An Open Letter to My Midwife

Dear Midwife,

Thank you for your email regarding my blog post about my first birth at home, entitled "Power Birth--Not to be Confused with Empowered Birth."

You're right that as a first-time laboring woman, I didn’t understand the reasons for the things that were done to me. I still don't. No one (be they midwife or doctor) has the right to do anything invasive to a woman’s body without explanation or permission, including manually dilating a woman's cervix to speed up her labor. Your statement that “a laboring woman often doesn't understand why the midwife does some of the things she does” is particularly true if the midwife believes that her authority is paramount and that explanations are optional. That attitude, which you demonstrated clearly at my birth, shows a lack of respect for the birthing mother. If the mother doesn’t understand why you’re doing what you’re doing to her, stop. Explain. It’s her body and her birth. She has a right to informed consent no matter where or with whom she is giving birth.

I don’t agree that I’m just one of the inevitable “unhappy customers” that a birth professional is bound to have now and then. If I go to a car dealership to buy a functioning car and they sell me a lemon that breaks down on my way to work, then I'm an “unhappy customer.” If I go to a care-provider for a safe, natural birth and get physically assaulted and coerced, my rights stripped away, and end up with life-threatening iatrogenic complications, I’m not “unhappy." I'm grateful to be alive. I'm obligated to speak out. I've met another woman who gave birth with you and is now recovering from a hysterectomy and rectum reconstructive surgery that she attributes to the start-pushing-at-5-cm/forced dilation technique. Is she just an “unhappy customer,” too?

Scolding me for writing about this on the grounds that speaking up about my experience will breed distrust of midwifery as a whole and will damage the home birth movement, causing childbearing women to run for the hospital, is backwards thinking. First of all, I don't align myself with any "home birth movement". I love home birth and I would like to see it normalized, but I'm not interested in convincing any woman that she should give birth a certain way. Each woman will give birth best wherever she feels safest. What I would like to help achieve is a world in which every mother has a full array of options open to her and perceptions of safety are based in reality. Covering things up, pretending they didn’t happen, and trying to silence the women who speak out about birth trauma is what breeds distrust of the profession. Secrets will keep this birth community stuck forever. Telling the truth dissolves fear and creates understanding, which increases safety and trust.

As more survivors come forward to tell their stories (many of them never will, because they’re afraid of the social fall-out. Some of them have been bullied into silence…) I hope you and every other care-provider who has practiced this technique will take a moment to just listen. Women everywhere are outraged at the thought of forced manual dilation. Birth belongs to the mother and baby, not the midwife or any other authority figure or expert. Birth should unfold according to the mother and baby's own time frame, not be forced to conform to the midwife or doctor's schedule.

I agree with you and I felt encouraged when I read this in your email: "As women and midwives, we spend too much time criticizing and placing ourselves above each other without understanding where the other is coming from. We also make no allowances for each other to grow and evolve into better midwives as we gain experience. We are constantly learning. I, for one, am a very different midwife than I was 25, 10 or 5 years ago." I'm glad to hear that. If you're no longer practicing this technique then I would like to know. I'm not interested in destroying anyone's reputation. I'm focused in the present, hoping to make here/now a safe and sacred space for expectant mothers.

I am also a very different woman than I was when we met. I'm not afraid to talk about what's happening in our birth community or to raise awareness about every mother's right to be spared unnecessary and unwelcome interventions and abuse. I believe this dialogue can be a catalyst for healing, growth, and evolution for all of us.

Your sister in peace and progress~

Music and Birth

Artwork property of Mandala Mom. Please do not copy without permission.

Music is one of the best learning tools there is. Put information to music and it becomes instantly memorable. This is why in Kindergarten, everything from our ABC's to shoe-tying directions were set to music.  

What you learn through music has as much the quality of an instinct or ingrained memory as of a logical thought. This is because music stimulates different areas of the brain simultaneously and forms a bridge between the old brain (instinct) and new brain (reason).  We use both hemispheres of the brain when we listen to or participate in music. The right hemisphere recognizes the melody and lyrics and changes in tonality. The left hemisphere is engaged in rhythmic alterations. 

The engagement of both hemispheres is what makes music such an enjoyable and sometimes emotional experience.  It is also the perfect tool for teaching concepts that you’d like to recall automatically, without thinking, which is useful during birth when the goal is to minimize neocortical stimulation (logical thought) and enter the intuition zone.
    

Rhythm organizes action and orients it in time. The rhythm of music echoes our own body rhythms (heart beat and breath, muscle contractions during labor) and helps regulate those processes. Research has shown that music stimulates the release of endorphins, the bodies’ natural system of pain-relieving opiates, so it enhances the management of pain in intense, physical situations.  Music also calms the mind and heightens concentration. Music is an integral part of yoga practice because it helps us center our awareness in the present moment and reach a deep meditative state. 

Singing doesn't stimulate the neo-cortex (the new brain, where language is processed) in the same way that speaking does, even though language is involved in the lyrics.  A woman can sing in labor, and you can sing to her in labor, without interfering with the old-brain’s work of producing the hormones of instinctive birthing. This is why BirthWorks (www.birthworks.org) teaches its doulas that if you need to speak to a woman while she's in active labor, it's best to sing the words.

Did music play a role in your labor and birth? Did you find that certain songs or types of music were especially helpful? 

Here's a beautiful video of a woman singing through her contractions. You may want to have a tissue handy...

Power Birth--NOT to be Confused with "Empowered Birth"

*******Trigger Warning*******

"PowerBirth" sounds great, doesn't it? It's Birth. It's Powerful. It's...POWER BIRTH!  But the term "PowerBirth" is not a reference to the power of birth, it's a midwifery technique that is about the power of the care provider to manipulate and control a woman's body during birth. Big distinction.

The first time I heard the term "PowerBirth" was years after I had experienced the technique first hand (no pun intended). My first home birth left me struggling to comprehend what had happened to me. I chose to give birth at home with a midwife because I believed that birth is safe and I wanted to have a natural experience with as few interventions as possible. I believed that midwives are women who safeguard birth as a sacred rite of passage and don't interfere unnecessarily.

My midwife never mentioned that she had been trained in the Power Birth technique. There were red flags that would have tipped me off that she wasn't the hands-off midwife I thought she was, if I had known what to ask or watch out for. She dismissed my desire to try a water birth (too messy, she said) or to deliver in a squatting position (too hard to prevent perineal tears, she said). When I asked her how I could prepare for labor and if there were any childbirth preparation classes she recommended, she said, "Well, there's Bradley, and there's Lamaze. Both methods were invented by men and men don't know anything about real pain." So, no, she didn't recommend any classes.

She was the most experienced midwife in my community, having delivered over 400 babies, and had been recommended by women I knew. I was naive and thought I was in the best of hands. I trusted her completely.

My "PowerBirth" went like this....

My husband and I went on a walk before bed and just as we were about to go to sleep, I began having strong, regular contractions that were about two minutes apart. I had been expecting labor to start slowly and to gradually build in intensity but right away I felt like I was struggling to stay on top of the sensations, which were concentrated in my back. My husband called the midwife just before midnight and I tried to talk to her on the phone but couldn't speak during contractions. She said she was on her way.

The first thing she did when she arrived was perform a vaginal exam. And then she kept performing them. Over and over. It seemed like every few minutes she was back, gloved fingers in my vagina, pushing deeply inside me throughout the contraction, muscles flexed with the physical effort of what she was doing. What on Earth was she doing? I had no idea. All I knew was that it was the most horrifically painful thing I have ever experienced. The pain of my contractions was vastly amplified every time she touched me. I wanted to fight her off or flee. But even if I had been physically capable of mobilizing myself, in spite of the runaway train of my labor, I did not possess the assertiveness at that point in my life to defy her authority.  At one point the midwife snapped at me, "stop screaming, you're scaring the baby." I couldn't stop. I had forgotten I was having a baby.

PowerBirth is promoted by its founder and proponents as an empowering approach to birth in which mothers are encouraged to push when they have the natural urge. Ostensibly, it promotes listening to women's bodies, instead of telling women to hold back and not "allowing" them to push until they're fully dilated. If PowerBirth was a philosophy that encouraged birthing women to follow their natural pushing instincts instead of relying on external control and arbitrary policy, I would be a promoter of Power Birth.

But listening to your body is not what PowerBirth is about. 

My midwife manually dilated my cervix long before I had the urge to push. She forced my cervix to open faster than it was opening naturally (even though my labor was proceeding efficiently and there was no justifiable reason to intervene). She did not explain what she was doing or ask my permission to do it. I never consented to being Power Birthed and didn't know that's what was going on. I only knew that something was going terribly, terribly wrong and I was not in control of my body and I wanted her to get her fingers out of my vagina. My husband sat silently by, not knowing what to do or how to help me, and for that he felt deeply ashamed he said later.

I had been laboring on my back in bed (The better to dilate you with, my Dear) since the midwife arrived, other than trips to the bathroom. On one return trip from the toilet, I stumbled upon the supported squat position. I don't remember how I got into it, but there I was, squatting beside the bed, supported between my husband's knees, swaying my hips, and Ahhhh! It was the first time during the labor that the contractions didn't feel like a battering ram against my sacrum.  A few minutes later I started bearing down involuntarily, and my bag of waters popped, and the midwife ordered me to lie down. I refused. My body was telling me to stay put. She quickly made a bed of blankets on the floor beside me. I wailed "Nooooo!" as I was moved over to the blankets and placed on my back. Shortly, my baby's heart rate began to decelerate, although her heart rate had been steady while I was upright. Then all was crisis and "Push! Push! Push!" and threats that the baby had to be born NOW. I pushed with all my might, determined to get the baby out quickly, and tore severely on her shoulders.

The entire birth lasted 5 hours, from first contraction to delivery. My baby was blue and had a low APGAR score and needed oxygen, which the midwife gave her. Once the baby was stable and had been bathed and weighed, and after I had been stitched (sans anesthetic, because the midwife didn't have anything for pain except ice cubes to “numb” the tissue) the midwife left.  (I saw her once more a few weeks later for an obligatory postnatal visit and never again after.)

Power Hemorrhage

Backing up a bit...I need to mention that immediately after the birth, the midwife roughly massaged my abdomen and applied traction to the umbilical cord and pulled my placenta out before it was ready. Patience does not seem to be a quality you will find in abundance at any stage of a PowerBirth. Before she left, I passed out while trying to hobble from the toilet back to bed and my husband questioned whether I had lost too much blood. The midwife said "well, it IS a lot of blood. If it were any more blood than it is, it would be too much blood, but as it is, it's okay." It was so "okay" that I ended up in the emergency room later, having a transfusion of 4 units. The emergency room doctor said "in the bad old days, you would have died. Maybe you'll think about this before you try to give birth at home again."

But I was never giving birth again, at home or anywhere else, even though I desperately wanted more children. I didn't believe I would survive another birth. I was profoundly damaged, physically and emotionally. The physical scars took many months to heal. The emotional scars took much longer. It wasn't just that I grieved the loss of the gentle birth I had been hoping for. Every aspect of my life was affected. I suffered from Post Traumatic Stress Disorder, PTSD, which is caused by hyperarousal of the autonomic nervous system during a traumatic event. In addition to panic attacks, crying, persistent insomnia, and obsessive fears of dying, I was unable to endure intercourse with my husband due to excruciating stabbing pain. Even after the stitches were gone and the abrasion and hematoma had healed and there was no discernible physical reason for the pain, sex hurt a lot. Our marriage almost didn't survive. 


The Road to Empowerment

I have arrived at a place of peace where I recognize the good that came from that birth (besides the obvious and ultimate good of a beautiful, healthy baby girl who continues to light up my world). The experience inspired me to learn everything I could about what had gone wrong and how to prevent it from happening again. Without the trauma of that birth, maybe I would not have been so passionately hungry for the truth or inspired to find a better way. Thankfully, I found the work of Michel Odent, Ina May Gaskin, Jeannine Parvati Baker, Suzanne Arms, Laura Shanley and other truth-tellers and champions in the instinctive birth movement. I learned to trust my body again. I learned how birth works.  I subsequently had two peaceful, nearly painless, trauma-free, ecstatic births--both at home, both unassisted--one squatting and one in the water (which was not messy). :-)

Five years ago I discovered BirthWorks International and took their Childbirth Educator workshop to gain the tools to help other women on the path toward empowered birthing. BirthWorks teaches that the knowledge of how to give birth is born within every woman. Part of the BirthWorks Childbirth Educator workshop involves healing prior birth traumas and clearing emotional obstacles to instinctive birthing. During the exercises, I was finally able to forgive myself for not being more informed and educated, more assertive, or more powerful during my first birth. I had been beating myself up for not listening to my gut, for not standing up to my midwife and telling her NO, but BirthWorks helped me to accept and love the young, inexperienced woman I had been and to recognize that I did the best I could with what I knew. After I forgave myself, the exercises also helped me to forgive my midwife. In my heart, I know she believes she is helping women. In some very misguided way, she must believe deeply in the rightness of what she's doing. I do not think she harmed me on purpose.

I really thought I had healed my heart and soul and completely let go of all negativity from that birth but recently I was triggered after hearing the heart-breaking stories of two other local mothers who had similar experiences, but worse outcomes. Apparently women in my community are still being Power Birthed against their will. The damage continues.

My intention as a doula and childbirth educator is to focus on the positive and help women eliminate fear and understand how to tap into their instincts in birth. My role is to support them unconditionally as they find their own path to birth.  I'm not writing this to bring anyone down, spread fear, or because I enjoy dwelling on the negative. But I have realized that forgiving my midwife doesn't absolve me of the responsibility to speak up about what happened, in case my story helps other women avoid trauma.

I consider my first home birth "a hospital birth at home" thanks to my involuntary introduction to the PowerBirth technique, which robbed me of an instinctive, natural birth. My first birth was filled with everything I didn't want. This brand of midwifery is not safe or respectful of women or birth. It divorces women from their instincts by stimulating the neocortex, shutting off the flow of oxytocin and triggering fear (read my previous post: Your Brain On Birth). But the most important message I want to convey about Power Birth is that it victimizes women when it is inflicted on them against their will. No true midwife practices her craft this way.


"PowerBirth" should be called "Abuse-of-Power Birth" and it needs to stop.


Women have the right to make informed decisions and to refuse unnecessary interventions that rob them of their dignity and their ability to give birth on their own time, in their own way. Regardless of where or with whom a woman is giving birth, she has the right to body integrity and autonomy. She has the right to be attended with patience and gentleness. She has the right to consent.


There are many wonderful midwives in the world who believe in the innate ability of women to birth without interference. There are many midwives in my local area who I unreservedly recommend to women who are interested in home birth. If you are looking for referrals in Southern Utah or would like more information about how to interview a midwife to find out if she's right for you, please ask.

*************************************************

Link:

Here is a beautiful, inspiring article written by Gloria Lemay, a midwife in British Columbia, about Interventions in Birth.

Your Brain on Birth

You probably remember that anti-drug commercial from the 90's that showed an egg being cracked into a sizzling-hot frying pan while a narrator soberly reported that “This is your brain… This is your brain on drugs.” It was a startling visual that demonstrated the profound affect drugs can have on our most important and sensitive organ. In the case of synthetic, recreational drugs, the impact is potentially deadly, thus the need for public service announcements that seek to inform people about the risks of chemically tampering with our brains.

I have learned from studying the work of pioneers in the natural birth movement, particularly Dr. Michel Odent of Primal Health Research, that our brains do complex things when we give birth, including secreting natural mind-altering drugs. Birth—the literal act of laboring and bringing a baby from womb to world—is an instinctive, old-brain process, perfected over eons. Women do not need to be taught HOW to give birth because the knowledge is born within every woman as her exquisitely intelligent brain coordinates the release of hormones--natural drugs such as oxytocin and prolactin-- that control the physical process of birth and create a mind-state of pure, intuitive KNOWING. It's quite a trip!

When labor and birth occur in an environment where the mother feels safe and undisturbed, the brain floods the body with hormones and endorphins that frame the involuntary physical process of birthing within feelings of ecstasy, bliss, and a profound sense of connection to the collective ancient wisdom of woman-kind. This is partly what makes instinctive birth such a profoundly spiritual rite of passage. It causes the mother to enter a sacred space of "oceanic oneness" (as Dr. Odent calls it) as her new-brain quiets and she becomes fully present in the moment. She may experience a keen sense of her own unity with God/dess and find herself floating in a blissful state similar to what yogis describe as “enlightenment.” When a woman is in labor, Oxytocin, the hormone of love, floods her entire system so that she is primed to fall deeply, madly, irreversibly in love with her baby. This is nature’s strategy for ensuring the mother’s protection of the helpless neonate into adulthood. Endorphins, the body’s natural pain relieving system of opiates, also flood the mother’s body when she is undisturbed, so that her perception of pain is greatly reduced or even eliminated and she walks away from birth feeling empowered and awed by her own strength.

The problem is that, as a culture, we have learned to fear birth. We have indoctrinated ourselves with the expectation that things WILL go wrong. This has caused our culture to develop strategies for managing and controlling the birth process to make it “safer”. Unfortunately, most modern birth practices stimulate the mother’s neo-cortex (new brain) and thwart the activities of the old brain, which cuts the mother off from her intuition and makes birth more painful and more likely to become pathological. When birth is tampered with and the mother’s instincts about her own baby and body are removed, she becomes dependent on external guidance and, possibly, rescue. We create our own reality.

Our culture mistakenly believes that birth is something a woman does with her reproductive organs only. But birth really happens, first and foremost, in another organ entirely: the brain. If we know how the brain works during birth and if we birth in integrity with the truth of our brains, the reproductive organs will almost always do their work without trauma or fuss. All we need to do is stay out of the way. Imagine a public service announcement that informed people of the need not to tamper with the brain during labor and birth. Instead of a frying egg, it might show a lotus blossom softly opening, and the narrator's voice would whisper: This is your brain… This is your brain on Birth...Let it be.

Recommended reading:
The Scientification of Love, by Dr. Michel Odent
Birthing In The Spirit, by Cathy Daub
Beautiful, Bountiful, Blissful, By Gurmukh Kaur Khalsa

Skin-to-Skin is a WIN for MotherBaby

(Reprinted with Permission) Here is a wonderful article from Dr. Jack Newman about the impact of skin-to-skin contact on breastfeeding and bonding. This makes a very good case against swaddling. I always noticed that skin-to-skin contact regulated my baby's temperature, sleep, heart rate and feeding patterns really well. What are your experiences with skin-to-skin?

"There are now a multitude of studies that show that mothers and babies should be together, skin to skin (baby naked, not wrapped in a blanket) immediately after birth, as well as later. The baby is happier, the baby’s temperature is more stable and more normal, the baby’s heart and breathing rates are more stable and more normal, and the baby’s blood sugar is more elevated. Not only that, skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother’s.

We now know that this is true not only for the baby born at term and in good health, but also even for the premature baby. Skin to skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their need for extra oxygen, and keeps them more stable in other ways as well (See www.kangaroomothercare.com) (See handout Preemie).

To appreciate the importance of keeping mother and baby skin to skin for as long as possible in these first few weeks of life (not just at feedings) it might help to understand that a human baby, like any mammal, has a natural habitat in which he is supposed to be: with and on his mother. When a baby or any mammal is taken out of this natural habitat, it behaves in a way which is unnatural. A baby wrapped in a blanket or swaddled behaves not so much like a baby, but instead becomes too sleepy or lethargic and needs to shut down; or becomes disassociated altogether. Or, such a baby may shake and cry and protest in despair. When a baby is swaddled it cannot interact with his mother, the way nature intended, and the way that is necessary for his very survival. The mother and the baby exchange sensory information that stimulates and elicits “baby” behaviour: rooting and searching to eat, calming in his mother’s arms, staying warm and maintaining his temperature.

From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least an hour, are more likely to latch on without any help and they are more likely to latch on well, especially if the mother did not receive medication during the labour or birth. As mentioned in the handout Breastfeeding—Starting out Right, a baby who latches on well gets milk more easily than a baby who latches on less well. When a baby latches on well, the mother is less likely to be sore. When a mother’s milk is abundant, the baby can take the breast poorly and still get lots of milk, though the feedings may then be long or frequent or both, and the mother is more prone to develop problems such as blocked ducts and mastitis. In the first few days, however, the mother does have the appropriate amount of milk that baby requires. She is not supposed to have a large amount—that would be inappropriate for baby and no baby could safely consume a large amount of milk--Mother has enough! Yes, the milk is there even if someone has proved to you with the big pump that there isn’t any. How much does or does not come out in the pump proves nothing—it is irrelevant. Also note, no one who squeezes a mother’s breast can tell whether there is enough milk in there or not. And a good latch is important to help the baby get that milk that is available. If the baby does not latch on well, the mother may be sore, and if the baby does not get milk well, the baby will want to be on the breast for long periods of time worsening the soreness.

To recap, skin to skin contact immediately after birth, which lasts for at least an hour (and should continue for as many hours as possible throughout the day and night for the first number of weeks) has the following positive effects on the baby:

* Is more likely to latch on
* Is more likely to latch on well
* Is more stable and has normal skin temperature
* Is more stable and has a normal heart rate and blood pressure
* Has higher blood sugar
* Is less likely to cry
* Is more likely to breastfeed exclusively longer
* Will self wake when hungry

There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. Baby may be placed vertically on mother’s chest and be allowed to slowly find his way to the breast, while mother supports him if necessary. During this period mother should be encouraged to allow baby to find his way while keeping her hands off his head. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. This is baby’s first journey in the outside world and the mother and baby should just be left in peace to enjoy each other’s company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother’s partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there “just in case”). The eyedrops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.

Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. The need for an intravenous infusion, oxygen therapy or a nasogastric tube, for example, or all the preceding, does not preclude skin to skin contact. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin to skin contact is important for the baby and the mother for all the other reasons mentioned.

If the baby does not take the breast right away, do not panic. There is almost never any rush, especially in the full term healthy baby. One of the most harmful approaches to feeding the newborn has been the bizarre notion that babies must feed every three hours. Babies should feed when they show signs of being ready, and keeping a baby next to his mother will make it obvious to her when the baby is ready. There is actually not a stitch of proof that babies must feed every three hours or by any schedule, but based on such a notion, many babies are being pushed into the breast because three hours have passed. The baby who is not yet interested in feeding may object strenuously, and thus is pushed even more, resulting, in many cases, in baby refusing the breast because we want to make sure they take the breast. And it gets worse. If the baby keeps objecting to being pushed into the breast and gets more and more upset, then the “obvious next step” is to give a supplement. And it is obvious where we are headed (see handout When a Baby Has Not Yet Latched)."

Questions? Email Jack Newman at drjacknewman@sympatico.ca, or Edith Kernerman at breastfeeding@sympatico.ca or consult: Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA) or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding; or The Latch Book and Other Keys to Breastfeeding Success; or L-eat Latch & Transfer Tool, or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond. See our website at www.drjacknewman.com.