Light Step Into Birthing in the U.S.A

I’ve recently looked under the surface into the deep workings of the birthing world. As I prepare for the next addition to my career in taking on the role of birth doula, there’s a natural deepening that happens. Through this deepening, I simultaneously feel ecstatic and frustrated. I feel so grateful to be getting this information at my age, when many women don’t ever receive it at all. I feel excited when I learn what the possibilities are and that they involve positive things. And I know too that the birthing world has always involved life and death, and that we lose mothers and babies sometimes without knowing why. However, I do feel anger for the women and babies born in this country whom go uninformed and unprotected.

Why Birth? My way of dealing with these emotions is through action. This blog series is a way for me to begin to contact the masses of people who are connected to the birthing world, one by one…because everyone is connected to the birth process. If you’re alive, you have your own birthing story. If you’re a parent, your body and mind have been there. If you have a family member who is even considering having children, this is for you. If you’re a daughter, son, parent, grand-parent, lover or partner or spouse, a professional who provides any type of support to clients or patients, if you’re interested in healthy attachment between parents and child, the list goes on…this pertains to your life and possibly your work in service. Our story of being in the world begins with birth. The question becomes: why not birth?

Disclaimer and side note: I am not here to preach what the best ways are or to tell you that you’re lazy if you don’t want a natural childbirth. My intention and motivation is to provide information and education that is both scientific and spiritual in nature, so that you and the women you know have informed consent and choice around the birthing process. I wish I could trust all the birth practitioners in our society to provide you with this education. Unfortunately for different reasons in different circumstances, that is not our reality in the United States. I know this by examples of multiple stories I’ve heard and read. The more I learn about what’s happening around birth in the United States, the more I see that information is sometimes withheld, misunderstood, and not utilized in the most healthy way due to convenience, policies, or simply not knowing. Women and children have been among the oppressed for ages. The power that society and professionals have over women and how they want to be treated, in relationship to their flesh and blood that is coming out of their own bodies seems wildly out of balance to me. The woman has a primal instinct for her child and their well being and safety. For example, why is a woman not allowed to move around during her birth in a hospital if she wants to? Why is she required to stay lying down on a bed when that goes against the intuition her body is trying to follow to birth that baby? Why is the woman not trusted to labor at her own pace, but forced to fit into the “24 hour period” before she is given drugs to speed up the delivery process?

I’m not here to bash doctors or the medical system, they have a rightful place and they save lives. They are equipped for emergencies that in ancient times we didn’t have tools for. And, I believe they might be more successful at easeful births if they had the information that midwives practice with. I want to support women and those who impact the lives and well being of women and their children. Support is what precedes movement, not the fight. I fully believe that this can make a difference, even if it’s one family at a time. If a mother has a more positive birth, there is more chance for a positive and easeful relationship with her child, which may lead to better overall family health and relationships. I’ve heard countless stories of people who have challenging or “traumatic” births who work through those births through some sort of repairative therapy, and have significant life changes. My point is, it can’t hurt to be more educated and intentional with these choices. We all need a dose of reality about birth and what it can be, feel like, look like, and the side effects of all the different ways to approach it.

My Invitation: This first writing is an introduction into the topic, a form of inquiry for myself and for you. Because this content can feel tender, unfamiliar, and uncomfortable at times, I’m going to take a light touch for this first writing. I’ll deepen as I write more as time goes on and I get to a level of depth in writing that feels tolerable and manageable when I consider “if I didn’t know much about birth, how much would I be able to handle in one read?”  I’m holding deep care for you as I write this so that I find a balance between providing education and also taking it slow enough so that you find yourself interested and curious but not overwhelmed. I’m holding the spiritual aspect of this world being about life and death. It’s natural that you may (and probably will) contact feelings of overwhelm and charge within yourself. Remember that you are safe in this moment, and come back to the steady beat of your heart and your feet on the ground.

In Reverence: Before I offer up any information, I want to hold deep respect and credit for Ina May Gaskin, whom I will be citing often throughout this writing. She is one of the top leading midwives in the country and runs The Farm in TN, USA. If you’re interested in learning more about this, you may want to watch the documentary The Business of Being Born (available for streaming on Netflix). Ina May is one of the speakers in this film among many others. I will also hold deep respect and credit for the medical doctors in our country, because the majority of them give their heart and soul into their work and are trying their best. Outside of the few whom maybe shouldn’t be practicing (we have those in every field), for the most part we all come from a place of wanting to serve and provide.

One Opinion: You may not know what a midwife or a doula is (I certainly didn’t up until about 3 years ago), so take this as it comes and know that we’ll get there. The information Ina May has provided is both researched and practiced, and backed by numerous resources. One of her books is named Ina May’s Guide to Childbirth. One of the testimonials for the book comes from Christiane Northrup, one of the leading MD experts in women’s care. Christiane states: “My most fervent prayer for all pregnant women is that they read this book and heed its wisdom. In doing so, they will remember their women’s wisdom and never forget it. Thank you. Ina May, from the bottom of my heart for writing this guide to childbirth…this information can change the world.”  No big deal, huh?

Let’s begin with the basics. Below are some key terms and parties who are involved in the birthing process in terms of professional care:

– Midwife: specialist in normal pregnancy and birth. Midwives provide all the prenatal care healthy women need. The ideal of midwifery care is to work with each woman and her family to identify her unique needs including physical, social, and emotional factors. Midwifery care is associated with  fewer episiotomies (cutting of the woman’s perineum to induce delivery), fewer forceps and vacuum-extractor deliveries, fewer epidurals, and fewer cesarean sections. Midwives are trained to identify the small percentage of births in which complications require a referral to an obstetrician. There are three basic categories of midwives (Certified nurse-midwives, Certified Professional midwives, and certified midwives). All the different categories may have different trainings and credentials. Most Certified Nurse-Midwives practice in hospitals. Be sure to inquire about the training and types of practices a midwife uses, the term midwife does not always mean the same thing. Midwives and doula’s are often seen as advocates for women-centered care especially when in a medical model setting such as a hospital.

** One statistic to note that can give perspective: midwives are required by law to be present at all births in Germany, are present at a very high number of births in Japan and other European countries, and midwives attend less than 10% of births in the US. This got me wondering why more of us don’t know what midwives do and why they seem to be in the shadows compared to all the other knowledge we get about birth.

-Doula: birth companion and post-birth supporter. A non-medical person who assists a woman before, during, and/or after childbirth, as well as her spouse and/or family, by providing physical assistance and emotional support. The provision of continuous support during labour is associated with improved maternal and fetal health and a variety of other benefits, including lower risk of induction and interventions and less need for pain relief. These benefits are particularly significant when continuous support is provided by someone who is not there as family/friend or as medical staff (i.e. a doula).

-Family Doctor: a percentage of family doctors in the U.S. provide maternity care (usually more prevalent in rural areas). Many don’t have surgical privileges and refer to OB’s if surgery becomes necessary. This does not mean they are inferior to an OB due to lack of surgical rights, studies have shown that family doctors tend to have lower rates of surgical intervention than OB’s. Some family doctors practice more similarly to midwives, and some practice more similarly to OB’s due to differences in trainings.

-Obstetrician: medical doctors specializing in obstetrics. Their medical training is focused on detecting and treating pathological problems of pregnancy, labor, and birth. They are surgeons and perform cesarean sections, forceps and vacuum-extractor births. In North America, because of history, they outnumber midwives and family doctors who provide maternity care. Due to this dominance, they design most of the hospital maternity-department rules and routines and usually determine the role of a family doctor if one is involved. Because of their training in pathology, they sometimes apply interventions that are more appropriate for complicated births, to healthy normal births.
** Interesting to note that OB’s provide maternity care for healthy and complicated cases, where in most other countries OB’s provide care for complicated cases and midwives care for the normal and healthy cases.

-Intervention: this is a wide range of options / practices performed by people who provide care to those in the birthing process. This means that the professional intervenes in the labor and delivery process. This can mean anything from medications to surgical delivery. A few examples are C-sections, forceps delivery, epidural injections, electronic fetal monitoring, Pitocin and other artificial induction producing medications, etc. I’ll define what more of these are and what the benefits / possible harms are in later posts. These interventions save lives and can also be harmful.

These definitions already shine light on some of the differences in training and care. The way that stuck with me was when I heard (generally, this is not true for every single midwife or every single OB): “medical doctors assume a birth is not normal until proven otherwise” and “midwives assume a birth is normal until proven otherwise”.  This slight but shining change in language shows how birth is viewed between different camps who have different approaches.

Another disclaimer: I will never say you should always choose a midwife or always choose an OB. Just like all other humans, there are always variations even in careers such as these. I know there are OB’s and MD’s who favor birthing practices that promote the health of the mother and baby and give their livelihood into serving them. I am also sure there are midwives who practice within hospitals who often use a high number of interventions. I’m not here to choose sides or get into the “always or never” game. I’m interested in health and empowerment no matter how we get there. I’m interested in fluidity and spaciousness so that we can get past what is right and wrong and land where each family gets to feel into what is the best fit for them based on being fully informed. What feels ideal to me is that we are well educated and know how to be smart shoppers. That we know the questions to ask and we track if we trust our providers or if we need to keep looking. We wouldn’t put up with sarcasm or defensiveness from another service, so if that is present in the relationship around birth, I believe it’s important enough to say thank you and to keep looking for the one whom has the whole package.

My piece: To be open with part of my own process, I’ve been re-learning what birth means to me. I get to re-write this story for myself and that has been a blessing. If I speak only for my experience, the messages I got about birth was that it is a challenging, difficult, and a sometimes terrifying experience for everyone involved. And I know that I was wanted and loved in every way, even if some of the circumstances of the physiological process of my birth were not ideal. Birth is a complex process, let us be careful not to simplify it. Repair doesn’t do justice when I explain how it’s been to hear of stories that involve joy, ecstasy, and fulfillment. Not that it’s not hard work, because it is. But it’s different. Through this process of re-learning and re-writing there have been moments of discomfort and anger when I read about certain interventions that I know happened within my own birth story. Thoughts and feelings of injustice for myself and my mother and my family. It’s been like the shedding of layers, letting go of false beliefs about how birth has to be. Seeing for what they are: the images and stories that I’ve gained from the media, stories, rumors, and hearing of my own birth. The pieces that were supportive of women and baby’s health, and the pieces that were not. You may be thinking that those stories that involve ease could never pertain to you or your partner or your child. I invite curiosity before those decisions are made internally. Breath with me.

Set it straight: The women who have had positive experiences with birth are not super natural or special beings. All women are!  Women possess within them the strength and primal wisdom to birth a baby. The physical process that the body goes through to birth is ancient and our bodies know it. And just like that primal and ancient process, birthing sometimes involves death and that is a reality that has been around for way longer than we have.

Let Ina May speak it for us: (taken from Ina May’s Guide to Childbirth)
-birth in our society has become complicated to imagine, given the widely accepted cultural myths about the physiological act. For example, contrary to myth, intrinsic physical characteristics only rarely interfere with the capacity to give birth (i.e. have you ever thought or heard someone say “My pelvis is not big enough to push out a baby!” … the truth is the ligaments in the woman’s body become extremely flexible due to high levels of hormones and the bones and muscles of the woman’s pelvis are malleable to shape shift and form around the baby so that birth is possible EVEN WHEN the baby is large and the woman’s frame is tiny). Ina May (who has attended thousands of births and an extremely high number of them have been without intervention, impressive!) points out that your pelvis is probably big enough for vaginal birth, almost every woman’s is. One thing to note is that what is “beautiful and ideal” these days, is a woman whom does not have wide hips, whom has a smaller than natural body. This is important to note IF your body is healthy, you should have no trouble with your birth unless there are unexpected complications.
– mental attitudes and emotions interfere with the ability to give birth far more than is understood. I will touch on the mind / body connection and birth in the next post, it is probably one of the most important things we as women can learn. If we learn and know and believe this and have people around us who can support strength and faith in the process, the necessity for worry for all the other pieces soften and may even fade away.
– For those of you who are interested in numbers, here’s one from The Farm (the birth center that Ina May and her midwife partners run): before the first cesarean birth was necessary, 186 babies were born. The second cesarean was the 324th birth. They achieved this low intervention rate without endangering women or their babies. That one can shake up the myth in my mind with the snap of a finger. I began to think “if those 186 women and babies could do it, then why do we have so much intervention happening everyday?”
– The principles The Farm rests on: They let the women feel in charge of their birth and saw themselves as support professionals whom hold the woman with love.  They let the women eat and sleep and drink fluids. They let women trust their own timing about when they went into labor and began pushing. They didn’t scare women. This combination of protocols that sound like no brainers (but that I’ve never heard of before beginning my learning) produced a process that lead to relaxed, happy, enthusiastic mothers and healthy babies. Part of being well-prepared for birth is being educated about the routines and plans that you may encounter if you do enter a hospital and how those might affect what is supposed to be your normal physiological process.

Ina May hits it home by stating: “I share my experience to encourage and inform you. It’s important to keep in mind that our bodies must work pretty well, or there wouldn’t be so many humans on the planet.” How nice is it to hear a birth practitioner being encouraging? This information that Ina May shares is special because it was “discovered and realized by a group of women who collectively learned that developing a women-centered style of maternity care made it possible to know things about their innate physiology that they had never before heard of” (in her own words).

That feels like a good place to pause for now. My invitation is that if this is new information to you, see how it lands and how you take it in. Are you relieved? Doubtful? In wonder? Frustrated? Filled with grief about a difficult birthing experience you’ve had? Excited for your future with birth? Curious about what your birth story is?

If this is old news to you and you want more details, please stay tuned for the rest of this blog series which will explore themes including the mind / body connection and the importance of mental attitudes & emotions, the physiological process of labor and delivery, a list of / explanations / cause and effects of the interventions commonly used in hospitals, the myths about birth, resources and unknown practices, and much more.

If you have questions, comments, or anything to share, please email me at alicianpatterson@gmail.com. If you are interested in services from a doula, I will be taking new clients in July 2015 and am happy to refer you to someone I know if you are in need before then. I will be providing one pro-bono service as a doula per year. Please inquire for more information about that and / or rates and logistics.

One resource to know about is that cranial sacral therapy (especially if it’s specifically tailored for birth repair) has been known to be especially helpful for babies and children who have challenging birth stories. If you and your child went through a challenging birth and there are any symptoms or curiosities around attending to that, you may want to check out cranial sacral treatment. You may not think the birth was challenging but if there were any chemicals or medications present, anything that prevented a vaginal birth or any sort of complications, your baby may have had some side effects you’re not aware of. Here is a possible referral for people local to Colorado or if you’re curious about what the practice entails: Click here to read more.

A few more resources if you want to learn more:
* A Guide to Childbirth and Spiritual Midwifery by Ina May Gaskin
* Childbirth without Fear by Grantly Dick-Read & Ina May Gaskin
* The Business of Being Born Documentary
* Baby Catcher by Peggy Vincent

Until next time, with love, Alicia

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About Alicia Patterson

Alicia Patterson is a Psychotherapist / Dance Movement Therapist, Birth Doula, Energy Worker, Dance and Yoga Facilitator in the Boulder / Denver area.
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