Babies experience of Birth

I just finished reading Wendy Ann McCarty's book, "Welcoming Consciousness, Supporting Babies Wholeness from the Beginning of Life". I first heard her speak at a conference three years ago and she deeply moved my approach to birth and babies.

The book stands for the experience of the baby. Please note as you read this that I am clear about the fact that the baby emerges from the mother and that supporting a healthy mother is essential to babies well being.

At the end of the book she describes specific therapy cases where she has worked with babies who have had difficult gestation, birth and immediate postpartum experiences. She describes how she listens to the baby react and re-enact their experiences. As I read this I think about the fact that most births completely disregard the woman's experience, thus clearly there is absolutely no context for understanding the baby's experience.

The way I see it, your birth, which is recorded in your implicit memory is your introduction to your parents, your world and your country. We are now aware of the long term impact of this on babies mental and physical health. I used to teach a workshop where someone was asked to leave the room and told to come back in. Upon entry we would treat them the way babies are taught in traditional Mexican hospitals. As beings with no feelings, no capacity and on the brink of death. We would rub them, aspirate their mouths with a bulb syringe, move them from place to place measuring body parts, etc. It was a traumatic experience for all involved. We would then ask the person to describe how they wanted to be greeted upon entry and we would participate in enacting this for them.

We often ask parents in our practice, how do you think your baby wants to be received? This is a very useful question for moving beyond the fear of "Will the baby actually breathe f there is no doctor to stimulate that?".

I challenge you then to ask yourself, as a parent or as a midwife, if I were to be born, what would be really important to me, and what would not? What would make me feel welcome and safe? What would help me breathe and encourage me to want to stay in this place?

Deliver me from Pain

This is a MUST READ for anyone interested in Birthwork and the history of obstetrics. The book is broken down into questions, which I thought was a brilliant way of indulging into the issue of anesthesia in obstetrics. The first chapter is called: The Question of Necessity. This chapter maps out how anesthesia became an issue within obstetrics to begin with. What is most fascinating about this story is that although women have always stated that first stage (dilation), particularly late first stage (8 to 10 cms) as being the most painful, because of the vocal and physical intensity of second stage (pushing) the medical community (new to birth!) got the impression that second stage was the moment of worst pain. So doctors started to anesthetize during pushing. Now thats going to make those forceps pretty handy!

What is fascinating about this chapter is how anesthesia became necessary and considered liberating, necessary or appropriate (depending on the historical times and jargon). From then on, pain became inappropriate in labor and unnecessary for birth; which brings us to where we are now- grand-daughters of women who were delivered under twilight sleep, daughters of women who "can't remember" how it was because they were over-dosed with scopolamine interlaced with their spinal and ourselves discussing with our obstetrician at what point in labor should we get our epidural.

What is interesting for me, as someone who listens and tries to answer women's questions, is: how do we talk about birth after not feeling it for 150 years? How do we tell women that natural birth at home, where we are free to FEEL ALL the pain and "become empowered" by it is better?? Please!!! I almost feel absurd.

What this book illuminated for me is that, after 150 years of first explaining to women to labor pain is SO unbearable that high doses of dangerous drugs, limp, breathless babies, detached families are not only necessary, but beneficial, and secondly eliminating therefore the collective memory of what labor pain feels like, but also our collective capacity to deal with labor pain. It is no wonder that grandmothers look at me and say- "I can't bear to see her in all this pain".

Funny thing is, I can. And so can she.

Homebirth Obstetriciians?

An interesting discussion emerged from the AMAYAL Humanized Birth Conference carried out conference in October 2009 in Monterrey, Mexico. It is important to note that Monterrey Mexico holds one of the highest cesarean rates in the world. In this context, Nacer Renacer, as the perinatal education branch of Amayal works through prenatal education and support to inform and educate women on natural birth. They are working with a male obstetrician who attends homebirths and natural births at the hospital working alongside a Doula.

The issue I am pondering is the emergence of “humanized” obstetricians attending home and water births. In this situation, male (mostly) obstetricians work alongside female doulas to increase access to normal birth. Midwifery is declining across the country and many countries lack midwifery training systems and recognition, for example Mexico only has one officially recognized midwifery school. In the north of Mexico there are very few traditional or formally educated midwives. The positive aspect of this diad is obviously increased access to care. However as a midwife many questions emerge, such as where do midwifery skills go within this practice? What are the outcomes? How is fetal positioning addressed? Are natural remedies used? My sense, from conversation with “humanized” obstetricians and doulas is that practice, like with any midwife is particular to each obstetrician. Some are much more open to learning from midwives and others feel that as obstetricians they have the knowledge they need. The general sense (not confirmed by data) is that cesarean rates are much higher. Barbara Katz Rothman suggested to a Venzuelan obstetrician that he should leave the births to the midwives and focus on providing humanized obstetric services. However, how many practicing midwives are there in urban Venezuela? Not many.

Although on one had I do believe that this diad is necessary and I am strongly in favor of increased access to normal birth. However, this diad emerges in the absence of midwifery. Where are the midwives? Some of these doctors have explained to me that they attend over 15 births a month. Can this replace midwifery care? 15 births a month?? When are home visits done?! Again, this clearly demonstrates the need to have more midwives. My concern about this diad is that it may imply that midwives are not necessary, that its sufficient for an obstetrician to attend homebirth in order to protect the space of normal birth. As midwives we know that our skills extend further than protecting normal birth and our outcomes are so good because of our skills in counseling, nutrition, herbs and homeopathy, fetal positioning and many more.

From informal conversations with the obstetricians I often get the sense that they don't feel that midwifery has much to teach them. They sometimes (please do not get the sense that I am generalizing) give me the sense that they insist upon the hierarchy within which they were trained and that their skills are sufficient. They state proudly that one of the benefits of their care is that is they transport, care is continued. Where I can see the benefits of this, it also makes me wonder, well how often do you transport?

Another issue that I see in this diad is almost a mind/body split. Seeing it physically I imagine that midwives have clinical and decision making skills that work within our intuition, nurturing and continuity of care. Within the obstetrician/doula homebirth model, it seems as through the midwives right and left brains are split into two people: an obstetrician who can diagnose, run an IV and make a difficult decision and a Doula who provides continuity of loving care. I have observed my reaction to this and I'm not sure if my skills and intuition could be split. So many times in prenatal or postpartum care the attention given is based on a sage combination of these skills.

I am curious to have more conversations with women who are attended by the obstetrician/doula, curious to see their results and outcomes and curious to ask them many, many questions. I also curious about whether or not midwives see this as an opportunity to stand in our ground as the experts in normal birth, as that is what we are trained for, and to train more midwives.

International Birth and Midwifery Conference

the BIG announcement!

International Midwifery and Humanized Birth Conference

June 11 to 13 2010

San Cristobal de Las Casas

soon to come, all the information on our webpage:

www.lunamaya.org/congress

See you there!!!

We are searching for workshop facilitators and key note speakers, if you want to or know of anyone who would like to participate, let us know!

Births that remind me why I love Birth

Some births are exceptionally special. They are undisturbed, physiological and divine. These are the births where I show up and the woman and her husband are loving each other secretly... where the lights are off. Births where the woman moves as she needs to and no one needs to talk or even whisper. Birth where the sounds remind us of Whales, swimming together.

These are births where the mother opens herself, emotionally, physically, spiritually... all of herself, to receive her newborn. Where when she touches fear she looks deep into her lovers eyes and says, "I can't do it anymore". and he says, "yes, you are doing it". Enough said.

These births remind us that birth is trusted when the midwife has nothing to do. Births where you are almost embarrassed from the intrusion on the sexual ritual that the couple is undergoing.

Births where the baby is born and the mother sings to her newborn, who just stares at her in recognition. Births where the baby didn't have to brake the mother to get through her and where everybody cried except for the baby.

I hope every woman can find this birth. Within herself.

These are the births that remind me of why I love Birth.

Reaching for straws

I heard this this week:

In an ultrasound exam a baby was detected to have femurs that are two weeks short. The physician therefore explained to the woman that they might as well schedule a cesarean because due to the short legs the baby wouldn't be able to push himself out of his mother's uterus when it came time for pushing- or stretching as this case might be.

Now thats really REALLY getting desperate.

The Post Partum War

Its 2.30 am and she hasn't slept since about three days before her birth. Which was about 3 days ago.

The baby is screaming.

Her breasts are screaming.

She cannot tollerate another hour of the baby hanging from her nipple, sucking the life out of her. She can barely sit because the stiches have swollen. Her arms are sore. Her back aches.

All day long her family has sat around her, passing the baby around and thinking of creative new ways to shut the screaming up. They've given their expert opinion on her milk making capacity, they've commented on the babies weight less (apparent, they say) and question on whether she is really going to wait five days for the milk to come in??? is she sure???

2.30 am and she is alone. The family has dissappeared with their expert opinions and their wisdom and their oatmeals and fennel teas. Her mother appears at the door and looks at her, "Is there anything I can do dear?" "No Mom." "Why is the baby crying again?" "I don't know mom". "Here, give me the child...."

The post partum war has established itself deeply in the folds of the bedroom curtains. It hides in the bed sheets jumping out everytime someone rustles the covers. It hides behind the door jumping out at her everytime she, or someone else opens or closes the door.

Its either me or the baby. And since I'm bigger and older, its going to be me who wins this one.

Despite our childbirth preparation, parenting classes, women's groups, feminism, blogging and midwifery model of care, as new mothers we are completely unprepared for the postpartum war. And we think we won't fight it. And time and time again, I walk into a woman's home postpartum and find her thick in the battle.

So what is the postpartum war?

1. It is our intuitive mothering skills that we inherit from our mother. This is beyond reading and reason. This is the basic, unconditional, completely dedicated love that our mother gave to us during our post partum period. Yes, that was the 70's wasnt it? Mom was in some purple post-anesthesia haze, with some bizarre formula instructions in one hand and the absolute urgency to train us, 5 day old women, to be independent and assertive. 30 years later, with a Masters degree and 5 years of therapy to heal mom's deep mistakes, we find ourselves wondering why the baby won't just shut up and go to sleep and stop being so dependent on us for every little thing!!!!!

Regardless of what we have learned, we learned to mother during our first two years post partum. We learned that from mom, who did the best she could. But also was fighting a war with us. Because she, like us, was told that babies need to be disciplined, managed, not spoiled. That we must set boundaries and not lose our independence. That life is too complex for unconditional dedication. There's too much to do. And babies need to learn independence and rules. Get them out of the bed and off the breast or they will be there for 38 years!!!

2. We honestly believe that two needs and desires cannot live in one space. You want milk and I want to sleep. You want attention and arms and I need to go to the bathroom (and I've been constipated ALL WEEK!!!). You need me to stare at you in bed all day and I have about 56 emails to answer right now. You need my completely undivided 24 hour attention and I need a breast pump so I can get out of this trap as soon as possible and regain the independence that it took me 33 years to achieve!!!

The truth is, as mothers we can and must learn to live with two needs and desires in one space. It doesn't have to be one or the other, as long as we are completely, totally dedicated to our baby when it is time to do that. As skilled as we are, we cannot multi-task when it comes to giving our baby undivided attention, which is what our babies need. Even if it is only a few hours a day. No one needs to win this war. We need to stop thinking we need to fight it.

3. The baby doesn't need to shut up, the baby needs to be heard. If the baby is screaming, the mother is screaming. The mother and baby are so fused during the first two years that it is impossible for the baby not to manifest the mother's emotions. As polite women, we keep our emotions within. Only to find that after all the lactation experts have left our bed-side, our baby screams for about four hours. The baby needs to be heard and the mother needs to listen. The mother needs to talk and state her needs and the rest of us need to listen. The rest of us need to listen to the baby and attend to its needs. And baby needs are pretty simple. LOVE. Pure, Genuine, oxitocin induced, dedicated, unconditional, focused love.

Eventually a baby who is never heard will shut up. And 30 years later she will wonder why her beautiful postpartum bed has become a war.