Author: Cathy Daub, PT CD, CCE (BWI)

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Birthing in the Spirit

 

She labored in the water, feeling her body becoming lighter as her abdomen tightened in another contraction.  Her partner looked at her saying, “Are you okay?” with a thumbs up to encourage her.  She smiled back at him looking relaxed in the water.  But inside she felt huge.  Her mind was whirling as she felt the power connecting her to all the women who have given birth before her. She was not alone. This power was sustaining her through strong, hard, contractions.  She thought to herself, “If they could do it, so can I.”

Birth is sacred.  What can be more sacred than the formless taking form through the human body.  This is something we may often forget, getting preoccupied with all the other concerns in birth.  For those attending births, the process may become routine and lose the wonder and awe of what has just happened.

Experience of the Body – Birth is an integrated experience of the mind, body, and spirit.  We know it is an experience of the body because we can see the body, feel the body, and hear the body.  We see the abdomen growing a woman as her fetus approaches full gestation.  A pregnant woman can feel her baby kicking inside.  These are tangible  experiences.

Experience of the mind – Birth is an experience of the mind, and even though we can’t see the mind, we believe it exists because of all the thoughts and emotions that surface during pregnancy, labor, and birth.

Experience of the spirit – When it comes to the spirit, there is more ambiguity because the spirit means different things to different people.  But the energy driving the passage of a soul taking birth must come from somewhere, and this remains one of the mysteries of life.

I believe love and spirit are synonymous with each other and that they cannot be separated.  Love is in spirit and spirit is in love.  From the time of conception to the end of our lives, the body serves as an instrument of the spirit.  The more the body can be viewed as a vehicle through which the spirit works, the more smooth the process of birth is likely to be.  At birth, a part of the body has now become separate from it and a baby is born with his own personality, inclinations, and tendencies.  This process can be likened to a flower.  The flower can be viewed as a vehicle for the fragrance so that it can be expressed.  This fragrance brings us joy.  In the same way, the body can be seen as a vehicle for the spirit bringing joy.  The sweet fragrance could not be enjoyed if it weren’t for the flower.  The spirit could not be enjoyed if it weren’t for the existence of the body.  Just as fragrance is in the flower, so the spirit is in the body.  Both the flower and the body are material and can be seen.  Both the fragrance and the spirit are nonmaterial and cannot be seen.

When a woman in labor views her body as a “vehicle” through which the spirit can flow, she is more likely to surrender to the forces of labor, welcoming contractions as they become stronger and more intense.  She feels more confident and has less fear.  She is more in touch with her instinctive nature and follows its guidance.  Focusing on the awe and wonder in the power of such birth-forces can bring a woman inner strength that will serve her well as she progresses into the unknown of labor.

 

“Birthing in the spirit is the birthing of our ancestors.  Before birth in the western world became mechanized and dehumanized, women and men honored the sacred ability of women to create and bring forth life.  Birthing in the spirit is reconnecting with those natural, primal beginnings.  More than just relaxing and letting go, birthing in the spirit is moving through the portal of birth to the transcendent place that birthing takes women;  the place of connectedness to every being and to the earth.  It is feeling life itself pulsing through your veins with the simultaneous power of a volcano and the peaceful silence of snowfall.  It is losing yourself entirely and only then knowing the core of who you really are.  Birthing in the spirit is what women do when we are honored, cared for compassionately, and deeply trusting of our bodies’ ancient wisdom moving us to that sacred space.  Birthing in the spirit is the ritual of motherhood;  it is through the intensity of the experience of birth that women find the power and the compassion to give all of themselves, and then to give more, to their babies.  It is in that place that we become mothers.”                                                           Jacque Shannon-McNulty

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Balance in Birth and Life

As a Libra, balance has always been an important concept for me.  As I have worked in birth for so many years, the concept of balance becomes even more important. There is a very fine line of balance in the body, physiologically, as when our temperature is even one degree higher than normal, we feel ill.   The body is always adjusting and being in balance keeps us healthy. When the body is too hot, it will sweat to regulate temperature.  When the body is cold, the pores on our skin close to keep in heat.  We can feel unbalanced in life when stresses become too great. Our bodies crave balance, and balance keeps us healthy.

The other important consideration with balance is realizing how connected every part of our body is.  When one part is out of balance, the whole body feels it.  Remember the hand relaxation exercise I wrote about in another blog?  Besides being a great exercise for women in labor, it also teaches us something else.  If you squeeze both hands very tightly and hold them that way for 30 seconds, you will have time to follow where the tension is moving in your body.  The tightening will slowly spread throughout the body, becoming more subtle the further it is from your hand, but gradually, you will be aware of it.  This means that tightening the hand will have an effect on the muscles of the pelvic floor.  Therefore, the more relaxed her hands are, the more relaxed is her pelvic floor musculature.

It is very important to have all aspects of the pelvis with its muscles and ligaments, balanced in birth.  For example, if the baby’s head is not positioned directly in the middle of the cervix, it will take longer for the cervix to dilate.   If a ligament is tight on one side, the baby may not be able to descend. If a woman is very fearful of contractions, her body may be in a fight/flight mode of survival trying to protect her with a guarding energy that creates an imbalance in her body.

You may be familiar with the exercises taught to birthing women to release their pelvic floor i.e the Sidelying Release and Forward Leaning Inversion (also called “Belly over the table”) originated by Dr. Carole Phillips.  It is important that the Sidelying Release is carried out lying on both sides so the entire pelvis experiences a release.

But just knowing and doing these pelvic floor exercises is not enough.  We must think in terms of the entire system because every part of our body is connected.  For example, how is a woman in labor breathing?  Are her breaths short and fast or long, deep, and more relaxing?  The more relaxed she is, the better her progress in labor especially if she is upright and moving around.  Then her entire body is moving in synchrony with the rhythm of her labor and she is sensing a balance that feels peaceful.  Even though strong contractions are coming and going, she is in her instinctive, primal brain that knows everything is okay and she is in the “zone” moving with her labor and guided by her body wisdom that already knows how to give birth.

And sometimes, doing all of these things still results in a baby not descending for one reason or another such as a tight short cord, but a woman who feels balanced in her life and in her labor,  still knows she did the best she could, is thankful for interventions that help birth her baby, and feels grateful for the experience.

Balance is very connected to peace and contentment. So many people say, “I want peace,” as they feel their lives are in pieces.   Helping women in birth to find peace automatically results in a feeling of balance and in that moment their breath is slower, their body is in synchrony, and  all is well.

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Profession forum at the BirthWorks Peace in Birth Conference 2019

At our professional forum our speakers commented on the following:

Question #1: What is the most important thing that women need to learn:

Amber Price: They have the power to change anything. One voice can make change. Consumer
demand is important.
Lewis Mehl Madrona: Consumer demand brought the epidural epidemic. If consumer demand
was for fewer epidurals, it would happen. Women need to see birth as a joyful experience and
not a fearful one.
Nancy Wainer: Remind women that their bodies are designed to give birth.
Michel Odent: The most important question to ask today is, “What is the future of humans?”
Obstetrics is trying to neutralize the cesarean section. Most people are looking at the past –
nobody looking at the role of hormones. We must consider another question, “Are we
neutralizing the laws of natural selection by obstetrics?”

Question #2: What will it take to do this? Is the pendulum swinging in a way to create
better outcomes?

Amber Price: Ways to change the world perspective is through the images that are shown in the
media, at baby showers, and other birthing events. We need to change the words we use around
being a woman and women at birth.
Lewis Mehl Madrona: We need more funding for midwives. Studies do count and need to show
the value of midwives. Maybe midwives can get masters and PhDs, do research, and publish.
Nancy Wainer: Have big billboards saying, “I had a natural birth!” Give talks in elementary
schools about natural birth. High schools are too late – we need to reach younger children. In the
media, have TV commercials of “I had a beautiful unmedicated birth!”
Michel Odent: Before asking the question, it is more effective to analyze the current situation.
We are neutralizing the laws of natural selection. Some women give birth easily and some don’t.
Some mothers and babies die. This is the law of natural selection. But today, some give birth
naturally and some by cesarean section. We have neutralized the law of natural selection. We
need to change our way of thinking. The key word is “protection” against factors that cause
stimulation of neocortical activity in labor.
Lewis Mehl Madrona: I believe that today, epigenetics is more important for the natural selection
of genes. Autoimmune disease is now known to be a change in function of the gene. The
environment is a switch that can turn genes on and off.

Michel Odent: The secret is the evolution of evolutionary thinking. Pure genetics is hereditary
but suddenly some traits are acquired in life through epigenetics. We have to enlarge our concept
of evolution. The mother is transporting genes and the microbiome to her baby long term – we
need to think pure genetics.

Question #3: If there was one road block for peace in birth, what would you replace it
with?

Nancy Wainer: Replace the belief that a cesarean section is an okay way to have a baby.
Michel Odent: It depends on your perspective…there are two places to give birth: home and
elsewhere. Both need to be safely available to women.
Amber Price: The biggest impact is for normal birth to be staffed by midwives.
Lewis Mehl Madrona: Have equal payment for equal work.

Question #4: What advice would you give to birth workers? What can they do today?

Lewis Mehl Madrona: Tell positive birth stories wherever you are be it in line at the grocery
store or at Walgreens. Guide them to think positive about birth.
Amber Price: Use a common language with consumers such as RMC or Respectful Maternity
Care.
Michel Odent: Talk with pregnant women. Birth must release hormones; one is oxytocin, the shy
hormone. Talking with them about birth helps them understand what is happening in their
bodies.
Nancy Wainer: Share your joy.

Question #5: Peace in Birth is achieved through….?

Nancy Wainer: Chocolate
Lewis Mehl Madrona: Peace anywhere is achieved through the process of radical acceptance.
When making a judgment, breathe deeply – realize the whole life that person must have
had…send love. I’d be happy to have a doula come talk to my medical residents. Have the
courage to reach out and have conversations.
Ambe Price: First, find the right persons to talk to. Be willing to have casual conversations, one
on one. This is the modality for moving forward. Invite providers into your community. They
will come because they want to learn more. We can’t change a culture from the outside.
Secondly, birth for one woman may be great and for another traumatic. Women are asking for
the image of empowered birth without doing the work of labor. Technology is here to stay.

They need to see positive images of women giving birth. Monday morning quarter backing is
extremely dangerous as in “If I’d been there, she wouldn’t have had a cesarean.”
Gabe Tullier: If you don’t understand what a person is doing to you, get on the same page. That
releases serotonin and brings peace.
Nancy Wainer: Peace comes from doing the best you can do in each moment. We can’t control
everything.

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The Baby Way

What better way to show cardinal movement, rotation of a baby through the
pelvis, than by demonstrating with The Baby Way, manufactured by BirthWorks
International. This is an “Ah Ha” moment for any pregnant woman, helping her to
understand the importance of movement in labor.
Our imagination is much more powerful than we may realize. Showing a baby doll
fitting snugly through a pelvic model, even if cloth, still gives the impression of a
tight fit. When women feel their own pelvises in BirthWorks classes, they can
experience and imagine more space that is there for their baby to move into.
Then when they see the diameters of the pelvis in The Baby Way, they understand
how the baby rotates to move through the pelvis in optimal pelvic positions. This is a powerful connection sure to have a
great impact on any woman giving birth.
The Baby Way is a must have tool for anyone birth professional including childbirth educators, doulas, nurses, doctors,
and pregnant woman. (See demonstration on BirthWorks website interview Nicholas Olow with Cathy Daub)

www.birthworks.org/product/the-baby-way-2/

The diagrams below show the pelvis in an upright
position which is optimal for birthing. Note that the
pelvic inlet is wider from side to side. Since the
widest part of the baby is the shoulders, the baby
must enter the inlet and then tuck his chin to turn 90
degrees so the shoulders can pass through. In
contrast, the outlet is wider from front to back.
Therefore, the baby must turn 90 degrees once again
to move his/her shoulders through the outlet.
Turn the head into a breech position with feet first and
demonstrate how a breech baby also turns and rotates to
pass through.

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Where is the pelvis? The Importance of an Upright Pelvis in Birth

We often ask, “Where is the baby?” in a pregnant woman, but even more important is the question “Where is the pelvis?”  A new vision is urgently needed in birth.  Anatomically, babies are supposed to be born “out the back.”  In the diagram here of a woman on a bike, note that even in an upright position, small movements in posture affect the angles between the spine and the pelvis.  The arrows depict the direction in which the baby will be born. Today, most women are lying on their backs birthing their babies “out the front” which makes birth more difficult.  Anatomically, babies are supposed to be born “out the back.”

Even though we are not always aware of it, our bodies are always in constant motion with the heart beating, lungs breathing, and blood vessels carrying precious nutrients throughout the body and excreting what is not needed.  Gravity plays an important role in these processes.  Even a newborn needs to start learning anti-gravity positions to start the process of being upright and eventually creeping and walking.  The human body wants to be upright and active to function efficiently.  This includes birthing a baby.

We have gravity because of the dynamic equilibrium of the Earth moving around the sun. The speed with which this happens creates a centrifugal force that balances the gravitational force between the Sun and the Earth.  Gravity is so important to our very existence that astronauts in space need to exercise at least two and a half hours each day to give the body a sense of weight-bearing.

It is much easier and more comfortable to defecate in upright positions.  In the same way, it is easier and more comfortable to birth our babies when the pelvis and the organs within it are in upright positions.  Just picture a section of a water hose held upward at either end.  If this was the birth canal, imagine how much more difficult it would be to have to push the baby up against gravity to be born – yet this is exactly what most women do!  They are lying on their backs with knees pulled up and out making birth much more difficult.  How much easier it would be to turn around onto hands and knees or on knees leaning over a birthing ball or pillows on a chair, or lying sideways with the pelvis shifted forward, or even standing, allowing gravity to be their friend!

Standing, holding onto a rope and taking weight off the feet offers a very important aspect of giving birth not much talked about.  This is the effect of stretch receptors feeling the stretch upward on the upper body.  It is helpful in labor to have the forces going up balancing the forces going down.  It is believed that stretch receptors actually play a part in signaling a woman’s body to go into labor. Gravity plays a role when giving birth as well.

The way in which a woman in labor postures herself, is likely to affect the way the entire birth may go.  This is because the baby has more space in which to move when the pelvis is tipped forward in upright positions.  This allows the baby to move into advantageous positions to move and rotate through the pelvis and helps to prevent dysfunctional labors.

The pelvis lying down appears very different than the upright pelvis.  Even slight angles forward make a huge difference in terms of how the baby comes out as can be seen in the diagram.   Lying down flat on the back, a woman is lying on her sacrum.  The sacrum needs to move forward and backward which actually changes the available space in the superior and middle inlets.  In an upright position, the pelvis is already, normally in an oblique position, tipped forward.  Add to that the help of gravity assisting the baby in coming down, and a laboring woman moving her body, changing positions, all of which can make labor easier. At the same time, the uterine muscle, itself, is working hard to contract down to help the baby move into the pelvis.  If a woman allows gravity to assist this process  by keeping herself upright or at least with her pelvis forward, she is likely to have a shorter and easier labor.  Of course, add to that the presence of a doula or birth companion so she feels safe, and the experience can be much more positive.

If you have seen women in labor lying down, you may notice something interesting.  This has to do with the Rhombus of Michaelis.  These are a bundle of nerves by the low sacrum that have a role to play in labor.  The baby in an OA or Occiput Anterior position, will flex or bend his head to put pressure on these nerves just before the moment of birth.  The mother will reflexively respond by lifting up her left hip and knee with a slight puffing out in her low back. This opens up the birth canal for birth so the baby can be born “out the back.”  With an epidural, you can see women trying to lift up this part of the back with none or limited ability to do so.

So which way do you want to birth your baby? With gravity or without gravity?  It is as simple as that!  Become familiar with upright, forward leaning positions for labor.  Try them out while pregnant so they become familiar to you.  Then know that these are optimal positions for your labor.  But if you need a rest, sidelying with an anterior or forward pelvis is also a good option.

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WHO recommendations: non-clinical interventions to reduce unnecessary caesarean sections1

Just 40 years ago when I first gave birth, a cesarean was still considered an operation done only for specific life-threatening conditions as well as when having had a prior cesarean.   Today, it has become an accepted, if not almost routine, way of giving birth.  What has caused this significant and disturbing trend?  Concerns about the sustained and unprecedented world-wide rise of cesarean section has prompted the World Health Organization to issue this report.  In the “WHO Recommendations Non-clinical Interventions to Reduce Unnecessary Caesarean Sections, they stated, “This is a major public health concern. There is an urgent need for evidence-based guidance to address the trend.” Their report was based on evidence of the effectiveness of interventions from an updated Cochrane review of 29 studies.

The importance of this WHO report is that it represents the first global guidelines of a clinical encounter between a health-care provider and pregnant woman in the context of patient care. The purpose of the study is to “provide evidence-based recommendations on non-clinical interventions that are designed to reduce cesarean section rates.” Their report acknowledges that a cesarean is a surgical procedure that when necessary can prevent maternal and newborn mortality when medically indicated.  However, beyond a certain threshold at risk, may result in increased maternal and perinatal morbidity along with both short and long-term health risks that may extend for decades beyond.  This in turn results in substantial increases in health-care costs, morbidity, and mortality for mothers and babies.

In the USA, about one in three births result in a cesarean, having increased dramatically from 5% in 1970 to over 32% in 2016. Today.  it seems to matter what country you are born in and in the USA, which state you live in. In the USA it is better to be born in Utah (22.3%), Idaho (21.9%), New Mexico (24.8%),  Alaska (23%) or Hawaii (25.2%) versus Mississippi topping the list at 38.2% or Louisiana (37.5%), Florida (37.4%), West Virginia (34.9%), NJ (36.2%) or Connecticut (35.4%).

Internationally, Finland has a low cesarean rate of about 16% of births and the UK’s rate is about 24%. Brazil tops the list at more than 50% with even higher rates in private sectors.  Latin America and the Caribbean follow with high cesarean birth rates at 40.5% and North America (32.3%) ranging down to Asia (19.2%) and the lowest in Africa (7.3%).

When cesarean rates vary to this degree, it must be due in part to how birth is managed rather than birth itself. The international health-care community has considered the ideal rate for caesarean section to be between 10% and 15%.  WHO concluded that “at the (global) population level, cesarean rates above 10% were not associated with reductions in rates of maternal and newborn mortality.”

The WHO report acknowledges that although societal changes such as increases in obesity, multiple pregnancies and older pregnant women have contributed to the increased cesarean rate, these are unlikely to explain the variance  of cesarean section rates between various countries or states.  Other non-clinical factors such as women wanting to plan their birth dates, physician factors, malpractice fears, and other economic and social factors are also implicated in the high variability of cesarean rates.

We know today that there are many non-clinical interventions that have proven to be successful in labor and birth but which are underutilized by most women, birth professionals, and facilitators.  These include warm water, optimal pelvic positioning,  the presence of a birth companion or doula, massage, speaking encouraging words, and keeping a positive and private environment.   On the contrary, medical intervention rates are very high with for example a 75% rate of epidural anesthesia and other obstetrical drugs to control pain.

In the WHO report, recommendations to reduce cesarean targeted women, health care professionals, and health organizations, facilities, or systems.

For women

  • Education that addresses fear of pain, advantages and disadvantages of cesarean sections and vaginal birth, risks and benefits of pain relief techniques and obstetrical drugs, and guidelines for indications and contraindications of cesarean sections.
  • Relaxation training and stress reduction programs conducted by nurses
  • Couple-based prevention programs that are inclusive and provide problem solving suggestions, mutual support strategies, and conflict management.
  • Psycho-education for women who fear childbirth itself and that address topics such as normalization of individual reactions, stages of labor, hospital routines, birth process, and pain relief.

For Health-Care Professionals

  • Implement “evidence-based clinical practice guidelines combined with structured, mandatory second opinion for cesarean section” in settings with adequate resources and senior clinicians.
  • Implement “evidence-based clinical practice guidelines, cesarean section audits and timely feedback to health-care professionals.”

Health Organizations, Facilities or Systems

  • Establish a collaborative midwifery-obstetrician model of care where the model of staffing is based on care provided primarily by midwives with 24-hour back-up from an obstetrician who provides in-house labor and delivery coverage.
  • Establish financial strategies such equalizing physician fees for cesarean and vaginal births.

The highest level of certainty evidence was the recommendations for health-care professionals where accountability was required.  Interventions in labor and birth need to be guided by the basic premise that if the harms clearly outweigh the benefits for valued outcomes, they should not be used.

The WHO report stated that women find learning new information about birth to be empowering  but it should not provoke anxiety.  Women want emotional support alongside the communication of facts and figures about birth. But interestingly, there seemed to be no differences in cesarean rates based on computer-based decision aids, booklets, role play vs lecture for women with fear of childbirth, or educational brochures in spite of the fact that women seemed to want such things.

They did not see differences among various ways to present the childbirth information, but none of the discussed formats for learning included an experiential and emotional preparation for birth that is based on basic human values as is available in BirthWorks.

BirthWorks childbirth preparation is designed to build confidence for birth.  We offer a broader systems approach to childbirth that is based on a foundation of human values where optimal pelvic positioning is key.  Women learn how to work with their bodies in labor, knowing that the knowledge about how to give birth is already born within every woman.  Included are also identifying beliefs and releasing fears thus re-framing them to a positive experience,  the role of hormones and the value of the microbiome as well as the importance of mother-baby skin-to-skin contact, mother-daughter relationships, the value of doulas, and grieving and healing.  Classes are interactive and a place of joy and learning which is what the experience of birth can be.  BirthWorks childbirth preparation builds confidence and decreases fear through the integration of mind, body, and spirit.

Reference:

  1. World Health Organization 2018. This report is available under the Creative Commons Attribution –NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO, https://creativecommons.org/licenses/by-nc-sa/3.0/igo).