Moved to a new space

16 11 2009

While I definitely love the look of this space, I’ve been feeling a little constrained by the layout and options available with a wordpress hosted blog…so we’ve moved. Please come join us at BluebirdMama. We hope you’ll like the new format.


Open Letter to BC Homebirth Study Critics

3 09 2009

Dear Uniformed Commenter

After reading the newest study on the safety of homebirth, I sat back to read some reactions from the press and the public. I had a look at the CTV coverage and the CBC coverage and I read over the comments in reply to each story. Imagine my dismay when I read some of your reactions! I was rather glad that the comments were closed because I was too upset to post anything coherent or cool-headed. Frustrated, I can not stop thinking about your replies.

First, I shake my head as it appears that you’ve neither read the study nor understood the very article you’ve responded to. You seem to have missed the point entirely. Your arguments fall into one of several categories:

1. The Personal Anecdote Rebuttal

This is some variation of “I can only imagine how horrible our child’s birth would have turned out if we had tried to have a home birth” and then launching into your personal story where everything was touch-and-go but thankfully the medical staff at the hospital saved your baby.

First of all, this is not a logical rebuttal to a scientific study. This is an emotional reaction known as a pathetic appeal. You are rejecting “a claim based on how it makes you feel without fully analyzing the rationale behind the claim”. You are appealing to people’s very real emotions about the health and safety of a tiny baby at the expense of being able to actually hear what the study’s authors are trying to tell you. While it is totally understandable that this is an emotionally sensitive topic for many, the problem is that you are overemphasizing the emotional component at the expense of the message (the logical component) – this is a flawed argument. Effective, yes – ad campaigns do it all the time, but flawed nonetheless.

Secondly, while my heart goes out to you that you had a difficult and scary time at the birth of your baby and while I’m glad that modern medicine was able to save your baby, we can’t actually compare your situation with that of the study subjects. We have no way of knowing with the few details you’ve given if your particular circumstances would have made you an eligible sample for the hospital group. Perhaps you had complications or a high-risk pregnancy that would have excluded you from the study. Therefore, sadly, your situation is not a relevant point of comparison for a study that was looking at births fitting very specific criteria. If that is the case, even the study’s authors, home birth advocates, the BC College of Midwives etc. would all agree with you: your child’s birth should not have occurred at home because it did not meet the criteria to have a home birth safely.

2. The What If Question

This argument boils down to “Yes, homebirth is fine as long as nothing goes wrong. But why chance it?” You have missed the point completely; the study concluded that home birth is as safe as hospital birth because in all the cases studied, virtually nothing did go wrong. The perinatal death rate was the same as for both hospital groups (in fact, it was marginally lower in the homebirth group). This what-if-something-goes-wrong argument was essentially what the study was trying to find out – how often does something go wrong at home? And the conclusion was, provided certain guidelines are followed: no more often than something goes wrong in the hospital.

3. The Get With The Times Blow Off

This argument is the most uninformed of the bunch. You demonstrate your complete lack of understanding of maternity care and midwifery with variations of “Midwives are old hippies with no training and would be useless in an emergency” or “Stop being so full of yourself and your need to prove something – modern medicine is here for a reason, use it.” This brand of reaction is intended to silence anyone supportive of homebirth by insulting and denigrating but it only demonstrates your own ignorance.

Midwives, in BC at least, have a 4 year University degree during which time they attend hundreds of births and spend half of their studies in practical learning settings. They are specialists in birth, female physiology, the newborn, breastfeeding and more. They carry with them resuscitation equipment including oxygen, various drugs (including drugs to prevent haemorrhaging) and can start an IV or intubate if necessary. There are two midwives present at a homebirth, one for the mother and one for the baby so that if anything should happen there are enough hands there to make sure that everyone is being cared for. Furthermore, one of the criteria for being eligible for a homebirth in BC is to be within reasonable distance of a hospital for a rapid transfer if necessary. These are not old grannies from the bush; these are highly trained and skilled experts in childbirth and maternity care.

Compare this with a physician who only studied childbirth, babies and female physiology for a fraction of their total time at school. Consider the study’s findings that the mean number of antenatal visits with a midwife was 11.8 versus 9.3 for a physician. Consider that doctor’s appointments run ten minutes while midwifery appointments are fifty. You would choose a heart specialist if you were experiencing angina right? Why wouldn’t you choose a specialist for childbirth?

The misconception that homebirth advocates shun modern medicine because they have something to prove or think they are above the use of life-saving equipment/procedures, thumbing their noses in defiance is also at the heart of the Get-With-The-Times brush off. The beauty of homebirth in this day and age is that we can apply our knowledge of medicine to increase the safety without losing the sanctity of birth for mother AND baby (no, it isn’t just about the mother’s experience) and WITHOUT the misuse of technology and abuse of power that is rampant in the hospital setting. We can trust birth, we can use our intuition, we can give mother and baby time to get in the right position to birth safely and efficiently but we can also safeguard against haemorrhage, infection and multiple other complications because of scientific advances. Homebirth and midwifery advocates recognize this. It’s not a case of throwing the baby out with the bath water. The homebirths you are envisioning, you know alone in a cabin in the woods without electricity? Those births would have been excluded from the study.

4. The Caesarean Card

Your disappointed reaction to the homebirth study is to play the caesarean card: “That’s all wonderful news but we had to have a caesarean.” This is a tricky point. There is much debate about whether your caesarean was necessary. It is generally accepted that the caesarean rate is too high (almost 30% in BC) and yet, each individual caesarean is somehow deemed necessary by physicians and families. When it’s your baby you’re talking about, you can’t help but feel that your situation was different than the other 1 in 3 families that faced unnecessary caesareans.

You use this as evidence that it was lucky you were in the hospital. And yet even women who were low risk (they met all the criteria for having a safe homebirth) were almost twice as likely to birth by caesarean if they planned a birth in the hospital with a physician. How do we explain that? Perhaps you wouldn’t have “had to have a caesarean” if you were birthing at home, or at least in a hospital with a midwifery care provider?? Unfortunately we can’t answer that question but it is worth wondering about.

5. The Attack The Stats & Study Design Argument

You like to poke holes in the study’s findings to appear as though you’ve read it. You say things like “oh, homebirth is associated with a lower incidence of epidurals. Of course that’s true. Last time I checked there was no anaesthesiologist waiting in the kitchen.” Again, you are not reading the study clearly. The lower rate of interventions is like icing on the cake. The study found that homebirths carried the same risks as hospital births in terms of perinatal mortality. Thus, if you are eligible for a homebirth you can consider it equally as safe as birthing in a hospital. But if it’s also important to you to avoid an epidural, infection or caesarean or to keep your perineum intact then the benefits clearly lie in staying at home, precisely because there is NOT an “anaesthesiologist waiting in the kitchen” or an OB down the hall with a stop watch and a scalpel.

The other common mistake you make here is to assume the study, like some previous studies, is not comparing apples to apples. You claim that hospital births had higher rates of interventions because all the complicated births had been re-routed to physicians and hospitals by the system. The groundbreaking nature of this study is that they did manage to compare apples to apples. The comparison groups (hospital birth with midwife or physician) were very carefully matched to the study group (home birth with midwife) on multiple measures including income, age, geographic location, parity and most importantly, status of eligibility for homebirth. This means that women were excluded from the hospital group if they were high-risk or experiencing complications. Furthermore, because the study looked at planned place of birth rather than actual place of birth, homebirths that ended up as hospital transfers (for emergency or other reason, like mother fatigue) were still counted as homebirths, rather than skewing the hospital numbers. If a mother planned a homebirth but transferred and ended up with a caesarean, that caesarean went in the homebirth numbers not the hospital birth numbers; otherwise, all of the caesareans would have been in the hospital group and then the stats and study design surely would have been faulty.

So we come to a problem with all of these comments. It appears that no matter how many studies are published showing the safety of homebirth and of midwifery care, skeptics refuse to see what the study clearly shows. As Jennifer Block puts it in her article The Birth Wars: Who’s really winning the homebirth debate:

This is a natural human tendency, to base knowledge on anecdotal experience, ‘and we have science to help us get around it. But for this topic it’s not happening.’

‘What’s interesting is why these studies have not swayed public opinion and not been integrated into the medical establishment,” she says. “People deeply, deeply believe that a baby cannot be born without massive amounts of medical intervention, and it’s nearly impossible to overturn that cultural norm. There’s something blocking people from operating on the basis of the balance of evidence.’ (Quoting Cheney)

So what is blocking all of you from accepting the evidence?

In order to accept the evidence a major paradigm shift is necessary. You have been so conditioned to fear birth and to consider birth an emergent medical crisis waiting to happen that you can’t even hear what study after study is trying to tell you. You have been so blinded by the medical model’s approach to childbirth in our technological society that you no longer have any trust in or reverence for the natural world. And despite this love of science and medicine, you won’t allow yourself to be swayed by good clean science telling you that birth is safe. It’s bad enough you don’t understand that with your intuition, you also won’t allow yourself to see the scientific facts. This is the epitome of closed-mindedness and it makes me despairingly sad.

It appears that until you can trust birth you will never be convinced of the wondrous truth. The truth that the female body of all mammals is perfectly, amazingly designed to give birth, that somehow we managed to put 8 billion people on the planet without the benefit of hospitals and that all your faith in technology has caused you to lose faith in yourself.

Six Week Check-Up

28 08 2009

Do you have new first time parents in your life? You’ve probably gotten them a gift and visited to meet the new wee one. You’ve probably puzzled over what a new family needs and how to help out.

There are lots of great ideas out there. Here’s one I particularly liked as it really rang true for my experience as a new parent. To take it one step further, I’d like to challenge everyone out there to do the Six Week Check-up. That is, make a point of checking in with the new mom as her baby nears the six week mark.

Why Six Weeks?
Do you remember the six week check up after you had your first baby? Do you remember what else was going on for you then? Maybe you haven’t had kids yet or maybe your kids are older and now that you’ve left the sleep-deprived haze, those early days are all a blur. Let me remind you:

The first few weeks were all bliss, staring at baby in awe, proudly presenting her to family and friends, feeling totally bonded to your partner for producing this perfect little angel. But now? Dad has gone back to work. The whirlwind of out-of-town visitors is slowing or they’ve all come and gone. Friends and family have all met baby and are back to their regular lives: working, house renos, family vacation. The new baby celebrations have all ended: the baby shower or meet the baby party was a few weeks ago. Friends are no longer dropping in with a cute onesie or yet another handmade blanket. The email congratulations have tapered off. In short, everyone else’s excitement has worn off. For them, now it’s business as usual.

For mom? She’s home alone with baby and the reality of her new life is finally starting to hit her. This likely means getting used to the isolation of maternity leave. The first few weeks felt like a well-deserved vacation, especially after the aches and pains and fatigue of working while pregnant. But now, she’s kind of bored. She’s surprised by how much she misses talking to adults when she’s staring at the four walls and nursing AGAIN. She’s surprised by how much she misses the noise of the office (or the restaurant or the store or wherever it was for her) when she realises how quiet it is at home alone while her friends and partner are at work. When she sees her friends, she realizes she has surprisingly little to talk about now that she can’t talk about her work. She wonders what to do with herself and she misses that productive self, that woman who excelled at her work. It’s lonely and she feels a little lost in a culture that defines people by the work they do.

After the standard first few weeks rest and recovery, she was feeling great and tried to get back to her normal routine, only to find that she’s still exhausted. Mama’s beginning to realise that her plans of continuing life as before with baby in tow might be a little unrealistic. Her thoughts of tackling some of those crafting projects gathering dust during her “year off” seem laughable now as she struggles to sleep enough, keep the house clean, shower and eat lunch. By 6 weeks, the new family is likely out of the extra freezer food they prepared before the birth and friends are no longer dropping off casseroles. Offers to throw a load of laundry in or pick up groceries while new mom grabs a nap have petered out. Mom’s learning to navigate the grocery store with baby (and all the baby gear) now. Every day is a list of laundry, nursing, diapers, nursing, napping, nursing, dishes, nursing, more laundry, more nursing, more diapers. She’s surprised at how little she accomplishes and she might be starting to get run down around the 6 week mark because she’s trying to do too much. Back to regular life?

Not exactly.

At 6 weeks, baby often goes through a growth spurt (also 3 weeks, 3 months & 6 months) which means that he’ll be cluster feeding. Mom will feel like she’s nursing all day and all night. It will feel like she can’t attend to the most basic things (like brushing her teeth) because baby is rooting and hungry every five minutes. Considering that the support and help have often faded away by this point, this particular growth spurt can be pretty overwhelming. Also, because baby is acting so hungry and fussy, mom may start to worry about her supply.

After 6 weeks learning to breastfeed, some women may have the hang of it and some may still be struggling but all are still vulnerable to fear, doubt and bad advice. They might feel on the verge of giving up. They might feel that they gave it everything they could and they just weren’t able to do it. They could all use encouragement and support now. As PhD in Parenting says in her post on When to Give Up on Breastfeeding:

“tell her that you know how hard it is. Tell her that you are proud of her for trying so hard. Tell her that it is her choice whether to continue or not and that you fully support her no matter what her decision is and that she is a great mother no matter what decision she makes. Read up about what it really means to support a breastfeeding mother. Give her a hug. Let her cry.”

Speaking of crying, here’s another reason six weeks postpartum is an important time to check up on your new parent friends: ever heard of purple crying? It is inconsolable, unpredictable LONG bouts of crying every evening. This crying tends to increase in the second week of life and peak around the sixth week. This means your new mama friend who is home alone with baby all day may also be spending her evenings walking the floor with a baby who just can’t be soothed no matter what she tries. Check out this graph showing crying patterns and note the peak at 6 weeks of age despite the wide range of distribution for all infants. New parents need your support at this time.

Lastly, everyone’s heard her birth story. Maybe twice. When mama starts recounting the details, they move on to other topics. But she hasn’t finished processing the event. It’s a major rite of passage and she may need to go over it, and over it, and over it. Especially if it wasn’t what she was expecting (true for most of us) but even more so if it was traumatic. She may be feeling horribly guilty, violated, disappointed, let down and conflicted. Other people don’t want to hear her go on about it anymore, they want her to focus on her healthy baby and get over it (“I mean it was over a month ago, right? And look at your beautiful baby. It’s all over now”). She may think there’s something wrong with her that it’s still so upsetting. She might need to talk about it again. And she might need to be pointed in the direction of good resources like Solace for Mothers and International Cesarean Awareness Network.

What is the 6 Week Check-Up?
It’s an opportunity to remember that 6 weeks with a new baby is not a long time. Everything is still new to your friends and even though your excitement might have worn off, they are still adjusting to parenthood. What can you do?

  • Renew your offers to pick up groceries or throw some laundry in for them.
  • Ask mom to go for a walk with you during the day (on your lunch break if you work).
  • Pop in with lunch for her. Hold the baby while she eats.
  • Encourage mom to get out of the house by joining a mom’s group, play group, neighbourhood drop in centre, La Leche League group, mom & baby yoga class. Offer to go with her if appropriate.
  • Call during the week and let her know that you are thinking about her (and she isn’t forgotten).
  • Drop off a casserole.
  • Ask her sincerely how she is coping.
  • Listen actively.
  • Ask her to tell you her birth story again.
  • Encourage her efforts to breastfeed. Let her know that it will get easier.
  • Tell her that sometimes baby’s cry a lot and it doesn’t mean she is doing anything wrong.
  • Remind her that it won’t always feel so overwhelming.
  • Be real – tell her a story about a time when you struggled in the beginning so she knows that she’s not alone and that we all struggled at first.

I remember sitting on my bed rocking a screaming baby back and forth waiting for my husband to get home from work. I remember feeling so inept and in over my head. I remember feeling like I couldn’t reach out and ask for help. Right then, a phone call or a knock on the door from a caring friend wouldn’t have stopped baby’s crying or alleviated my sleep deprivation but it sure was what I needed.

Birth Plan Basics

23 08 2009

Once unheard of, it is now routine to hear “this is a copy of my birth plan” as a woman is admitted to L&D. There is a lot of info (and opinions) out there about birth plans. This post is intended as a primer to get you pointed in the right direction.
Often explained as a document outlining how you wish your childbirth experience to go, the birth plan is much more:

The birth plan is way to prepare for your birth: properly prepared, it will require discussion with your care providers and likely personal research and reading. It will allow you to seriously consider how you feel about medications, interventions, procedures, and yes, emergency situations should they arise. It will give you an opportunity to talk with your partner about his/her hopes and fears and to communicate about what is important to you both.

The birth plan is a communication tool: hopefully it will clearly and succinctly spell out your wishes and expectations not just for your childbirth experience, but for the safety of your baby and yourself. It can function as a reminder to your care provider of things you may have talked about weeks before. The birth plan can have the power to speak for you despite staff shift changes, whether or not you have an advocate there for you (partner, family, friend or doula) and whether or not you are in a condition to speak for yourself.

The birth plan is not a frivolous wish list: it is a simple one page statement outlining what you are ok with and what you are not ok with. Birth plan detractors seem to feel that a birth plan reflects a selfish mom’s over-attachment to her own experience. However, we all have the right to informed consent when it comes to medical procedures and your birth plan should focus on this aspect rather than getting caught up in small details like whether or not you want to have your ipod in the room.

The birth plan unfortunately is not a legal document: there will be hospitals and staff members and births where the birth plan does not get followed. Make sure to go over it with your care provider ahead of time. Is your care provider comfortable with the plan? Find out if the points you’ve made are even possible at the place where you are delivering – does hospital protocol even allow everything you’ve outlined? Bring multiple copies with you to give out. Be prepared for shift changes. Remember that circumstances might arise that you didn’t consider ahead of time and some parts of the plan might not get adhered to.

The birth plan is not a road map: no one can really plan out their birth. Birth is almost always surprising in some way. It is hard not to get caught up in your vision of the ideal birth but birth is unpredictable. Remember to account for things you hope will not happen. The birth plan should not become a way to cling to control. Carefully consider the points on your birth plan and thoughtfully write it out. And then, hand it to your partner and let go of the plan so you can embrace the unknowable aspect of birth.

Connecting with your Community

20 08 2009

Parenting can be lonely. Your lifestyle changes drastically. Perhaps you are the first in your circle of friends to have children. Perhaps you are surprised by the isolation of maternity leave. Perhaps you long for a real connection with other parents rather than those conversations where you pretend it’s not as hard as it is. Perhaps you find the playground intimidating.

Most parents agree that parenting is both the hardest and most fulfilling job they’ve ever held. You can try your hardest to prepare yourself but no amount of reading, observing and talking to other parents can prepare you for it.

Parenting transforms your life to the place where you can’t imagine your life before children. And suddenly you find yourself relishing conversations about the minutiae of raising children. It just isn’t the same without a community to share it with. So what can you do to foster that need for community?

Check out these articles on community:

Finding Your Tribe: Feed Your Soul while Feeding Your Kids – an article from Mothering Magazine on creating a parenting community for yourself.

Longing For Community – Natural Parenting guru and former Mothering Magazine editor Peggy O’Mara’s thoughts on community.

Create a Date Night Group
Join up with 3 other families and start babysitting each others’ kids. Each week one family watches all the kids. The other 3 couples get date night. So 1 Friday per month you might have a mad-house full of kids—the other 3 Fridays you get to be alone with your partner! And as the years pass, the kids will entertain each other and all you’ll have to do is make sure they are safe.

Start a Book Club or a Knitting Night

Find a group of parents and read parenting books to discuss at a potluck. Have older kids? Start a book club and invite the kids like the Mother/Daughter book club The Page Turners in the November/December 2008 issue of Mothering Magazine. Always knitting? Start a knit night with other moms. Rotate meetings so each family takes a turn hosting.

Team Up
Commit to regular check ins with another mom so you can encourage and support each other with your parenting challenges and triumphs. Agree to call each other once a week just to see how it’s going. Find a parent with older kids who is willing to act as a mentor to you. Check in regularly (once a week or once a month). Read the book The Mother’s Guide to Self-Renewal and if you’re in BC join a Mama Renew group.

Birth Choices – what is right for you?

19 08 2009

Today we have more choices than ever about how we birth. We have the choice of using a doctor or midwife for our practitioner. We have the choice of birthing in the hospital or at home. We can choose who is present at the birth. We can choose to hire a doula. We can choose between a multitude of prenatal classes ranging from hospital-run classes to private classes in Lamaze, the Bradley method or Birthing From Within. We can enroll our older children in Sibling Preparation classes, we can take prenatal yoga or prenatal pilates, we can bring music, pillows and massage oil to the hospital. We can choose to labour in the tub or the shower or on a birth ball. We can play cards or go for a walk. We can birth squatting or standing or via elective cesarean. We can even write up elaborate detailed lists of all of our preferences and give this Birth Plan to our practitioners.

Faced with all of these choices, how do you know what is right for you? How do you know that the choices you made before the big day will still be right when labour starts – especially if you are a first time mom?

Choice, in general, can be a double-edged sword. On the one hand, it is empowering and enriching to be given the opportunity to have a say in what happens to us. On the other, given too many choices or inadequate information to help in our decisions, the process of choosing can cause stress, anxiety and even guilt and depression. And when it comes to birth, it can give the misguided impression of control.

Relinquish Control (even those subconscious thoughts…)

The first thing you can do on your journey towards the right birth for you is to forget about those fantasies of your ideal birth. We all do it: we all have a vision in our heads of the way we hope our birth will proceed. These visions are rarely realistic (unless you imagined in your ideal birth that you would be half-naked on your hands and knees in a roomful of strangers). Birth is a dynamic process and we cannot control what happens. The woman who is determined to get her epidural before she’s finished with the hospital admitting desk may deliver baby at home in the bathroom attended by her partner. The woman who preaches natural birth from before conception may end up with a complication, or labour induction and a cesarean delivery. We’ve all read these stories and hoped it wouldn’t be us. But it could be. So the first step is to let go.

Read everything you can get your hands on
Knowledge is power. If you aren’t a reader, ask questions. Ask all the mothers you know what their experience was like. Ask your practioner all those nagging questions you’re afraid to speak out loud. Explore all the birth possibilities there are. Don’t shy away from those topics that you hope you won’t have to face (like having a long, drawn out back-labour or requiring a cesarean). Don’t write off ideas that are new to you (like homebirth, or hiring a doula). The more you can understand about the way labour progresses (or sometimes doesn’t) and the way labour is managed (or sometimes mis-managed), the better the chance that you will be able to play an active part in the process.

Be Flexible (but know your limits)
That is, be prepared to change your mind. Something that seemed right before birth may no longer be fitting during birth. Hell, something you asked for during one contraction, may not be what you want during the next. Accept the fact that you may need to revise your thinking in the face of new information. However, if at any time, you are uncomfortable with the care you are receiving, be confident that it is okay to assert yourself or have some intervene on your behalf. By trusting your instincts and your birth team, you’ll know when to stand your ground and when to adapt.

Gather good people around you

The people who support you and care for you during labour can make a huge difference. Consider carefully whether you want a doctor or a midwife, whether you will hire a doula and which friends and family members you would like present. Ask your care-givers questions and reserve the right to change your mind if you don’t feel comfortable. The time it takes at first to find good people could make the difference in how your birth unfolds or at least in how you feel (even when things don’t go as planned). Good people will give you information and not rush your decisions, will help keep you focused, will make you feel supported and empowered, will be positive and encouraging and will inspire trust.

Face your Fears
We all go into labour with a mixture of elation and apprehension but it’s good to ask yourself what it is you are afraid of before your water breaks. Hopefully a few weeks before. It’s hard to know how to manage a nebulous, nameless fear. But if you can seriously explore what scares you about birth (and motherhood) before the throes of labour send you into panic mode, the odds are you’ll be better equipped to deal with whatever comes your way. Try, if you can, to go a little deeper into your fears than the obvious like fear of pain or fear of a long labour. What about the pain scares you? Fear of not being strong enough? Fear of losing control? What about a long labour scares you? Facing your fears is emotionally exhausting but it would be a shame to let fear hold you back from the possibility of a truly rewarding experience.

Know yourself, know your situation
This is the easiest part because it might be decided for you. Are you a home-body who feels most comfortable with a few close friends rather than in the middle of a party? Maybe homebirth is an option for you. Are you an analytical person who is comforted by procedures and technology? Are you someone who always wants to be prepared for the worst case scenario? You might feel strongest birthing at a hospital or birth center. Are you totally against medicated birth? Perhaps a water birth is right for you. Is your baby breech? The safest bet for you and your baby could be a cesarean. Was your pregnancy a textbook case or did you suffer from multiple complications? Your health practitioner will be able to explain what your options are based on your personal situation and with a bit of self-analysis and thought, you’ll find the answers you’re looking for.

Often as labour day unfolds, it doesn’t come down to choice at all. We don’t choose when our babies will come or how they will make their entrance. Sometimes, circumstances arise that take the power from the mama and she needs to stretch and bend around the situation she is given. And sometimes, with trust, in our instincts, in ourselves, in our babies, in birth itself, our babies come just the way we knew they would. We do what we need to do and the most right thing of all is that they are safe.

Recipe for a Gentle Birth

18 08 2009

Have you ever wondered what exactly people are talking about when they say “gentle birth”? From the way our culture talks about birth, there doesn’t seem to be much about it that is gentle. This week, I’ve been re-reading Barbara Harper’s Gentle Birth Choices – A Guide to Making Informed Choices and would like to share with you some of her suggestions for a birth that’s gentle on mom and baby.

Barbara Harper is a former nurse who went on to form Global Maternal/Child Health Organization and Waterbirth International following the births of her children. She lectures around the world on maternity care reform and describes gentle birth like this:

“A gentle birth begins by focusing on the mother’s experience and by bringing together a woman’s emotional dimensions and her physical and spiritual needs. A gentle birth respects the mother’s pivotal role, acknowledging that she knows how to birth her child in her own time and in her own way, trusting her instincts and intuition. In turn, when a mother gives birth gently, she and everyone present acknowledge that the baby is a conscious participant in his or her own birth. The experience empowers the birthing woman, welcomes the newborn child into a peaceful and loving environment, and bonds the family.”

I love this description of a gentle birth because on the one hand, it seems so simple and obvious that we should be respectful and gentle with the two main participants in any birth: mother and child. Yet, on the other hand, it highlights for me how rarely this happens in our high-tech culture and how difficult it is for many women to achieve a gentle birth.

What are some simple, practical suggestions for a gentle birth?

1. Preparation

In the past, preparation would have probably included talking to older experienced women in your community: your mother, grandmother, aunts, older sisters, and probably witnessing a birth or two before you had to do it yourself. Nowadays, some key aspects for preparation are:

  • choosing a childbirth educator that trusts birth and brings a positive attitude to their classes
  • taking care of your body: getting adequate rest, exercising, eating well
  • remaining open-minded and flexible about how your birth might unfold
  • taking an honest hard look at your attitudes, beliefs and fears about birth

2. A Reassuring Environment

The human body is designed with some wonderful pain management chemicals called endorphins that are triggered by the contractions of the uterus. The stronger the contractions, the more endorphins are released. Working in direct opposition to endorphins is adrenaline. Adrenaline is triggered by fear and stress. It prepares us for the fight or flight response by tensing our muscles for action. It is the anti-thesis of staying relaxed and letting your endorphins do their job. One key way to help a laboring woman cope with pain is to keep her relaxed and confident. This can prove difficult if she is surrounded by busy attendants, beeping machines, scary looking resuscitation equipment and ticking clocks.

3. Freedom to Move

It is vital that a woman be able to move about during labour, to adopt whatever position she needs to birth her baby instinctively. Lying on her back is more painful and unlike more upright positions (kneeling, squatting or leaning on furniture or a support person), she is working against gravity to deliver baby. Moving around during labour helps baby to readjust and descend and keeps mother actively participating in the process.

4. Quiet

Keeping the birth room quiet is essential. Partners, support people and birth attendants must respect the mother’s need to focus. Each woman deals with contractions in her own way but it’s absolutely important that she be able to concentrate. Quiet also fosters a sense of intimacy and baby’s transition into a world full of sound is much less jarring.

5. Low Light

Turning the lights down or off has much the same effect as turning down the volume. Mother feels calmer and more relaxed. The room becomes comforting and intimate. Baby is more relaxed and alert, able to open his eyes and look at his mother without the glare of bright lights in his sensitive eyes.

6. Continuous Labour Support

Studies (M. Klaus, and others) have shown that maternal satisfaction and birth outcomes are much better when the mother is not left alone to labour. Mothers who were given continuous interactive labour support had 50% fewer surgical births, requested painkilling medication 60% less often than the others, and also had much lower incidence of interventions such as forceps or vacuum deliveries.

7. Labour Starts on its Own

Despite technological advances and extensive research, it is still difficult to determine exactly when conception may have occurred or to determine the perfect moment when labour will start. Due dates are calculated using educated guess work based on a menstrual cycle of 28 days. Only 15% of women have a 28 day cycle. It is fair to say that at this point, with our limited understanding of the natural processes at work, it is very presumptuous to think we know better than Mother Nature. Induction is common enough in America (36%) to have created ample opportunities for research. This research has shown that to artificially initiate labor for any but the most critical medical reasons is to create an unnecessary and potentially serious risk to mother and baby.

8. The First Breath

Until the baby takes her first breath, she is receiving oxygenated blood from her mother through her umbilical cord. Cutting the cord too quickly after delivery forces baby to abruptly begin breathing air on her own for the first time. By delaying cord cutting, baby can gradually take breaths while still receiving precious oxygen from mom. And should baby need some extra stimulation to breathe on her own, a gentle rub will usually do the trick rather than hitting or slapping.

9. The First Caresses

The newborn should be handed to mother immediately after birth. Babies benefit from skin-to-skin contact and are reassured by their mothers’ loving touch. Mothers are eager for these first caresses too: she may be experiencing feelings of loss over the end of her pregnancy, she may be relieved that the hardest part of the birth is behind her and excited to meet her child. Fathers can get in on the skin-to-skin touch right away as well and it might be the first moment when the baby becomes “real” to him. These early moments of holding and touching baby help to bond all three.

10. The Baby at the Breast

The minutes after birth is the best time to get baby started breast-feeding. Suckling gives babies immense comfort and after a brief period of alertness, baby will often sleep, exhausted from her efforts during the birth. The earlier you can start baby on the road to nursing, the more chance of success. Breastmilk production increases with demand, colostrum (the nutrient rich, high protein first milk) helps get baby through until mother’s milk comes in and the act of nursing releases oxytocin in mom which stimulates contraction of the uterus (preventing hemorrhaging) and magnifies those lovey-dovey feelings for mama.

11. Bonding & Attachment

Time together as a family to get to know each other after the birth is especially important. Separating mother and baby is extremely stressful for both and should be avoided. In a gentle birth the mother is awake and aware, highly conscious, energized by having given birth, and extremely eager to spend time with her child—touching, feeling, resting or sleeping together. The newborn needs and wants the comforting presence of its mother, her warmth, touch, sound and smell. After a gentle birth most mothers experience an incredible exhilaration that helps them to overcome their exhaustion. A gentle birth does not involve baby being left in a bassinet in a nursery far from her family.

As Harper herself indicates, this list isn’t a prescription or a set of rules, but rather an approach to birth that each woman must customize herself, taking into account her own values and beliefs to achieve a gentle birth whether at home or in the hospital.

Adapted with permission from Barbara Harper’s Gentle Birth Choices