Wednesday, April 15, 2015

Don't Give Me My Baby: Bonding After Normal Birth

There is an old video from Brazil called "Birth in the Squatting Position".  This video, made in the 70's, got under my skin in a huge way and took my studies, explorations, and ruminations upon birth to a whole new level.

It is not the squatting aspect of the mothers delivering their babies that is so fascinating to me.  As a long time doula, I have witnessed many women squat to give birth. I squatted myself (for many hours) to birth my first child, who remained stubbornly face-up (babies normally emerge face-down).  What excited me and moved me to a whole new level of appreciation for the team effort between Birth Giver and Baby were the things we do NOT see in this video.

The birth giver and the baby are undisturbed in the second stage of labour.  However, they are in a clinical setting, which needs to be clear.  This is a medical birthing centre, not just women squatting willy nilly in the woods.  I actually LOVE this aspect.  It demonstrates the possibility that birth givers and babies can have their cake and eat it too, meaning they can be trusted to do their work together without unnecessary distraction AND have the clinical safety net the majority of families want for those times surprises happens.  When disruptions in the normal process are radically minimized, we will likely see an increase in uncomplicated births and a decrease in the births that require a need to get the birth/baby dyad out of a potentially iatrogenic pickle.

So let's look at what we don't see:

1) Nobody is telling the birth givers to lie on their backs.  The intro to the video states that many of the women this clinic supports are very active, and when they get the opportunity to chill out, they so by squatting.  They traditionally birth in the squatting position.  So these women are doing what comes naturally, or are at least being guided to do something that is more ergonomic than the medically preferred semi-reclining (or even lithotomy) position.

2) Nobody is coaching them.  Now granted, most of these are probably not first time birth givers.  Subsequent babies do tend to come out with much greater ease.  However, in my doula practice which consists mainly of people having subsequent babies, the surge of "rush" energy rises in the room like a tidal wave, people charge in, and many voices often help them to "remember how to push".  The squatting birth givers in this video have their need for quiet and concentration respected.   I have no doubt there are some loving murmers going on that we don't hear over the flute-y music, but I highly doubt the "push harder...NO..slow down...NO push more" during the crowning/expulsion phase is going on.

Some people give birth in near silence with great focus simply breathing their babies out, and others give a high pitched shriek, often referred to as the "perineal cry".  If things are moving along well, it is probably unnecessary to tell them to do other than they are doing.  I have seen many birthers told not to scream, directed to bear down and push through that pain even when it is clear Baby is emerging without a hitch.  I wonder if that final shriek often given at the end isn't a natural way for some of the powerful energy to be dispersed, like steam from a kettle, with the result minimizing the force with which Baby comes through, and perhaps reducing tearing.

3) The birth giver's genitals and the baby's emerging head are not touched.  
It is not unusual in a hospital to see a lot of perineal and vaginal manipulation throughout the pushing phase.  It is most certainly with the kind intention to help.  But what we know about stretching things out or fiddling as a default rather than just when there is evidence it is necessary, is that it brings extra blood flow to the area.  This means it can potentially make the area thicker.  For a perineum to slip as gently over the baby's emerging head as possible, a thinner quality of tissue is likely more acceptable (Thank you, Gloria Lemay).  I wonder, though these things are hard to know for sure, if we would have LESS tearing if there were LESS touching.

I have a feeling Baby is often not happy about having its tender, oh so squished little cranium touched while trying like a little trooper to crawl out of the smallest space they will ever be in.  They are working hard.  I imagine it could be very distracting for them.

4)   The baby is not delivered by anyone but the birth giver.
There are supportive hands available to prevent any bumpy landings, as well as to intervene quickly if necessary, and perhaps to provide a little positioning help if a baby has landed on their face.  But given that squatting brings birthing bottoms close to the surface the feet are grounded, a soft place for Baby to land seems to be what's most needed.  Babies do tend to come out, even if there is nobody to "catch" them.

5) Nobody interferes with the birth givers' instincts.
In a lovely effort to get them participating with the delivery of their babies, many birth givers are encouraged to "touch their baby's heads" or to "reach down and take their babies".  This is actually a sweet gesture that many people who birth in a highly clinical setting with monitors, strangers, prescribed positions, etc. appreciate.  I used to encourage this too....until I realized as I observed (which I get to do, not having to worry about anyone's clinical safety) that most people appeared shocked and pulled out of the deep space they were in to follow my direction.

There are deep resources and motherwit within that rich inner wold of the birth giver.  Brain waves shift.  Hormones flow.  There is a primordial blueprint.  The shrieking (if there is shrieking), or thrown back head, closed eyes and perhaps the clinging tightly to someone or something are not generally signs of terror and disassociation.  Rather, they are usually signs that the birth giver is tapping into and riding a massive flow of power.

In this video, we see the women left to their own motherwit, bringing forth life without the external world assuming to know better and exerting pressure upon the experience.

6) and this is my favourite thing of all....nobody hands the birth givers their babies!

The "Birth in the Squatting Position" video suggests, as well as other studies that have observed what humans tend to do on  a primal level when left to birth undisturbed, that placing Baby directly upon the chest or abdomen is NOT "natural".  It is done in the name of "immediate skin to skin" if the hospital wants to appear progressive or simply because the bottom of the hospital birthing bed is removed, so right after birth there is nowhere else for the baby to safely go.

This is a very accepted part of our birth culture.

If you observe, though, which I have, as well as having experienced this myself, there is something that happens when someone claims their own baby.

What generally happens, is that the birth giver goes to a peak level of human experience.  As has the baby.  They are off in realms that are not akin to our normal, every day brain waves.  This is a consciousness that cannot quite be described.  If they are left undisturbed, they will stay in that space for a little while.  I have a belief that in this space, subtle "information" is being downloaded.  Genes are being activated.   Ancestral memories are being evoked. Neural pathways are being forged.  Something is being shaped. It seems like there might be some really important stuff going on that we should probably think twice about messing with.

Watch the women in this video.  They take a few deep breaths, slowly coming back to themselves a little.  When they are ready, they look kind of sideways at their babies.  With one hand first (likely their dominant hand), they touch and stroke one side of the baby (who is to say this type of touching is not part of some kind of important human activating system), and then with the other hand they stroke the other side of the baby.  Within a minute or so, these women are not handed their babies to them, they CLAIM THEM, and when they have emerged from wherever it is they went, they emerge with their babies, stepping into their identities as new parents.

When I teach prenatal classes, I let parents know that likely, unless they say otherwise, their babies will be put immediately onto their abdomens or chests.  Most of them will likely love it and grasp enthusiastically for their babies.  And some will feel shocked.  Why?  Because they are being pulled prematurely from that important place.  If birth givers are not told about this, they sometimes feel guilty, as if they are lacking in parental instinct.  They are "supposed" to want their babies plopped onto their chests by an external source.  I tell them they are simply demonstrating normal mammalian behaviour.  It is perfectly fine for them to wait until they are ready to claim their babies on their own terms (if possible), having the baby supported at their thigh while the cord remains intact, or perhaps handed over to the partner for a few moments.  Or...what if...what if...we did nothing at all but wait and have a little trust?  But definitely not handed over to someone for weighing and examinations unless necessary.

Not all births unfold in such a way that this way of welcoming Baby is possible.  I don't think it's something to worry about if it doesn't happen.  Parents have enough pressure for "perfection" on them, and it is not my intention to add further duress.  I am simply looking at a wider scope of possibility and wondering what could happen on a biological and cultural level if birth were left to unfold with less ownership from external sources when it comes to "delivery",  "placing" the baby on the parent, or "initiating" skin to skin and seeing how beautifully that dyad usually works together to the beat of internal rhythms.  It can totally be done within a highly clinical context if that is important to the parents.

A dream of mine is to see these few precious moments before Birth Giver claims Baby restored to human birth.  I want to see it as understood, honoured, and protected as the important concept of skin to skin has been.  I am excited to explore the impact this could potentially have upon humanity as a whole.  So may it be.


Saturday, April 11, 2015

7 Steps to Owning Your Hospital Birth

You're about to give birth in a hospital.  Perhaps you're a bit nervous about how you will be treated, or about what kinds of things the health care providers are going to do with your body while you are in the throes of labour.

As a doula, I attend birth in every setting: from home births, to births in free standing centres run by midwives, to births in hospitals with family doctors or obstetricians.  A beautiful birth experience can be had anywhere.  In a hospital, however, there can be a seemingly endless sea of unfamiliar people tending to you.  Many only know your name by looking at your chart.  Fewer have time to get to know what you truly want or don't want for your birth.  This is where your need to use your  voice to stand up for your wishes (whenever possible) becomes important.

These are some tips to help you feel like you have some influence within a situation like childbirth, which can be so very unpredictable.

1)  Know Who Delivers

This is not about knowing the person who will deliver your baby when it is time.  In many hospitals, you will have no control over this, and likely, this person will be a stranger.  What it means is knowing who the power of birth giving belongs to.

A prevailing attitude among birth givers in our highly technocratic birth culture is: "Women have been having babies forever, so I'm sure it will be fine.  I trust my doctor to get my baby out."

There is a dangerous discrepancy in this statement. There is the intuition to" trust my body", but then the responsibility left entirely in the doctor's hands to "get my baby out".

Though it is acceptable to say that doctors and midwives deliver babies, if we look more closely at the truth of that, if all is going well, all they really need to do is "catch" or "receive" your baby as you give birth.  Most health care providers admit that in a normal birth, aside from a little vigilance, encouragement, and a few reasonably simple safety measures, it is you who does all the work.

After the blood, sweat, and tears of birthing a baby, the glory of delivery belongs to YOU!  Nobody can have your baby but you. Step into and deliciously own YOUR power and agency in bringing forth life.

2) Don't Leave it to Chance

The "whatever happens, happens" attitude towards childbirth does have its benefits in some ways.  It is important to be flexible when it comes to giving birth. You can certainly have a goal. Relaxation, a trust in your birthing magnificence, and positivity lend beautifully to the crafting and realization of your birth vision. Sometimes, though, your little passenger within calls some of the shots regardless of your hopes. Finding the balance between your expectations vs the reality of your birth's unfolding will leave you ready for unpredictability.

Leaving it all up to your hospital care providers and luck, however, can set you up to feel quite discombobulated if you're not prepared for certain things. You don't want things to be a shock on the big day,  like the reality of the sensations of labour, or the fact that anesthetists (if you want an epidural) aren't always available when you call them. You also don't want to miss opportunities to feel more comfortable, and should know that in many places you CAN eat if you're hungry and NOT lie on the bed if you're not happy there. Just because you're led to do something, doesn't mean you have to do it if you don't like it. Ultimately, if you don't know your options, you don't really have any.

It is so important as a pregnant person to take the time to explore how you would feel most powerful and satisfied giving birth.  It doesn't really matter how, as long as you feel GOOD about it! Envision yourself giving birth. What might you like or not like? What makes you feel better when you are stressed out and in pain?  What are your values about giving birth? Do you want to/will your health allow your birth to unfold as normally and naturally as possible, or do you feel like/know pain relief or a Cesarean birth would be an important option for you? So many things to think about!

How do you begin to look at these options?

3) Educate Yourself

Nothing beats good childbirth education which focuses on your empowerment. A prenatal class that spends ample time describing the sensations of labour and how you and your partner (if you have a partner attending your birth) can cope with the experience is an excellent idea. This is important even if you plan on having an epidural early on. Why?  Because it is not feasible to expect you can co-opt all your sensations to be relieved by drugs as soon as you want that to happen. Not because you shouldn't want that if that is your comfort zone, but because in a busy hospital, things don't always go that way. Many birth givers have to wait much longer than they wanted for their pain relief, some having their babies come before the pain relief got there. Sometimes they receive a desired epidural, only to have it not work as well as they'd hoped. So having a few solid coping skills under your belt can ensure you are able to navigate the sensations of birth no matter how things happen. This can reduce the incidence of shock and birth trauma.

A good childbirth education series should not push any kind of agenda, but be open and inclusive to all your potential choices, informing you of the important things to expect, and how to speak up for yourself.

4) Know Your Rights

Hospital birth givers have rights. Often, you can find these rights published. This is what we have here in Quebec:
Women's Rights in Pregnancy and Delivery in Quebec

Here are some examples:

a) You have the right to eat and drink as you please in labour.
b) You have the right to be informed of the benefits and risks of all medications and procedures
c) You have the right to informed consent and informed refusal.
d) You have the right to labour and deliver in any position that suits you.

Research the rights in your area!
In the US check out this book "The Rights of Patients" by George J Annas (thanks Jessica Turon!)

5) Use your BRAIN

When making decisions about your care, keep the following in your mind so you can make the best decisions for yourself.  It is important BEFORE you give birth to have an idea of what you want or don't want so self-advocacy is easier, but if you are presented with something you're not sure about, use the following questions as a guide:

B-What are the BENEFITS of the medication/procedure being offered?

R-What are the RISKS?

A-Are there any ALTERNATIVES to what you're being offered medically? (example: having a snack and going for a walk up and down stairs to try to move labour along instead of labour augmenting medication...or maybe, you'd just like to have a nap and not have your birth clock monitored)

I-What does your INTUITION say? Your motherwit, meaning your innate, practical intelligence and common sense can be more active than you imagine in labour. What does your gut tell you?

N-NOW? Health care providers are usually open to giving your body a chance to do its thing normally, so don't be afraid to ask. Also, the word NO is allowed to be said! Even if you choose something the caregivers aren't fond of, if this is your conviction, you have the right to say NO. "I do not consent." is a phrase that holds a lot of power.

Parents often worry that a doctor or nurse will walk out of the room and abandon them if they make unpopular choices, but this is not the case.  They can be challenged at times by your wanting to labour or push in different positions or refuse an episiotomy, or whatever it is you feel strongly about, it is true.  But hey are not allowed to abandon you and leave you without care.  Practicing in pregnancy how to deal calmly and effectively with other people's reactions to your choices can give you confidence. Most often, you will find your caregivers on your side and will be very happy for you if you have the birth experience you were hoping for.

6) Get Your Partner on Board

As many birth givers realize when the heat of labour is on, all of the above gets very difficult to implement because the brain goes from think-y to primal. Even just talking, never mind intellectual discernment, becomes challenging as the waves of contractions sweep you off into the hormone- hazed mind trip that is Active Labour.

Ensuring your support person knows your wishes allows them to do some advocating for you.  Nobody can ultimately speak for you in labour, however, they can relay the wishes you communicated to them prenatally, "Pat was wanting a hep lock for the Step B treatment instead of the whole IV setup," for example, while you're busy having a minute power snooze between massive contractions. Your partner is generally your strongest ally. Especially if they are one of the child's parents, they have a say!

Many people create Birth Plans or Birth Preference Sheets to articulate their desires in labour. This can be helpful IF you have the type of hospital in which caregivers have the time to read them.  Many don't.  Personally, I have never seen a birth plan make the difference between a good birth and not.  Birth Preference Sheets or Birth Plans are more effective as prenatal tools to help you explore your options and clarify your values than something to actually bring to the hospital.  They don't "protect" you from anything. Only using your voice gives you the best shot at that.

7) Hire a Doula

"If a doula were a drug, it would be unethical not to use it." -John H. Kennell, MD

While a doula cannot and will not assume to speak FOR you in labour, they will respect and uphold your sovereignty as a birth giver. They have spent  a fair bit of time with you prenatally, getting to know your hopes and fears, gathering ideas of how to tailor their support techniques to suit your own individual style. They also know what your partner needs to feel safe and supported as they witness you traversing rough and unknown terrain.

If your doula knows, for example, that you expressed a strong desire prenatally to push your baby out in the hands and knees position, and when the time comes you find the nurse turning you onto your back and putting your feet on the pedals, your doula will probably gently ask you, "Are you comfortable like this?  Is this how you want to deliver?"

Your doula will not jump in and say to the nurse, "Hey, don't put my client on her back!"  Why?  This will create tension in the room in a big way, which is the last thing you need.  Your doula will not say, "Let's get on your hands and knees.  That's how you wanted to be, so let's get you off your back now."  Why?  Because you might have changed your mind.  There is a possibility you are actually super comfy the way the nurse is positioning you and find you want to be this way after all.  Your doula will not assume.

A question like, "Are you comfortable this way?" gently nudges your hormone besotted mind to remember what you valued prenatally. It is okay if that value has changed, but the doula wants to make sure things are going how you want.  The question allows you to say, "Yes, I'm good like this." or "No, Nurse, this is not what I want."  This is the subtle, elegant way doulas serve as supporters of your self-advocacy, leading you to use your own voice whenever possible.

While experienced doulas are experts in informing, comforting, and supporting a birth giver and their partner/s, they don't generally claim to offer expert advice.  Why?  Because their job is to shine a light on your personal power and have you claim your own expertise as the one who makes, carries, births, and parents this baby/ies.  Your doula supports your work to step into this power that is already yours, and celebrates you as you own your birth.

Have a strong and wonderful birth!

Lesley Everest
MotherWit Doula Care