Friday, August 24, 2007

Formative words

I've been thinking a lot recently about my paradigm of childbirth and how I got from point A (assuming I'd birth in a hospital with an OB and epidural) to point B (giving birth at home unassisted). Several things I've read, in particular, stand out in my mind. They made me uncomfortable. They challenged assumptions I had held about birth. I ready many of these after I thought I had already been converted and was done paradigm shifting!

1) Peggy Vincent's Baby Catcher. This book changed me from thinking "I would definitely want to give birth in a hospital. Maybe with a nurse midwife--that sounds nice" to "Of course I will give birth at home!" Peggy Vincent is a fantastic story teller, and I still crack up in parts even though I've read it oh, at least 6 or 7 times. She is more interventive than I would personally feel comfortable with, something I have noticed more after exposure to unassisted birth and to midwives advocating unhindered births.

2) This birth story: The Birth of Grey Forest Walt, and the mother's subsequent processing of that birth and her decision to have her next baby unassisted: The Birth of Samuel Rune. (Both stories are quite long, but really you need to read the whole deal in order to "get it.")

3) Midwife Jeannine Parvati Baker's words. The first two paragraphs are from her book Prenatal Yoga & Natural Childbirth. The last two paragraphs are from an article called Shamanic Midwifery: Hands That Heal Birth.
Actually I trust doctors more now for being so obvious about their beliefs. With midwives you never know if they will turn medical on you during a birthing. Unfortunately, almost all midwives will rely on medical technique in an emergency. That is, midwives who have such training. And those midwives with state license are the most dangerous as they are bound legally to respond in crisis in a medical way. There are very few midwives I know---and I know a lot of them having "un-trained" many through Hygieia College and touring the country speaking to birth audiences--whom I would trust to act harmlessly during a birth crisis. (64)

Halley [her sixth baby] was born without a midwife or doctor in attendance and no other adults for support. If birth is a natural expression of sexuality, why hire a paid paranoid "just in case?" In the words of Artemis, "Birth is as safe as life gets." We have now experienced the fullest expression of our sexuality and spirituality at once in freebirth and realize that if we needed no one present at the conception, we need no one present at the outcome of that loving ceremony, the birth. From this experience I deepened the vision received at Quinn's birth--this is possible for all families. Free birth and we free our selves from primal fear, from blaming others, from the cult of experts who from that point on attempt to take responsibility for our children's lives. The original lovers are most able to respond to our co-creation if we are present, without distracting fears and assessments from those who have been trained beyond their natural intelligence to just witness the ordinary miracle called birth. (85)

My community made me a midwife by asking me to attend births. Rather than getting trained by an institution, and learning a medical set of rituals to take women through birth, I apprenticed directly to birth itself. My promise as spiritual midwife is to honor the journey, be attentive to what presents itself, and remind a mother by my presence that she already knows how to give birth. I trust that if a woman consciously conceives her baby without the help of experts, she is able to give birth unassisted by the medical experts....In over a generation of attending births, every woman I have midwifed has given spontaneous birth.

Once I was called to a birth and forgot to bring my birthing kit. Then I realized that I am my midwifery kit--I had my ears through which I could hear the baby's heart, I had my hands through which I could feel the baby, and I had my heart--which loves the baby earthside.

4) This article by Gloria Lemay called "Interventions." Not the typical Big Guns that we natural birth people love to denounce: epidurals, Cesareans, inductions, EFM. Nope, in this article Gloria talks about the interventions that well-meaning midwives do, without even realizing how they are affecting the birth process. One of the most shocking and unsettling paragraphs at the time for me was where she discussed A Clear Road to Birth.

I will end this post with a long excerpt from her article, which appears in Midwifery Today (22 September 2002).

"The first intervention in natural childbirth is the one that a healthy woman does herself when she walks out the front door of her own home in labor."
Michael Rosenthal, OB/GYN
This quote is an attention grabber and one that should set us all to thinking. We know about the "cascade of interventions" that sends most North American births down a tunnel of medical mishaps strip membranes, Pitocin gel induction, continuous fetal heart monitoring, pain medications, distress in the infant, cesarean, post-surgical infection, breastfeeding problems, postpartum depression, etc., etc., etc. Iatrogenic meddlesomeness at its most blatant is easy to spot and condemn. We like to shake our heads, point our fingers and tut-tut-tut about this type of intervention. 

But what of the interventions that we don't see, the ones we are guilty of ourselves? The Oxford dictionary defines intervene: "to interfere, modify course or result of events." Something that seems as small as turning on a light could be classified as "an intervention." Is it an intervention to wear perfume to a birth? To monitor the heartbeat of the baby every half-hour? To leave a clock within the mother's view? To watch the mother? To speak to the mother? To ask her to take a walk outside? To tell her husband to get in the water tub with her? Do midwives take any time at all to ask themselves these questions? 

What would "the course of events" be like if we weren't there? How could we possibly know? Recently I came into possession of an amazing video. This video is the raw home movie footage of the births that are shown in the unassisted birth film A Clear Road to Birth. There is no attendant present at the births. The families have, for the most part, just put the video camera on a tripod and let it run. The result is an amazing view into a place that I have never been privileged to enter--a birth that follows the natural course of events. I found it difficult to watch because it is so very intimate, and I wasn't sure that they'd want me to ogle their beautiful, private family moments. It is a sacred film. I came away from it with questions about how my presence at a birth affects the behavior of all the participants. The women on this film are not asking, "How much longer will it be?" They are not saying, "I can't do it anymore." There is no illusion or possibility of some other woman "saving" them. They are going to do it themselves, and they seem to have an inner core of resolve about it. Their husbands and children mostly seem "surprised" that the baby is really there. This is unlike births where there is an "expert" present, and the waiting and watching seem to go on forever. 

This film of unattended births leads me to question, "What about women who have unassisted prenatal care?" We are told that prenatal care is essential. We believe it is a cornerstone of good maternal/natal health. But is this true? Are there interventions that take place in childbirth classes that are subtle and affect the course of events? If we think of the spoken word as "an intervention," we must wonder if we are causing changes in the course of the birth long before the membranes release. I cringe at some of the "meddlesome midwifery messages" that women are given at prenatal checkups. Messages can be imparted both verbally and nonverbally. I remember when I took prenatal classes 25 years ago, the nurse managed to impart the message that she didn't approve of breastfeeding with just the look on her face when she said, "How many of you are planning to breastfeed?" Her attitude changed the course of events for a lot of the women in that class. It was absolutely an intervention. 

I have learned a lot about how to question my own interference in birth from listening to Michel Odent. His message is repeated over and over: "The most important thing is do not disturb the birthing mother." What does a nice midwife do that would disturb? Several years ago, I went to a birth as assistant to the midwife. I was assigned to take a video of the birth and so I familiarized myself with the family's camera and began to do a little filming of the mother while she was in the water tub. I was getting some nice footage when, all of a sudden, the room went completely black, and I couldn't get an image in the camera. I looked up to see what had happened: the brother-in-law of the birthing mother had turned out the lights. I went over and turned them back on so I could get on with filming and, presently, the man came back and turned them out again! I was very annoyed and, in that moment, I realized that he was right! He was more in tune with what his sister-in-law needed than I was. Birth seems to flow best for human beings in the same conditions as most other mammals. Darkness, familiar smells, privacy and quiet are the main ingredients for a smooth birth. Who in North America can give these simple things to a birthing mother? Are we willing to trade monitoring and charting for births that truly flow along smoothly? Are we willing to sit, out of view of the woman, completely still while she focuses inward and makes her own journey to meeting her child? Can we forgo the acknowledgement and appreciation for all we "do" and be deeply satisfied with "being" unobtrusive? 

... I believe that the "3 Ps" of obstetrics should be "patience, patience, patience" and not "passage, passenger and powers." I am fond of the Buddhist words from The Tao of Leadership:
Being a Midwife
Remember that you are facilitating another person's process. It is not your process. Do not intrude. Do not control. Do not force your own needs and insights into the foreground. If you do not trust a person's process, that person will not trust you. Imagine that you are a midwife; you are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say: "We did it ourselves!"
--The Tao of Leadership by John Heider


  1. yes, it's clear: i love you.

    please link to that article by gloria.

    i love michel odent and feel that he's gotten so much flack by midwives and the natural birth movement for being too honest.

  2. I don't have a link--I accessed the article via my university account. The article is almost all there on my post, except for a few paragraphs near the end. I can send the whole thing to you if you'd like.

    I didn't realize Michel Odent had that reputation among some midwives. I've only heard good things about him. Hmmmm. He is quite direct. I love it! I met him a few years back at a birth conference and was totally star-struck. We chatted (in French, bien sur!) for a while and I got a picture with him. Oooh, that would be fun to post here! Off to do that...

  3. This was such a good read...your insights as well as the writers you quoted. Thanks for putting it up. I am meeting with my potential childbirth attendants tomorrow for the first time, and this has given me still more questions to ask of them. Thank you!

  4. "We are told that prenatal care is essential. We believe it is a cornerstone of good maternal/natal health. But is this true?"

    This is an interesting quote. I've been doing a lot of thinking along these lines lately because I have discovered a disturbing characteristic in myself - when I relinquish even a part of my autonomy as I meet with a medical professional for any reason, homebirth midwives included, I automatically feel the need to relinquish all of it. I find that suddenly I am no longer the expert in my own body because I bow to the expertise of another person, though they may not know me from Adam. This is mightily disturbing. It is why I no longer go to well-baby checks for my kids. It is why I avoid going to the neurologist with Josh unless absolutely necessary.

    My husband is still very uncooperative with the idea of a UC, but my concern is that in order to have a midwife there who is familiar with you, you have to meet with them beforehand. I, however, am feeling a pull towards a UP because I do not want to give up my autonomy with the next baby. I think I want to do a UC, but I also want peace and harmony with my husband. Must I really make this choice?

    I love your blog, Rixa, because you say things and link to things that cause me to think. Like you, I thought I had made my paradigm shift, but as I read what you write, I realize that I have come nowhere near completing the process. This is a disturbing and encouraging thought.

  5. I LOVED Baby Catcher. Although I cried a dreadful amount and had horrible dreams after reading about the prolapsed cord.

    But I think my favorite funny story from there is about the woman birthing in the car and their whole process of trying to get TO the hospital, only to have the baby born right there and then, and the husband stomping on the placenta so it wouldn't rush down the drain.. lol

    and I still quote about the "spirit babies" beautiful. especially after having a miscarriage and becoming pregnant this time around within the same month.

  6. Kelley,
    I sympathize with your dilemma. Perhaps your first job is to figure out why you feel the need to give up autonomy when you see a health care provider. There are awesome midwives out there, so it might not be an either/or dilemma. Of course, the awesome ones might not live in your neck of the woods...

    I do understand the feeling of helplessness and indecisiveness in the face of medical authority. When I brought Zari in for a PKU test at 8 days after the birth, my family doc gave me a big scare about jaundice because she looked a tad yellowish. I had read Jack Newman's book cover to cover a few times and I *knew* that jaundice was normal, physiological, and not something to be worried about, especially because Zari had no other health issues that would suggest she had pathologic, rather than physiologic, jaundice. The doctor started giving me scare tactics (although she would not frame them as such) like, "Well it's your choice if you don't want to test her bilirubin levels but I wouldn't want to risk a brain-damaged baby." I mean, talk about a hard thing to say to a new mother! Anyway I ended up doing the bili test (partly to get her off my back, and partly because she was already doing a heel prick for the PKU so it wasn't any additional poking). Retrospectively I was somewhat surprised that I agreed to it, since I knew there was nothing wrong!

    Anyway back to my original thought: I think education and research on your end, and a respectful HCP on the other, might yield a more fruitful relationship. I might feel intimidated researching neurological problems, but knowing about birth is totally do-able. You already know a lot anyway! Also, if you at some point establish a relationship with a midwife (perhaps starting well before you're pregnant so you're less emotionally involved?), I would be totally direct and upfront with her about your desires for autonomy and UC/UP, your previous home and hospital birth experiences, your husband's desire for a midwife, etc. If the midwife isn't right for you, there's no obligation to hire her. There ARE midwives out there who are fine with doing limited prenatal care, with sitting in the driveway until they're called in, etc. Now, unfortunately, they are few and far between. But you never know unless you ask, right?

    So perhaps you could have a working agreement with your husband that you will look for a midwife who is totally on board with your needs for pregnancy & birth and that if you feel one, and feel right about it, you will use her. But if you don't find a midwife who can support your wishes, then you will continue with your UP/UC plans. And on his end, he could agree to learn more why you want a UP/UC, do some reading about UC from the father's perspective, etc. Also, he could agree to approach the issue with an open mind and not to let his own fears or hesitations block him from knowing what is the *right* decision for you and your family.

  7. I agree wholeheartedly with the quote about midwives. They may be more natural-minded than the average OB, but they are still bound to do things "by the book," unfortunately.

    I think I may have read those birth stories before, but I'll go back and read them again later when I have more time.

    This was a great post, it's interesting to see how one's view on something like this shifts in response to other influences.


  8. Jill,
    Regarding midwives doing it by the book, I'd say that it depends. These quotes made me squirm and do a lot more reading, because at that point I really idealized home birth midwives. The stories and articles in this post suggested otherwise. Not that all midwives are interventive and protocol-oriented, or that all doctors are bad, or whatever. But at the time, the idea that midwives could interfere with the birth process--especially home birth midwives, who were supposed to be the ones who "got it" and respected the natural process--really challenged me. At first I didn't really want to believe it.

    So it's not that I've gone from thinking that midwives = good to midwives = evil incarnate. I just have a more realistic view of them, just as I do of obstetricians. There are fantastic ones, egotistic ones, bait-and-switch ones, medically oriented ones, and so on. I guess in the end, what I learned is that you can't assume that your birth will be a certain way just because you have X or Y title of caregiver. Makes sense?

  9. Absolutely. There are still lots of great midwives, just like there are great OBs out there, but it's a huge letdown to expect that because a midwife has that label, that she will welcome a natural birth, which isn't always the case. Of course, I'm only speaking of my limited experience with CNMs (MEDwives), I've never had a homebirth with a midwife, be she CNM or lay midwife, so I admit my perception isn't very broad. ;)


  10. Excellent, Rixa! I hadn't read that before. Gloria is a gem.

  11. One of the things that surprised me the most about doing my own prenantal care was how very seriously I took the job at hand.

    I had thought during my first three pregnancies that I was particularly proactive and worked hard to make a healthy child, but until I took it upon myself during my fourth pregnancy to do the whole pregnancy without seeing anyone for anything, my own definition of personal responsibility took a swerve up into the clouds.

    In the past twelve years friends who discover that I gave birth alone are very surpised, but they are completely gobsmacked when I tell them I did my own prenantal care.

    The ripple effect into a family is powerful. I continue to observe friends do so much for older children that they are completely capable of doing for themselves.

    My own children seem to feel the spirit of Freebirth in our home. They are so proactive on so many levels of their lives. Not claiming they are perfect mind you, but the sense of "I can do it myself" is very, very strong in our home.

    Currently I am enjoying my four year old Ben as he gradually weans from our Family bed, and attachment breastfeeding. He is so confident some days. He wants to sleep in his own bed, nursing is for babies, and he is the MAN in little boys body.

    Yet he has moments of complete surrender to his needs as a little person, and happily reverts back to a mommas boy for nursies, naps, and snuggle time in bed with mom and dad. He is my first child that will self wean, I had to use extreme coersion with three previous babes to get them off the breast. My daughter stopped nursing at 4 and a half, not because she was ready but because momma was tandem nursing during a pregnancy and could not do it anymore.

    My next two boys were both weaned on third birthdays, although they were also not ready. I tried to wean Ben on his third birthday for consistencies sake, but he moped around for a week and was so sad, I did not have the heart to do it.

    I find it no accident that this child who was Freeborn Lotus Style, who has such acute intuition to his own needs as a preschooler that he regularly informs me in direct and very clearn language exactly what his needs are in the moment, I find it no accident that this pattern of internal confidence to know his own needs continues on.

    During his pregnancy I would regularly talk to him to ask what he needed from me in terms of exercise, nutrition, etc etc... And he guided me through my dreams, my mothers intuition, and spirit to spirit to know exactly what he wanted. Up to the second he was born, I was being guided, mostly by him (and his assorted guardian angels).

    This perfect guiding is SO MUCH more powerful that an outside paid hireling giving his or her "expert" opinion on the various issues of pregnancy.

    I challenge all women to take on the task of growing and birthing the baby all by themselves. It will change everything in your life.

    Jenny Hatch


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