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Posts Tagged ‘labor support’

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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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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This week we are delighted to bring back Cole Deelah to shares the second part of her 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.

The atmosphere in the birth center was fabulous: dim lighting, candles by the tub, inspirational music softly playing when I wanted it, and temperature controlled to my liking…I truly don’t know how anyone achieves a natural birth in a brightly lit hospital. The half-darkness helped me to stay calm. In fact, for most of my labor, I kept my eyes closed and just wanted to be left alone with the comfort of the select few members of my birth team.

The midwives took turns monitoring my progress.  Every 15 min or so they were listening to the baby’s heartbeat with the Doppler. I was so glad I was not restricted in my movement in any way by an electric fetal monitor or by an IV.  They were also checking my blood pressure and my temperature often. Everything was normal, which was very reassuring.  I also remember how vastly important it was for me to have someone’s hands to hold during each contraction.

My husband was the best support I could have ever asked for.  He was calm and reassuring.  He held my hands and gave me water to drink.  When he needed a break, my doula was there, holding my hands, massaging my hands, telling me I was doing great.  I am forever grateful for the hands I held during each contraction.

I think the atmosphere in the room started to change around 3:00am (24 hours after my water broke), when I still was not pushing.  I remember Jackie telling me that another hour or two and they’d need to take me to the hospital.  I was so scared.  I did not want to end up with a C-section.  I’m not sure if the thought of going to the hospital motivated me or slowed things down, but soon after that I began pushing.  I felt an urge to push, but it was not an uncontrollable urge…I think I was rushing it because I was scared.

We encouraged you to tune into your body and push only when you couldn’t not push. You became very introspective at this point, totally tuning the world out and listening to your body. You moved your hips back and forth, side to side, and began lots of loud vocalization. We could all hear the slight push that began to appear at the peaks of some birthing waves. You were not quite ready, though, and chose to return to the warm water of the birthing tub.

At this point, I know I was in transition.  I was afraid I would not be able to push the baby out. Later, my doula told me a conversation I had with my husband during this time.  Me: “I’m scared.”  Him: “The baby is coming.”  Me: “The baby will come any day now.”  Him: “You are doing great.  The baby is going to come.”  Me: “The baby will come any hour now.”  Him: “You’re right.  The baby is coming.”  Me: “The baby is going to come any moment now.”

I also remember telling myself (silently) that I was NEVER going to have another baby again.  Then I said a prayer out loud,  and I thought about all the people who cared about me and the baby. It gave me strength and at that moment, I chose to surrender to miracle of birth.

Shortly afterward, we started to really hear pushing noises from you for longer durations. You moved to the edge of the bed and squatted… really feel more pressure and starting to ‘wish push’ with each peak. We reminded you  to conserve your energy until you had no choice but to push. Like magic, within the next two contractions, your pushing changed, your body had taken the reigns and you were submitting to the power of bring your baby forth.

Now I was definitely feeling the urge to push, and push I did.  For pretty much the whole time, I remained in a full-squat position with my arms supported on the edge of the bed and my hands squeezing my husband’s hands.  I was beginning to feel progress, and I continued to be encouraged by the midwives and my doula saying “Great job Lynnette.”  “This is normal.”  “You’re doing great.”

Then, the midwife got a mirror and placed it under me to see if she could see even just a little part of the baby during one of my pushes. I was elated when I heard that the baby was crowning. The whole atmosphere of the room changed, and I knew in my heart that I would indeed be willing to have more children and I would definitely choose this same route.  I was going to have this baby at the birth center after all!

This indeed was the most painful part of labor, but without a doubt the most joyous.  I had been so afraid of this part, but it was the best and easiest part (mentally and emotionally) of labor.  Real progress was being made and my baby was coming into the world.

I was impatient at this point and was trying to wait for a strong contraction before pushing, but I just pushed and pushed, wanting my baby to be born. Looking back, I should have taken more time with this part and waited for the peak of contractions to push…I think this is why I ended up with a tiny first degree tear requiring 2 stitches).

Before I knew it, my daughter’s head and then shoulders emerged from me. And with one final and amazingly awesome feeling, her body came forth.  She was born at 8:05 am (29 hours after my water broke). I was told, reach down and take your baby, which I did!

Your eyes popped over, you cooed ‘oooh!’, broke into a smile, and took your baby by the arms, lifting her out of your body and into your loving embrace.

I brought her to my chest and smiled and looked in her beautiful eyes and knew that I was blessed beyond measure.  She was perfect.  Her skin was amazingly pink and she looked into my eyes and let out some beautiful baby sounds.  She weighed 7 pounds 2 ounces and was 20 inches long.

I cried with joy and exclaimed, “Oh my gosh, she’s my baby!  Oh my goodness.  Hi sweetie.  Hi sweetie.  Oh my goodness.  I love you so much.  I love you so much.  Hi sweetie.  Hi sweetie. She’s so cute!  My baby girl; I love you.”

The midwives and my doula all helped me with breastfeeding within 20 or 30 minutes of the birth.  My baby latched on right away with no issues whatsoever. She never left my arms. This was the most amazing bonding time, completely uninterrupted by the routine things (bath, shots, baby warmers, etc.) that would have been done at a hospital.  Instead of all these procedures, I got to hold my baby skin to skin and bond with her.

The placenta was birthed and then my family came in to see the baby. My husband played his guitar and sang a beautiful version of “Somewhere Over the Rainbow”. Our baby stayed awake and alert for a good 2 hours after the birth, staring into our eyes.  Afterward, we were left alone with her in the peace and quiet of the birthing room.  We were told to nap, but I was so happy, so high on life, that I could not sleep a wink.  I did rest. I did smile.

Our journey into parenthood had begun.

Beautiful family! What a blessed event! The laughter in that room, the joy and triumph, love and peace! It was an honor to attend you during the birth of your beautiful baby girl!

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.

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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.

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Mickey Sperlich, well-known midwife and childbirth advocate, speaks about post-traumatic stress disorder (PTSD) in sexual abuse survivors this week. Mickey shares with us her experiences with “survivor moms,” and provides hope that post-traumatic stress can become post-traumatic growth with a safe, healthy, fulfilling birth.

MA: Many women who experience sexual abuse suffer from post-traumatic stress disorder, or PTSD. Can you tell us about your experience with PTSD?

MS: I’m a semi-retired midwife. I had a home birth practice for 20 years, and my interest in working with what I call “survivor moms” really grew out of my practice. So, some very powerful experiences that I had with my clients caused me to realize that survivor moms were bringing particular issues to the whole childbearing process, and needed care and attention that I wasn’t necessarily educated to give them [at the time].

I can give you the example of working with a woman who was pregnant for the fourth time. I’d helped her with three babies prior to that, and they were all boy babies. Everything had been super smooth for her first three pregnancies. This time around, she intuitively sensed that she was carrying a girl. We ended up having an experience late in pregnancy where I was examining her, and she suddenly flashed back to being a little girl. I was no longer her supportive, loved midwife that she knew really well — I was her abusive mother. And, that was a really challenging experience, not only for her obviously, but for me too — to be cast in that role where it certainly wasn’t my intention. Thankfully, I had enough trust established with her that we really worked on this and what had happened. … What she had experienced, that re-experiencing or flashback, that’s one of the hallmark features of post-traumatic stress disorder — which I found out later, in the process of trying to educate myself about this. This happens quite frequently to women, so I just determined — I’m going to find out everything I can.

MA: Speaking of survivor moms, tell us a little bit about your book, “Survivor Moms: Women’s Stories of Birthing, Mothering and Healing After Sexual Abuse.”

MS: I started a survey project around the country where I began asking women, “How do you feel that your history as a survivor of sexual abuse has affected your pregnancy, or your birth, or the post-partum period, or how you feel about yourself as a mother?” I got hundreds of responses, and then I invited those women to write their story in a narrative form, and eventually published a book on that — which is the result of their stories. More than 80 women reported their life story to me within this context. … I was [then] fortunate to hook up with my co-author, Julia Seng, who is a certified nurse midwife, and got her Ph.D. looking at post-traumatic stress disorder and its affects on childbearing outcomes.

For more information on “Survivor Moms,” please visit Midwifery Today.

MA: How would a pregnant woman or her care provider recognize PTSD?

MS: One of the hallmark features would be the re-experiencing … it may be that they feel as if the trauma is happening all over again. A classic example during pregnancy might be if a woman has to have an internal examination for some reason, and in the midst of that, feeling as if she’s triggered back to a rape scenario. And even some of the terminology we use, like telling her to relax and all of that — it seems like a good thing for us to say, unless you consider the [possible] context. When was she told that before? So, some of the language we use can really be triggering. Women, when they’re pregnant, can [also] feel sort of invaded by the baby — out of control. One of the features of having been traumatized, especially sexually traumatized, is feeling like it [the situation] was out of your control. Being pregnant for some women is just a very wonderful, rosy situation, and for other women, they feel like: “Here’s my body — not under my control again.” That would be an example of the re-experiencing.

Then you also have the numbing — that’s another feature. So, feeling like you’re not there, like you’re not connected to what’s going on. Some women might report, “I don’t really feel pregnant,” or just feel really disconnected from their bodies. … Also, just anxiety, fear, anger, irritability — those things come along, as well.

MA: In the wake of PTSD, how can women empower themselves to move forward — specifically during pregnancy and birth?

MS: Something that I’ve found while practicing midwifery is that pregnancy is a wonderfully gestating transformative time — just in its very nature — so it actually is a really good time to work on your psychological issues, and to seek help. Many women reported to me in the narrative project that they saw a great opportunity to stop the cycle of abuse. They were like, “Oh my gosh, I’m going to be a mother. I know that I don’t want to be this kind of a mother — that’s real clear. I know what that looks like, so how can I envision how I do want to be?”

And they’re going to need a lot of support, so reaching out — that’s where maternity care providers can really be helpful, by modeling healthy relationships, listening to women — that’s key, being listened to. When you look at the data about who is resilient or not growing up in an atmosphere of abuse, a little girl or a little boy needs to have one adult in their life who they trust, and who they know really deeply cares about them and wouldn’t harm them. And it doesn’t have to be a parent. It can be a teacher, it could be a friend — it doesn’t matter, but we have to be able to connect in that way. And so, being able to connect in that way is one of the things that allows us to connect with the infant, to be able to attach with the infant.

MA: Is it actually possible to move beyond PTSD?

MS: Absolutely. There’s a lot of talk now about post-traumatic growth. One very cool thing is that many women have reported to me how utterly healing becoming a mother was. Especially for women who had been sexually abused, and that’s how they developed PTSD. To take this space that was formerly violated — a violated space — and to have this beautiful transformation of the baby coming through. Growing a baby, and then birthing that baby, and then having this precious life that you fall in love with — that that in and of itself was transformative, and healing, and fostered their growth — their post-traumatic growth in ways that they had never dreamed possible, actually. And that’s a wonderful opportunity we as midwives have, to foster that, to protect that space for the woman so she can have the kind of pregnancy and birth experience that would allow for something like that.

This interview, originally video-taped for Mindful Mama, was transcribed and re-purposed with permission from Mindful Mama.

Mickey Sperlich, a certified professional midwife with nearly 20 years of experience, helps women on the journey of pregnancy and birth. Mickey is the mother of two grown children, and has been married since 1980. She appreciates being a midwife and mother, and learning so much from the women and families she has served, and also from her own children. Mickey is recently retired from full-time midwifery, but continues to focus on women’s health issues. She currently manages various research projects that look at the effects of post-traumatic stress on childbearing at the University of Michigan’s Institute for Research on Women and Gender. Read more on Mickey’s blog, Survivor Moms Speak Out.

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This week, we want to hear from you!

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.”

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A staggering 65 percent of women experience some form of sexual abuse in their lifetime. This week, Katie Wise opens a 3-part Mother’s Advocate series about survivors of abuse giving birth. She courageously shares her personal story and insights for other women who’ve survived, and for the people who care for them.

There is a club that no one wants to join. Yet, more than half of all women will join this club at some point in their lives. There is no mark, no mascot, and no handshake. In fact, you could be standing next to another member and never know it. But every once in a while, in the right setting, a woman tells another woman her story. And then there is the knowing moment, the held eye contact, the smile to say, “I know, I’m a member too.” The members of this club are sexual abuse survivors. Every member’s story is different, but one thing is the same. You cannot turn in this membership card. This story is now part of your life.

Somewhere along the way, survivors miraculously open their hearts (and bodies) again —to love, to partnership, and sometimes to pregnancy. For many sexual abuse survivors, preparing to give birth is a moment of truth. Their healing is about to be put to the test. A full-grown newborn baby is going to come through their body, through their pelvis, and through their most sacred places, to make its way into the world. This shy, sexual place — with all its hurts, secrets and stories — is about to be turned inside out, opened to a profound, chosen violation. I use the word violation here for a reason. Our baby is not truly “violating” us, but I can think of few things in life that provide such an intense opening, tearing, out of control feeling as birth. And for members of the club, birth can easily trigger the feeling of violation.

I am a member of this club.

My story is unimportant here — better than some, worse than others — a story of being manipulated, being controlled, and having my body used by someone else without my permission. By the time I was pregnant, I felt I had done my due diligence on my story. I had packaged it up in some deep closet of my being — safe, sound, sleeping. I had supported other survivors giving birth as a doula, and knew all about the questions to ask them. I would make sure they had talked to their partner, their care provider, and anyone else who would be at the birth. I helped them identify potential triggers, and ways to cope if things came up. I, however, had done none of this for myself. During my own pregnancy, my story seemed far from my mind.

I did notice, however, that I was preoccupied with avoiding a cesarean birth. Having seen 130 births before having my own, I knew this was common. Most women feel strongly about avoiding a cesarean. I also knew this fear could be a barrier in my birth process. With a keen guide and the powerful tool of art therapy, I was able to dive deeper. Near the end of a session one day, we decided to tackle my fear of cesarean birth. Having supported other women, I knew the play-by-play and setting exactly. I carefully drew the details: the blue sterile drape, the medical instruments, my arms strapped to the table with restraints, doctors in masks. My therapist then gently pressed me to look closely.

“What about this image is the most scary for you?”

And there it was … the restraints. More than the incision, more than the blood, the anesthesia, the scalpel — it was the restraints. And like a time traveler, I was thrown back to another time and place — my wrists bound, my scared naked body, and the eyes of my perpetrator looking cold and devious. A flood of tears erupted, and suddenly I remembered: I was a survivor.

I needed to treat myself as I would my clients — with care, gentleness and awareness. In that moment, I was waking up to what it meant to be a survivor giving birth. This was a time for opening to the softness, the feminine, the mystery, and the hurt inside of my core as a woman. Needless to say, our session went a little over. When the tears subsided, we returned to the art, to the image — adding light, adding God, taking the masks off the doctors, and giving them humanity. Taking one hand out of the restraints, and adding last, but not least, the miracle of the day — the baby. My baby.

As I walked home that day, I knew that I was healing. By looking the dragon in the face, I felt my whole being soften. I knew I would no longer need a cesarean birth, or any other specific birth outcome to teach me something. Nor would my fears cause my body to shut down. And I knew if a cesarean birth was what my baby truly needed, that I could meet it with grace and consciousness.

I also knew I had a lot of work to do.

I needed to talk to my care providers and my husband about my past, and more specifically about how it might affect my present. Perhaps the most important thing we can do as survivors preparing to give birth is to tell our story. Working with a midwife or a very compassionate doctor who will take the time to listen is especially important for survivors. You may choose to have your partner join you for the conversation and focus on the facts: “I’d like you to know this about me. You don’t have to fix anything, but here are some things that I need you to do. Tell me before you do anything physically to my body, so I can be prepared for what to expect. Avoid the following words: ‘Trust me,’ ‘relax,’ etc.” If you are closer to your care provider, you might choose to really let them into your story, to open yourself to their healing words and experience.

If there are certain words that your perpetrator used, advise everyone who will be at your birth to avoid those words. If you’d like to avoid unnecessary vaginal exams, communicate that. If you need to have one hand free from the restraints in a cesarean birth, put that in your paperwork. With preparation, compassion and communication, your birth can be a profound place of finding your voice — and speaking up for that little girl or young woman inside of you.

Next, I explored the differences between abuse and birth.

If birth could feel like a violation, how would I tell my body that this was different — that there was a purpose? I looked at the differences.

Permission: I will be choosing to allow this baby to spread my pelvic bones wide, as I welcome him into my arms.

Love: This baby was created from an act of love, as is giving birth.

Protection: The people around me, as opposed to my perpetrator, are there to protect and support me.

Power: I will give birth. I will actively work with my baby to create a miracle. Very different, indeed.

I am happy to say that when I did give birth — although it was not easy — it was not violating. And although I felt forces much bigger than me at work, I never felt out of control. In contrast to what I feared, the moment of pushing and helping my baby navigate my pelvis was the most powerful moment of the whole experience. As my baby pressed into the walls of my being, pressing impossibly wider with every push, the old story seemed to be forced right out with him. There was no room for the story of a small, voiceless victim. A new story was being written, cell by glorious cell. This part of my body was a place of power, of divine strength. This was a place where miracles happened. This was a home, the beginning of another person’s life. This small, perfect boy was remapping the way for me, showing me what femininity was all about. He was teaching me about trust. He was showing me that I could be violated, could give way, could tear in two — all in a glorious celebration of life.

Through this act of love, I deepened my healing.

After the birth, the small tear healed, the bleeding stopped, and I was new. Something had shifted — so powerfully that I knew my membership status had changed. Of course, I was still a member. I always will be. But I could feel that the shame was gone, and in its place was a desire to help others find this “reset.” I wanted to help other survivors approach their births as more than just an ordeal to manage, more than the avoidance of their triggers. I wanted to help other survivors realize that birth is an opportunity to dismantle the entire trigger itself. And as I held my perfect little man in my arms — both of us tired and weeping — I wanted to thank him, over and over again, for showing me love, for showing me my strength, and for being part of my healing.

Katie Wise is a doula, childbirth educator and birth advocate, as well as the owner and founder of Yo Mama Yoga and Family Centers. Her work and writing have been featured in “Whole Life Times,” “Yogi Times,” “Los Angeles Daily News,” “Special Delivery,” the “Boulder Daily Camera,” and on NPR. Katie believes that women’s bodies have the wisdom to give birth. Her purpose in supporting and educating pregnant women is to uncover and foster that instinct and faith. Katie is also the host of the Mother’s Advocate “Healthy Birth Your Way: 6 Steps to a Safer Birth” video series. Please visit Katie’s site to read her blog or find more information.

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