on my kids surely it could work on audiences. And it has.

Meet Vanessa: “Women always say, ‘you’ll forget the pain’. Trust me, even with an epidural, you don’t forget about the pain of a baby coming out of you. How could I forget a sensation that felt like the baby was coming out of my butt? Nobody tells women this. Believe me, you never forget a baby coming out of your butt.”

The irony is, that for all the belly laughs Vanessa gets from the audience, there is a deep truth in her message: mothers are scared out of their butts to give birth.  Of course a baby is not going to come out of a woman’s butt, but how the baby will navigate through the birth passage is a source of endless worry for many pregnant moms.

As a result, moms are running to epidurals and other interventions.  Roughly 50-70% of mothers today have an epidural for pain relief. (Midwifery Today, Issue 95, Autumn 2010). Among the 100+ mothers that I interviewed before writing my play “Birth”, most told me they chose an epidural simply because everyone else was having one.

Nearly 100% of my interview subjects had not researched the risks/benefits of epidurals.  As Judy Slome Cohain, a midwife, points out: “Women get epidurals for one of the main reasons so many women smoked pot in the 1970s – their friends are doing it”. (Midwifery Today, Issue 95, Autumn 2010).

Wait – you mean that a woman who has a PhD in physics and flies all over the world impressing audiences with her knowledge had no idea that epidurals can cause a fever in mother and baby? Probably.

A growing number of doctors tell us pregnant moms are asking for more intervention and that’s why the cesarean rate is now over 30 percent. This may be partly true. But the deeper questions we must explore are these: What is it about our culture that feeds a pregnant mom’s blind rush to grab an intervention? What is the baggage that prevents women in the United States from having powerful births?

One word: Fear

Again, Vanessa: “GIVE ME THE EPIDURAL!!!! I thought I was going to die. Yes. Honestly, I don’t know how women go natural. You don’t get a medal for doing it natural so why do it?”

It’s true.  Women don’t get a medal for giving birth naturally. There is no powerful birth award. So why do it?

One word: Faith.

The clear antidote to counter fear is faith.  The more faith we have in our bodies – the more we connect to our inner knowing that birth is normal process – the quicker our fear subsides. Try it. Every time you feel fear connect to your body (dance, laugh, take a nap) and what happens? Less fear.

Instead of feeding fear, I vote for pregnant mothers feeding connection and embracing truth. Here are three suggestions to help pregnant mothers connect to the truth that pregnancy is a normal process:

1.     Movement. Spend at least 10-15 minutes every day doing some form of movement even if it’s just to close your bedroom door when you get home and dance around the room with your eyes closed. Look for CDs/DVDs that specifically help you connect to your body, like Toni Bergen’s Journey Dance.

2.     Yoga Nidra (otherwise known as: sleep!). Every pregnant woman needs sleep! Yoga nidra is a powerful, guided meditative practice that gives you quality sleep and allows your body to welcome emotions and beliefs for “tea and conversation”. It has helped many people overcome trauma, stress, and connect to their inner knowing. Commit to 10-20 minutes every day. You can purchase CD’s online. Robin Carnes’ CDs are great for the beginner.

3.     Journal. Free-write for 10-15 minutes every day.  Just put your pen down on the paper, no topic, and let your hand write away! You will be surprised where you go. (thank you, Natalie Goldberg!).

Want a transformational challenge? Do one of these three suggestions for 40 consecutive days. Then ask yourself what kind of birth you want.

Karen Brody is the playwright of BIRTH and founder of BOLD, a global movement to make maternity care mother-friendly. She also runs The My Body Rocks Project where she teaches workshops, gives talks on “How to Creatively Empower Birthing Women”, and trains doulas, childbirth educators and activist in her My Body Rocks method for having a mother-centered birth. She is also a passionate napper and has written about the importance of sleep for mothers in the Huffington Post and Mothering Magazine. She is currently registering mothers for her two online courses: My Body Rocks Pregnancy class and a 40-Day Nap Challenge for Moms and in April will offer a teleseminar outlining her new new mother-centered birth trainings. For more information visit:  www.boldaction.org and www.mybodyrocksproject.com.

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Elective Cesarean vs. Spontaneous Labor

Does early elective birth impact fetal development?  Kristen Oganowski — doula, blogger, aspiring childbirth educator, PhD candidate and mother of two — weighs the risks associated with early induction.

As women near the end of their pregnancies, many encounter an onslaught of questions and comments from friends, family members, and even their care providers about when their babies will be born:

“So, when are you going to induce?!”

“Do you have your c-section scheduled yet?”

“Since 37 weeks is ‘full term,’ why don’t you just schedule and induction already?”

“Babies really only gain weight during the last few weeks of pregnancy, so we can schedule your induction or cesarean section as soon as you’re technically full term!”

But as casually as people discuss scheduled birth in everyday conversation, current research shows that the topic might deserve a bit more seriousness after all.  In fact, the topic of early elective birth has been buzzing throughout the world of maternity care advocacy lately.

Early elective births are scheduled cesarean sections or inductions of labor that occur prior to 39 weeks and without medical indication.  And while many care providers and moms choose to schedule birth before the 39th week of pregnancy, one message has become increasingly clear in recent years:

Because of the risks associated with early elective induction, women and their care providers should avoid scheduling elective inductions or cesarean sections before 39 weeks.

Research shows that when babies’ births are scheduled before 39 weeks, they are at an increased risk for respiratory problems, NICU admission, and even neonatal and infant death.  These risks are serious, and they have even prompted various hospitals in the United States either or to require onerous paperwork in the event of an early scheduled birth or to prohibit early elective births altogether in order to minimize these risks.

Acknowledging both the seriousness of these risks and the fact that the induction and cesarean rates have been growing with alarming frequency over the past two decades, The Leapfrog Group (a hospital quality watchdog group) recently released the results of a survey documenting the rates of early elective births at hospitals across the United States.  Setting a target rate of 12%, the Leapfrog Group found that the hospitals’ rates varied from nearly 0% to well over 50%.  Notably, the wide variations in these rates even occurred in hospitals within the same city or region.

On the one hand, these results (which hospitals offered voluntarily) demonstrate just how crucial it is for women to know not only their own care provider’s induction and cesarean rates but also the rates and patterns of early elective birth at the location where they will give birth.  On the other hand, they also demonstrate just how important it is for women to know why they should think twice about scheduling their babies’ births before 39 weeks.  Avoiding early elective birth isn’t about trying to make busy families’ lives more inconvenient—it is about protecting their new babies from the harms of scheduling their births too early!

This doesn’t mean that inductions and cesarean sections should never happen before 39 weeks.  When scheduling birth is medically indicated—when a mother and/or her baby’s health would be compromised by continuing pregnancy—then the benefits of an early birth certainly outweigh the risks.  To this effect, Childbirth Connection has published a resource on labor induction that outlines the instances in which the evidence does  support induction of labor as a way to improve outcomes for mothers and/or babies.  This resource also defines the circumstances in which research is either inconclusive regarding the effects of labor induction or clear about the ineffectiveness or even harm of induction.

But without a medical indication for an early scheduled birth, there is the chance that a baby will miss out on the important fetal development that occurs up to and perhaps even beyond the 39th week of pregnancy.  This information is especially significant considering that many women are told erroneously by others (including some care providers) that babies “only gain weight” during the last weeks of pregnancy.

As a final note, it is also important to remember that unless an induction or planned cesarean is medically indicated, there are benefits to waiting for labor to begin on its own—even after the 39 week mark.  Induction and cesarean section at any time carry risks and thus should not be taken lightly by mothers or by care providers.  For unless otherwise indicated, waiting for labor to begin spontaneously is healthy for mothers, and it’s healthy for babies too!

Kristen Oganowski, CD(DONA) changed career paths from academic philosophy to maternity care advocacy after being utterly awed and inspired by the births of her two children: one born via cesarean, one born via VBAC.  Now she is a doula, blogger, aspiring childbirth educator, PhD candidate and mother of two in Columbus, Ohio.  You can find her speaking up for healthy pregnancy and birth on Twitter (@BirthingKristen), on Facebook, and on her blog, Birthing Beautiful Ideas

 

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