Monday, December 1, 2008

Fathers at Birth

Because there has been such a long struggle to allow fathers to participate in the birth experience with their partners, it sometimes surprises me when I read or hear someone talking negatively about fathers at birth.

When Dr. Bradley began teaching women how to give birth naturally, fathers’ only participation was pacing in the waiting room, smoking a cigar. It wasn’t until Dr Bradley continued receiving lavish affection from these mothers after their births that he realized what an intimate and bonding experience birth was, and maybe he should invite the fathers to take part in it. I love what Dr. Bradley has to say about the fathers’ role, that it’s not just his job to plant the seed, but to nourish it and remove any weeds of doubts and anxieties.

There is an idea in most Americans’ heads of what labor looks like. Generally, it’s of a woman in pain, screaming at/hitting/or pulling on the man that put them in that situation. In all the Bradley births I’ve attended and heard feedback from, this has never been the case. When a mother is nurtured by a loving husband throughout her pregnancy, when he takes the time to understand what is taking place inside her, when he devotes his time and energy to working with her through the whole process, then birth is not a blaming or hurtful event. It is a bonding and loving event.

I strongly believe that women should be supported by women in labor. But I also believe that there is a crucial role for the father as well. A woman in labor needs to be cared for by other women and her husband. Each of them brings something to the laboring woman that the other can’t, which makes for a more fulfilling experience. While a husband may see his wife in pain and only think of ways he could take away the pain, another woman can look at the difficulty of labor and know that the mom will be okay. At the same time, this husband is also the only one who knows this woman intimately, all her deepest desires, her loves, her passions, is the only one who loves her deeply, and is the only one who makes up part of the baby being born. While a father can never truly understand what a laboring woman is going through, understanding the process, learning tools that help, and being an emotionally strong presence will truly lead to an experience that exceeds all others.

Is this too much pressure on the father? Some (a lot?) think so. While I don’t think fathers should be made to suffer through the laboring experience because their wives are experiencing pain, I do think it’s important for a father to see the process. When he sees the hard work that labor is, when he puts himself to use to help her through, he’s able to see a strength in his wife that he may not have previously seen before. He’s also able to see what great lengths one goes through to bring a child into the world, and experience the sacrifice of parenting from the start – an important concept to learn in the parenting journey.

When a father has an understanding of what’s happening, and is willing to be there with his love and support, birth, no matter what the outcome, becomes an experience of love and relationship. You see the two become three before your eyes. You watch as a family emerges, and you can SEE the love. The father’s love for the mother, the mother’s love for the father, the parents’ love for the baby, and the baby’s love for it’s parents. And it’s astounding.

Sunday, November 9, 2008

Got To Go Through It!

We're going on a bear hunt. We're going to catch a big one. What a beautiful day! We're not scared.
Oh-oh! A forest! A big, dark forest. We can't go over it, we can't go under it. Oh, no! We've got to go THROUGH it!

Why am I quoting a children's book on a birthing blog? Well, I was reading the book Baby Catcher by midwife Peggy Vincent this past week and I came across a birth story that brought this children's book to mind. It was Peggy's own birth story, the birth of her third baby.

"I struggled to find a path around the pain. If not around it, then
under it, or over it. I ground my knuckles so deeply into my hip that
bruises remained for a week afterwards. Nothing helped, and I fought the forces of my body...

The next contraction came grinding down on me, but it felt different. A white-hot hole of knowledge opened in my pain. I saw
that in my effort to get around or under the pain, I'd been avoiding that central point of intensity, staying on the brink of the primitive surrender that's required to get a stubborn baby out...

With sudden clarity, I knew it would have to hurt more before it got better. I wouldn't be able to circumvent the pain. I had to go through it, enter willingly into the void, hoding nothing back. I had to jump off the diving board."

The bear hunt book is a great way to visualize the different stages of labor. We start with some long grass. We need to go through it, but it's not too bad. Next, we come to a river. A little more apprehension because we need to get cold and wet, and maybe the force of the river pulling us is a little frightening, but we can make it through. Now, we get to the mud. It sucks at our feet and makes us very dirty. This is getting to be harder. Then the forest, a big, dark forest. Entering into the unknown, tripping and stumbling along, we see how going *through* labor can be scary. Then, a snowstorm! It's whipping us, howling at us, we can't see where we're at, we're lost in the forces around us! And then, we're almost there. The cave. A narrow, gloomy cave. At the other end of the cave is...

In the book, it's a scary bear. But for the laboring mom, the nose, eyes and ears belong to their baby! Their sweet, precious babe that emerges from the cave.

If the mom had not traversed all the different terrain, she would not be at the final place where her baby emerges, ready to meet her.

So, you can't go under labor, over labor, or even around labor. You can't escape and get around the pain. You've got to go THROUGH it, and you'll get to the end much quicker, and be able to relish in the beautiful results of your hard work.

Books used for this post

Baby-Catcher by Peggy Vincent

We're Going on a Bear Hunt by Michael Rosen and Helen Oxenbury

Saturday, November 1, 2008

The Law of the 3 P's vs. Sphincter Law

This weekend, I had the privilege of attending a workshop on Pain vs. Suffering presented by Penny Simkin, noted author, doula and one of the founders of DONA (Doulas of North America). During her talk, I kept thinking back to Ina May Gaskin’s discussion of the physical workings of labor, and how emotions and how a woman feels plays even more important a role in how her labor progresses than the strength of contractions, position of baby, and size of a mother’s pelvis. Ms. Simkin brought up how a woman’s past can have a huge affect on her labor. Abuse, trauma, and shame can lead to fear and suffering during an event that should be celebrated. This makes perfect sense, and physicians normally take past history into account when working with a patient. But when it comes to a woman who does not have a past history, physicians rely heavily on the Law of the Three P’s for understanding progress and time of labor.

I first read about the Law of the Three P’s along with Sphincter Law a few years back in the book, Ina May’s Guide to Childbirth. It sparked an interest in me, but not until this year have I really dug deeper into understanding the differences between the two and how they really play out in childbirth.

What is the Law of the Three P’s?
The basics of the law say that:
• A woman’s body, if it is capable of giving birth, should produce a baby in a reasonable amount of time.
• If progress is not apparent, one of the three P’s is dysfunctional, and intervention becomes necessary.
• Strength of uterine contractions (Powers), size and position of baby (Passenger), and/or type and dimension of pelvis (Passage) are the main components in a labor’s progress or dysfunction.

First, let’s look into what a “reasonable amount of time” really amounts to. In the 1950’s an OB resident at Columbia-Presbyterian’s Sloane Hospital for Women in New York took on a project of plotting the progress of labor in each of the laboring women in his ward. With the initial intent of seeing if caudal anesthesia had any impact of the speed of labor, Emanuel Friedman unknowingly changed the course of obstetrics by presenting for the first time an average length of time of the three stages of labor. While he considered the information to be used to help doctors determine if their patient’s progress was well outside of normal, Friedman became frustrated when he saw that doctors used the averages as absolutes, not taking into consideration how many women fall on either side of his asymmetrical bell curve.

In Norwitz and Schorge’s book, Obstetrics and Gynecology at a Glance, a “dysfunctional labor” is diagnosed if, during the active phase of labor, a first time mom is dilating less than 1.2 centimeters per hour and/or baby is descending less than 1 centimeter an hour. In a mom who is having a second (third, fourth, etc.) baby, dysfunction is diagnosed if she is dilating less than 1.5 centimeters an hour, and/or baby is descending less than 2 centimeters an hour. An “arrested” labor is diagnosed if a mother has not progressed in dilation for more than two hours, or progressed in baby’s descent for more than one hour in multiparas and two hours for first time moms.

How limiting! Within only these very narrow margins, a “normal” labor is considered. If a woman falls outside these margins, then the first step is to augment the Powers, the first thought being that the uterus is dysfunctional in being able to produce strong enough contractions to get the baby out. If mom doesn’t get on track with augmentation, then baby or pelvis must be to blame, and cesarean is considered the only way for baby to get out.

Since uterine contractions, baby and pelvis seem to be the main parts of laboring, this law may seem reasonable. But it definitely puts limits on a woman’s abilities and does not take into account that the uterus does not work apart from a woman’s brain.

Understanding the Laboring Brain

From the works of Michel Odent, we are able to see how much the brain is involved in labor. The brain is made of two layers – the primitive brain, and the neocortex. The Neocortex is the newer, rational part of the brain, which plays a role in abstract thought. The Primitive part of the brain, also called the brain stem, governs instinct and is considered to be a gland that releases hormones.

Labor is all about hormones! Oxytocin, endorphins, prolactin, etc. are all released by the primitive part of the brain. Dr. Odent likes to call it a “labor hormone cocktail”. No amount of thought or rationalizing will be able to make more hormones to produce the proper workings of labor. In order for these hormones to be produced, a laboring woman must allow her primitive brain to take over. In natural births, you see this in women who are laboring. You can tell when a woman has gone deep into “laborland”, and is no longer aware of what’s going on around her.

But what happens when we force that woman out of her primitive brain? Stimulating the neocortex by asking a laboring woman to answer questions that require thought, being near her in a way that makes her feel self-conscious, subjecting her to bright light, or failing to protect her privacy can actually inhibit the action of the primitive brain in hormone release. So, in reality, much of what goes on in a hospital room is working against the entire labor process.

How Sphincter Law differs from the Law of the Three P’s
While the Law of the Three P’s takes only three physical parts of the body into account for labor progress, Sphincter Law takes a look at the woman as a whole being, and considers that the cervix and vagina, being sphincter muscles, are highly responsive to fluctuation of maternal emotions.

The basics of Sphincter Law say that:
• excretory, cervical, and vaginal sphincters function best in an atmosphere of intimacy and privacy.
• these sphincters cannot be opened at will and do not respond well to commands
• when a person’s sphincter is in the process of opening, it may suddenly close down if that person becomes upset, frightened, humiliated, or self-concious
• the state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, the vagina, and the anus to open to full capacity.

Consider what your needs are when having a bowel movement. In order for that sphincter muscle to relax and open fully, most desire a moment of privacy. If, in the midst of a bowel movement, the bathroom door was suddenly thrown open, what would happen? The sphincter muscle would probably tighten back up. It is also necessary to be comfortable and relaxed in order to have a bowel movement. I know people who have a hard time with bowel movements if they can’t take off their shoes. If you are stressed and rushed, bowel movements may not occur. When you consider that the cervix is a sphincter muscle as well, it makes perfect sense that the needs for bowel movements would be similar to the needs of having a baby.

If the Law of the Three P's were truly a law, then it would have to be true in every circumstance. And when we scan the entire U.S., we see many variations in the amount of intervention deemed "necessary" in womens' labors. Cesarean section rates vary from doctor to doctor, hospital to hospital. There is more prevelence of pitocin use in certain areas than others. Women at The Farm, Ina May's village in Tennessee, have consistently had a cesarean rate of less than 2%, while the rest of the country sees more and more cesareans each year, with a national rate of nearly 33%. How can this be if there was truth in the Law of the Three P's?

Even in Lawrence Impey’s textbook, Obstetrics and Gynaecology, right in the middle of discussing the Three P’s, he deviates away from his own writings by saying this:

"General Measures to Maintain Progress
Continuous support during labour is associated with a reduction in operative delivery and length of labor. This should be from the midwife, as well as partner, or from non-medical supporters or “doulas”. The impact of support is seldom remembered, but reflects the importance of psychological well being on obstetric outcomes. Mobility should also be encouraged."

It's very interesting to me to read in the middle of the formula for diagnosing dysfunctional labor, and how to correct them (artificial rupture of membranes, pitocin, then cesarean section), something so simple and so far removed from the medical/pharmacutical mindset. It also seems to counter what the Law of the Three P's deems to be true. That labors don't progress due to insufficient strength of the uterus, too large or malposition of baby, or too small inlet of the pelvis. How is the presence of a partner or doula making a uterus stronger, a baby smaller or better positioned, or the pelvis outlet bigger? While there are certainly things that a doula can do to help with these things, "psychological well being" is what is being pinpointed here. Isn't this what Sphincter Law concludes as well? That feeling loved, supported, protected and safe will help with labor progress?

So why are emotions so discounted in the obstetrical world? Or perhaps its not the emotions, but how to help a woman's emotions in labor that is being brushed aside. When administering pitocin is something that can be done quickly and checked on from time to time, staying with a laboring woman and supporting her seems like a big waste of time.

It just seems to me that obstetrics and hospitals function in a way that sets up a laboring woman to fail.

Information for this article came from

Birth, by Tina Cassidy

Ina May's Guide to Childbirth, by Ina May Gaskin

Obstetrics and Gynecology at a Glance, by Errol R. Norwitz and John O. Schorge

Obstetrics and Gynaecology, by Lawrence Impey

Monday, October 20, 2008

Natural? Are You Crazy?!

The topic of natural birth can be a difficult one to discuss. Those who've had one are typically very passionate about their experiences. Those who've not had one are usually just as passionate about how crazy we are to go natural!
Having a natural birth does not mean that a woman is better than one who had a medicated birth, or surgical birth. Having a natural birth is not a goal to attain in order to join the rank of "super-woman"hood. Having a natural birth is not something to be had in order to make others feel guilty, sad, defensive, or less of a mother. Having a natural birth is a personal decision that a woman must make for herself for her own personal reasons. It's just that there are so many good reasons, it's hard to keep them to ourselves!
My reasons for having natural births were my own, but I'd like to share them here with you:

My body was made to give birth. If all of the women before me could give birth this way, why would I need to do it differently? God made my body to do this work. He does not make mistakes.

No drug is proven safe for the unborn. Why would I shy away from any medications throughout my entire pregnancy in order to flood my body and my baby's with drugs just before they enter this new world?

There's a reason for everything. There's a reason for labor. There's a reason why our bodies surge with hormones, and why we work so hard to bring our babies into our arms. To brush away those things would be messing with an inner-working that is much larger than our ideas.

I am strong and capable. I did not want anyone telling me what I could and could not do. My body was strong enough to grow this baby in my womb, and it would be strong enough to work it out! There's no reason to force a woman to do things that make no sense when she's the only one who knows her body and her baby.

Everyone has a personal reason for their decisions. I just ask that you make an informed decision. Ask questions, look into the safety of each procedure. Think about the effects on your baby, and on yourself. Take care and do no harm!

Sunday, October 12, 2008

How Labor Prepared Me for Motherhood

In my childbirth classes, we mainly focus on labor, birth and the first few hours post-partum. Because this single event is so life-changing, many times parents focus so much on the birth that the actual parenting part is forgotten until you actually have to parent!
Even though we don’t’ go into great detail on parenting in my classes, I do feel that what I teach, and what these parents learn from coming to classes and going through labor, has life-long effects. What they learn about pregnancy, labor, and birth can greatly be carried over into parenthood.
Each of my own labors, just like each of my children, was unique. Each brought something new to experience, new challenges to face, and new victories to relish. This is how my labors prepared me for motherhood…

Labor is hard work, and so is mothering. Sometimes it can be painful, but mostly it takes a lot of time, effort, and patience.

Learning to work with your body makes things easier. Learning to work with your child instead of against him/her makes for easier parenting. Sometimes you want to cringe and grit and say, NO! It’s going to be MY way! But taking a deep breath, understanding the workings of their little mind and body, and helping them advance in their own natural way, rather than pulling against it makes for a smoother process.

Build up a toolbox. In labor, knowing that different stages call for different needs, you want to have a bunch of techniques, visual aids, physical aids, etc., to help a mom get through. In motherhood, the same applies. Sometimes children are at the easy, excited-to-be-here early first stage where all they need is your smile and hug. Other times they go through the difficult nothing-can-help-me-now transition stage where they need bigger, better, different, nothing, all of you. Having plenty of resources at your fingertips can help you all make it through.

Don’t interfere with “Mother Nature”. Your body knows what to do to give birth. When you start interfering, things start going wrong, and we get way far away from what childbirth is supposed to be. Your baby knows what it needs. It was born with the ability to let you know. Listen, and don’t try to change a baby’s intuition. Messing with a child’s nature will only cause further problems down the road. Children learn without us even having to try to teach them. Go with what their nature already is. Work with it, not against it.

The safer, more effective way usually takes dedication, hard work, and sacrifice. Dealing *with* contractions rather than escaping them usually yields greater rewards. It may be harder to experience all the sensations of labor and birth, but it is safer for the mother and baby, and usually allows the body to work the way it was meant to. Working daily with a child, being consistent in re-directing rather than relying on some “quick-fix” method, making nutritious, healthy meals rather than quick, nutritiously-void ones takes a little extra time, a bit more effort, but it safer, and allows a child’s body to work and grow in the way it was meant to. The easy way is not usually the best way.

Surround yourself with good support. It’s so much harder to do this on your own! Having the support of a loving husband and generous friend is what carries us through labor! It’s also what carries us through motherhood. Having someone you can release your emotions to, and knowing they can handle it can be a real life-saver. Having the support of someone who knows your true heart in spite of the words you may be uttering gives us freedom to feel loved despite our weaknesses. Mothering with community is good for moms, and good for children!

You can’t really understand it until you’re in it. As much as you learn about the physiological functioning of labor, as much as you practice relaxation, as much as you practice labor rehearsals, until you truly experience it, you really don’t know what it’s like. Mothering cannot be explained. It needs to be experienced. And unless someone else is mothering your child, they cannot really understand what it’s like to be you, no matter how much education they may or may not have.

Fear causes pain. This is the very basic of childbirth. Thanks to Dr. Dick-Read, our modern methods of pain-coping and childbirth philosophies rest on this principle. Our child-rearing practices should as well. So many mothers parent their children based on fear. What will so-and-so think? What will they say if I do this-or-that? My doctor said if I don’t do this, than that could happen. This only ends up causing pain to both mother and child. Do not mother based on what anyone else thinks or says. You are the sole mother of your child. You know what is best. Have confidence that you know what your child needs, and it doesn’t matter what others think because your job is not to meet their needs, but to meet that of your child! Fear-based parenting is just plain painful to live, and painful to watch.

It usually doesn’t go exactly as planned. You cannot predict how your labor will go. I held lofty goals for each of my labors, and none of them went according to *my* plan. They went according to how they were supposed to go! Children don’t understand your goals for them. They don’t understand the future you may have mapped out. They understand what they need to do to be themselves. And we as parents, while holding lofty goals, need to be open enough to accept changes along the way. It might be that you are blessed with a high-needs child who doesn’t follow your nap schedule and feeding plans. It might be that you are blessed with a child that wants to wait until he’s REALLY sure he’s ready to use a potty. Sometimes children don’t have the same athletic skills, or social desires that a parent has, and we parents need to be okay with that.

Motherhood is a roller coaster ride, that’s for sure. And just as soon as you think you understand what’s going on, you are thrown into a different direction, and get to learn all over again!

Thursday, October 2, 2008

How I Got sucked Into “Birth”

My first birth experience felt okay to me at the time. I had wanted a natural birth, but didn’t realize how important it was to have dedicated support when going naturally in a hospital setting. Laboring in the hospital bed, I caved in to the repeated offers of pain medication the nurse kept presenting. When my baby was placed on my chest, I didn’t realize it was the drugs, having messed with that natural workings of labor, that caused me to feel so disconnected from this baby that had just come out of me. I didn’t even realize I was *supposed* to feel ecstatic. I just felt exhausted, and said to myself, “oh, so that’s a baby”. We bonded over the next few days, but this baby was a lot of work, and I often questioned my abilities to mother him.
The second day after he was born, while I lay on the couch, bottom too sore from the episiotomy to sit upright, I remember thinking, “Alright, now that I know what it takes, I want to do it again – but this time I *will* do it naturally.”
And I did.
During my second pregnancy, I sought out Bradley® Natural Childbirth classes, which hadn’t been available in our area during our first pregnancy. I was so excited to get face-to-face instruction, and have my husband learn everything I was learning! I asked my Bradley® teacher to be my doula, something I hadn’t heard of before taking classes, because I wanted my husband to also have support. The birth was amazing. And so healing of all that didn’t go well in my first. I was lovingly, strongly supported by my doula and a husband who knew what was going on, what he could do, and what I needed. I cried with joy when my baby came out, and lavished him with love, saying, “Oh, baby! Baby, baby, my love!” I hadn’t torn and felt so good after the birth, we were discharged within twelve hours. The pictures of me after my fist birth and after my second are drastically different. In the pictures of the first, I’m puffy, tired and lethargic looking. In pictures of the second, I am bright-eyed, energetic, and radiating with joy.
And that’s what changed me.
Why would anyone want that first experience when they could have the second?! Why not offer everyone the chance at having a joyful birth?
When my second baby was a year old, I started going to Bradley classes, just to sit in on them, and glean all this wisdom from my teacher. I wanted to go to the Teacher’s Training to become a Bradley teacher myself, but felt I needed to wait a bit. In the meantime, the opportunity to attend doula training fell into my lap, and I just could not pass it up! The ALACE training was put on by a local licensed midwife, and gave me so much more to work with. I wanted to do this! I wanted to support women through one of the most life-altering experiences they could go through! And so I started attending births right away.
And, I got pregnant again.
I attended my Bradley® teacher training while 8 months pregnant with my third baby. After the training, and after a beautiful, gentle birth, I started teaching classes right away, so thankful for the year and a half of observing *my* former Bradley® teacher.
I love meeting with couples for 12 weeks before their births. I see their apprehensions turn to excitement, and their fears turn to conviction. When they call me to tell me about their births, I hear their joy beaming through the phone lines. I love sharing in their birth highs!
And that’s how this whole thing started.

About Me!

My name is Amy, and I am a Bradley(r) natural childbirth instructor as well as a birth doula serving the Kitsap County, Washington area.
I have four young children, and a hard-working husband. We stay busy at our house, but we have lots of fun!
I love being a part of the birth community, and always enjoy the opportunity to learn and grow.
I am currently working on getting all my ducks in a row in order to enter the world of midwifery. It's going to take awhile, but I'm excited to think of the future, while staying home with my kiddos right now.
I look forward to sharing some of my thoughts with you on this blog!

Kingston, Poulsbo, Suquammish, Hood Canal, Silverdale, Keyport, Bangor, Seabeck, Bremerton, Port Orchard, Belfair, Olalla, Gig Harbor, Olympic Peninsula