Friday, November 17, 2006

Trusting Birth Even More

This essay was written on November 6, 2006 by Carla Hartley, director of the Ancient Art Midwifery Institute. Begun in 1981, AAMI is a distance learning program for direct-entry midwives. Carla also founded the Trust Birth Initiative, a grassroots movement that inspires women to trust in the birth process. Many thanks to Carla for giving me permission to post her essay here!

I hear lots of birth stories. Most of them are wonderful. Today a friend emailed a very tragic story of loss and despair. A mom going in for her second cesarean suffered a massive rupture and lost her baby and her ability to have another. It shook my friend to the core and I certainly understand why. I have been in similar situations and know how desperately everyone involved wants answers. I wish I had them.

When tragedy strikes sometimes there are no answers. I do not know if it was attributable to induction or pitocin and know nothing about the previous cesarean. But even if this mom had been just walking down the street when this catastrophe happened, it doesn’t affect my faith in the intrinsic safety of birth. I am terribly sad for them but I still believe that birth is safe.

Living is synonymous with risk. There is no escaping it. Everything we do carries some risk and there are many reminders of the fragility of life. Some years ago a young friend of mine died just moments after she had given a presentation at a summer church camp where she was a counselor. I had known her for more than 7 years. She was a beautiful, vivacious girl. The autopsy report could not tell her parents why their child died. At 16, she just sat down on a bench and her heart stopped beating.

Just this last week I have learned four people I know have died very recently. One was an apparent SIDS death of a 6 month old. A few months ago a family friend, who was only 18, ran a stop sign and was killed. So many people in my life have been killed in car wrecks that I am absolutely convinced that driving is a considerably riskier than we do on a regular basis. That is why I made Jessie take her driving course twice.

In fact, there are many, many things riskier than birth. I am positive that unhindered, unmanaged birth is really, really safe . . . as safe as breathing. I did not believe birth was as safe in 1975 as I do today. I wasn’t scared of birth as far as I knew, but I thought I needed an authority, and an expert or something bad might happen. That birth, and everything that has happened concerning birth in my life since, has taught me that if something bad does happen it is more likely to be due to interference with birth, rather than a flaw with the design or deficiency in the process.

I preach to all who will listen that the best way to serve a woman during her pregnancy is to help her to realize that she is her own authority and that a midwife or doctor or doula is ONLY a paid consultant. A consultant may be an expert about birth, but I believe that a woman is her own best expert for her birth, and that her body knows EXACTLY what to do if given the chance.

Some of you know about the June twelfth birth of my namesake, Carla Rae. I attended as Baba only. I toted water to the tub as the hose was too short to reach the spot where the kiddie pool was. I also handed the mom the honey spoon from time to time. I said almost nothing. I did not do anything midwifey. The mother had a previous section 3 years prior almost to the day. She knew nothing about birth then but afterwards was sure that she wanted something different. She wanted a home birth. She had watched What Babies Want at my house and it “opened the curtain.” From that point on, my daughter-in-law read and watched everything she could. Her favorite book was The Power of Pleasurable Childbirth. She loved hearing my birth stories and especially my “did not push, just let my body do it birth.” And Marcela did just that with the birth of Carla Rae. If I had been her midwife I would have suggested that she do some things differently. As her mother in law, I suggested nothing, did nothing. I just loved her and did what she asked.

If I had been her midwife I would have most assuredly said something when it took soooooo long for another contraction after the head was out. As the mother in law, I said nothing. And after what seemed an eternity to the midwife in me, I observed her powerful uterus rise up and push that baby out in one contraction, with no assistance from the mother. Truly, as many of you have heard me preach, the body that managed conception, and pretty much grew a healthy baby with little assistance or direction, did not forget what to do at the end. In fact, it was quite efficient in ejecting that baby.

Last Monday, I observed this amazing phenomenon again as I was with my first home born baby as she gave birth to her second child. Heather’s first birth was a lovely midwife attended water birth. Excruciatingly painful for my daughter but a beautiful birth, nonetheless. This time, she prepared the same way in terms of nutrition, labor prep and daily chlorophyll, with a few additions. She did a lot more kegels this time. She went to the chiropractor regularly because of her incredibly uneven pelvis due to scoliosis. She took arnica in the last three weeks to help with the hip pain. The difference that made the difference, in my humble opinion, was that she determined she was not going to call the midwife this time. Heather adores her midwife and was very happy with how she assisted in the first birth. This time, though, she wanted to “do it herself.” She read everything she could find about unassisted birth and she read Sarah Buckley’s Gentle Birth, Gentle Mothering repeatedly. She read it so often that she could quote long passages of Sarah’s take on the wisdom on the body.

In spite of the fact that Heather had almost no sleep in the last month and was totally exhausted, once real labor started, it lasted just under two hours. She had a lot of back labor and she and her husband were alone almost all of those two hours as I was out running errands for them. I got back less than a half hour before the birth. Once again I spent most of that time toting water, but this time because the hose was just not filling fast enough. Heather stood up out of the birthing tub and leaned on me while her husband continued to try to get more air into the blow up pool. During her last water birth, the sides had been under inflated and there was considerable water spillage. Her husband is somewhat of an efficiency expert and did not want a repeat of that. (That is funny to us now, that he just would not fit it in his head that the birth was imminent. I can assure you though, that at the time it was very irritating to Heather. The speed at which this labor progressed was a shock to both of them. In fact when she stood up and felt the baby move down dramatically, she asked in disbelief how it could be happening so soon as she had not had time to dilate. There had been no exams but she was comparing it to her 21 hour labor the first time!)

The water broke just before the baby was born. Much to my surprise, I heard a gurgly inspiration and cry immediately after that. I have never heard a baby cry before the head was out. Heather had just asked me to confirm that was indeed the baby’s head emerging between her legs so I could tell her husband that now was the time for him to get in position! The water broke on my hand. After I heard the cry, the midwife in me wanted that baby to be born pretty quickly, but Heather’s body, being much wiser than I, waited a bit. And that was a good thing in the end as it gave her husband time to turn off the air compressor, put down the air hose, get into the tub and get behind her to catch his baby. In the position I was in, supporting her front to front I was able to literally feel her amazingly powerful uterus bring her baby into the world. It was incredible to feel my daughter’s body doing its job for her. Heather did NOT push, even once. It took 3 or 4 contractions from the time she stood up until the time her baby was born. She told me later that once she realized her body was doing it, she literally could not have pushed if she had wanted to. She had given her body permission to do it’s job with no interference from her and there was no going back.

Heather is convinced that not pushing was beneficial in other ways. She had no trauma to her perineum or vagina whatsoever. No swelling, tears or skidmarks. Honestly, she did not look like she had had a baby ever. She bled very little and her lochia is almost completely gone at 6 days. She feels great. She is in a perpetual state of awe when she talks about her birth. In spite of the pain, she would love to do it again today. I can completely identify with the feeling. After Jessie was born I had the incredible desire to put her back in and do it again. It was the most amazing feeling I can imagine. For Heather, the sensual, powerful feeling of allowing her body to do what it was designed to do has changed her life as well. She has always been a committed believer in the safety of birth, but now she has experienced a whole new level of trusting her own body to give birth, as well.

My wish for every woman would be to experience the power of unhindered birth as I have, and as Marcela and Heather and many others I know have experienced. We are so conditioned to believe that we have to work hard to push babies out, when more likely, most would come out better if we just allow our bodies to do their job.

So, once again, I find myself trusting birth more than I did last week!


  1. Rixa,

    I am recommending to several people that they come read this blog, and I will highly recommend that they start with this essay. So beautiful. I just want to read it over and over.

    I understand what she means by wishing that she could put the baby back in and do it again. I had that with my third baby, and I am so excited to do it all over again.

    Thank you for sharing such profound truths on your blog. It is incredibly empowering to hear how powerful our bodies really are.


  2. This is a great essay. I remember after Ethan was born, the doctor said, "Wow, it's like your body was made to do this." And I thought, duh, of course it was!


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