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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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I attended  a beautiful birth three days ago at our local, newly-renovated hospital. This second-time mother was amazing. She was so in touch with her body and what she needed to do at each and every moment: walk, sit, lie down, be in the bathtub, eat, drink, lean on her husband, visualizations for intense contractions.

Natural hospital birth requires women to be in charge of their births, and the book I wrote about natural hospital birth focuses on what WOMEN can do to achieve natural hospital birth. I chose to focus on what we CAN do, rather than on the systemic issues that we can’t control as individuals. We really can’t control the hospital staff. So women who desire natural hospital birth have to be ready to work with all different kinds of providers who have all different kinds of ideas about the best way to give birth.

Still, there are certainly ways that hospital staff can support natural hospital birth. And when I encounter hospital staff who really, really support a laboring woman I want to sing their praises everywhere! There were a thousand ways that the nurses and midwives with whom we worked last week supported this natural birth. Here I want to focus on just one of those “little” big things they did. Well, actually that they did not do. After my client was admitted to the hospital from triage, she never had another vaginal examination!

Her waters were intact and she was pronounced five centimeters when we arrived, so I expected that we would have several encounters with hospital staff about vaginal examinations through her labor. Instead, they quietly monitored the baby’s heart rate and the mama’s blood pressure for eight hours and never mentioned a vaginal exam once.

Here are some of the many other ways the staff was supportive: They never turned on the light when they entered the room. (The nurse used a flashlight to find things in cupboards.) They brought us extra pillows, extra towels, and extra hospital gowns when we asked. They pointed us toward the snack room when we were hungry. The midwife brought two glasses of water for the husband and me (the doula) during the most active part of labor, when we were working hard giving back pressure and talking the mama through each and every contraction. They were supportive in so many ways.

But by answering the mother’s questions about how her labor was progressing each and every time with a smile and reassurance that everything looked “great” — instead of saying, “Well, let’s check and find out” — they gave her such a gift of confidence. It makes me want to cry from happiness. It’s such an easy thing to do: suggest a vaginal examination. The vaginal exam, by giving everyone a “number,” appears to answer the question, “How are things going?” But, of course, it does not answer the question at all. If a woman is at seven centimeters, there is no way to know whether she will progress to ten in five minutes or five hours. There is no way to know whether she is feeling strong and capable or weak and defeated.

So often women know intuitively before or during labor that hearing a “number” will interfere with their ability to trust their bodies. (More rarely, but occasionally, some women know that they will be empowered by knowing this number. These women want to have vaginal exams and use this information to help themselves. The key is: Know Thyself!) For most women, though, hearing this cold, hard “fact” speaks to our brains, our rational selves. This is not the self who needs to be in charge of labor. Rational Self needs to step aside and let Intuitive, Body Self be in charge. There are many subtle ways that our Rational Self gets reactivated in labor. Imagine a woman in active labor who is sort of floating on hormones that take her out of normal conversational range. When the hospital shift changes and the new nurse comes on, she might come in and introduce herself and ask questions like, “So are you allergic to any medications?” She just activated the rational mind of the laboring woman! An immediate consequence of even one (much less a few!) rational thought is a lowering of our ability to cope with pain. The brain waves that allow us to be in a meditative, inner state are different from the brain waves that allow us to hold conversations. These brain waves are associated with changes in hormone levels, blood flow to various organs, heart rate, etc.

So, the fact that these nurses and hospital-based midwives were willing to forgo vaginal exams for EIGHT HOURS was a gift beyond measure. This mama got to labor and remained the expert on her labor. Her bodily sensations, her noises, her movements guided how the rest of us acted. We did not ever try to push her to get labor going “more” or “better.” No one had to feel disappointed or worried about how much longer there was to go, based on a number we heard at a particular moment. We all got to focus on a woman in labor. What did she need? What helped her feel the most comfortable?

When the baby arrived, she pushed twice. The baby arrived happy and healthy. I assume she had made it to “ten.”

What was your experience with vaginal exams at hospital births?

 

 

 

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It always feels so awesome to feel like you’ve made a difference in someone’s life. I met Heather Boyd last year as a student in one of my classes at Eastern Michigan University. I always offer “alternative” projects in my classes and in my medical anthropology class that fall I said that students could take a training program in becoming a doula, homeopath, herbalist, etc in lieu of a final paper. Heather took me up on the idea and became a doula that semester. She told her classmates all about the first birth she attended. I think they were all a bit in awe that she was out there, supporting a family at a hospital birth, while they were researching things like ADHD treatment in on-line journals. Last semester, she and two other students helped collect over 200 letters to representatives in support of Michigan midwives. This year, Heather is creating a non-profit “Students For Midwifery” and writing a workbook for teens who are pregnant. Check out her project on RocketHub and consider donating what you can. Twenty-five dollars? Ten? Five? It all adds up to better birth. http://rkthb.co/4703

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Hire a doula to avoid an induction!

There is an epidemic of inductions occuring in the United States and Canada right now. The Listening To Mothers II Survey found that, “More than four out of ten respondents (41%) indicated that their caregiver tried to induce their labor. When asked if the induction caused labor to begin, more than four out of five of those women (84%) indicated that it did, resulting in an overall provider induction rate of 34%.”

(You can read more about it at http://www.childbirthconnection.org/pdfs/LTMII_report.pdf)

At the end of pregnancy these days, there are a host of potential reasons your caregiver might suggest an induction. UNLESS YOU HAVE SOMEONE TO TALK TO about it, you are likely to go along with the suggestion. Think about it: at 38 weeks, most of us feel DONE with being pregnant. We’re ready to meet our babies! So when someone offers to make that happen, like, tomorrow, it’s hard to resist. Especially if they add a medical-sounding reason to the idea.

But the fact is that most women do not grow babies too large to birth and most women have plenty of amniotic fluid. But these reasons to induce are offered to many, many, many women nowadays. It’s just not possible that 41% of North American women have suddenly developed narrower pelves and have less amniotic fluid. We have more information (like estimates of amniotic fluid levels) because of more technology. But more information is not leading us to make better decisions. Instead, our caregivers feel compelled to give us the information and the “worst-case scenario” associated with that information. That worst-case scenario is likely to sway us toward induction.

But if we are able to wait a few hours, breathe, relax, think it all through, we can make the decision that is right for us. Of course, there are some situations that call for an induction. But there are many, many more that do not.

Here’s where your doula comes in. Your doula will not be able to give you medical advice and she will not be able to make the decision for you. But she can offer help in YOUR decision-making process. She can ask questions. She can point you to resources. She can connect you with other women who have faced similar dilemmas who might be willing to share their wisdom. She can tell you stories. She can suggest a long list of natural induction methods you might try before going the medical route. She can guide you to think through how you might feel if this induction turns into either an epidural or a cesarean.

In short, she can help you make your best decision. It might be that the best decision is to induce. It might not. However, talking your decision over with your doula — someone who knows your birth plan, your birth vision, your birth dreams — will help you have peace of mind.

I run mom-and-baby groups in my hometown. So many new mothers come to our group with great sadness and regret about how their labors went. They say, “If only I had known…” a lot. A doula is like insurance against regret. She helps you make your decision fully and consciously so that, no matter what happens later, you have confidence that you made the right decision to begin with.

[P.S. Why does avoiding an induction matter? Because when women are induced, a host of other interventions often follow (called “The Cascade). A common drug for induction, Pitocin, makes contractions feel more painful. FOr a woman planning a natural birth, this can really get in the way! But even for a woman planning an epidural, Pitocin contractions in early labor can be a problem. If you get an epidural before active labor really kicks in, your labor can be long and slow. But if you wait until active labor is really going, you will probably have to weather some significant, unplanned-for pain. In other words, no matter what kind of birth you are planning, Pitocin gets in your way. (If you want to read more about this, I refer you to either Henci Goer’s book “The Thinking Woman’s Guide to a Better Birth” or my book “Natural Hospital Birth.” Both of these books talk about Pitocin in detail.)

Another important reason to avoid induction is that the rise in induction rates corresponds with a rising rate of babies born prematurely. If our dates are off (which they often are!) we could be asking our babies to be born a few weeks too soon. Nature has a fabulous plan for your baby’s birthday. Let a doula help you avoid an unnecessary induction and discover your baby’s “real” birthday!]

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