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BIRTHWORKS FOR NEW ZEALAND’S YOUNG PARENTS

By Rosemary Joyce                                                                                                                                                                                                                                                                                                       January 2015

New Years day saw people celebrating a fresh start the world over. But in Canterbury, New Zealand, the birthing community was celebrating for a different reason. The 1st of January 2015 marked the first day of district health board funding for young expectant parents to do BirthWorks with The Birthing Room, through The Youth Alive Trust. And this is worth celebrating for multiple reasons! Whilst The Birthing Room has been facilitating BirthWorks in Canterbury since 2013, it is the first time the NZ government has actually funded a completely different kind of antenatal education (i.e. one that differs from the medical model). So it is the first time parents in NZ have been able to do BirthWorks for FREE. And BirthWorks changes lives!

The excitement and support from the midwifery community has been wonderful. Midwives are really looking forward to young expectant parents receiving positive, empowering messages about birth. They believe this not only sets up young people for a positive birth experience, but also on a life altering path of good self esteem and gentle, loving parenting.

In February midwives, family doctors, and school and sexual health nurses will be welcomed to an introductory evening of BirthWorks. This will be a special opportunity for key health professions to ask questions, hear from other’s experiences of BirthWorks, and see what the future holds for Cantabrian young parents.

The Youth Alive Trust’s antenatal education for young expectant parents is called BUMP. As well as BirthWorks with The Birthing Room, the BUMP journey includes antenatal exercise, budget advice, nutrition and cooking skills, breastfeeding support, postnatal playgroups, and a mentor throughout each parent’s pregnancy and early parenting journey. The first BUMP course begins on March 31st.

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The Importance of Prenatal Education

By Mali Schwartz

There are many prenatal programs that have been developed over the years to help women cope with childbirth.  The first childbirth education programs in America were conceived by men such as Dr. Fernand Lamaze, a French Obstetrician who introduced The Lamaze Method in 1951 through observing birthing techniques in Russia.  Dr. Grantly Dick-Read, an English obstetrician, introduced the idea of childbirth as a natural process whose book “Childbirth without Fear,” was published in 1933.  Dick Read’s work helped spawn the natural childbirth movement in the 1960s.

As childbirth became influenced by more advanced medical technological advances and the cesarean section rate rose in the 1980s, a number of grassroots organizations were formed to help educate the public about their birth choices.  BirthWorks International was created to educate women about the viability of having a VBAC – a vaginal birth after a cesarean.  BirthWorks International is one of the most comprehensive prenatal education programs available today.  It offers a holistic approach that focuses on the whole person. 
The prenatal education a woman receives through BWI not only helps her to understand proper nutrition and learn about the physiology of birth, it also includes topics that more standard prenatal education programs don’t even touch upon.  For instance one area that BirthWorks focuses on is healing past emotional pain in preparation of birth.  If a woman can heal emotional scars from her past – which may go all the way back to childhood, she has an opportunity to clear out negative energy fields that can hold her back from having an optimal birth experience. 
One example of how deeply held feelings manifest in the body is when a woman may experience bad headaches, feelings of numbness and depression.  These symptoms are related to holding anger and resentment, but she hides these toxic feelings behind a smiling, cheerful demeanor that she shows to the outside world.  In order to understand why she holds such anger, she must first explore and look for hints that lead to an understanding of what is happening.
Emotions allowed to flow freely in the body invariably change.  Using anger as an example, anger that is held typically remains anger.  But anger that is felt and allowed to move typically changes into other emotions, often fear, sadness, or pain. 
As an integral part of her training to become a BirthWorks International educator, a trainee must enroll in a three day workshop where she is led through a series of exercises to help release any deeply held emotional pain she might hold.  This will help her to act as a facilitator for her students to help them clear their own emotional fields. 
For instance exercises that ground and bring energy down through the legs and feet as well as working with the breath, the body, and the energy fields, is a way to clear out dead energy.  This allows for a basic sensation of feeling and a sense of grounding.  Simple exercises that help to open the energy centers on the bottom of the feet by standing and rolling one foot and then the other on a small rubber ball, stretching the toes and soles of the feet, squatting and straightening out the legs until there is a strong sense of the legs, helps a woman to feel more connected to her lower torso and feet.  This in turn gives her a greater sense of solidity and balance. 
Even though some women may not even be aware that their bodies are holding negative energy patterns, a perfect time to clear out these stuck patterns is before they actually give birth.  By clearing emotional blocks, an expectant woman will have much more energy to birth her baby into this world. 
Enrolling in a BirthWorks International childbirth education class give women the latest cutting edge childbirth information as well as helping them to delve into the essence of their being. 
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Supporting Women Without Epidurals

Presentation at the Virtua Voorhees Hospital
by Cathy Daub,  PT
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I recently gave two presentations on “Supporting Women Without Epidurals” at Virtua Voorhees, the local hospital in Marlton, NJ. The hospital has approximately 5,500 births per year and  a 43% cesarean rate.  New Jerseyand Floridahave the highest cesarean rates in the country.  My audience consisted of doctors, midwives, doulas, labor and delivery nurses, and the nursing supervisor.  One doctor stayed for both presentations.  At the end she stood up and said to everyone, “I think it is time for Virtua and BirthWorks to have a relationship with each other.” 
They were very interested in hearing what it means to have an emotional preparation for birth as well as an academic preparation.  Human values, pelvic bodywork, grieving and healing, and primal health are not part of their current childbirth preparation curriculum. They do not see underwater births because they have no birthing pools.  So many women give birth with epidurals there, that they are not as familiar with the fetal ejection reflex and behaviors of hormones. 
The need to present such a topic as this indicates that with such a high epidural rate, many nurses and caregivers are not witnessing women giving birth normally and naturally anymore.  They only see birth as a medical event that is treated with medical procedures and obstetrical drugs.  They do not see women moving around, working with their bodies, and having euphoric endorphin expressions that come with feeling the experience of birth.   
I presented three surveys on the topic.  The first was an informal BirthWorks survey with 55 responses that addressed the following questions:
  1. Where do you feel safe giving birth?
  2. I want to be engaged in my birth and am choosing not to have an epidural.  Some tools and strategies for my birth are?
  3. If you have previously given birth without an epidural, what kind of things made your pain better (less)?
  4. What can birth professionals and hospital staff do for women who choose not to have an epidural?
  5. Do birth professionals and hospital staff need training not currently being provided?  If yes, what type?
The second was a small Facebook survey with 16 responses, and the third was the Listening to Mothers II survey1 with over 1500 responses.  The surveys presented all pointed to the same conclusions as the Listening to Mothers II survey
         Our maternity care system is profoundly failing to provide care that many mothers told us they want and that is in the best interest of themselves and their babies.
         Safe and effective maternity practices are available but not being used by enough pregnant women. The goal is to increase childbirth preparation for all childbearing women and their families so more can achieve safe vaginal birth. 
         Health professionals need to become educated in normal birth and improve their care and skills to help more women achieve safe vaginal birth.
         Research must seek ways to translate current knowledge about safe and effective maternity care practices, so they are easily understandable, and can be put into practice by not only childbearing women and their families, but also health professionals. 
Few women used highly rated nonmedical methods of pain relief such as:
  1. Fetal monitoring with handheld devices rather than electronic fetal monitoring,
  2. Drinking or eating during labor,
  3. Freedom of movement during labor,
  4. Pushing and giving birth in non-supine positions, and
  5. Supportive rather than directive bearing down. 
The Listening to Mother’s II survey concluded:
  • Nurses should be very concerned that care practices known to support normal birth are apparently unavailable to the majority of healthy childbearing women in the United States.
  • The challenge is to take seriously and respond to the disregard for care practices that support normal birth apparent in the experiences of women reported in Listening to Mothers II.
These conclusions point to three concerns:
    1. We need more childbirth educators.
    2. We are not reaching enough pregnant women and their families with good quality consumer oriented childbirth education.
    3. Birthing women need to learn about non-pharmacological ways of coping with labor that are proven to be effective and safe.
    4. Childbirth education is beginning too late in pregnancy; it needs to begin in the first trimester or even before women become pregnant.
    5. Essential topics such as pelvic bodywork and human values are missing  from most traditional childbirth education classes.
Consider becoming a childbirth educator today.  Contact BirthWorks International to begin a career helping women and their families to have more positive birthing experiences.
Reference:
1.  Declercq, E.R., C. Sakala, M.P. Corry, and S. Applebaum.  2006.  Listening to Mothers II: Report of the Second National survey of Women’s childbearing Experiences.  New York: childbirth Connection. Available at http://www.childbirthconnection.org/listeningtomothers
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Exploring The Home Birth Option

“I really want a home birth but…” How doulas and childbirth educators can help expectant parents explore the home birth option. By Monica Basile, CPM

 How many times as a doula or childbirth educator have you heard someone say, “I really want a home birth, but…?” Usually this is followed by a list of perceived barriers to home birth or misconceptions about home birth, rather than personal convictions, structural barriers, or health concerns that might make hospital birth preferable or necessary. When a woman says to me, “I really want a home birth but…” what she is usually communicating is that she has an active desire for home birth but does not know how to realize that desire, or has not explored it fully enough to feel confident in her decision about her birth place.

  As a home birth parent myself, and as someone who has been teaching childbirth classes and attending births for 16 years, it’s taken me a while to discern how to best respond to clients when they say this. Years ago, I would simply let it go. I’d be thinking to myself, “this person needs better information,” but because I didn’t want to be perceived as trying to sway anyone’s birth decisions, I’d respond by saying things like, “it sounds like you’ve thought about your choices and that the hospital is the right place for you.” What I now realize is that this expression can be an important invitation to us to share information and engage parents in a process of self-discovery to help them clarify their desires and options.

 It’s no wonder that many people don’t know how to pursue home birth. We live in the midst of a culture of birth fear, which spreads mostly misinformation and misrepresentations of birth, especially home birth. Depending on where you live, home birth midwives may not be able to practice legally, and may therefore be extremely hard to locate or financially inaccessible. Friends and family members may be skeptical or unsupportive, and your client might not know anyone who has had a home birth. Although many women feel intuitively drawn to home birth, it can be hard to imagine the practicalities of making such a countercultural decision.

 Helping a woman to conceive of ways to manifest her deepest wishes for birth is an important task – one that can inspire a lifetime of empowered decision-making. I encourage all doulas and childbirth educators to not shy away from these conversations, but to undertake them in a compassionate, thoughtful, and nonjudgmental way, without attachment to the ultimate decision. I believe strongly that each person has the right and the ability to decide what kind of birth is most appropriate for them, and that everyone deserves access to information with which to evaluate the choices available. In this spirit, I offer some strategies for sharing information and drawing out clarity with those considering home birth

  Address Common Concerns.First of all, it can be useful to explore the “but” in the statement “I would like to have a homebirth but…” Often, these “buts” are simply misapprehensions about home birth that come from either the imagination or the media. (For example, “I want to have a home birth but I don’t want to have to clean up all that mess.”) Here are some of the concerns I hear most often:

  Mess: Birth is actually not as messy as one might think, and midwives tend to have a very efficient system down for mess prevention and cleanup. Typically, when the midwives leave the home after the birth, it’s cleaner than before they got there.

  Cost: Depending on what state you’re in, and your midwife’s credentials, home birth midwives may be able to accept Medicaid and/or private insurance. If not, it never hurts to ask a midwife about payment plans, bartering, and sliding scales for students or those with low incomes. Often, the cost for a midwife’s services is less than or equivalent to insurance deductibles.

  Small space: Although different midwives have different preferences, I have attended many home births in small apartments; even in boarding rooms. Even in large homes, midwives often find themselves in close quarters when women decide to give birth in the corner of a bedroom, between the bed and the wall, for instance.

  Other children: Depending on the age(s) of the child(ren), and the mother’s preference, it may or may not be desirable for siblings to be present at a home birth. I recommend having someone who can be on call to take care of older siblings, either at home or away, depending on the preferences of all involved. I have never encountered a sibling who was voluntarily present at a home birth who felt traumatized by the experience. This can be an extraordinarily special way for children to bond with the new baby.

  Switching care providers: If your client has an established relationship with a care provider in a hospital-based practice, it can seem difficult to end that relationship. However, this is usually a very straightforward process. There’s no point at which someone is obligated to stay with a care provider they don’t like, or who doesn’t suit their birth plans. Sometimes, people choose to continue concurrent care with the original provider after making plans to switch to a home birth midwife.

  Encourage parents-to-be to interview a midwife — or several. Know your local midwives, and if an expectant parent is considering home birth, encourage her to contact a midwife for a consultation. This is the number one most important resource you can offer. Most people considering home birth have a long list of questions that only a prospective midwife can answer. Usually people want to know what happens in case of complications, and what reasons a hospital transport would be necessary. Rather than speculating on these answers, it’s much better to talk to a midwife about reasons and protocols for transport. (When I was pregnant, I asked my midwife about complications, to which she replied, “which complications are you most worried about?” I realized then that I didn’t really know – I was just duplicating the fears that others had voiced to me. My midwife empowered me with specific information, and I felt both comforted and capable of educating my concerned family and friends.)

 Your client has nothing to lose by interviewing a midwife; a consultation does not obligate her to enter into a midwife’s care. If she decides to pursue home birth, this will put her on her path. If not, she can rest easy knowing she has investigated every option available and made a truly informed decision.

  Share evidence-based information on home birth safety. In 2005, The British Medical Journal published the largest, most well-designed study to date of out-of-hospital birth in North America. The study found that planned home births attended by Certified Professional Midwives are just as safe for low-risk women and babies as hospital birth, with many significant benefits over hospital birth in terms of lower cesarean rates and lower rates of common interventions, such as induction of labor. This study is just one in a large body of literature documenting the excellent outcomes associated with midwife-attended home births. The World Health Organization, the American Public Health Association, and the American College of Nurse Midwives all support increased access to home birth as a safe, responsible choice. A link to this study, as well as plenty of other good information, is available here: www.mothersnaturally.com

  Be clear about legal status in your state. Some people erroneously believe that home birth is illegal. This is not the case – a parent may choose to give birth wherever she wishes. There are no laws against having a home birth. Laws pertaining to home birth apply to birth attendants. In 27 states, direct-entry midwives (non-nurse midwives trained specifically in home birth, and credentialed as CPMs, or Certified Professional Midwives) are licensed, easily accessible, and accepted as part of the health care system. In the remainder of US states, licensure is not available for direct-entry midwives, and in several of these states, practicing as a midwife is illegal. This does not, however, mean that there are no midwives in states without licensure – it just means finding one to work with will be more difficult. Educate yourself and your clients about the legal status of midwifery in your state. You can find a state-by-state chart of midwifery laws here: http://mana.org/statechart.html and find a link to your state friends of midwives organization here: www.thebigpushformidwives.org

  Encourage honesty and harmony with spouses/significant others. It’s common for a pregnant woman’s partner to feel protective, and sometimes this manifests in disagreements about birthplace. Help pregnant women to remember that they have the same ultimate desire as their partners: a healthy birth with a healthy mom and baby. I always encourage expectant couples to go together to a consultation with a midwife, so they both get a chance to voice their concerns and ask questions. This provides a good foundation for further discussion.

  Encourage autonomy in relationships with parents and siblings. Many people express extreme apprehension about a lack of support from family members. There are several potential ways of dealing with this. Protecting one’s inner peace about the choice to birth at home may mean not sharing this information with family until after the birth. For some, on the other hand, it can be very empowering to discuss their decision and share information with family members. Sometimes, inviting a family member to be present at a home birth can be an effective and mutually satisfying way of garnering support. In any case, and regardless of birthplace, becoming a parent ushers in a growth transition in which new parents differentiate from their own parents, and it can be helpful to put this in perspective.

  Encourage positive community.If a woman or couple has never met other home birth parents, it can be very isolating to choose home birth. Share information about birth circle groups, La Leche League or other breastfeeding support groups, home birth meetups, Holistic Moms Networks, childbirth classes, Babywearing groups, or other potential resources for positive community building.

  First births are important.It’s not uncommon to hear someone say, “Maybe I’ll plan a home birth next time.” This is a good opportunity to ask questions like, “How is it that you envision a future pregnancy and birth as being different from this one?” Many people have the idea that they will “know better what they’re doing” and be more self-possessed with second or subsequent births. This might a good moment to remind your client that her body already knows what to do, and that the capacity to give birth already exists within her. You may also want to help her keep the importance of the first birth in perspective: avoiding a primary cesarean has been identified as a key factor in avoiding maternal and infant morbidity associated with repeat cesareans and birth complications resulting from previous surgery. The cesarean rate for planned home births in the U.S. is roughly 4%, which stands in sharp contrast to the national cesarean rate of 32%.

  Pay attention. Sometimes, a woman will say “I really want a home birth but…” and may not actually feel at all comfortable with home birth. Instead, saying this may be a way for her to communicate her orientation toward a more holistic mindset in general. If this is the case, she will likely not engage actively with attempts to open up an in-depth discussion of home birth. Listen attentively, follow her lead, and remember, it’s up to that mother-to-be to know what’s right for her birth.

  Home birth may not be the right choice. There are several reasons that home birth may not be the right choice for your client. One woman’s perceived barrier may be a very real barrier to another woman. If home birth is ruled out for any reason, you can still provide, or refer her to, doula services to help her maintain continuity of care and preserve other birth preferences. If you don’t have access to home birth midwives in your area, as is unfortunately the case in some parts of the country, further options to explore include traveling to give birth, unassisted birth, birth centers, or hospital birth.

 By sharing this information and giving our clients the opportunity to explore their thoughts, desires, hopes, and fears, we fill an important role: that of taking women’s desires for birth seriously. This is an invaluable service, regardless of the decisions our clients ultimately make about where to give birth.

 —

 Monica Basile is a BirthWorks Certified Childbirth Educator, DONA Certified Doula, and Certified Professional Midwife. She is the mother of a 15-year-old son born at home, and is a co-founder and member of Friends of Iowa Midwives. She holds a PhD in Gender, Women’s, and Sexuality Studies from the University of Iowa.

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Fear In Birth

Fear in Birth by Katie Immel

 “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face.” –Eleanor Roosevelt
The light switch for our main bathroom is housed outside the door. This bathroom has no window. Clearly, this setup was designed by an evil prankster (or maybe just someone without kids). The children of the house have, on numerous occasions, found sheer joy in flipping the switch when someone is in the shower behind the closed door, leaving the poor shower dweller in utter blackness. If the shower dweller is under the age of 14, this event is often accompanied by shrieks of indignation from within the bathroom confines, and angry demands to turn the light back on RIGHT NOW. After a few good giggles, the culprit usually turns the light back on, knowing that it won’t take long for a parent or the victim sibling to inflict some undesirable consequences.

 Children are afraid of the dark, and a lot of adults aren’t terribly fond of it either. When I asked my 6-year-old about this curious fact recently, her only comment was “it’s creepy.”

 But when you really think about it, there is nothing about the dark that can hurt you. If we really analyze it, it seems to me that it’s not so much the darkness itself that is frightening, but rather the way that it hides potential danger that can harm us. In darkness, I have no idea what to expect. I don’t know how to find my way. I don’t know how far in front of me the wall is, or what else is in my path that I might crash into. I don’t know whether I’m going to accidentally step on the cat, or reach out and grab ahold of the cactus, or step on a Lego helicopter. In darkness, I am paralyzed, because any move that I make holds the potential for harm to me or someone else.

 We are not afraid of the dark. What we really fear is the unknown.

I don’t know that this philosophical analysis of her actual fear versus her perceived or described fear would mean anything to my daughter. I don’t know that she would even care. All she knows is that when it’s dark, it feels creepy. And she is afraid.

 Many childbearing mothers find themselves in this same situation. In the same way that darkness stops us in our tracks because of the unknown, mothers fear the unknowns in childbirth.

 Unfortunately, we live in a culture that consistently surrounds childbirth with fear. As a result, when a newly expecting mother begins to search for information, she may run into “horror” stories of their own births from well-intentioned friends or family and Hollywood and media portrayals such as One Born Every Minute (link to http://www.mylifetime.com/shows/one-born-every-minute), which portray “normal” birth as a bed-ridden, dangerous medical event in which mothers have very little input on what happens. Add to this a care provider who does not trust birth, is terrified of a lawsuit, focuses on pathology rather than physiology, and provides her with every potential harmful outcome, and the level of fear skyrockets. If nothing changes, when labor arrives, along with it arrives an environment with unfamiliar sounds and people, bright lights, stimulation, questions, needles and monitors, and the result is a mother completely paralyzed by fear. The sum total of all these influences is a big, ugly mess.

 So what can we do about this? How can we empower mothers, help them conquer their fear and restore joy in the journey of bringing new life into the world? It is not an easy task; you may feel like a lone voice in the wilderness, calling mothers to trust their bodies, believe in their inner strength and in the process of birth in the midst of a chorus crying danger and fear. But the first step is simple: turn on the light! Help her break out of the unknown into a place of knowledge by providing solid information on all the things she needs to know: ways to care for her body and nourish her growing baby, the processes the body takes as it prepares for and begins labor, the process of labor, both physical and emotional, what she may need and expect from those surrounding her during her labor, what to expect right at birth and after, and resources for the journey. In addition to this critical information, parents also need tools to help them set healthy boundaries, ask thoughtful questions and take responsibility for the choices that are made, engage in respectful dialog and evaluate whether a complication warrants extra outside measures. With the right information and tools at her disposal, the darkness will begin to dissipate and that paralyzing fear of the unknown will begin to subside. Then, it becomes possible for her to face labor and birth with confidence and joy, trusting herself, her body and those around her. What a wonderful way to begin motherhood! The mother who labors in an environment of confidence, safety and security, who is surrounded by people attentive to her needs, who trusts herself, her baby and the process of birth, who is consistently given respect, encouragement, information and choices, will emerge from her child’s birth transformed, regardless of anything that may happen outside of her control. This is the kind of birth I dream about for every mother, the kind that I define as a success – one in which the veil of fear has been pulled back and the truth of its joy revealed – a birth that she has owned, in which she is left feeling empowered, joyous and loved. For as long as I am able, I will continue to do my part in making this kind of birth a reality for every mother that I can reach.

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Reclaiming Our Birthrights

By Melissa Feldman

By reclaiming our connection to nature, women get in touch with their nurturing skills, which help to preserve our own species. According to an article “Wild at Heart” that appeared in O The Oprah Magazine in July 2002: “Women know in our bodies, our souls and our histories what it means to be domesticated, managed and tamed. Yet medical research has revealed that our bodies work on an innate circadian clock that changes with the ebb and flow of sunlight and seasons.”
I gave birth to my four children during the natural childbirth movement in the late ’70s and ’80s. While pregnant with my last two children, I became interested in the alternative childbirth scene. I intuitively connected with the idea of the Leboyer method, in which lights were turned off and babies were welcomed to this world in a warm, comforting environment.
I also read about how women could have control in how they gave birth, in the positions they assumed and by working with professionals who were open to how they wanted to give birth. So I decided to take a training to become a doula. I attended several births and thought about becoming a childbirth educator as well.
I had heard about BirthWorks International from the women who gave the doula workshop I participated in. Reading about the BWI philosophy, which “Provides high quality training that instills confidence that the knowledge about how to give birth already exists within every woman”, struck a chord with me.
I also realized that natural childbirth methods that were available when I was given birth had been created by men. It was gratifying to learn that in the early 1990’s, a new generation of women reclaimed their innate ability to give birth in a way that suited them and wanted to educate other women, as well. I wanted to be part of this movement. Self-expression was a strong impetus for me.
Helping women to find their own voice during the process of giving birth can help them become more empowered in all areas of their lives. Women helping women is an idea whose time has come.