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Posts Tagged ‘birth’

Not everyone who is having their first baby had a wedding first. If you did, though, you have a natural window through which to peek at your relatives’ likely behavior — and your likely feelings about their behavior — at the birth of your baby. If you did not have a wedding, you may be able to think of another emotionally-heightened event at which family play a big role that will act as this window.

Mothers, mother-in-laws, sisters, and close friends are all likely to want to play a role at the time you give birth. I will focus mostly on mothers here, although for any mom-to-be it may be a sister or friend who lives nearby who is the focus of your attention. The question that pregnant women often ask their doulas is, “Should I invite her to the birth?”

If the woman had a wedding, this is where I usually start my questioning. Because it’s not about whether the relationship itself is good or bad. If you are considering inviting this person to your birth, I will assume the relationship is at least pretty positive. It’s about how the woman feels when she is doing something meaningful, stressful, and full of rapid decision-making in the presence of this other person.

Did you feel like your mother (sister/aunt/friend) understood exactly what you needed in the moment and was acting like an extension of yourself at all the wedding events? Or did you feel like she kept bringing you problems and issues to solve? Did she love your ideas and offer to help out anywhere? Or did she disapprove of your decisions (subtly or not so subtly)? Did she try to talk you out of ideas that meant a lot to you? Did you feel like her feelings enhanced and deepened the meaningfulness of your wedding for you? Or did her feelings about your wedding interfere with your own enjoyment?

 

Mothers can be just like us or very different from us and still be capable of offering genuine support. But not all mothers can offer genuine support. Their own needs get in the way of that.

Take a good look at how you felt about your mother (sister/aunt/friend)’s role at your wedding. If you have any lingering feelings of resentment or disappointment, I would strongly urge you to find a way to keep your laboring space free of their presence. Give her an important job to do away from your birthing space (making a birthday cake for the baby is a great job, for example). You do not get a re-do on your birth experience, so, like a wedding, it’s important to plan carefully. Don’t discount this treasure trove of information about how people are likely to act. Together with your gut instinct, this information about the past can usually tell you what you need to know about, “Should I invite her to the birth?”

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Brazil ImageBrazil has a cesarean rate that is, depending on the year, the highest in the world. Their rivals include Taiwan and China, but not the United States. Here we hover around the 33% mark, but in Brazil about half of all babies are born by surgery and in some urban, private hospitals the rates are in 70-90% range.

To put this in perspective, if we took a 20% cesarean rate as “normal” (and I do not think that is normal!) as a 2010 World Health Organization report did, several million Brazilian women are having unnecessary cesareans every year. That report calculated a world-wide excess of 6.2 million cesareans annually and half of those are in China and Brazil.

(http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf, p. 8).

Why is the cesarean rate in Brazil so high?

If you ask Americans, they tend to blame Brazilian women.  Almost invariably, the first ideas we Americans have are about how the WOMEN must want more cesareans, how the women must be more used to surgeries (since they have so many more plastic surgeries than American women), how the women must be more concerned with keeping their vaginas tight and beautiful, how the women must not be willing to undergo labor.

But when I ask Brazilians in the United States, they tell me the same things that American women tell me. They say things like, “My doctor told me I didn’t have enough amniotic fluid” or “My baby was too big to be born vaginally” or “My baby was in distress.” In other words, Brazilian women understand their own cesareans as medically-necessary, even though statistically it can’t be true for most of them. (The same phenomenon occurs in the United States, I find.)

A 2014 article in the Atlantic confirms this. That article concluded that the medical system is not set up to support laboring women who are aiming for vaginal births (much less unmedicated vaginal births!). In hospitals where 70% or more of births are by cesarean, women who aim for vaginal birth are nuisances to the schedules of doctors and nurses. And it is a self-fulfilling prophecy that doctors and nurses who are skilled at cesarean birth become less and less skilled at managing natural labors.

All of this adds up to a fascinating cultural picture that I am eager to learn more about. So I am headed to Brazil at the end of May for a two-week crash course in all things birth in Brazil. I will be in Florianapolis with Ana Paula Markel, doula trainer extraordinaire, and in Belo Horizonte with my Portuguese teacher, who has promised to introduce me to young women and their families who are in the thick of this childbearing conundrum.

I’m so excited! If you are Brazilian, Brazilian-American, or an American who has given birth in Brazil, I want your stories!

Here are two articles if you’re interested in more.

http://www.theatlantic.com/health/archive/2014/04/why-most-brazilian-women-get-c-sections/360589/

http://www.pri.org/stories/2014-05-14/brazil-half-all-mothers-have-c-sections-whether-they-want-it-or-not

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So, I wish I wrote this about the cesarean rate. And I wish I made all the great graphics to go with it. But, even though I didn’t write it myself, I’m in love with this piece. It’s really helpful for answering the question I get all the time, “So, why do you think the cesarean rate is so high?” I can talk, talk, talk about all the reasons, but this piece just quickly runs through the reasons and more importantly gets to WHAT WE CAN DO actually.

Let’s get to it!

http://www.toprntobsn.com/bringing-birth-back/

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Waves

Surfing the waves of contractions, photo by Folkert Gorter

Active labor.  Contractions are hard and occasionally whipping up higher than expected. Massage and hip squeezing isn’t working. The birthing mother’s voice is getting higher and tighter.

As a doula, sometimes in these situations I reach for a visualization. And for active labor, there is no better metaphor than waves. There are so many ways to use this metaphor. Here’s an outline you can use and embellish as you like on the spot.

Here comes the wave… Take a deep breath… Now dive under this wave and through it and through it…. and now you’re coming out on the other side… swim up… Take a breath… Let it go

It’s OK if there are moments of silence in between your words or sentences. You don’t have to be talking the whole time. Speak slowly and use a low, calming voice. If she follows your lead, her own imagination will be filling in most of the details. You are just there to give her a bit of guidance. By focusing on this image of a wave, she can more easily let go of other thoughts that might have been causing anxiety (like, “How much longer will this go on?” and “I’m afraid of the next one.”) Our minds will fill with thoughts if we don’t give them something to focus on.

If you’ve never talked someone through a visualization, it can feel strange to do it the first time. I think we fear that everyone will look at us strangely and wonder why we have started talking in a sing-song voice about waves. In reality, my experience is that everyone in the room is usually happy that there is something besides pain and, often, the blips of machines on which to focus. Often the birth partner and nurses in the room will quietly take part in visualizations and, if it appears to calm down or help the birthing woman, they will even take it up, adding their own voices to the visualization. You may feel funny at first, but if you give it a real try, I guarantee you will be pulling this trick out in a lot of births.

What’s your favorite visualization?

 

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I got to speak at University of Michigan on Saturday to a packed room of what looked like 100 people or more. Wow! There were nurses, midwives, doctors, doulas, and pregnant women conversing together. Again, wow! It’s so great to be HAVING these conversations. Here’s an article from the University of Michigan website:

Hospital can provide safety net without pushing interventions; expert panel discussion planned at U-M March 24

Nadine Naber labored with a midwife, who guided her through her pain. Her husband was at her side, holding her hand, as she gave birth to her youngest son in a water-filled tub.

It was everything she dreamed a natural childbirth could be. But it didn’t happen at home — her son was born in the hospital.

Naber is one of many women who find that a natural hospital birth — a childbirth without medication or other intervention — is possible at Von Voigtlander Women’s Hospital at the University of Michigan. U-M has eight nurse midwives on staff and encourages women to set a natural birth plan that still offers the advantages of being in a hospital setting.

“I truly and deeply experienced what I would dream of with a natural birth, in every way possible, without any sense of it being medicalized,” says Naber, a 42-year-old mother of two and Ann Arbor, Mich. resident.

Naber says the natural hospital birth offers the best of both worlds: a birth plan without unnecessary medical intervention but also the safety net of the hospital setting.

U-M and Douglas Care will host a panel discussion, “Supporting Natural Birth in Hospital Settings,” on March 24, featuring author and professional doula, Cynthia Gabriel. Gabriel’s book, “Natural Hospital Birth: The Best of Both Worlds,” features a forward written by U-M’s Timothy R.B. Johnson, M.D. , who is professor and chair of the U-M Department of Obstetrics and Gynecology.

 http://umhsheadlines.org/20/natural-births-possible-encouraged-in-hospital-setting-at-university-of-michigan/

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Dear Doulas,

My sister recently attended her first two births as a professional doula! (See her at https://www.facebook.com/DueLove?sk=wall) I am happy to say she was also MY doula when she was fifteen years old and I was giving birth the first time. AND she attended our niece’s birth when she was only twelve, I think.

It made me remember those wonderful days of beginning down the doula’s path. I was full of passion and fire. I was really jazzed about women’s power. I couldn’t wait to attend LOTS of births. I was ready to be awake all night. I was so ready, in fact, that when my second birth was imminent, I couldn’t sleep for days BEFORE the baby arrived. And that labor turned out to be two days long. Rookie mistake. 🙂

I wanted to write to my sister, and all the other beginning doulas out there, to share something I’ve learned over the years to avoid burnout but keep up my passion. I heard it first from my doula instructor Ann Fuller, but it didn’t sink in. Then I heard it from a midwifery teacher, Elizabeth Davis, but it didn’t sink in. Then I learned it from a wise doctor in Russia and she said it just differently enough that it finally sank in.

Ann Fuller said: “When you attend a birth, remember you are not the one giving birth.”

Elizabeth Davis said: “When you attend a birth, remember you are not the one giving birth.”

Still, somehow I managed to feel disappointed, as if I had failed in some way, if my clients did not have what I considered “perfect births.”

Finally, about a year into being a doula, while I was working in a Russian birth hospital, I was lucky enough to hear a Russian doctor say, “It helps me if I assume that the Universe gives every woman and every baby exactly the birth they need to learn the lessons they need to learn in this lifetime.” Wow. That shifted my thinking. She later told a group of Americans who were complaining about the Cesarean rate in the United States (in 2000 it was at 25% and we were complaining. Now it’s at 33%) that she believed that, while the rate was high and we should all do what we can do to lower the rate, she preferred to think of it a different way. She said, “What if most of the souls who need the lessons of a cesarean birth are choosing to be born in America?”

I do not use this rather “spiritual” thinking to justify unnecessary interventions in birth. I use a different part of my brain, a very rational part of my brain, when I am analyzing cultural patterns and medical statistics. When I write and talk about larger cultural patterns, I think it is appropriate and useful to access anger and outrage.

But when we are talking about an individual’s experience, I find that accessing this spiritual, zen-like, accepting mode of thinking helps me. I can focus on learning lessons from the experience, rather than kicking myself for failure. Believing that a woman’s labor went just the right way for her and her baby helps me bring a softness, an acceptance, a respect for what she actually, really experienced. I can honor what really happened instead of focusing on what “should have” happened.

And, best of all, I can work as a doula without carrying the weight of the world on my shoulders. I can help women and families. I can rejoice when births go “perfectly,” but I can also rejoice when they go less than “perfectly.” I am better able to focus on the power, strength, and effort of women (and their families) and I am less likely to focus on the negative.

Please do not misunderstand me. I believe that COLLECTIVELY we must focus on improving birth in America. But not at the expense of burning out doulas, midwives, nurses, or doctors. And definitely not at the expense of blaming individual women. If women do not get the birth they truly desire, I automatically blame what surrounds them: a culture that says pain is bad in all forms except perhaps sports, a culture that turns to pharmaceutical solutions far too often (not just in labor), a culture that makes birth sound terrifying and awful, a culture that does not honor the work of women generally (or the family work of men, for that matter).

But accepting each individual birth as perfect just as it is, that is good for my soul.

Thank you for doing the work you do, doulas!

Yours, Big Sister Doula

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This is a quickie post to let you know I will be speaking at the DONA International Conference in Cancun, Mexico as a keynote speaker in July 2012. Come to Mexico with us! I’m so excited!!!! Here’s the link to the conference site: http://www.dona.org/Conference2012.php

I’m planning a session on “Secrets to Support a Natural Hospital Birth” and “Regifting the Gift of Birth By Developing Empathy for Hospital Staff.”

Who’s coming???

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