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We Must Do More to Honor Birth as a Peak Life Experience

by Molly Wales, CCE(BWI)

Excerpts from a talk given on Labor Day Weekend, 2012, at the Unitarian Universalist Fellowship of Athens, Ohio.

Molly with her newborn daughter
 My name is Molly Wales.  I am the director of The Birth Circle (a consumer birth group) in Athens, Ohio, and am a BirthWorks childbirth educator.  I’m here today to talk to you about why I believe that we aren’t doing enough in our country to honor birth as a peak life experience.  Perfect for Labor Day!
A short review of where I stand:  I believe that all people are deserving of equal treatment and opportunity.  I believe that a woman is born with the knowledge of how to give birth, and that if Mom can give birth with people who make her feel safe and secure, she’ll be able to follow her instincts and her body and her baby will know just how to work together.  I believe that a woman should have the right to give birth wherever she pleases, with whomever she pleases.  And I believe that birth is a hugely pivotal moment in life, and that the birth experience has a life-long impact on the mother, the child, and on their relationship.
These views do not represent the norm in our society.  Americans, in general, are taught not to trust birth.  Many, if not most, fear it.  And so we keep developing new ways to manipulate and change what already works. And as we force our control like this, the effects are disastrous.
According to a recent Amnesty International report, “The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 49 other countries, including Kuwait, Bulgaria, and South Korea.”  What?!  WHAT?!  Why is this happening?  What has gone wrong with maternity care in our country?
Imagine a mom has her first visit with her care provider, be it an OB or midwife.  She’s told, “You are capable of having this baby without drugs.  And if that’s what you choose, we will support you in that.  If you or baby needs medical attention, we’ll be here.  But otherwise our job is to let your body do what it was created to do.”  If that were that norm, we wouldn’t be in such a crisis.  Rates of intervention would drop substantially, and our moms and babies would be healthier.
But that isn’t the kind of support that moms in our country generally receive, unless they choose a home birth assisted by a midwife.  Because OBs and hospital-based midwives work under protocol and deadlines that rush the process and place little to no value on the emotional importance of the experience.  Now I don’t mean to say that the OBs and midwives themselves don’t value the experience, necessarily, but rather that they are put under restraints that severely limit what they can do to honor birth as normal and natural, and to work with a mother on her body’s own timeline.
For example:  One of my students recalled going in for her very first visit with her OB, to talk about her exciting new pregnancy.  The doctor told her, “You’ll go into labor, you’ll come to the hospital, and we’ll get you an epidural.”  Notice the commands.  Notice the lack of choice.  Notice the complete failure to acknowledge this mom’s innate ability to give birth to her baby on her own.  In one short sentence, her power was robbed from her.
Or another student, who, while having a perfectly normal labor at the hospital, noticed that everyone in the room kept their eyes fixed on the monitor, telling her when a contraction was coming, telling her how hard it was…when all she wanted, needed, was some eye contact, someone to acknowledge that SHE was doing the work here, and that she was a healthy human mother, not just another illness hooked up to a machine.
And so most moms, at least in our country, never get that chance to realize their own power, that chance to feel accomplished as a mother, right from the very start, those sensations of labor that combine intense vulnerability with unimaginable atomic power.  When a woman gives birth naturally, she has to open up, physically and emotionally, to greet her baby.  It is an incredible start to the mother-child relationship, one of deep bonding, as mom and baby work together through one of life’s greatest challenges.  If we in the U.S., this world power, honored birth as the baby’s start to life-long mental health, and as the mother’s chance to untap her human potential, just think of how we could empower whole generations of women and children.  I remember saying to my little Lola, six short months ago, as I held her there on my living room floor in the darkness of the morning, “We did it, honey, we did it!”  So she was born into that joy, that total soul bearing, that pride.  What an advantage for us both. And I am no extraordinary woman.  Most healthy women are capable of having their babies without medical intervention.  Now certainly homebirth isn’t the right choice for every woman, but imagine what a difference that would make, in our country and in the overall state of our planet, if the majority of mother-baby pairs were trusted, unrushed, and just given a chance to let their bodies work in their own way.
But they aren’t.  Instead most pregnant women in the U.S. are highly uninformed.  They are treated as if their pregnancies are an illness. In labor, they are offered drugs when they should be offered emotional encouragement.  And yes, of course, a healthy baby and healthy mom are the most important things.  But they aren’t the ONLY important things.  There is a chance there for a peak life experience, for both mom and baby, a chance for that relationship to begin with a surge of strength, hormonally and emotionally, that fortifies them for years to come, if not for their whole lives.
In the end, it’s all about creating a peaceful world, isn’t it?  And where better to start, than our barest beginning.
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How caregiver inquiry can shape prenatal care and birth experiences

By Anna Holder, CCE(BWI)

“What’s your cesarean section rate?”
“What is your episiotomy rate?”
“May I eat and drink during labor?”
“May I have a doula/ lots of family/ a photographer at my birth?”

Women and their partners are often encouraged to ask these and similar questions when selecting a care provider for their pregnancy and birth, the theory being that the provider who provides the answers the woman and her partner are looking for will provide safe and effective care. What about compassion, satisfaction in the birth process and empowerment of the woman and her partner? 

The answers are in the questions — the questions that the provider asks, that is.

When a doctor or midwife goes beyond impersonal lifestyle surveys and “intake” questions, they are able to establish a relationship of trust with their client. They are also gaining a unique and in-depth look into the lives of their clients. Conversely, women and their families are given a strong voice and are invited to become true partners in their care and birth process rather than obedient “patients”. If a provider can not be bothered to ask in-depth questions or encourage the birthing family to research both scientific evidence and their own personal realities, why would that provider value the laboring woman or her support team in the throes of labor? Moreover, if the woman and her care provider have not explored these issues in the relative calm of the prenatal period, how will the relationship between them play out in the excitement of birth?
Some questions prospective caregivers should be asking women are:
  1. Tell me about your previous births or experiences with birth. What did you like or not like about them?
 This question encourages reflection on the part of the woman and her partner and identifies possible fears, expectations and goals. When started early, this dialogue can build a foundation of trust between provider and client as well as between the woman and her partner. It also helps to create a framework of what client and provider are working towards in regards to maternal and fetal health and birth process.
 I once had a client who wanted a vaginal birth after cesarean (VBAC). Her primary cesarean was for a breech baby where no option for External Cephalic Version (ECV) was offered. She was separated from her child for 3 hours and suffered Postpartum Depression. Upon learning of her second pregnancy, she chose a different provider and place of birth. When it was found that her second child was also breech, she was encouraged to try herbs, acupuncture and positional techniques before being offered an ECV. When the version was unsuccessful, she chose to go into labor on her own before a repeat cesarean was performed. She was never separated from her child and reported a great deal of healing from her first experience. As she had explained her hopes and fears to her doctor, she had her wishes honored and had a respectful birth. 
  1. Why do you want to have or avoid particular tests or procedures? Have you read about the risks and benefits?
Asking this question sets the stage for informed consent or refusal and promotes research and accountability for the birthing family. When families are encouraged to participate in their care and hold some level of responsibility for it, they are more likely to make well thought out choices in addition to feeling more satisfaction with their experience.
The safety of VBAC is well documented. However, many obstetricians dissuade women from pursuing this option in spite of the most current recommendation by the American College of Obstetrics and Gynecology (ACOG) endorsing trial of labor after cesarean(s) (TOLAC). Even a cursory exploration of the current research would provide those wishing to have a VBAC with ample support of their goal.
  1. What are you eating? How can I help you incorporate healthy changes?
Simply telling a woman not to smoke, drink alcohol and avoid sushi is not the same as ensuring proper protein intake and identifying any potential deficits in diet. By dedicating ample attention to nutrition, mother and baby can achieve optimal health while avoiding complications from morning sickness to pre-eclampsia.
I know of a woman who was planning a home birth with a midwife. At her home visit it was found that her blood pressure had elevated after she had been following a strict diet and herbal regime. After asking more questions and a tour of her cupboards, it was found that a powdered tea beverage the woman was drinking daily was delivering a whopping 27g of sugar.  The midwife counseled her that this was not helping her pressures and could make her already presumably large baby bigger. After removing the beverage, the woman went on to have a healthy 8lb 15oz baby at home 3 weeks later. (Okay, okay, the woman was me, but I still haven’t had any more chai).
Just as a provider’s cesarean rate doesn’t always belie their philosophy about birth, the number of births a woman has had doesn’t illustrate the unique circumstances present in her current pregnancy. The earlier providers establish a deep dialogue, the more compassion and satisfaction are united with safety and efficacy to provide better outcomes for moms, babies and providers.
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BirthWorks 5K Fun Run!

BirthWorks International will be hosting its first fundraiser, the BirthWorks International 5K Fun Run at Freedom Park in Medford, NJ.   The walk will be preceded by a free yoga class and registration.  After the walk, the rest of the day will include fun activities for the family, a mini pelvic bodywork class, vendors and much more!
The run will take place at Freedom Park in Medford, NJ on September 8, 2012.  The park is located at 86 Union St. in Medford, New Jersey.   The event will occur between 9am and 3pm.  There will be a free yoga session at 9am, taught by Tricia Heiser of the Yoga Sanctuary of Medford followed by the 5K Fun Run/Walk at 10am.  Cathy Daub, the president and founder of BirthWorks International, will teach a free pelvic bodywork class for expecting mothers at 12pm.  Furthermore, the event will hold various children’s races and activities.  Prizes will be rewarded to all winners.
BirthWorks International embodies the philosophy of developing a woman’s self-confidence, trust and faith in her innate ability to give birth.  BirthWorks seeks working relationships with other childbirth related organizations, striving together to help birthing families make more informed and safe choices for birth.  It is our mission to train childbirth educators and doulas that in turn provide evidence-based, current information to birthing families through a unique experiential approach that is based on human values.  All proceeds from this event will fund programs that help educate and empower women and families around the world about safe birth practices and natural birth options.
            
    Being an international organization, we are aware that many of our friends and colleagues are unable to attend this event on September 8th; however that should not discourage anyone from helping us raise the funds necessary to provide these programs and research to birthing families and enhance their knowledge and experience during this special and important time in their lives.  Please join us as a virtual walker.  By registering online at www.active.com/running/medford-nj/birthworks-international-5K-run-walk-2012, you can support BirthWorks and its philosophy by asking for sponsorship and donations from family, friends or co-workers.  Thank you and good luck!  
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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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BirthWorks

In May of 1981, forty women from the United States and Canada met in Boston for a conference with Nancy Wainer to discuss cesarean prevention and Vaginal Birth After Cesarean (VBAC). Their energy, enthusiasm, and dissatisfaction with the current medical obstetrical management of birth were profound. Under the direction of Esther Booth Zorn, this group of individuals joined with others to bring about the International Cesarean Awareness Network (originally known as CPM–the Cesarean Prevention Movement). The organization was officially established in June 1982 with the publication of its first newspaper, The Clarion. It soon became apparent that there was a need for a comprehensive, inspiring, and activating childbirth education program. Cathy Daub, PT, had designed and taught the first BirthWorks classes in 1981 in her home in New Jersey. She agreed to bring the BirthWorks program to ICAN and chaired the ICAN Education Committee, which developed BirthWorks into a national childbirth certification program. The BirthWorks manual was written and edited by the change makers in childbirth including Nancy Wainer, Doris Haire, Diony Young, Lynn Baptisti-Richards, Lewis Mehl-Madrona, MD, Gayle Peterson, Claudia Panuthos, Elizabeth Noble, Anne Frye, Cathy Daub, and others. A pilot program was run from 1985 – 1987. BirthWorks became a full certification program for childbirth education in 1988. In 1995 BirthWorks became an independent non-profit organization with a full Board of Directors. In 1998 BirthWorks developed a certification program for doulas. Today, the BWI Leadership Board, faculty, professional staff, and regional ambassadors are working together to ensure that all women have the opportunity to give birth with faith and dignity. BWI remains committed to VBAC support and education.

Current BWI Advisory Board:
Dr. Michel Odent
Susan Ludington, PhD,CNM
Kirsten Uvnas-Moberg MD, PhD
Mary Zwart
Heloisa Lessa, CNM
Jan Tritten
Henci Goer
Ina May Gaskin
Bethany Hayes, MD
Barbara Harper, RN
Marshal Klaus, MD
Lewis Mehl Madrona, MD
Jean Sutton
Suzanne Arms
Nancy Wainer
Ray DeVries
Phyllis Klaus, MFT, LCSW
Doris Haire
Elizabeth Davis