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Archive for the ‘Pregnancy’ Category

Sky Diving

I awoke one morning thinking birth is like sky diving. This thought comes, ironically, into the mind of a woman afraid of heights. A woman, perhaps least likely to personally determine the accuracy of the idea, as I have no intention of voluntarily jumping out of a plane. Even so, here are the aspects of each that lead me to the conclusion:

  • With both birth and sky diving, others can witness the events, read about and discuss different options and become educated by ideas. But we can’t really KNOW birth or skydiving until you’ve been there.
  • All the preparation and education available doesn’t eliminate unseen risks, although both are relatively safe when the processes (steps involved) are understood.
  • Both are life-affirming events, and are not medical events unless and until a medical need is present.

And perhaps the most important comparison, both have dual aspects of perception:

When sky diving are you falling or weightless? This opposite-yet-simultaneous perception, this duality of experience is also present during birth.

The energy of labor, the contractions, can be painful and ecstatic at the same time. The exhilaration of the process, the overwhelm, the anticipation are merged with the ebb and flow of timeless labor. When you’re in the middle, everything takes a moment and an eternity. It’s overwhelming, all-consuming, everything.

During labor I held the most intense feelings I’ve ever experienced. But they could not be neatly labeled as one thing or another at any moment. The sensations physically and emotionally intertwined so completely that a new, unnameable experience was created in me.

Did it hurt? Yes.

But it opened me in a way I had never opened before. My body shifted. My heart shifted. My being shifted. I was no longer the me I thought I knew. I suddenly understood that my capabilities are not definite, but infinite.

I still think sky diving might be like that. (And I’m still not sure I’ll ever know.)

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My Body Knew

As part of the Healthy Birth Blog Carnival from Amy Romano’s blog at Science and Sensibility, I wanted to add my two cents about this month’s topic, Lamaze Healthy Birth Practice #5: Avoid giving birth on your back and follow your body’s urges to push.

The first time around, I was so excited to see that my hospital was ahead of the game. They even had squat bars as part of the “special birthing beds” so women could labor upright and be in a more natural position to push. I talked to my doctor about it, got his confirmation that this would be fine, and included it in my birth plan. I knew from what I read (and instinctively it fit) that pushing in an upright position was easier on the body because the pelvis is open wider.

On the day of my labor, when the time came to push, the nurse began setting up the bed with stirrups. I reminded her I wanted to use the squat bar. She told me there were no doctors who used the squat bar, mine included. The doctor said, I won’t be able to see anything! I persisted. I insisted. (Women who have been through labor will understand that arguing can be quite difficult at this stage of labor, especially with an overwhelming urge to push.)

Although the staff agreed to let me try, I was allowed to push squatting for 3 contractions before being told, This isn’t working, and put on my back for the remainder of the birth.

(It occurred to me later that the doctor didn’t really need to see, and that if he really did want to see, the entire bed could be raised up 2-3 feet.)

The second time around, I let my midwife and doula know how important it was to me that I be encouraged (not just allowed) to follow my body, especially for pushing. I labored in the tub for about an hour before my water broke, and I quickly felt like bearing down. I went from hands and knees to semi-squatting, then back to hands and knees between contractions. It felt so natural and good to move with my body.

My daughter was born with a nuchal arm (her head and hand/arm together) and there was some tearing, but I didn’t even feel it. I felt only the power of the moment, the roar of a birth goddess within me, following intuitive guidance from the body I had learned to trust.

I learned later that many women, given the freedom to do so (both physical freedom and freedom from self-consciousness) will draw up into a semi-squat naturally, to open more fully to birth their babies.

I am blessed to have had the opportunity to trust my body to birth. And I am blessed to be surrounded by women who trusted me to follow my body. My body knew exactly what to do.

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Was I taught somewhere along the way that it is a weakness to need help from others? I don’t think anyone ever said so out loud, but it’s what I thought was true for a long time. But it isn’t true.

In fact, asking for help- and being willing to receive help- is one of the most powerful things I can do. I am strong enough to receive.

Women, especially when birthing, understand and know that although all the power that is ever needed is inside us, support from the outside helps us connect to the truth and power inside. We sometimes need to be reminded of our strength. We sometimes need to be surrounded by people who believe in us.

This week I asked for help from my friends- doulas, midwives, birth activists and moms. And I was awed and honored by their response. As I flexed my asking and receiving muscles, I could tell it had been too long since I really stretched them.

So I’m going to ask for your help too.

Next Monday at 1pm ET, I’m trying something new with my radio show, A Labor of Love. I usually connect with topics I feel are important to moms and moms-to-be by talking with guest experts. And although I enjoy the show, I trust that it is time to birth something new: I really want to connect directly with other moms and moms-to-be who are listening. I want to connect with you.

This is how you can help: Don’t just listen to the show- CALL ME! Let me know what you’re thinking. Share your experience- what worked and what didn’t.

The topic for Monday’s show is Taking Responsibility for Pregnancy and Birth. Read the full description HERE.

To connect to the live show, click this link: A Labor of Love at 1pm ET. Then call in during the show at 866-472-5972.

If you can’t make it to the live show, but have some thoughts you’d like to add to the conversation, send me an email. Include your comments, your first name and where you live, and I’ll share your ideas during the show. Email IntentionalBirth (at) yahoo (dot) com.

Thanks for connecting with me and for reminding me that I’m strong enough to ask. Will you help?

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There are people who really believe that having a baby is inherently dangerous. Maybe more dangerous than extreme sports.

Not just people watching A Baby Story on TV, where women are routinely whisked away in a panic for surgery. Not just people regularly watching women on soap operas faint, only to find out they are pregnant. Not just the drama made for television and the movies, teaching us visually that clearly most women just aren’t up to the job of birth- it’s way too hard, too painful, too scary.

According to some medical providers pregnancy and labor (but especially labor) are accidents waiting to happen. And for these practitioners, the idea of a woman giving birth outside of a hospital setting is selfish and extremely dangerous. For all who believe birth is inherently dangerous, I bring you Birth – an Extreme Sport.

Welcome to the Birth Arena.

First in the line-up is Mary Averagemom. A generally low risk pregnancy, Mary’s fundal measurements were on target with her estimated due date throughout her pregnancy. Her practitioner began discussing induction at her 35 week appointment, to prepare her for this eventuality. He also offered to schedule an elective c-section at the same appointment.

When Mary made an appointment, at about 5 months along, specifically to discuss her written birth plan, her provider reviewed all the items and agreed to all of the options, as long as there were “no complications during labor” and “assuming hospital policy allows it.” This included intermittent EFM (15 min on, 45 min off), no IV, no induction/Pitocin, no epidural, eating & drinking during labor, husband and doula present, squatting for the pushing phase and baby presented to Mary skin to skin at birth.

Hospital policy did deny food during labor, but Mary was told the other requests listed were the doctor’s prerogative. So begins this Extreme Birth– because shouldn’t these be Mary’s prerogative?

Throughout her time in the hospital, even with the support of her husband and doula, Mary was bombarded with pressure from staff (nurses and OB) to consent to protocols. Mary refused the unnecessary IV line 4 times before being told she could not decline. Although she had discussed intermittent use of the EFM for monitoring well in advance of labor, (and agreed to 15 minutes of monitoring per hour) she was regularly scolded for detaching the belt and getting out of bed to change position. (The staff did not respond to Mary’s call button at the agreed removal time- another example of ignoring her limited consent.) Pitocin was brought up multiple times (at least 4) although Mary was clear she would not consent to Pitocin during early labor.

When it came time to push, Mary was told not to push(!) because the doctor was delivering another baby down the hall. When pushing did not go according to the count, Mary was scolded and told her wasn’t trying hard enough. (This all followed an argument about the use of the squat-bar on the bed -part of the original birth plan, which the doctor had affirmed agreement to at 8:30 am that morning. It’s extreme that a doctor would attempt to argue with a woman in labor, ready to push, and expect a discussion. Words don’t come easily during pushing and I believe he expected Mary would be unable to defend herself at all and simply yield to his preference- which eventually she did.)

Following “delivery”, minor tears were sewn while baby nursed. Nursing staff refused to speak to Mary after she’d been so difficult. (Doctor also left the room without a word.)

This is extreme treatment. Ignoring consent. Condescension. Mary’s discovery that her doctor had no intention of honoring her birth plan- finding this out during labor!Extreme measures that disregard the definition of CARE for women.

Care- to be concerned or attentive; have thought or regard; with the opposite being indifference. But this “care” was indifferent, and the fact that this is the standard of care, means the standard is indifferent to women.

Contestant number 2:

She’s mom to a young toddler, pregnant with baby number 2, and views birth as a physiologic process designed by God. She’d like to birth in an environment where she is respected, her choices are honored, and no one is trying to rush things along. She’d also like the option of having child #1 present to witness the birth of her younger sibling. Meet Hannah Homebirth.

During her first birth in a hospital, she experienced care like Mary’s. She wants to avoid a repeat of that routine treatment and has chosen a homebirth midwife for prenatal care and to attend the birth.

Hannah read several books about birth during this pregnancy: Henci Goer’s The Thinking Woman’s Guide to Better Birth, Pam England’s Birthing from Within, Ina May Gaskin’s Ina May’s Guide to Childbirth.

She discussed with her midwife reasons a transfer to a hospital might be needed. Which hospital, admissions through ER, the potential reception by staff. Hannah and her husband have discussed reasons to birth at home, concerns, risks with each other & their midwife.

The time for labor came on naturally, 40+ weeks. Hannah drank some water & ate a granola bar. Contractions just begun, a walk around the block brought Hannah into active labor. Doula & midwife arrived to find a relaxed, focused beginning labor. Hannah headed to the birth ball and asked her husband to fill the tub.

The water- the heat and buoyancy- relieved a lot of pressure. Contractions became closer, stronger. Hannah requested no vaginal exam & although the midwife legally had to offer and document findings, the exam was presented as an option. She refused each time, feeling no pressure.

Encouraging words spoken through labor- “You’re doing a great job!” “The baby is doing great” (after intermittent Doppler check.)

Pop! Water bag spontaneously broke at 9:15 pm. (Light on.) A quick check revealed no meconium in the fluid. (Lights back out. Candles flicker.) Relief of darkness & relief at clear fluid.

Time to push. On hands and knees, semi-upright, Hannah roars her baby out slowly. No one else present makes a sound. Once her head is out (and midwife checks for cord), 2 pushes bring her fully into the world. To Hannah’s breast, a beautiful baby girl! 9:45 pm.

Perhaps these are the extremes: from indifference to genuine love. But it’s an extreme worth looking into. I don’t want my birth to be part of someone’s routine. I want my birth to be part of someone’s passion.

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Women experience birth. Every life experience leaves an imprint. It’s really that simple.

The experience of birthing a new life (vaginal or c-section) can have a profound impact on the woman. It can be as much of a life-changing event as parenting a new baby. For some, birth results in a new awareness, confidence and purpose. And for some, it can mean insecurity, depression, and fear.

Giving birth- especially the first time- is a pivotal point in a woman’s life. She is transforming from woman to mother. She is often confronted during pregnancy with fears and insecurities about being a good mom, knowing how to respond to her baby’s cues, and wondering how life will change.

And anyone with children knows that life will most certainly change, in many wonderful ways.

The process of giving birth- the birth experience- can impact women positively or negatively based on the woman’s perception of what happened. What many care providers see as routine, women are experiencing for the first time. Because labor and birth is largely hidden from our modern society, women have their own expectations as they approach motherhood. And many expectations are based on individual factors like self-image, education, self-confidence, and the experience of autonomy women enjoy in our contemporary culture.

I have heard first-hand from women who were so traumatized by the birth of their first child that they are purposely preventing pregnancy, even though they once dreamed of many children. I read online the blogs and stories of women coerced into submitting to interventions they initially refused, trying to figure out how to advocate for their children, when they were not able to stand up for themselves.

So what happened?

In a nutshell (and in my opinion, of course) women don’t expect the world to be turned upside down because they are pregnant. If a woman generally makes her own decisions in her life, she expects to continue making her own decisions during pregnancy and labor.

Women expect, and rightly so, that being intelligent, autonomous persons, they will be permitted (and expected) to make their own healthcare decisions, even during labor. They believe that trusting their care provider equates to being cared for. Why would a doctor or midwife attempt to manipulate or rush labor? Certainly these professionals have enough experience to understand labor can occur any time of day (or night) and last as long as it will?

The relationships women form with their providers are often based on assumption, because communication is often difficult during 5 minute appointments. But women have reason to feel confident about asserting their right to informed refusal. They are often educating themselves during pregnancy, reading books that help prepare them, mind and body, for birth. Armed with information about possible complications and procedures, they expect to discuss benefits and risks with their provider if circumstances warrant.

And when situations arise, in the office or in the hospital, where the woman’s voice is ignored, where she is discouraged from asking questions, where she is told she is endangering her baby (selfish, bad mother!), where she is manipulated or coerced in submitting to procedures or tests… then she is upside-down.

The world has suddenly shifted and she’s lost the ground. All her life, she’s been told to speak up, ask questions, try harder, think smarter. Now she’s been told she’s a bad mother for expecting to have a say about her own body.

When women with stories like these speak up, they are often told to get over it; that they are making a big deal over nothing; that they are scare-mongering other women; that they are selfish for wanting to feel whole AND have a healthy baby. (And this time, it’s usually other women/mothers calling her selfish!)

Every pregnant woman wants a healthy baby. And it’s ok to want that.

But when you say a healthy baby is ALL that matters, you disregard the mother. Mothers matter too.

Mothers want to feel cared for during pregnancy AND BIRTH.

Mothers deserve to make their own healthcare decisions- even during labor.  (Are other patients also treated with disrespect when they decline routine, but often unnecessary, tests and procedures?) Mothers deserve clear communication and to be approached with respect, as living, thinking, feeling human beings. Women are trusting midwives and doctors (and L&D nurses too) to provide safe care- to hold this trust, and help us be active participants in our care so we are making informed choices for ourselves (powerful, not powerless!)

And when women are offered a relationship of trust and care, when they are afforded the respect to make choices, when they are encouraged to trust themselves during birth, often they learn they are capable of amazing things- including mothering.

Mothering relies heavily on following your instincts. Babies don’t come with instructions and we all worry about knowing what to do. Having a birth experience where you trust yourself can give you confidence to trust yourself to meet your baby’s needs when s/he is born.

If you have experienced birth trauma, you are welcome to comment here about your experience. Also be sure to check out today’s episode of A Labor of Love for more information.

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If you heard my recent interview with Henci Goer, you know I’m really interested in women having the information they need to make decisions for their care, especially during pregnancy. I also think women have the right to choose the care they feel most comfortable with, no matter how certain data is interpreted, or by whom, or if there is no data at all. For example, choosing midwifery vs OB care can be based on statistical data of outcomes for certain providers, or it can be based solely on how a woman feels about a particular individual.

When it comes to risks and benefits, it’s up to individual women to discern their own comfort levels, especially about safety, weighing the benefits and the risks based on her individual perspective.

Similar decisions are made by individuals all the time. For example- the option to drive or walk to the store:

I live less than 2 miles from my local grocery store. A sidewalk exists on one of the 3 roads that I need to travel. The speed limit on the roads without sidewalk is 30 mph, but enforcement is nil and generally cars travel about 40 mph. Because I live in Florida, the weather is generally nice enough to walk 90% (or more) of the time.

Benefits to Walking:

  • Walking is great cardio exercise.
  • Carrying my groceries will help me save money b/c I may not be able to carry “extras”
  • Ecological benefit- less pollution
  • Save money on gas
  • Fewer miles on car/less maintenance needed
  • Safer than driving

Risks to Walking:

  • Possibility of getting hit by car where there is no sidewalk
  • I could trip/fall
  • May take time away from other necessary activities

Benefits to Driving:

  • Faster
  • Can carry as much as I want/need to buy
  • Safer than walking

Risks to Driving:

  • Possibility of car accident (3 left turns to get to store)
  • Danger of navigating the cars backing out of parking spots
  • May spend too much money due to no limits on carry weight

If you read closely, you’ll notice each option is “safer” than the other, as listed under benefits. That’s because there is a risk of injury in both cases, and ways to be safer in both cases. I could walk on the grass shoulder; wear a seat belt; wear reflectors; drive defensively. I’m sure somewhere I could find statistics that define the probability of accidents for walking vs. driving this distance under various conditions and make a statistical comparison.

But even with a thorough review of the statistics, I get to choose which feels safer to me. Even if the data “clearly show” a greater chance of injury for one option, the benefit of speed (or a smaller carbon footprint) might outweigh the risk.

Choices should be offered to women for childbirth with the full understanding that women are ultimately responsible to choose, and that women have the right to choose for themselves, no matter how others interpret the benefits and risks involved.

After all, risks and benefits cannot always be measured and statistically defined. In birth, it’s more personal than that.

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I was thinking about Rev. Dr. Martin Luther King Jr and his most famous speech- how one man articulated the dream of so many. It wasn’t his dream alone and he didn’t want it only for himself. The dream was so big & amazing and became possible only because so many were willing to speak out, be present and stand strong together for a common goal- real freedom & equality for all people regardless of their color.

My dream doesn’t make headlines. No one is marching – yet.

I have a dream that women (and men) might see more clearly that how women are treated during labor matters. That honoring the wisdom of the body, allowing labor to wind its way to birth, holding a sacred space for birth, and keeping intervention to a minimum matters- for both mother and baby (and for generations to come.)

I have a dream that women won’t have to struggle for informed consent and refusal and that the courts stop ordering medical management of pregnancy, labor and birth against any woman’s decisions. I dream that women have the resources they need to be educated about their body and the community support they need to remember their innate strength, and to find confidence from the experience of birth.

I dream that the hostility and judgment of women by women ends; that women unify to leverage their majority to create real solutions that support women and validate and honor individual choice.

I dream that women might not have to choose between caring for their children at home and earning a living apart from their families- that working together solutions can be found that allow babies to accompany their mothers if they choose to engage in professional work.

I dream women will no longer need to act like men to belong in the world. I dream that being feminine and female is honored- that the role of mother and nurture-giver is respected as valuable work; that women and men will each be respected for their differences- in perspective, in approach to problem-solving, in simply be-ing.

I dream that all women have the opportunity to understand and embrace conscious conception, bonding before birth, gentle pregnancy, and trusting birth; that women have empowered choices for labor; that they are recognized as the experts of their bodies.

I dream that my daughters grow up valuing their femaleness; and that being female is synonymous with wisdom and respect – and the right to bodily integrity.

What are you dreaming?

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