Summer 2017 Group Prenatal Classes for Surrey Langley have now been scheduled!
These classes are for expecting moms due August or September. Groups are kept small to ensure parents get their unique questions and concerns addressed. Prenatal Journey’s prenatal classes are specially designed for people who would prefer to have as natural a birth as possible.
The classes will empower you to understand the physical and emotional journey of childbirth and what effective strategies real life women use to get through labour and have positive birth experience. You will also learn how to make informed decisions about your healthcare and that of your child.
Moms often start out feeling nervous about their ability to cope with labour, but end up feeling confident in themselves, their partners, and looking forward to meeting their babies and the journey that brings them.
I am absolutely ecstatic to announce that I had my fourth kid, and 2nd daughter in January 2015. She was welcomed into the world by her older brothers and sister with so much love.
Of course as a doula and prenatal teacher, I was very interested in putting all the skills I teach in my classes to good use in my own labour.
First of all, right from the beginning of my pregnancy, I wanted to choose the best health care provider that would be a good fit with my birth preferences. This is one of the most important things I tell my clients that will affect the kind of birth you have. Don’t just choose any random maternity care provider. Find the ones who best fit with the kind of person you are, and the kind of birth you want.
Secondly, birth can be unpredictable, so when things don’t follow the textbook version of labour, you have to make informed decisions regarding what to do. There are ALWAYS options. When my water broke and my labour didn’t start for over 24 hours, it was stressful because, of course, as a mom, you naturally worry. But I kept reviewing my options and the potential risks of all the options available and kept discussing things with my midwives. Just to be clear, I felt totally fine with having any medical intervention that was clearly necessary and helpful, but I also know when interventions are not entirely necessary. There are always risks to both sides – having a medical intervention or declining it. In my situation I had the options of going to the hospital to start an induction, using non-medical ways of starting labour (herbs/ acupuncture etc which can be highly effective), or simply waiting it out. That’s another reason moms love having a doula with them in pregnancy and labour – if unexpected situations arrive, the doula can often talk moms through the decision making process, empowering them with a range of information on options so that moms can make an informed choice and feel good about it.
I knew the risks and possible outcomes of all scenarios and decided to take various herbs to get labour started. I also know that emotions and ’emotional blockages’ can have a huge impact on labour. So with the help of my doula friend, I worked through any deep seated emotions I was having that could have been blocking my labour from starting. That was EXTREMELY helpful because after I realized a huge emotional block I was holding, and then let it go, my labour started soon after.
Thirdly, of course, is all the pain coping strategies I teach. Once labour started, the first half was the easy part. The key for that is to keep focussing on staying completely relaxed. Holding on to any tension or resistance will cause pain. I was able to feel no pain at all for the first half of the labour by breathing out all the pressure waves and making a low toning sound. You can try it now, just let yourself sigh with a deep sound. You naturally let all your tension go and you feel more grounded. Remember fear in labour = adrenaline = pain = more fear = more pain. You have to keep the adrenaline out of the equation in labour and keep deep breathing away any tension or pressure you feel building up. Pay attention to your body.
As contractions intensified, I moved around, feeling for whatever positions felt more comfortable. Sitting, squating, standing, lunging, leaning forward on furniture, sitting backwards on the couch, swaying my hips etc. I was chatting with my doula, friend, mom, and midwives in between contractions. Eventually, I felt like leaving the living room and going up to my bedroom. In labour, women naturally experience a going within. They feel like they are going deeper and deeper inside themselves as labour progresses. A woman starts using more of her primitive, instinctual brain and less of the cerebral cortex. It is the instinctual part of the brain which controls the natural process of labour. Labour flows more smoothly when a woman is undisturbed so she can smoothly go deep within herself. Any distractions that pull a woman out of this state of mind will slow down the labour and also create unnecessary pain sensations. Bright lights, too much talking, asking questions, talking about time (which is a cerebral concept), telling a woman what to do so she can’t listen to her own body’s instincts, disturbances like frequent blood pressure checks, vaginal exams etc. will all take a woman away from her “labour land” state of mind. And to the labouring woman, this feels quite irritating.
I told my midwives that I wanted a very hands off approach to my birth. I didn’t want any unnecessary disturbances such as internal dilation checks or them telling me what to do. But having them there in the background helped me feel safe in the rare situation where medical help might be needed. It is important for birthing moms to feel safe and supported. That will lead to a smooth labour process. Anything that makes them feel worry, fear or anxiety will cause a slowing down of the labour process, or even complications.
Once I got to my bedroom, the lights were off with just a dim light on in the bathroom. My older daughter had woken up by this point and she lit some candles to add to the mood of the room. My mom made sure the music playlist I had put together for the birth was still playing. I had complied a series of songs that I found both inspiring and relaxing. I love music and I find it helps me set the tone for focusing on feeling good. In labour, you want to take your attention off the pain sensations and replace them with anything that makes you feel good. My doula was massaging my sacrum while holding a hot pack on my lower back. My husband rubbed my back and shoulders. That all felt really good. By this point, I was not feeling zero pain, like in the earlier part of the labour, but all these things helped take the edge off the intensity of contractions so they were completely manageable.
People often tell me that I’m brave to have a homebirth. Nothing could be further from the truth. The truth is, in terms of pain management, homebirth is often easier to manage because I feel more comfortable at home and there are so much fewer disturbances to my instinctual state of being. In terms of safety, solid evidence shows that homebirth is as safe, if not safer, than hospital birth, as long as it’s a healthy pregnancy, there are trained care providers in attendance, and a hospital is less than an hour’s drive away if there is a need to transfer. Here in the lower mainland, BC, Canada, we are so lucky to have a fantastic midwifery system that functions relatively smoothly at home or hospital. If you feel more comfortable having a homebirth, definitely go for it, or at least look into it. If you feel safer and more comfortable in a hospital, then hospital is the place for you. Birthing moms should be in the place that is more conducive to them feeling safe and supported. You have to know yourself, and know what you prefer. It doesn’t matter what anybody else does. It only matters what kind of experience you want and how you’re going to get it.
Eventually, my contractions got pretty strong and I wondered if getting in the bathtub with warm water would help. I wasn’t particularly planning a waterbirth, but I always keep my options open. The warm water does take the edge of, but of course, labour is still a pretty intense and powerful process. At one point I joked with my midwife, “So you brought an epidural with you, didn’t you?”
“Yeah, it’s just in my back pocket,” she smiled.
“Oh good. I wouldn’t want to be crazy enough to have a natural birth.” 🙂
(Just in case you didn’t know, you can’t have an epidural or any other drugs at a homebirth because of the risk those things entail.)
I remember, through one contraction I just swore the whole way. Then for the next one I struggled to remember what the purpose of all the pain was. Oh yeah, to open the cervix and let the baby out. So I started chanting “Open, open…” through the whole contraction, while visualizing my cervix opening fully, quickly and easily. Soon after that I started to feel worried. I had the presence of mind to remind myself that this was a normal emotion during transition (the last bit of the dilation phase before the pushing phase). I was worried that this would go on forever and the baby would never come out. It’s common to have this rush of irrational feelings in transition, and a doula often reassures a labouring mom that this is a natural part of the process and it’s good sign that means things are progressing. It is important for the mom to go back to her state of feeling safe and relaxed instead of letting the worry and the adrenaline intensify. Again, smooth, fast and instinctual pushing phase vs. prolonged and worried pushing.
I soon began to feel “pushy”, meaning I felt like pushing a little at the peak of each contraction. I let the midwives know so they could get ready and everyone else too. My younger two kids were woken up so they could be present for the birth. I tried different positions in the tub – on my back, side, hands and knees, until I found the most comfortable position for myself, which just happened to be squatting facing the width of the tub instead of lengthwise so my feet could push against the side while my back rested on the other side.
Pushing contractions feel different than dilation contractions because you’re not just trying to relax through each one. You’re actually actively pushing with each one. And in a drug free birth, you can feel the powerful force of your body pushing instinctively. It’s not something you can stop. It’s like one mom said, it feels like you’re body is just vomiting the baby out. It’s so strong and so involuntary. In a drug free birth, no one has to tell the mom how to push. Her body just does it. Pushing feels way more fun than the dilation phase before it. I felt very powerful.
Once the baby’s head was low enough in my pelvis, I could feel it. It was definitely a strange sensation and I exclaimed to all the 10 people who, by now had piled into my bathroom, “It feels like a bowling ball.” I put my finger in and felt the top of the baby’s head less than an inch away. A couple more pushes later and I could feel her head crowning. This feels like a burning sensation as the perineum stretches around the baby’s head. I expected this part to take a while, as it can take several pushes to slowly push the head out. But my body just kept going and in one push she went from completely inside to completely out. I had planned to catch her myself if possible, but she came so fast. No one was quite ready for that. Luckily my husband was speedy quick in catching her and lifting her out of the water and onto my tummy. She was happy and content sitting on my tummy, looking around.
We hadn’t found out the gender, so it was very exciting to look down and see it was a girl. My daughter finally got the sister she had been hoping for for so long. Here’s the picture that captures the sheer intensity of emotions of that moment right after birth – relief that it’s over, exuberance over the new person you are meeting, and for me the shock of how fast she came out and surprise that I got the girl I wanted.
It was a lovely family experience to have all my kids there, my mom, sister-in-law and friend. My husband caught the baby, my daughter took the photos, my older son cut the cord and my younger son helped the midwife weigh the baby. My kids will all grow up knowing that birth is just a normal, natural and safe part of life. Not something to fear. By the way, I wanted to wait till after the placenta was out to cut the cord, or at least until the blood in the placenta had finished pumping to the baby, instead of cutting the cord immediately. This is so that she can get her full blood volume and have a gentle transition to life on the outside.
Once I got out of the tub and walked back to my bed, I birthed the placenta and breastfed my baby before letting everyone else have her for some cuddles. My mom made me a nutritious, yummy smoothie with a tiny piece of placenta blended in. Having a bit of placenta reduces the risk of postpartum hemorrhage.
It was a lovely morning. I stayed in bed all day snuggling my new sweetheart. And the other kids were just over the moon excited with their tiny sister. Plus they got to take a day off school. 🙂
Birth Trauma is a topic that has been weighing on my mind quite heavily the last couple of days. There have been ongoing protests outside BC Women’s Hospital in the last few months, and more are planned for different locations and hospitals around the Lower Mainland and Fraser Valley. The protests certainly caught my attention with this video on you tube Birth Rally at BC Women’s Hospital.
I know Birth Trauma and Post Traumatic Stress Disorder as a result of a birth experience exists, but this was the first time I was seeing people openly speaking out with terms like “Obstetric Violence” and actually naming the doctors who imposed unnecessary medical procedures on women without their consent. Seeing the signs just gives a glimpse of the tip of the iceberg. It’s hard to understand exactly what they mean until you take a closer look at what happened, why and how it causes the actual experience of Trauma. Then after that, the important question of, “What do you want to do about it?” needs to be asked.
One of the organisers of the events, Kalina Christoff, has also provided a detailed explanation of what exactly happened that caused her distress, what she did after to start a dialogue with hospital staff, and why she eventually felt like holding rallies was the only way left to create change for other women. You can read her story here : Vancouver Birth Tauma.
Untangling the mess
The term ‘Birth Trauma’ can refer to two things – physical damage to babies during birth; and the psychological damage to mothers during birth. Of course, there is also psychological damage to babies that can happen during birth but since that is harder to study, research in the area is relatively new and scarce. The content of this article will be about birth trauma to mothers. (I believe that mother-baby are not separate and what causes stress and harm to mothers, causes that to babies as well. And when mothers are treated well, babies are treated well. You can’t stress the mom out and say you’re doing it to take care of the baby. The mom’s stress will stress the baby out too.)
The general public has a perception of what Birth Trauma means. They usually assume birth is pretty painful and can be so unbearable that it can be traumatizing. So an epidural seems like a pretty good solution. Or they may think that women may feel traumatized only when their babies are injured or die during the birth process. While these events may happen, there is a much more multi-layered dynamic.
First of all it helps to understand the process of Labour and Birth as made up of two distinct processes –
1. The natural course of events that would take place if there was no human intervention, and
2. The human intervention that takes place, usually in the form of medical procedures, some minor and some major, both of which can alter the course of the natural process itself.
What Causes Trauma?
While the natural process may be painful and difficult, that in itself does not cause the experience of trauma unless there is some cause for strong anxiety or fear. The more common cause for feeling traumatised is feeling the loss of power over your own body and situation when people do things to it that are outside your control. That is the cause of all trauma – Feeling Powerless over your own situation.
In other areas of life, you can see how certain types of situations can cause people to feel traumatised. Eg. Bullying, for example, where the victim feels like they have no power to prevent the bullying, War is another situation where people can feel traumatised, both the civilians who have no control over the events in their lives, and the soldiers who have to obey orders and do things that may not necessarily choose themselves.
So how can trauma happen in a birth situation?
Firstly, during labour and birth, the moms are in a vulnerable state. They are dependent on the care providers for helping them and their babies safely through the process to varying degrees. They also have some level of trust that their care providers will take care of them appropriately. Physically, they are vulnerable because they are in pain, half-dressed and may be exhausted and not thinking straight.
While most of the time, care providers are motivated by moms and babies best well-being, the fact is that they are also human. Just because we, as a society are trained to believe that we should always trust doctors, doesn’t mean that every doctor will never abuse his/her power. They are human. It would be ridiculous to think that everything a doctor does is always for the safety of moms and babies in birth. It’s not unreasonable to realise that there are other factors that effect decisions doctors, nurses and midwives make in labour. For example, scheduling, time, other patients, being tired, not wanting to do extra work, differing payment amounts for various procedures, peer pressure, lacking in experience or knowledge about certain situations, and as Kalina experienced, needing to train student doctors, nurses and midwives.
This leads to a heck of a lot of medical procedures done that kinda, maybe needed to be done, but probably not. Things are done to speed things up, make extra money, train students, get it over with so they can go home, go to sleep or go on to the next patient. The thing is, nobody is going to come right out and say that. They say things like, “The baby could be in danger,” “The baby’s heart rate is not looking good,” “It’s best for you and your baby,” and so on. Most mothers and fathers would not have the background knowledge to know the difference between a real problem, and a fudged one. They might happily agree to any procedure thinking it was saving their baby’s life. That probably won’t lead to feeling traumatised unless the procedure directly or indirectly causes some unexpected damage or pain, and the mom realises later on that the procedure may not have been necessary.
Many times, the risks to procedures are not explained before they are done. This can eventually lead to women feeling like they have no control over their situation because they don’t know what could happen or what they are agreeing to. Agreeing to a membrane sweep, induction, forceps, c-section and many other things has unwanted risks, but women are not told about them before they are agree to it. Worse still, it is common for membrane sweeps to be done by some doctors at 38 or 39 weeks without even informing or asking the woman’s permission. Forceps of vacuum can be great if the baby’s life is clearly truly in danger, but in those iffy cases where maybe, sorta the baby may be starting to show signs of distress, are the risks of forceps greater than the risk of waiting and trying other methods? Forceps can hurt the baby as well as cause permanent damage to the moms pelvic floor resulting in incontinence. If the mom is saying no, and the doctor does it anyway, can you start to see why some women say the way they were treated in labour was a violation just like rape?
That’s what causes the feeling of trauma and powerlessness. That’s what causes post-traumatic stress disorder after birth and some cases of post-partum depression. It is estimated that 4% of women have post-traumatic stress disorder after birth. But birth is a funny thing in human experience –
1. It is one of the few things that only women do. Probably if men did it too, it would be handled a totally different way.
2. It is a private event behind closed doors so the birth is not in public awareness.
3. You may learn how to fix basic things in your car, how to do your own accounting, how buildings are made even though you are not a mechanic, accountant or engineer. But, even though every single person on earth is born, shockingly very few people learn any basic knowledge about birth. Most of what they know is from the media, which is saturated in complete misinformation. Because of this fact, the decision making power over decisions about your own body and baby in birth is often handed over to health care professionals. This is a huge amount of power.
4. Unlike war, which is associated with death, birth is associated with being a happy time with a new baby. It is extremely confusing for both moms and other people when the joy and love is totally mixed up with trauma and horror over the way they were treated.
So because birth is quite different than most things in human experience, the general public cannot even comprehend why some moms could have birth trauma. This is quite clear when you start to mention Homebirth. The most common response is, “Why would anyone want to give birth at home?” “To avoid the risk of having my decision making power over my own body and baby completely violated, duh! What else, would it be?”
I have seen births with complications where the medical staff was awesome, focused and committed to honoring the mother’s wishes within the realm of safety. For example, there was a baby who was having a little trouble breathing and they figured it would be better to take her to the nursery. It was important to the mom to have a few precious moments to see and touch her daughter before she was taken away. The hospital staff totally respected the mom’s request and understood how important it was. They took a lot of care to explain and comfort the parents about everything that was happening with their baby in the nursery so that the parents would not be overcome with worry. It was very touching.
In other situations, however, I have seen medical staff get annoyed with moms’ reasonable requests and feel that they are unimportant. The attitude is that it doesn’t matter how moms feel. They should just be grateful to have a live baby.
The thing is this, there was a study done which showed women’s experience of birth was influenced most by the way they were treated by the people around them, not so much the length of labour, the amount of pain or even the outcome of the birth. Women can have extremely long, painful labours, and feel really good about them if their care providers and support people treated them with respect and dignity. Women can go through miscarriage and stillbirth, and even though that may be very upsetting, can feel soothed by care providers who treat them in a caring way and involve parents in making decisions. Women may have a short, straightforward labour and a healthy baby but feel terribly about their birth experience if care providers were brusque, demeaning or disrespectful to the moms.
As I am writing this, an article is published int he New England Journal of Medicine. Court-Ordered Care – A Complication of Pregnancy to Avoid. It highlights cases where mothers are forced by courts and doctors to undergo medical procedures supposedly for the health of their fetus. Now for the people who can’t see the stupidity and violation of that, I don’t know what else to say. But I know one thing, there is no one in the world who cares more about the safety of her baby than the mother herself. Mothers are not stupid. They are completely able to make decisions about what’s best for their babies and would do whatever they felt was necessary. The doctor doesn’t always know what’s best.
If you or someone you know feels like they have birth trauma, please read Kalina’s page Recovery from Birth Tauma. If you would like to talk to someone, you can call me at 604 809 3288, or email kaurina @ prenataljourney.ca.
Kaurina Danu is a Birth Doula and Prenatal Class teacher is the Surrey / Langley area. She works to empower mothers who want to make informed decisions about their pregnancies, births and parenthood.
Vaginal Exams are commonly done in labour by nurses, doctors and midwives to find out how dilated the labouring mom’s cervix is. Other terms that refer to the same procedure are VE’s,Internal Exams or Pelvic Exams. It is basically putting two fingers in the vagina all the way up to the cervix to feel :
1. How DILATED (open) the cervix is
2. How soft and short the cervix is (EFFACED)
3. Which direction the cervix is facing – POSTERIOR (to the back) or ANTERIOR (to the front, when labour progresses)
4. Where the baby’s head is in relation tot he pelvic bones (STATION)
5. And what position the baby’s head is facing.
While this can be a very useful procedure to find out very useful information, women also need to understand the full picture.
First of all, the damn thing hurts. It ranges from slightly uncomfortable to downright excruciating. Now remember, in nature female animals and humans don’t regularly go around sticking things up their cervix to cause even more pain and irritation when doing one of the most difficult and intense jobs in their lives – giving birth.
Secondly, it is not an exact science. It is not as if they are putting a ruler in down there. They’re just feeling around and making an estimate with their fingers and their experience.
Thirdly, having too many done can introduce germs and cause an infection, especially if several are done after the water has broken. In general, VE’s should be kept to a minimum and used wisely, but after the water has broken, this guideline should be followed even more strictly. I have seen some births where The rupture of membranes happened days before birth (called premature rupture of membranes), but there was no infection because they were extremely careful to avoid internal exams and instead assess progress by external signs. And I have seen births where the rupture of membranes happened normally at the start of labour * but an unnecessary number of pelvic exams were done, only to cause infections in the mom so that they had to have cesareans.
*Note : Most labours start with contractions and the water breaks towards the end of labour (around transition which is between 8 – 10cm dilation). Only 20% of labour start with the water breaking and then contractions follow soon after. If contractions don’t start within 12 hours of the water breaking, it is called Premature Rupture of Membranes (PROM).
Be wary of having students nurses, doctors or midwives at your labour. They need to learn how to do VE’s effectively, so they do one, then the mentor does one to make sure they’re estimate is right. Then when there is a shift change, the new person might want to do another one. All of this is unnecessary and simply risky once the water has broken.
Some caregivers do internal exams towards the end of pregnancy because they want to guestimate how soon you’re labour will start. Some caregivers don’t do any internals before labour because they don’t see any point in it. They figure labour will start when it starts. There are some changes that take place before labour. The thing is, there is no way of knowing when labour will start because the changes can take place, but then no action may happen for weeks, or no changes may happen and then in a very short time, everything can happen and labour can be quick.
Labor is not simply about a cervix that has dilated, softened or anything else. A woman can be very dilated and not have her baby before herdue date or even near her due date. I’ve personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she’s been told that this baby isn’t coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.
Some practitioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks.
So another reason some caregivers do weekly pelvic exams from about 37 weeks onwards is, if the cervix is slightly dilated enough to fit a finger in, they might try separating the amniotic sac from the uterus to try to hasten the start of labour. Some caregivers ask for permission before doing this, but some don’t even inform the women about what they are doing. So if you do not want his done, make sure you discuss it before allowing a pelvic exam in pregnancy. A lot of women get fed up with being pregnant and want this procedure done in hopes of speeding up the start of labour. But not all women want to do that. Know what you want and let your caregiver know what you want.
Fourthly, the results of a VE can be very discouraging if they aren’t what you expect. A woman who is in intense labour with contractions coming one on top of the other may be feeling that she’s in transition, yet have a VE say she’s only 6cm. This can be discouraging. The thing is, she may actually progress very quickly to 10. Where you are now has no relationship whatsoever with how fast you are going.
The fifth thing to consider will help you determine when a pelvic exam might be useful and when it might be useless or harmful –Will the information from the exam help us make a decision about the course of action ?
A lot of vaginal exams are done just for the heck of it to “assess progress”. Most of the time this is unnecessary and leads to unnecessary cesareans. Sometimes there may be no dilation for hours. There can be several reasons for this :
The mom might be feeling anxious or stressed, which can inhibit labour from progressing. To understand how emotions can effect labour, Read my article.
Or there may be a genuine problem that cannot be solved except with medical intervention.
So the question to ask your caregiver if they are suggesting an exam that you are unsure about is, “What will you find out from the exam and what might you do based on what you find out?”
Usually two basic VE’s are done in labour, although sometimes even these are not necessary. One is when you get to the hospital, or if you are having a homebirth, when the midwife gets to your house. They usually do a VE to check if you are in active labour (4cm or more). Before active labour, the hospital will send you home, and the midwife will go home. Early labour can take hours and there is no point of being in the hospital before then unless there is some medical problem. If you are past 4cm, they will get you a room in the hospital, or the homebirth midwife might call the second midwife to get ready to come.
The second VE may be done when you feel an overwhelming urge to push. They may want to make sure there is no cervical lip left before you start pushing. In both these cases, action will be taken based on the results of the VE.
Other times that a VE may be useful are when a mom is really asking for medical pain relief. The amount of dilation will determine what kind of pain relief (epidural or morphine) may be appropriate or whether labour is close to the end and maybe no pain relief is necessary.
The thing is, some VE’s are done just for the sake of charting purposes. There is a ridiculous theory that dilation ought to be at least one cm every 2 hours. It doesn’t take a rocket scientist to figure out that different people do things at different rates and that’s ok. It doesn’t mean anything is wrong.
The important thing is to limit the number of VE’s done by figuring out if the information they provide will help you and your caregiver make decisions about what to do next. Don’t take the results of VE’s to seriously. Don’t get discouraged if it’s not what you expect. (I know that’s easier said than done.) And try to have only one person do the VE’s in labour instead of different people and different opinions.
To find out more about prenatal education, natural birth information or doula support in labour in Surrey or Langley BC email kaurina @ prenataljourney.ca or call 604 809 3288.
Anyone who knows me, knows that I’ve been working on writing a book about birth for a couple of years now. Anyone who’s ever written a book, knows that writing a book is a tricky process.
For me, the trickiest bit has been deciding on the angle to write it from. I know what specific topics I’m passionate about. I’m just trying to figure out how all the theses I have evolved over the years can fit together like nice a big puzzle. And how it’s going to have themost impact on improving the culture of birth in the world.
So far I have come up with an outline I’m pretty proud of. Here goes :
The Epistemology of Woman-Centred Maternity Care :
Bridging The Gap Between Natural and Medical Models of Birth
In the book I would like to offer solutions to a problem as I see it. While so many advancements have been made in the field of maternity care, and we now know more than ever before, the outline of the problem is this :
1.The statistical rates of mortality, morbidity and complications are still higher than they need to be in much of the world, as evidenced by considerably lower rates in a few places in the world. While poverty is a factor that contributes to much of those statistics, and is a factor that is beyond the scope of this book to address, there are other easier to address factors besides poverty that can be reduced, and I shall highlight some of them. The natural process of birth and medical management of birth exists in a delicate balance. Many experts point to evidence that overuse of medical intervention in birth has tipped the scales of safety towards less safe outcomes. While benefiting those who need it, it has been suggested that its over reliance and use on those who don’t need it has in fact, CAUSED some complications and poor outcomes for mothers and babies.
2.Beyond the statistics, are many women and children who are physically and emotionally damaged in small and large ways by the management of their births.
3. In an effort to avoid this overuse of medical techniques in birth, a small but growing percentage of the population of North America has turned instead to avoiding the hospital altogether as they do not feel safe giving birth there. There is also an alternative philosophy to the medical management model, which is woman-centred care. The field of midwifery is generally responsible for the knowledge produced on woman-centred maternity care, although many individual doctors practice this way, and not all midwives practice woman-centred care. Woman-centred care is the topic I would like to delve more deeply into in this book so that everyone can get a clearer picture of what that means, what it entails in real life practice and how it can make significant differences in outcomes as well as people’s real lives. So while there is a body of knowledge that comes out of the experience of midwives and the experience of homebirth, there is a tremendous gap between that body of knowledge and mainstream medical maternity care.
4. Furthermore, the body of knowledge that is still missing from both these perspectives of midwives and medical professionals is the epistemology that can come from the experience of the women doing the birthing themselves. I would like to suggest that by piecing together the knowledge from individual women’s experiences and formulating a collective position, it would be possible to bring maternity care a a whole new standard, as well as bridge the gap between the medical and natural birth worlds.
Everything in our world is always improving and evolving. There is no reason why the culture of human birth should not. I strongly believe, however, that the improvements will not come from more technology, but from a deeper understanding into the human psyche of labouring women themselves. It is the inner mental and emotional experience of labour that can offer the clues to understanding the delicate hormonal balance that controls the normal process of birth. While medical advancements have made it safer than ever before to use medical interventions such as epidurals and cesareans in birth, they will probably always be less safe than the non-man-made process of birth. Just as infant formula can be made as close as possible to breastmilk, it will always remain a far cry because it is impossible to create the living enzymes, antibodies and ever changing micronutrients in breastmilk. The long term effects of medical interventions into the process of birth is far greater than anyone can comprehend. I would like to suggest, despite all our advancements and 100,000 years of human history, shockingly little is understood about the normal, uninterrupted process by which human beings come into the world. I would like to bring more understanding of this into mainstream knowing. It is my hope that by fitting the missing pieces together, we can have a future world where human beings start off their lives with less trauma and more love because it is this that makes us human.
I’m putting it out there for anyone reading this : If you would like to add your contribution to the book, please let me know. You can email me at kaurina at prenataljourney.ca or call 1 – 604 809 3288.
I am looking for : childbirth experts – midwives, doctors, nurses and doulas, as well as, moms who would like to add their own experiences.
I know your time is valuable, so I would make it as easier as possible for you to add your input. If you prefer to writing, you can write me an email on the aspect you would like to contribute. If you would like to do an interview instead, I can set up a convenient time for you to do an interview.
You wouldn’t expect labour and delivery rooms in hospitals to be places of great romance, but I’ve seen it with my own eyes. Much has been written about the love between mothers and their newborns. Sometimes it’s a quiet, gentle love, and sometimes it’s an overwhelming, life changing love. But the kind I’m talking about right now is the love between the mom and the dad in labour.
The media has solidified an image of the interaction between moms and dads in the delivery room revolving around the mom swearing profanities at the dad, and the dad being mostly clueless and bumbling. I honestly don’t know how representative that is of most labours because I don’t see most labours. I only see the ones I’m doulaing for. And what I see is the deeply moving culmination of the romance and bond of the two people who have worked so hard and put so much of themselves into bringing forth a new life.
I see men who love and care for their wives and newborn children with so much strength and intensity. I am profoundly touched every time I see a dad wrapping his arms around his wife’s shoulders, putting his forehead against hers, supporting her through contractions, loving her with every fibre of his being. Every time a dad goes hours, tirelessly massaging his wife’s back to take the edge of each contraction, or holds her under the shoulders to support her weight if she’s more comfortable in an upright position but is too tired to support her own weight.
I see the look in their eyes as they look at their wives with awe of her strength and beauty through the whole amazing process of birth. The worry and concern they have if their wife is having a hard time. I see women holding on to their partners for solace, or resting their heads against their partners chest to help them relax. I see dad watch mom’s every move, anticipating when she might need a sip of water or a cold cloth to wipe her brow. The sweet whisperings of encouragement and love. I see the tears of joy or beams of radiance when dads hold their newborns for the first time. It’s such a well deserved high for both the mom and dad who’ve worked so hard together.
I see men who will be forever changed by the experience of being so helpful and supportive of their wives through labour. It deeply strengthens their relationship and connection to their partners and their children.
I don’t know what dads are like at births I’ve not been at. I imagine some men are naturally great at supporting their partners in labour, and some are not because they are feeling unsure, overwhelmed or disconnected. I know some parents-to-be, when considering if they want to have a doula with them at their birth, are concerned that the doula will take over the dads role. I can understand that concern, but actually, it’s quite the opposite.
I don’t ever take over the dad’s role. That is the primary relationship that the doula can never replace. The dad is so helpful in the delivery room just by being there and loving his partner. I always recognize and support their relationship. I’m just there for a short period of their lives, but they are the ones who are going to be raising their child together for years, so I try to enhance their connection during this intense experience of labour and birth.
For the men who are unsure about what to do in the delivery room, they quickly gain more confidence by watching what I’m doing and figuring out how they can support their wives. Quite often dad and I tag team to provide massage, counter pressure or hip squeezes to mom for hours on end. If dad has any concerns, I am immediately there to answer all his questions as best I can. The dads never feel overwhelmed that too much responsibility is on their shoulders.
Occasionally I meet a dad at the prenatal visit who really does not want to be in the delivery room. If the mom doesn’t want him there, then it’s fine. But if she does, then I want to make sure I address his fears and make it clear that he can participate as much as he’s comfortable with since I will be there too. If he’s still not convinced, I talk to him about something extremely difficult he’s experienced or witnessed in his life. Then I get him to imagine the difference between having people to support him through it versus doing it totally alone. That’s always enough to flip the switch and motivate the dad to commit to being there no matter what.
Sometimes a dad will have a strong emotional reaction and it helps to have someone there to share it with instead of keeping it to themselves. One dad was really worried for his wife when she became sick with an infection in labour. He felt relieved after talking to me about his fears. Another dad took me aside after the birth to talk to me. The intensity of the experience brought up memories of their previous child who was stillborn. He recounted his last experience and said that him and his wife had no one to support them through that. They felt so alone. In contrast, this time, they felt so supported. He thanked me for, “caring for his wife better than her mother could have.” I was so moved by this man’s love for his wife, the strength of their bond through their shared experiences and the deep healing of the past hurt.
I am confident that these couples will go on with their lives with more love and connection than before their birth experience. I know the dads will continue to express their profound love beyond the delivery room in practical ways – caring for their newborn, waking up in the middle of the night to rock a crying baby or change a diaper, working extra hours to provide for their families.
Romance in the delivery room is such a special thing and I am so grateful to be able to witness it. What are your thoughts and experiences? Leave your comments below.
Many people say to me when they find out I’m a doula, “What a great job! It must be so nice to be able to hold so many newborn babies!”
But in reality, I am not a doula because I like newborns, although they are fantastically amazing, miraculous, fascinating people newborns are. I do it because of the MOMS. I do it because I know the simple things I do can and will have a life changing impact, not only on the women and their birth experience, but because it changes lives. I do it because when I focus all of my attention on caring for moms at one of the most important, challenging and vulnerable times of their lives, they are better able to care for themselves, their babies, their children and their families. I take care of the emotional needs of the dads as well in that critical period, so that the couple’s memories of the start of their child’s life is that of love, care, pride and strength. Not that of stress, anxiety desperation and disempowerment.
Sometimes it’s hard to know if what I’m doing is making a difference, because pregnancy, birth and the post-partum time can still be fraught with challenges. But the moms and dads make it clear how important it was to have someone there they could always call day or night if they were worried about anything, how it important it was for someone to be only focused on what they were thinking, how they were feeling, and doing all the little things to help them feel good.
In the big picture, I do it because I believe that each family who starts out with love and care, will raise more loving and caring people. And doulas the world over are helping to change the world one birth at a time.
Every time I look at premature babies isolated in incubators, my mind screams out, “Let the mom hold it!!!” For years I wondered if I was the only person who felt that way. I know premies need to be kept warm, away from germs and with little stimulation, but separating them from their moms seems counterproductive.
Then I learnt about the options with cutting the umbilical cord – immediate cutting or letting the blood continue to flow from the placenta to the baby until it stops pulsing by itself. The common medical practice in many places is to cut the cord immediately, especially when baby needs medical help. The irony is that if a baby is not breathing, or is premature and needs medical help, they are more in need of the extra flow of blood, oxygen and nutrients from the placenta, and yet these are the ones who are more often separated from the source of that which can help them.
It was heartwarming to read of the recent story in the National newspaper in New Zealand, of a very tiny premie, who was born in an ambulance before the mom and midwife could reach the hospital. Because they were not in a hospital, they had to resort to basic techniques to help the baby. Two of the things they did was to leave the cord intact to allow blood and oxygen to continue flowing, and put it on its mothers chest. The baby did surprisingly well.
The baby girl was born at 10.50am weighing just 907grams, but she was pink and breathing by herself.
“I was so relieved and impressed that this tiny little thing was fighting so hard to breathe.” While midwife, Ras, was monitoring the baby’s oxygen and caring for her mother, James and Reesink were organising a helicopter with a paediatric team from Whangarei.
Ras, who specialises in natural birth, says: “In an emergency like this, with no immediate hospital back-up, you go back to the basics: all babies need air (oxygen), warmth, food and love. On mother’s chest, close to her heart, connected to the placenta and oxygen near her mouth – this was the best we could offer her for the first hour. We made a little hat of Gladwrap and a Gladwrap blanket over her body so she wouldn’t lose heat or fluids through her very thin skin.
“Babies who are born this early can’t suck or swallow so we could only hope the paediatrician would come soon to put a drip up with glucose and the necessary medication.” The ambulance moved to the Kerikeri Domain to be ready for the emergency helicopter. Every time the mother moved, the baby made little noises like a bird, Ras says.
The temperature in the ambulance was up to about 30 degrees C when the paediatric team, including a doctor and a specialised nurse, arrived by helicopter from Whangarei.
“They were surprised that little Cynthia Jane was still pink and breathing and her blood sugar level was pretty good. It was an amazing team effort with five people in an ambulance on the Kerikeri Domain, fighting for the life of such a small baby, who even in a tertiary hospital might not survive.”
Could it be that the baby did so well because of the basic things the caregivers did, which would not have been done had it been born in a hospital with more high tech stuff? Of course this is just one story. One story is not proof. But it does beg the question. I had a friend whose premie baby died despite all medical efforts to save him. Looking at the details of his particular situation, I can’t help but wonder if he died because of all the medical efforts to save him. There was one point in which they could have waited to see, instead of intervening. But we will never know. The doctors were just trying to do their best with what they knew.
One of the most painful memory my friend had was that in the months he was in the incubator, she did not touch him or hold him. She just wished she could have held him. It would seem to me that, as much as the mom has an overwhelming need to hold her baby, the baby has an overwhelming need to be held. I was thrilled to come across clear and evidence-based information about Kangaroo care for premies, and I imagine, lots of it is useful for sick babies and normal babies as well.
Dr Nils Bergman and his wife, Jill Bergman, from South Africa, have worked on the figuring out the best care for premies. Their website, http://www.kangaroomothercare.com/ , features an all-rounded approach to this insanely stressful time for parents of premies, the medical team caring for them, and the best health practices for the premies themselves. Their video on you tube describes the book written especially for parents to understand the medical stuff so they can feel empowered to make decisions together with the medical team. http://www.youtube.com/watch?v=_O0w8Lhekb0
It is my hope that medical care for premies and sick babies continue to improve and continue to take into account the emotional as well as physical needs of the babies and their parents. Until then, I hope that parents who have a premie can use this information to help them negotiate and discuss the care plan for their babies with the doctors and nurses, and also get support for their emotional health needs.
If you need to talk to someone about your emotional health surrounding any pregnancy, birth or parenting issue, now or in the past, you may call Kaurina at 1 – 604 809 3288.
“Laborland” is a place doulas, midwives and mothers talk about when they refer to the mental and emotional state of labor. It is a state unlike anything in normal, everyday life. It was the journey to this state of mind that I found so fascinating when reflecting on the birth of my children.
It felt like a journey to a place deep inside myself. That was one of the reasons for the name “The Prenatal Journey”. It seemed that labor felt very irritating when people were disturbing me, talking to me, taking blood pressure and so on. When I closed myself off from everyone and went inside myself, I found the stillness in the eye of the storm. I didn’t feel much “pain” anymore. The further into labor I went, the deeper into the state I was.
I was inspired to write this post after reading an article by Nancy Salgueiro called Getting To Labor Land.
“In labor the mother needs to be in control of what is happening around her, who is there and what they are doing. This needs to be dictated before she goes into labor and she needs to know that she can trust her desires are going to be respected so that she can completely let go of that control while in labor.
If she feels safe and knows the people around her will honor her requests and desires she will be able to let go of those things outside herself.
She needs to be able to completely surrender to her body and the sensations without conscious thinking. This is how she will be able to go to what is called “labor land”.
Labor land is like a deep meditative state. It is like an out of body experience except that it occurs so internally, totally within your body and in the meditative part of your mind. Being in this state allows the mom to get into the rhythm of her contractions and to develop a routine of what works for her to stay on top of the intensity of her labor.
It is important that no one tries to talk to her or pull her into her conscious mind when she is in labor land. This can take her out of her zone and make it more difficult for her to deal with the sensations she is experiencing.”
I noticed that when I was in laborland, my sense perception was different. I couldn’t actually hear or see very well. If someone was more than a meter away talking to me, I couldn’t quite focus on what they were saying. I also couldn’t hear most of the music or see the candles by the time I got to active labor. That’s why the doula who was so fantastic at my birth spoke to me right next to my ear. I could focus on that.
Another thing I noticed was that I had a heightened perception of other people’s emotions. Even though I couldn’t see or hear them clearly, I could sense what people in the room were feeling even if they were far away. It was helpful when they were feeling caring, supportive and believing in my ability. But when they were worried on my behalf or focused on mundane discussions with other people, it shook my confidence and focus.
The reason for this shift in mental/emotional states
There is a reason for this shift in awareness. Birth, like other instinctive functions, is programmed into the lower mammalian brain. There are different parts of the human brain, some of which we share with other animals. The highly developed neo-cortex is where all the conscious thinking, speech, language, sight and sound is processed. But birth requires the use of the mammalian part of the brain. All mammals instinctively know how to give birth. they don’t have to read books, attend prenatal classes or watch other females of their species to learn. It is instinctive. Human females have the same part of the brain and the sooner they leave the neo-cortex the sooner they will labor from their primitive brain.
It can be difficult to do that sometimes, especially with a lot of distractions pulling us back into conscious thought. And also our own lack of trust in our instincts and natural abilities.
It may be easier to understand if we think about the emotional / mental state of a similarly instinctively programmed function – sex. Sex is very similar to birth in more reasons than just one being the beginning and the other the end product. Sex is a function that is programmed into our mammalian brains for the survival of the species. But we can probably remember times when we had sex with our attention in the conscious, cerebral part of the brain. Compare that with how it feels the times we have sex while not in our conscious thoughts, but acting from pure animal instinct. That’s very similar to birth. You can birth from the neo-cortex and think your way through, and probably have a harder and more painful time, or you can surrender to your natural instinctual self and know that it knows what to do and it will do it well. Deep within you, you are programmed to give birth and know exactly what to do at every point in the journey.
The simple answer is, “NO, but for most women it is.”
No one actually knows why labor feels painful. There are many theories. It’s sort of like what causes period cramps and why do some women feel period cramps and others not?
The part of labor that is mostly “painful” is the contractions of the uterus which pull back on the cervix to dilate it. The uterus is the strongest muscle in the human body so when it gets going, it’s pretty powerful. The brain interprets these intense sensations as pain.
Some women either naturally don’t feel pain at all or deliberately work to mentally and physically relieve the pressure and interpret the sensations positively instead of as pain. I’m not saying it’s an easy thing to do. You can’t just say ‘mind over matter’. It’s a lot deeper than that. Some women feel so overwhelmed with positive emotions and endorphins and love that they have an orgasmic birth.
The majority of women however, do feel pain, but let me separate the “good” pain from the “bad” pain. If you think of the natural process of birth ie. animals, tribal people, people who give birth in their home surroundings, the pain is never more than they can handle. A bit of pain can be useful. “Pain with a purpose.”
A bit of pain sends a signal to the brain to produce corticosteroids, which is the hormone that stimulates the baby’s lungs to produce surfactant. Surfactant coats the lungs so that the baby can breathe air when it’s born. Babies born by scheduled cesarean without labor tend to have a slightly higher risk of respiratory problems because they don’t have enough surfactants. Also, a bit of pain can be useful in evolution for letting the mom know something big is happening so she needs to move to a safe place.
The other kind of pain is what I call “bad” pain. It is the kind of pain that is useful in letting us know that something is wrong, you need to do something about it. Think about when you have gotten a massage. The massage therapist presses on a sore point to relieve the pressure. It feels a bit painful, but it feels like a good pain. Then maybe she presses with her nails, or presses on a new injury. That feels like a something-is-wrong pain. You tell her to stop. Or like if you put your hand on a stove. The pain tells you to move. If you didn’t feel the pain, you wouldn’t know to move.
Labor is like that. There’s the normal intense sensation, and then there’s the something-is-wrong pain. The trouble is, as a culture, we have been programmed to believe that labor is supposed to be the most painful thing ever, so we don’t know what to do with that overwhelming intense pain. We just think, get an epidural.
There are a few factors which produce that kind of pain :
1. Being in a not so great position. Lying on your back is probably the most painful position to be in. It’s also the least optimal for the baby’s descent and rotation. In all tribal cultures studied, not a single woman labored on he back. The problem is, that’s the position we always see women giving birth in on TV. And hospitals tend to ask women to labor or birth lying back because the fetal heart monitor works best that way, and it is convenient for the hospital staff. If a woman is listening to the pain as information from her body, she would lie down, say, “oh that’s too painful,” then change to a different position. Some other more comfortable positions might be sitting, kneeling, standing or even lying on the side.
2. Another factor is having a labor that is induced or augmented with artificial oxytocin or prostaglandins. These can make contractions more intense than natural labor, and the uterus may not relax as much in between contractions. Other kinds of interventions can also restrict mom’s movement, disturb her from fully relaxing in between contractions and being able to go inside herself, breathe and focus while she is having contractions. These can cause a greater perception of pain.
3. Another huge factor is what is called the fear-pain cycle. When mothers feel safe, and supported, they’re bodies produce oxytocin effectively and when labor gets going, they produce endorphins. But when moms feel anxious, disturbed, unsafe, stressed or fearful, they produce adrenalins, which inhibit oxytocin, endorphins, and make the sensation of pain feel much more intense. This is telling the body that something is wrong. Mom doesn’t feel safe. This is when labor feels like unbearable pain. Knowing this, Mom and the people supporting her can help reduce her anxiety and help her feel safe and supported.
A lot of research has been done on having a Doula (professional, non-medical labor support) in childbirth. They found that doulas help reduce the need for epidurals, cesareans and instrumental deliveries by about half. The reason for this is that doulas are trained, and focused on reducing moms fear and stress as it comes up, and helping her feel safe, supported and confident in her own abilities. This doesn`t just make for a more pleasant experience. Moms`emotions in labor affect the hormones she produces, which affect the amount of pain she feels as well as whether labor will be smooth or complicated.
I teach a whole in-depth class on how to have less pain in labor, or even no pain, so It can`t be summarized effectively in a post. Let me know if you want to find out about pain-free birth. 604 809 3288.