Semetics of Birth

Semantics of Birth

 

Brittany Sharpe McCollum, CCE(BWI), CD(DONA)

Language has incredible potential to build community, strengthen concepts and definitions, and create empowerment. With these great strengths comes the conflicting  potential to to segregate, disempower, and induce fear. Just recently in a class I facilitated, an expectant dad brought up the hypocrisy of the term “natural birth.” As a class, we chuckled and briefly discussed what reality would be like if birth was the norm and interventions were not. People would be coming to class, heading to hospital labor rooms, preparing for birthing, actually interested in “birth” and looking to avoid “intervention birth.”

The way we discuss contractions as pain and tension, versus discussing waves as sensation and release are building a framework for how one approaches these challenges of labor. When asked what labor feels like, legendary midwife Ina May Gaskin states “Contractions are intense sensations that require all of your focus.” Pain brings on feelings of tension, the term contraction builds a tightness in the pit of the belly. When we open the mind to new terminology, we approach a new space of understanding, perspective, and, ultimately, ability.

When I practice visualization techniques with my clients, one of  my main goals is to help them recognize the control they have over their bodily response - the great impact the mind has to positively affect bodily function. We dive into green pastures, softly cresting and ebbing waves, and the rustle of leaves surrounding us but not before, first, thinking intently upon our favorite treat. Imagine warm, slightly fudgy, chocolate cake, layered with whipped dark chocolate frosting that careens down the side and forms soft peaks overtop. The smell of cacao that wafts up when the fork sets slowly through the pillow of cake and draws it upwards to the mouth. The sensation of chocolate and fudge blanketing tastebuds. The final tongue swipe that pulls the last bit of icing from the lips.  You may already have watering of the mouth which  is a bodily response showing how powerful language can be.

As a society, as a culture, if we are able to reorganize the language norms surrounding labor, we gain the ability to approach birth fearlessly, with empowerment, relaxation, and excitement.  Yes, birth is challenging,  and yes, birth can be uncomfortable.  Birth is not all roses, but discomfort is manageable. Tightness is temporary. And the ebb and flow is exhilarating.

Let’s say for a moment that larger society phrased things differently - midwives catch babies, women give birth, couples are clients. The empowerment, sensation, and potential that comes from the change in perspective that language can offer is astounding. When we discuss our births with our children and our friends and in our birthing circles, let’s talk about waves, and sensations, and challenges. Let’s leave behind contractions, pain, and tension. In doing so, we can further encourage women to embrace their births and their bodies, rise up to take back the fluidity of labor, and settling in to enjoy birth as an extraordinary rite of passage.

Keeping a Heathly Skepticism with Medical Procedures in Birth

Keeping a Healthy Skepticism with Medical Procedures in Birth

I have been involved with childbirth for many years now.  When I had my children, a cesarean was still an emergency and I didn’t hear much about induction of labor.  Even epidurals were rather uncommon.  I remember having an x-ray taken to see that my daughter was in a single footling breech presentation

Today this has changed. Cesareans have become more commonplace and are no longer always considered emergencies and inductions and epidurals are performed so frequently that women associate them as a way to give birth. And the risks of x-ray are well known and thus not used  in birth today, having been replaced by ultrasound. Ultrasound produces an image on the screen by moving sound through a liquid medium.  Sound is vibration and vibration has heat.  We don’t know the effects of these bursts of heat on the fetus.

As a physical therapist, I worked many years in the public schools with special needs children. I was also teaching BirthWorks childbirth preparation classes.  In both areas of work, in the early 1990s I began hearing about more inductions being performed.  At the same time, I also began hearing more about a rising incidence of autism and was treating more of these children in the schools as many had low tone and delayed gross motor skills.  I wondered if there was any relation between induction and autism.

If you go to Dr. Michel Odent’s primal health database (visit www.birthworks.org) and click on primal health research, a number of studies can be found exploring possible connections between obstetrical drugs and medical procedures in birth and autism. One such example is the study from Japan titled “Autistic and developmental disorders after general anaesthetic delivery.” (Hatton R et al. Lancet 1991;337:1357-1358) The abstract of this study states that:

Children born in a certain hospital in Japan were more at risk of becoming autistic.  In this hospital, children were usually delivered by the “KitasatoUniversity method” which is characterized by a complex combination of sedatives, anaesthetic agents and analgesics together with a planned delivery induced by oxytocin or prostaglandins a week before the expected date of delivery.

Then just this past September, CNN announced concerns that induction and augmentation in labor may be associated with an increased risk of autism. They were careful to say that this is not cause and effect but only concern.  Here is what they said:

Pregnant women whose labors are induced or augmented may have an increased risk of bearing children with autism, especially if the baby is male, according to a large, retrospective analysis by researchers at Duke medicine and the University of Michigan.  The findings, published in JAMA Pediatrics on August 12, 2013, do not prove cause and effect, but suggest the need for more research, particularly as labor induction and augmentation have been used more frequently in recent years.  Expediting deliveries has benefitted women with health conditions that pose a risk to them and their unborn children.

In this study, the researchers looked at records of all births in North Carolina over an eight-year period and matched 625,042 births with corresponding public school records, which indicated whether children were diagnosed with autism.  Approximately 1.3 percent of male children and 0.4 percent of female children had autism diagnoses.  In both male and female children, the percentage of mothers who had induced or augmented labor was higher among children with autism compared with those who did not have autism. 

The findings suggest that among male children, labor that was both induced and augmented was associated with a 35 percent higher risk of autism, compared with labor that received neither treatment.

I maintain a healthy skepticism towards the use of obstetrical drugs and medical procedures used in birth today.  There are certainly good reasons for their use in very specific instances when the mother and baby are truly at risk, however their routine use needs to be decreased.  We simply know too little about the human body, especially a fetus, to completely understand how obstetrical drugs and medical procedures may affect the delicate physiology that composes the human body. We must remember that birth is sacred and a baby is a miracle and not interfere with a process thousands of years old, unless absolutely necessary.  

Childbirthing Class coming soon!!!

BirthWorks International is bringing a Childbirth Educator Workshop to Garnerville, NY!!!!

Dates: March 28, 29, 30, 2014

BirthWorks has been educating women and offering childbirth classes for over two decades and doula certifications and services for over one decade.  We place a high value on empowering women through the process of birth helping them to experience transformation into motherhood. 

Call 1-888-TO-BIRTH to sign up!

Autobiography

Debbie Reiners

It was 1979.  I was in my last semester of college browsing the bookstore.  The book Immaculate Deception by Suzanne Arms caught my attention and I was changed forever.  I was naturally aligned with the ideas in this book and I knew I was to walk in the childbirth field, a field of ancient arts, women, midwives, human rights, activism, and timeless wisdom.

The world of nature, magic, truth, and justice was my realm.  In childhood, animals, rocks, and bugs were always important; I sought them and collected many.  As I grew I yearned to hear the voices of the downtrodden, victims of social injustice, the weak, the sick, the voiceless. 

After college I had seasonal work with Colorado Outward Bound.  I led a high school group to Mexico, sailed Belize for three months, was a Colorado horse ranch hand, assistant manager of a natural foods store, an apprentice with midwives in Missouri, and potato sorter on The Farm in Tennessee.  I was a barista in Santa Fe, and lone caretaker of a mining claim at an altitude of 9,000 ft, 12 miles from the road, off the grid for four months.  During these adventuresome years I sought out midwives and progressive families everywhere I went.  I read voraciously and studied hard.  I was invited along the way to “coach” or assist at homebirths. 

While helping at a birth above Aspen, the midwife left for a bit during a long labor.  I was the only one present with any knowledge, albeit small, and Mom looked at me and said, “This baby is coming.”  Her eyes shone and she had a luminous quality about her.  I remained calm and managed the roomful of people, trying to exude Peace and Love, and find calm in my racing brain and heart.  The baby arrived.  I placed her on Mother’s belly.  The placenta came and the bleeding began.  I had only book knowledge of the physiology of birth, and calmly, but with authority, asked the Mother’s friend to suckle on her breast to help the uterus contract.  Baby was resting.  The bleeding stopped.  The room was joyous.  The birth angel watched over us.  I was 21.

It has always been inherent in me, to respect nature, and to know that the design of childbirth is perfect.  I married Tom, had four homebirths, and during that time taught my own and a midwife’s childbirth classes.  My favorite classes were made up of home, hospital, and birth center couples/singles.  I shared risks and benefits of each location and good conversations ensued.  Sometimes they changed their birth place.  I have always had respect for mothers choosing what is right for them.  Where do they feel safest giving birth?  No one size fits all.  There are too many complexities at work: emotions, fear, trauma, grief, a  couple’s relationship, self-trust, and misinformation, to just name a few.  I cannot ever purport to know what is best for anyone else.  I do know that love, peace, and respect help support this grand design.  I led La Leche League meetings for three years.

I volunteered as a Doula at a Milwaukee hospital for several months.  I spent 12 hours thought each Saturday night, in scrubs, attending nurses’ shift change meetings, and assisted where needed.  I witnessed loving care as well as cruel and abusive care.  I witnessed outstanding care at the hands of physicians as well as much harm.  Observing the hierarchy of the nursing staff, residents, and attending physicians, helped me understand my M.D. husband better.  It also illustrated why teaching hospitals sometimes have the worst childbirth outcome statistics.

In the 90’s I attended a new direct entry midwifery school in Madison, Wisconsin that had an innovative 80% experiential learning model.  I apprenticed locally in Wisconsin and I attended births of all risk levels at Victoria Jubilee Hospital in Jamaica with Shari Daniel.  In Madison I assisted with the next class of midwifery students.  The head of the school asked me to partner in her homebirth practice which I did for a year and then had my own practice for two years.  I taught classes for my own clients.  After 20 years and nearly 300 births, I walked away from my calling.

In 2012 our grandson was born at home.  My daughter-in-law, an airline pilot, had a precipitous delivery with substantial blood loss.  She then developed a vaginal hematoma requiring weeks of bed rest.  She had excellent, skilled clinical care.  I stayed with them for weeks and balanced many roles: in-law, mother, grandmother, postpartum doula, and former midwife.  While I have forgotten many facts, I was overjoyed to discover a luminous glow of instinct and knowledge living inside of me.  With this renewed inspiration I choose to teach again.

I believe that Birthworks’ experiential, interactive approach to teaching, addresses the complex needs of adult learners.  I appreciate the Professional Standards of Practice and am aligned with the Statement of Beliefs.  I love the academic and emotional content of the curriculum.  I was an average educator, although student evaluations were great.  I want to be an excellent teacher and I believe that with BirthWorks, I can fulfill this goal.

 

Debbie Reiners

TEACH

EMPOWERING

CHILDBIRTH CLASSES

BIRTHWORKS INTERNATIONAL IS BRINGING

A CHILDBIRTH EDUCATOR WORKSHOP

TO YOUR AREA…

MARCH 28, 29, 30, 2014

GARNERVILLE, NY

BirthWorks has been educating women about birth and offering childbirth

classes for over two decades and doula certification and services for over one

decade. We place a high value on empowering women through the process of

birth helping them to experience transformation into motherhood.

KEY TOPICS INCLUDE

• Holistic healthcare - Importance of nutrition, exercise, birth

plans, postpartum, breastfeeding

• Writing a birth plan and choosing a birth team

• Comfort measures for the laboring woman and her partner

• Pelvic bodywork and effective positions in labor

• Physiology of birth

• Minimizing neocortical stimulation

• Integration of the mind body and spirit when giving birth and

parenting

• Practicing human values to build confidence when giving birth

• Risks and benefits of medical procedures

• Vaginal birth after cesarean and cesarean decision making

• Grieving and Healing

• The importance of positive thinking and re-framing techniques

TO JOIN GO TO: WWW.BIRTHWORKS.ORG

Click on WORKSHOPS

EMAIL: INFO@BIRTHWORKS.ORG

CALL: 1-888-TO-BIRTH (862-4784)

“If someone had reminded me

that my body already knows how

to give birth, I would have felt

more confidence during labor.”

“The workshop was truly

transformational and

challenged many ideas and

thoughts that I previously had

about birth. It has helped me

develop more faith and

confidence in birth and in

women’s bodies to birth as

well as in myself to serve

childbearing women and their

families.”

Fear In Labor

by Cathy Daub, BWI President

A few weeks ago when I was seeking donations for the silent auction at our recent Celebrating Birth event, I walked into a store. The woman at the counter was about seven months pregnant with her first baby. We started talking about her plans for giving birth. As I was leaving, I mentioned, “Just remember to keep moving in labor as much as you can.” She looked back at me with tears and a quivering voice saying, “I’m so afraid of labor.” I was only in her store for about eight minutes.

I remember that my due date for my first child fell on the date of the Boston snow storm in 1978 that shut down the entire city of Boston for three days. No traffic could move on the roads so if I went into labor, I wouldn’t be able to travel. I would have to walk a number of blocks to a hospital nearby and enter as a walk-in. To further complicate matters, my daughter was breech. In spite of all of this, I don’t remember being afraid of labor. I had confidence that I could handle whatever happened. My body ended up being wise by going into labor three weeks later.

What has changed since then? Back then, a cesarean was still considered an emergency procedure. The epidural and induction rates were much lower but the rates of episiotomy were much higher. Today episiotomy rates are much lower and epidural and induction rates are much higher. Of greater concern, however, is a changing societal belief that a cesarean is safer, easier, and more convenient than a vaginal birth. Some women opt for cesareans to avoid possible damage to their pelvic floor musculature.

Birth has become an industry that is governed more by economic, financial, and legal incentives, rather than true medical reasons. For example, what would be the reason for administering an epidural to a woman fully dilated and with the baby’s head crowning? I was with a woman in labor walking the hallways of the hospital with her. Not many women are walking the halls in labor. But then as the contractions began to become stronger, she requested an epidural and the nurses weren’t surprised – in fact they were expecting it. With many hospitals today having 90% epidural rates, the medical team may have seen few if any women laboring and birthing normally without medical procedures or obstetric drugs.

In BirthWorks we empower women by reminding them that they were born with the knowledge about how to give birth and that birth is instinctive. What is instinctive doesn’t need to be learned. Rather, we help them to have more trust and faith in their body knowledge that already knows how to give birth. This is a unique approach and one that decreases fear and increases confidence. If you want to help empower women in birth, become a part of the solution by joining our childbirth educator and/or doula programs. Become a respected childbirth educator and/or doula in your community and help pregnant women become more confident about their ability to give birth.

I have recently been hired to teach childbirth preparation classes at our local hospital where there are about 5,000 births a year. Their rates of cesareans, epidurals, and inductions are very high. They currently have two childbirth preparation classes, one that is two hours in length and the other that is four hours in length. I am bringing in an eight week (16 hour) course. It is in the proposal stages now and will take some months but when I begin, I’ll let you know how it goes.

What is Primal Health?

By Mali Schwartz

Michel Odent, pioneer of Primal Health

In thinking about how birth has been viewed throughout the ages, it wasn’t that long ago that childbirth was considered a mystery – one that engendered both fear and joy. The process of how an embryo developed in the uterus or how the actual birth could impact the development of the baby was not known but guessed at. Slowly the feeling of awe that the birth process was held in was peeled away layer by layer as modern technology and scientific research paved the way toward a clearer understanding of this process.

Today the mystery of birth has been uncovered. In our country it is common to have the doctor schedule an ultrasound where prospective parents can find out the gender of their baby, although some elect not to find out and to be surprised at the actual birth. While finding out the sex of your child is one of the outcomes of modern technology, wouldn’t you like to have access to even more essential information regarding the future health of your baby?

The subject of primal health has been the focus of birth activist Michel Odent who sits on the advisory board of BirthWorks International. The definition of primal health is that our health is to a great extent shaped at the very beginning of our life. Odent’s primal health research can be accessed by going to the Primal Health Databank.

A series of event helped Odent pursue his interest in primal health when in the early 1980’s he was asked to speak in Oxford by McCarrison Society for Nutrition and Health. Odent shared the message that a new kind of research was needed to test the hypothesis that our health is to a large extent shaped at the very beginning of our life. When Odent met Niko Tinbergen, a pioneer and Nobel Prize Winner in the field of ethology who had explored the risks of autism in relation to how a child was born, it encouraged Odent to write a book entitled “Primal Health” the first edition of which was published in 1986.

The advent of advances in computer sciences helped to facilitate a new generation of research. Odent’s objective was to compile all studies in the medical and scientific literature that belong to the framework of primal health research. Odent explains that while there have been other studies conducted in this area, “one of the main differences is that our key word is “health” instead of “disease”. My first preoccupation has been to understand the genesis of a good health.”

In 1998 Odent created www.wombecology.com, a website that has as its objective “to convince anyone that prenatal ecology is the most vital aspect of human ecology, and that the period inside the womb is the life period with the highest adaptability and vulnerability to environmental factors.” Scientists are currently questioning the critical time periods for genes-environment interaction. A new concept called ‘gene expression’ has helped to clarify why some of our genes express themselves, while others become silenced.

This new avenue for scientific research has created a new function for the Primal Health Research Database. The database has become a unique tool to provide clues regarding how the critical time period of conception and fetal development in the womb relates to the state of health, pathological conditions, and personality traits of an individual into adulthood. Primal health research can even impact the naming and classification of diseases which before was mostly based on descriptions of symptoms, on altered functions or on altered organs.

Primal health is an avenue of research whose time has come. I invite you to read up on this important topic to find out about the connection between womb ecology, various birth methods, hormones such as oxytocin and what influence these variables can have on a baby’s health throughout its life span.

Pushing Past My Comfort Zone: Childbirth Educator Workshop in Huntsville, AL

By Shandus Parish

I attended the BirthWorks Childbirth Educator workshop on February 1-3, 2013, in Huntsville, AL, with facilitator Sally Healey. Although the weekend was packed with challenging exercises and conversation, I had a wonderful experience engaging in self-reflection, learning a great deal about myself, and forging deeper relationships with a group of women I previously knew mostly as acquaintances. I expected to learn the nuts and bolts of facilitating discussion, become educated on a variety of birthing topics, and generally learn about leading a class. I was pleasantly surprised to discover that this workshop involved something much more complex – nitty-gritty, emotional, soul-searching.

I was inspired many times that weekend, particularly in response to the visualization exercises. I’ve always struggled with this kind of exercise because I find it difficult to stay focused on something that felt forced and, frankly, a bit hokey. However, the exercises we used in the workshop did not feel forced, I think because they were structured in a way that required full participation from our inner consciousness. I was astonished by my responses to some of them, coming up with answers that I didn’t even know were in my head. For example, during one visualization we were instructed to imagine a maypole with many colorful ribbons attached to it. In our mind, we were to visualize grabbing hold of one ribbon and to reflect on how that ribbon symbolized ourselves. I expected to see a strong, thick, sturdy ribbon, but instead I immediately imagined a crinkly, fragile-looking ribbon. Despite my best efforts, I couldn’t get that ribbon to morph into anything else. It revealed to me a deep sense of fragility that I didn’t realize I still had.

Another inspiring activity involved writing about our own birth story from our mother’s perspective and then to analyze any negative assumptions that were revealed in that story. I expected this to be an easy, fairly objective exercise, but as I wrote and then shared with the group, I sobbed uncontrollably as I sympathized with the deep embarrassment, hurt, and abandonment my mother felt at the time of my birth, due to actions of my father. I grieved for my mother and the experience she had, and developed a strong sense of gratitude and understanding of the strength she must have had to mother me so well, despite her circumstances.

In general, I was inspired by how powerfully the births of our own children (even our own births) influence our personalities, emotional responses, and ways of interacting with the world. Conversely, the culmination of how we were raised, the experiences we had as children and young adults, and the relationships we’ve had with significant others and friends can have a tremendous influence on our birth experiences. To ensure the highest likelihood of a positive, empowering birth, expectant mothers should intentionally explore and process through those experiences so that they can begin to own them and transform negative circumstances into empowering memories.

For my own life, the workshop reminded me to trust my instincts more often, not just when giving birth, but in every moment of my daily life. Our inner consciousness knows far more than we can ever realize! I was reminded how important authenticity is in my life and relationships, and to embrace my true self, regardless of how others may receive it. Additionally, it taught me to be more aware of how others’ experiences have shaped their behaviors and how they respond to the world. That is, I should be gentle with everyone, because I may never know what struggles they have to work through.

The workshop will influence my teaching in several ways. For one, I will research and practice ways of responding to my students’ answers so that I can be prepared for any response. I have facilitated many group discussions in the past, and I know how easy it is for a discussion to end too quickly when a facilitator isn’t skilled at helping individuals process difficult emotions and at drawing out responses from those who tend to be quiet and non-participatory. I will also make myself engage in activities that may seem silly or uncomfortable to me, because at the workshop I found that when I was faced with an exercise that made me feel uncomfortable, I had a great deal to learn about myself and about why that discomfort was there. Pushing past my comfort zone was always rewarding. Because of that, I will embrace those uncomfortable, challenging moments in my classes, knowing that if we can all push through that wall, we may discover something momentous.

Oxytocin: The Hormone of Love

Kerstin Unvas-Moberg

This is Part Two of BWI President Cathy Daub's report on the Mid-Pacific Womb Ecology Conference, held in Honolulu, HI in October of 2012.

From a lecture by Kerstin Uvnas-Moberg MD, PhD

Kerstin Uvnas-Moberg began her lecture by describing oxytocin as a highly charged protein that does not pass membranes easily. Thus, it cannot be measured well in saliva or mucous. It is also a neurotransmitter in the brain. The Paraventricular Nucleus (PVN) is a very important oytocin producing site. From the PVN, neurons pass down to the pituitary but also to many other areas of the brain. Thus oxytocin may have psychological effects as well as physical effects like breastfeeding. The important thing is that oxytocin releases in the brain and circulation at the same time.

What triggers oxytocin release? Labor activates nerves from the cervix to the spinal cord and to the brain. Mammary sensory nerves send impulses to the brain for oxytocin release. Skin nerves release oxytocin so touch is very important. The effects cannot be obtained by looking, but rather by touching and being held. In fact more oxytocin is produced when a baby’s hand massages her mother’s breast than by nipple stimulation. This massaging creates a positive cycle where the mother is more interested in her baby and more oxytocin is produced. Babies have an inborn capacity to suckle within one hour of birth. There is a higher rise of oxytocin when the baby is on her mother’s skin right after birth.

Oxytocin is also released from neurons in the brain and leaks out and reaches lots of areas in the brain without even needing nerves so it is acting in many ways. More oxytocin is released in a new mother just by seeing and hearing her baby. Finally, it is interesting that oxytocin triggers its own release, which further triggers other releases.

The mother’s temperature pulses with skin-to-skin contact with her baby. She becomes warm and this helps the babies to relax and open their blood vessels. These babies have better self-regulation one hour later and this becomes a learned response.

Kerstin explained that children who have not had skin-to-skin contact with their mothers at birth and through breastfeeding, exhibit behaviors that are not as closely connected to their mothers as those who have had skin-to-skin contact and this remained true at one year of age. Children were filmed during play interaction one year after birth. Those with mother/baby skin-to-skin contact were more sensitive and interactive as compared to those without mother/baby skin-to-skin contact. In addition, the babies’ ability to handle stress was better than those babies without mother/baby skin-to-skin contact, showing there is a long-term effect.

In the HPA (Hypothalamic Pituitary Axis), oxytocin makes the mother calmer in the amgydala (limbic or emotional brain). Oxytocin neurons pass down to the pituitary to enhance production of prolactin and other substances for breastfeeding. Dr. Moberg also related that the half-life or duration of the substance is stated in the literature as being three minutes but that this is not true. In actuality, oxytocin has a much longer half-life of about 20-30 minutes. Dr. Moberg mentioned that if there is no mother/baby skin-to-skin contact in the first hour after birth – a biological window – later, there would be a need to repeat things more often to get the same effect. Early interaction influences the long term – it is more difficult for mothers and babies to come back to this positive interaction later on.

Obstetrical anesthetics interrupt the natural flow of hormones and have behavioral consequences. Dr. Moberg said that mothers who didn’t have oxytocin release were the mothers whose children didn’t touch their mothers – they received blocks. The mother and baby interacted less efficiently. You could actually calculate if mothers had received blocks – babies had to press twice on mother’s breasts and still less oxytocin was released so the whole system has become less sensitive. In other words, there is a blocking of the whole oxytocin system. This is important because this early interaction influences the long term. We have lost this positive influence to the brain and it leaves mother and baby where stress will have a much greater impact.

Mothers with normal birth have more social babies and both mother and baby are more relaxed. With a cesarean section, there may be no oxytocin release. If a scheduled cesarean, there is no labor to stimulate the release of oxytocin compared to normal vaginal delivery. Four days after birth, a woman normally has oxytocin pulsing releases at 90 second intervals and each time there is a milk ejection release. With a cesarean these nice pulsing releases are absent. So there is a disturbance in oxtytocin release in cesareans. This may be due to lack of skin-to-skin contact. There are no peaks in prolactin levels in cesarean mothers four days after birth so a lack of oxytocin has made prolactin release affected so breastfeeding in cesarean mothers is difficult.

An epidural blocks transmission of nerve impulses in the spinal cord so there is a decrease in oxytocin production during labor. In addition, with an epidural, there is an inhibition in the rise of skin temperature in the infant. When a mother holds her baby, the baby’s skin temperature increases which is a sign of relaxation. You normally see nice skin rising temperature in the first couple days after normal birth, but you don’t see this a couple days later in cesarean mothers. Mothers with decreased oxytocin secretion had higher blood pressure and cortisol levels i.e. increase in stress hormones with decreased ability to relax.

In summary, Dr. Moberg expressed her concern:

In labor, something happens in the regulatory system when there is interference in the natural process and this is especially true if it happens during a sensitive period. There are long-term effects. When you give exogenous oxytocin (Pitocin) to rats, it lowers their blood pressure – and it remains lower for life. Problems with breastfeeding are consistent with the effects of a sensitive period and it is likely that this can have an influences in a negative way for a long time. Low oxytocin levels lead to low breastfeeding and long-term impact.

Dr. Moberg’s new book “The Hormone of Love” will be published in March 2013.

Looking into the Future: Visioning Birth in 4012

This is Part 1 of Cathy Daub's report on the Mid-Pacific Womb Ecology Conference, held in Honolulu, HI in October 2012.

By Cathy Daub, BWI President

In October of 2012, I had the pleasure of attending the Mid-Pacific Womb Ecology Conference in Honolulu, HI.

The concept of Womb Ecology, which is promoted by Michel Odent, MD in his newsletters and books, is gaining acceptance and having a global impact. I was honored to be asked to present a workshop with midwife Elizabeth Davis entitled “Transcendent Emotional States in Birth.”

At the conference I was also pleased to speak several members of our BirthWorks Board of Advisors, including Michel Odent MD, Kirsten Uvnas Moberg, MD PhD, Elizabeth Davis, Jan Tritten, Suzanne Arms, and Heloissa Lessa, a midwife from Brazil who helped Michel Odent organize the conference.

The conference brought together representatives from 52 countries. As I gazed across the audience, I realized I was in the midst of more than 600 people who would be spreading the concept of Primal Health and Womb ecology to all corners of the globe. In a day and age when birth has become an industry, and technology, and obstetrical drugs are dominating the birth scene, I realized the magnitude of what was about to happen. We would be hearing speakers who would talk about the interaction between art, science, and techniques, and engaging meaningfully with the idea that interfering unnecessarily with the environment around the womb is fraught with dangers that can influence our health as adults.

One of the most interesting parts of the conference was a panel inviting speakers to share their vision of what birth will be like 2000 years from now, in the year 4012. Here are some highlights:

Vision for 4012 birth: Panel

Michel Odent asked a panel of experts what their vision was for birth in 4012.

Peggy O’Mara said we would be moving towards total trust of the body towards normal birth. There will be more midwives and fewer specialists.

Robbie Davis Floyd said we’ll be giving birth in 0-gravity space. There will be sophisticated technology and private enterprises such as hotels on Mars. Birth centers will orbit the earth and moon. She noted that birth on Star Trek were normal, natural birth. There will be an entire industry for orbital birth. Her fears included, “Will we be choosing the gender of our babies? Will we be ordering babies from a catalogue someday – breeding for color of hair, etc.?” Yet she does envision normal physiologic birth in 4012 believing that, “Mothers have the power to give birth and babies have the power to be born.”

Sarah Buckley envisioned a future where a loud noise lasting 11 minutes would cause the cessation of all electric fetal monitoring equipment, ultrasounds, and the clock. She asked what birth without monitoring would look like. There would be no more epidurals, inductions, and cesareans that were necessary would be short and efficient. She said Jan from Midwifery Today would train a new generation of midwives who know how to trust labor without technology. Love and connectedness would in our cells and generations of babies would be born that would lose the imprinting of fear in childbirth. Once physiologic birth is in place, we would have a generation of people who would treat the earth gently. There would be few obstetricians and attendants would be good at knitting.

Jackie Chang of Korea said that we will not argue about how we’re going to give birth anymore but will focus on maternal instinct and being ourselves. We will learn to be wise again and listen to each other. We will be dancing and singing together giving birth. Rapid changes are taking place in birth in Korea and not just in lifestyle – also in philosophy. Maybe some women need cesareans for their own survival and others need to be natural. Right now, cesarean mothers have an enormous guilty feeling after cesarean section. We must find out how we can be together so there is no judgment. Please don’t let one mother feel guilty.

Michael Stark MD said, “I’m afraid we don’t have good news for the future and in 4012 it will not be what we are expecting it to be.” He went on to say that 4,000 years ago in Egypt, there were midwives and midwifery schools. In 4012, he believes we will have produced artificial ways to conceive and give birth - the artificial woman.

Odent to Stark: You’ve made the cesarean so simple today – has this done more harm than good?”

Stark: “There are currently high rates of cesarean section. It was never my intention to make delivery easier for the woman through cesarean section.” He went on to describe what the future might be with a civilization born by cesarean section. “Just 150 years ago, people tended to be smaller. In one to two generations, we have become taller. If we continue with this direction of more cesareans, we won’t need a wide pelvis and the pelvis may evolve to become smaller. Babies may have smaller necks and the head may become larger and pregnancy may take longer. If we don’t need to deliver by nine months, we might have more mature children with bigger heads.”

My hope is that small things can happen to change history. “Michel, I believe you are one of these people. In 4012 perhaps all the world will have Odent delivery rooms. Less is more. There is so much love in this hall, maybe it is like oxytocin spray.” Both of Dr. Stark’s grandchildren were born normally.

Odent: “In Rio de Janeiro, they use spray of oxytocin in the shop. It can reach brain receptors and in subtle ways make people feel comfortable and want to come back.”

Jan Tritten of Midwifery Today emphasized that we all have a responsibility to make decisions that will benefit future generations. We have a planet, food supply, and mothers to take care of. People in China and around the world want to change current birth practices. Oceans are going to rush in. So let’s take care of the planet and our mothers and babies. Two thousand years from now is only 80 generations.

Laura Uplinger, interpreter for the conference being fluent in four languages, spoke about how we can reach the golden age in 4012. Babies will be given better conditions and optimal biochemistry will be flowing in the mother’s blood. The importance of the Primal Period will be better understood. Every pregnant woman needs to eat well, feel joy, and be inspired by birthing. There will be more resources for mothers such as birthing centers built in gorgeous parks where pregnant mothers walk together enjoying joyful synergy. Hospitals will have closed their doors to birth. Breastfeeding will be a universal practice. Children will live longer and enjoy good health.

The panel ended with Michel Odent saying, “We have no concensus of childbirth in 4012. We need other conferences. Technology is going fast. We need to organize our next conference outside the planet earth – somewhere over the rainbow and at our next conference our dreams will come true.

We ended the panel by singing “Somewhere Over the Rainbow.”  

Birth Is Instinctive

By Cathy Daub, BWI President

When Roanna Rosewood contacted me and asked me to be part of her birth visionaries platform for the launching of her new book “Cut, Stapled, and Mended,” I immediately accepted. Her book is her story of having had two cesareans followed by a VBAC. It is conversational and enjoyable reading and takes us through the wide range of emotions that women have when making decisions about birth and then living with those decisions. The glimpses she gives us of her personal life are engaging and touch feelings and issues all pregnant women have in birth. Her story is honest and genuine. I highly recommend her book.

All visionaries on her platform were asked to provide a downloadable bonus gift. I offered and carried out a one-hour teleclass on the topic “Birth is Instinctive.”

The underlying message of my talk is that all women are born with the knowledge about how to give birth. Therefore birth is instinctive and what is instinctive doesn’t need to be taught. When people ask, “Then what are you teaching in your childbirth preparation classes?” I respond, “We are helping women to have more trust and faith in their body knowledge that already knows how to give birth.” This is accomplished through the understanding and practice of human values and provides a unique approach to childbirth preparation that is empowering and transforming in nature.

Those on the call had an opportunity to ask questions. Here are a couple I would like to share with you.

First question: I had a beautiful home birth with positive thoughts. I was confident about being able to birth my baby. But then I hemorrhaged after my baby was born. Now I’m pregnant again and have fears because of what happened the first time. What should I do?

Answer: Every birth is unique unto itself. We all know how different children are and even how different one labor is compared to another. Each is a new experience. Therefore we need not compare a previous birth with a new upcoming birth. It is good to say an affirmation (positive thought pattern) to yourself over and over again such as “I am birthing a new baby unique unto herself.”

Second question: I was with a woman who had a previous cesarean and worked hard to have a VBAC. She did all the right things, saying positive affirmations, finding a safe place to give birth, yet she had another cesarean. What can I say to her?

Answer: She needs your comfort, support, and love. She needs to know she did the very best she could and that she cannot ask more of herself than that. Everything in life is a learning experience. It is important that all women continue to love themselves regardless of the birth outcome.

Birth has the potential to be a peak experience in a woman’s life and my wish is for all women to experience the full potential of what it has to offer.

Book Review: Optimal Care in Childbirth

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by Jane Beal, PhD, CD(DONA), CCE(BWI), CLS

Henci Goer and Amy Romano, Optimal Care in Childbirth: The Case for the Physiological Approach (Seattle: Classic Day Publishing, 2012). 583 pp. $46 Paperback / $39 Kindle.

After a friend had a “pushed” birth followed by an unnecesarean a few years ago, I gave her a copy of Henci Goer’s The Thinking Woman’s Guide to a Better Birth. She had a VBAC the next time around, arriving at the hospital just in time to push out her second baby girl with her body’s own power. She was overjoyed!

Like The Thinking Woman’s Guide, Henci Goer’s new book, Optimal Care in Childbirth, co-authored with Amy Romano, MSN, CNM, presents research that supports evidence-based practices in maternity care. It specifically advocates physiologic birth and expectant management. But unlike The Thinking Woman’s Guide, the intended audience is not expectant parents, but caregivers: doctors, nurses, doulas, childbirth advocates, and midwives. Its purpose is not to help parents make wise decisions in childbirth (indeed, the complexity of the information presented here makes this book inappropriate for most laypeople), but rather to change practices in obstetrics and midwifery.

Optimal Care has been endorsed by Helen Varney Burst, CNM, Ina May Gaskin, CPM, and Penny Simkin, PT. It’s been adopted as part of the reading list for the NARM examination and as a textbook in some certified nurse midwifery training programs. This shows that it is already reaching the next generation of midwives. But it could clearly benefit doctors-in-training as well.

The book presents extensive mini-reviews of several hundred controlled randomized trials conducted between 1990 and 2010. The authors use these mini-reviews to support well-reasoned arguments against the liberal use of cesarean surgery, elective repeat cesarean, elective induction, augmentation of first stage labor, continuous electronic fetal monitoring, the use of IVs, the non per os (“nothing by mouth”) dictum, and epidurals. They further question the need for actively managed second stage labor, instrumental vaginal delivery, fundal pressure, episiotomy, actively managed third stage labor, and the harmful interventions of current, wide-spread newborn practices, including suctioning, immediate cord clamping, and separation of mothers and babies after birth. They make extensive, evidenced-based recommendations for optimal care in childbirth instead.

Goer and Romano make crystal clear that America’s over 30% cesarean epidemic is completely unnecessary, caused by economic factors (cesarean is quicker and more profitable than vaginal birth), legal factors (surveys show that doctors believe they will not be sued, or if sued, they will not lose if they have performed a cesarean, but this assumption has proven false) and social factors (convenience). It is not caused by a sudden inability among American women to give birth vaginally. The authors point out the risks to mother and baby from the first cesarean as well as risks in subsequent pregnancies. (Compare to Goer and Romano, “Vaginal or Cesarean Birth: What is at Stake for Mothers and Babies?”) They do the same with the subject of induction. Clearly, patience is never a greater virtue than when it is practiced by caregivers during childbirth. This point, and many others, are made persuasively.

Just three things gave me pause while reading this book: the recommendation to begin an induction of labor 18 hours after PROM (p. 157); the characterization of “the doula paradox” (p. 427-34); and the lack of strong support for homebirth (p. 501-30).

About PROM and induction: I’ve smelled chorioamnionitis in the labor room before, and as the colloquial saying goes, it ain’t pretty. No one wants a bacterial infection in the laboring mother to put the newborn at risk of sepsis, which usually necessitates a full work-up in NICU and antibiotics for both mother and newborn in hospital. That said, PROM is not the cause of infection. Bacteria is. And it’s the number of cervical exams after PROM that puts mothers at higher risk of bacterial infection. So the “optimal strategy” is not induction 18 hours after PROM; it’s no cervical exams after PROM.

Goer knows this. She advises in The Thinking Woman’s Guide, in her section "The Bottom Line on Induction for PROM," “refuse vaginal exams before active labor” (p.68), and “wait at least 24 hours before inducing unless you show signs of infection” (p. 69). In fact, 75% of women will spontaneously start labor by 24 hours, and 95% will deliver by 28 hours (see Constance Sinclair, A Midwife’s Handbook, p. 143), but only 50% of women will spontaneously start labor by 18 hours after PROM. So starting an induction at 18 hours is 10 hours short of a physiologic birth for 45% of women.

As midwife Gloria Lemay points out, in Europe, the recommendation is that babies be born within 24 hours after the first cervical exam – giving the mother weeks before induction might be necessary if no cervical exam is performed after PROM. In fact, when mothers experience PPROM (Preterm Premature Rupture of Membranes), most American doctors will sit on their hands while mothers are on bed-rest, waiting for the baby to mature as much as possible to increase the chance of survival outside the womb. They do wait for weeks with PPROM. And what if PROM is actually PPROM? Not all due dates are accurate. Again, patience is a virtue!

About the “doula paradox”: Optimal Care argues from survey data that doulas are not always welcomed or appreciated by hospital staff, which can lead to conflict, but on the other hand, doulas can be manipulated by hospital staff into “gaining cooperation” from the mother to submit to unwanted procedures. The authors conclude: “women are better off with doulas than not, but whichever path to doulas take, all too often they and the women they serve lose” (p. 430).

This strikes me as an oversimplification of the results of the 2003 Cochrane systematic review of 15 RCTs of continuous female labor support vs. usual care, summarized online here, which may be beside the point anyway. Goer and Romano’s evidence shows that choice of primary caregiver, not the doula, has the most effect on maternal outcomes in childbirth. Yet the authors do not consider the educated and experienced doulas who are steering women toward primary caregivers with low intervention and cesarean rates. And what does the Listening to Mothers II survey say about doulas? 88% of women gave doulas an “excellent” rating for their support, above both midwives (68%) and nurses (68%). That’s not a paradox. That’s the result of women actually getting the emotional and physical support they want in labor – from their doulas.

About homebirth: The authors ask the question, “Do we know if home birth is safe?” (p. 506). They note that “women perceive homebirth to be safer than hospital birth because they can trust their care providers, have autonomy, and avoid interventions that they do not want and are not supported by evidence” (p. 509). That sounds positive, but the authors go on to say:

"Improving hospital care may in fact be the most important strategy for improving the safety of home birth. If hospitals respected informed consent and refusal, if physiologic care was standard, and if hospital-based providers reliably offered evidence-based treatments for complications, fewer women would choose home birth…" (p. 509).

If. If. If. Maybe “Do we know of home birth is safe?” is not the most useful question. Clearly, homebirth can be safe for low-risk women with a skilled caregiver in attendance, and it appears that, statistically, such homebirth results in lower mortality and morbidity rates for mothers and babies than hospital birth. It’s more affordable, too. Even for high-risk women, midwifery care can be an excellent option that promotes maternal physical health and emotional well-being, which are of course related. Worldwide, midwifery care is essential to resolving preventable complications of childbirth, as the World Health Organization clearly explains in “10 Facts on Midwifery.” More midwives are needed everywhere, especially in the developing world, where hospitals may not be accessible or may refuse care to impoverished women. But the fact is, less than 2% of American women give birth at home.

So, as Miriam Perez points out, a better question might be, “Is hospital birth safe?”

In their conclusion, Goer and Romano make the argument that America’s maternity care system should be led by midwives, who would care for the majority of women using expectant management, while high risk cases could be co-managed with obstetricians (p. 450-51). European maternity care systems run on this model, and they have better maternal and perinatal outcomes than America does. Unfortunately, with fewer than 12,000 midwives in the country (about half of them CNMs and the other half DEMs, CPMs, RMs, or LMs), midwives are not in a position to handle the number of births in this country without doctors: almost 4 million per year. In contrast, there are about 40,000 obstetricians in America today. So many more thousands of midwives need to be educated and trained to fulfill Goer and Romano’s goals. Yet programs to educate them are few, and many are not affordable. Thus, what needs to happen to improve hospital birth in America right now is that the education and training of doctors needs to shift to support physiologic birth.

If more midwives held leadership roles in teaching hospitals, where they could be recognized as “experts in normal birth” and instruct residents, then doctors would learn a great deal that could change the maternity system overall. (This is currently happening in at least one hospital in the Denver area where I serve, as well as in hospital where midwife Betty Anne Daviss serves in Canada, so it is not as unlikely as it may sound!) If ACOG were to change many of its recommendations to doctors, advocating expectant rather than active management, this would also make a huge difference. But the economic, legal, and social factors currently working against change are powerful.

One of the most significant of these factors is consumer demand for pain relief medications in the form of epidurals, which necessitates additional active management and often results in cesarean, especially when labor slows in first stage or the mother cannot make effective pushing efforts in second stage. Historically, we know that women led the way in demanding the “right” to pharmacological pain relief, following in the footsteps of Queen Victoria. Many women today may be unaware of the risks involved in making this choice, and caregivers certainly bear responsibility for negative outcomes that result from the epidural intervention (I’ve personally seen a woman paralyzed by a mis-managed epidural), but I think it’s important to acknowledge that the epidural epidemic is consumer-driven. The “failure of obstetric management,” as the authors call it, at least in this case, is shared with mothers demanding drugs in labor. That’s where childbirth educators have a key role to play, one which is not discussed in this book. Doulas can help, too, for their presence reduces the use of anesthesia and analgesia, but they attend fewer than 5% of births in America today.

Optimal Care in Childbirth is an ambitious book. In it, the authors have synthesized a tremendous amount of information in support of physiologic birth. So it is an incredibly valuable resource. Despite a few caveats (discussed above), I recommend it to all childbirth educators, doulas, nurses, midwives and doctors. If the strategies for optimal care in childbirth provided in this book were followed by caregivers in America, more mothers and babies would live and thrive.

We Must Do More to Honor Birth as a Peak Life Experience

by Molly Wales, CCE(BWI)

Excerpts from a talk given on Labor Day Weekend, 2012, at the Unitarian Universalist Fellowship of Athens, Ohio.

Molly with her newborn daughter

 My name is Molly Wales.  I am the director of The Birth Circle (a consumer birth group) in Athens, Ohio, and am a BirthWorks childbirth educator.  I’m here today to talk to you about why I believe that we aren’t doing enough in our country to honor birth as a peak life experience.  Perfect for Labor Day!

A short review of where I stand:  I believe that all people are deserving of equal treatment and opportunity.  I believe that a woman is born with the knowledge of how to give birth, and that if Mom can give birth with people who make her feel safe and secure, she’ll be able to follow her instincts and her body and her baby will know just how to work together.  I believe that a woman should have the right to give birth wherever she pleases, with whomever she pleases.  And I believe that birth is a hugely pivotal moment in life, and that the birth experience has a life-long impact on the mother, the child, and on their relationship.

These views do not represent the norm in our society.  Americans, in general, are taught not to trust birth.  Many, if not most, fear it.  And so we keep developing new ways to manipulate and change what already works. And as we force our control like this, the effects are disastrous.

According to a recent Amnesty International report, “The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 49 other countries, including Kuwait, Bulgaria, and South Korea.”  What?!  WHAT?!  Why is this happening?  What has gone wrong with maternity care in our country?

Imagine a mom has her first visit with her care provider, be it an OB or midwife.  She’s told, “You are capable of having this baby without drugs.  And if that’s what you choose, we will support you in that.  If you or baby needs medical attention, we’ll be here.  But otherwise our job is to let your body do what it was created to do.”  If that were that norm, we wouldn’t be in such a crisis.  Rates of intervention would drop substantially, and our moms and babies would be healthier.

But that isn’t the kind of support that moms in our country generally receive, unless they choose a home birth assisted by a midwife.  Because OBs and hospital-based midwives work under protocol and deadlines that rush the process and place little to no value on the emotional importance of the experience.  Now I don’t mean to say that the OBs and midwives themselves don’t value the experience, necessarily, but rather that they are put under restraints that severely limit what they can do to honor birth as normal and natural, and to work with a mother on her body’s own timeline.

For example:  One of my students recalled going in for her very first visit with her OB, to talk about her exciting new pregnancy.  The doctor told her, “You’ll go into labor, you’ll come to the hospital, and we’ll get you an epidural.”  Notice the commands.  Notice the lack of choice.  Notice the complete failure to acknowledge this mom’s innate ability to give birth to her baby on her own.  In one short sentence, her power was robbed from her.

Or another student, who, while having a perfectly normal labor at the hospital, noticed that everyone in the room kept their eyes fixed on the monitor, telling her when a contraction was coming, telling her how hard it was…when all she wanted, needed, was some eye contact, someone to acknowledge that SHE was doing the work here, and that she was a healthy human mother, not just another illness hooked up to a machine.

And so most moms, at least in our country, never get that chance to realize their own power, that chance to feel accomplished as a mother, right from the very start, those sensations of labor that combine intense vulnerability with unimaginable atomic power.  When a woman gives birth naturally, she has to open up, physically and emotionally, to greet her baby.  It is an incredible start to the mother-child relationship, one of deep bonding, as mom and baby work together through one of life’s greatest challenges.  If we in the U.S., this world power, honored birth as the baby’s start to life-long mental health, and as the mother’s chance to untap her human potential, just think of how we could empower whole generations of women and children.  I remember saying to my little Lola, six short months ago, as I held her there on my living room floor in the darkness of the morning, “We did it, honey, we did it!”  So she was born into that joy, that total soul bearing, that pride.  What an advantage for us both. And I am no extraordinary woman.  Most healthy women are capable of having their babies without medical intervention.  Now certainly homebirth isn’t the right choice for every woman, but imagine what a difference that would make, in our country and in the overall state of our planet, if the majority of mother-baby pairs were trusted, unrushed, and just given a chance to let their bodies work in their own way.

But they aren’t.  Instead most pregnant women in the U.S. are highly uninformed.  They are treated as if their pregnancies are an illness. In labor, they are offered drugs when they should be offered emotional encouragement.  And yes, of course, a healthy baby and healthy mom are the most important things.  But they aren’t the ONLY important things.  There is a chance there for a peak life experience, for both mom and baby, a chance for that relationship to begin with a surge of strength, hormonally and emotionally, that fortifies them for years to come, if not for their whole lives.

In the end, it’s all about creating a peaceful world, isn’t it?  And where better to start, than our barest beginning.