Birth Hurts, But You Can Do It!

Recently, I saw a meme going around on facebook, a quote about childbirth from one of my all-time heroes, Ina May Gaskin: “Don’t think of it as pain, think of it as an interesting sensation that requires all of your attention.” Did I mention how much respect and awe I have for Ina May Gaskin? I have studied her, read her books, and watched videos of her speaking. Her wisdom inspires me to no end, which is why it’s a little awkward for me to say that I think this quote is an oversimplification, misleading even. I think it’s safe to say it’s not her complete philosophy about pain in childbirth.

I’m about to say something controversial: birth hurts. I imagine there are many women out there who have given birth who don’t find that controversial at all- they already know that. So why is it provocative to say so? Because I am a midwife, an advocate for natural birth, someone who helps women prepare for childbirth. I am not in the business of bringing more fear to the realm of birth. It is not my intent to add another agonizing or horrifying labor tale to our cultural memory and experience. But I think it’s time we, the voices of the natural childbirth movement, be more real. Pain doesn’t have to be a dirty word in birth stories. No, pain doesn’t have to be the focus, either. But giving women the idea that pain is not a normal part of birth is a disservice to childbirth preparation. I’m calling our bluff.

In the last decade, I have witnessed the popular messaging of the natural childbirth movement promote ideals about natural childbirth being orgasmic, painless, or ecstatic. Don’t get me wrong, I don’t seek to insult the wonderful tools and preparation methods that have helped many women cope with childbirth. Nor do I intend to invalidate the women out there who have experienced pain-free or orgasmic births- I know they happen. In fact, validating orgasmic birth is arguably as important as validating traumatic birth. Birth has infinite possibilities, and it’s a positive thing to explore the spectrum of experience. I am just wary of the pain-free birther being the poster child for the natural birth movement. It’s exclusive, it’s uncommon, and for many, it’s unobtainable.

Idealizing painless childbirth is a backlash, I surmise. For so long in this culture, women have been fed misogynist ideas about childbirth pain: pain is a punishment, it’s deserved, we won’t be able to handle it, we need to be saved from the pain by medical intervention, birth is inherently dangerous. So it makes sense that, over time, when women began to take back the story of what birth is and can be, that we swung way out to the extreme. Thanks to many important voices[1] in the natural childbirth movement, we know a lot more about the relationship between fear and pain in childbirth. Fear and lack of relaxation can increase pain and interfere with physiologic labor. We know that preparation for childbirth is valuable. Women have internalized a lot of scary or sabotaging concepts about what birth is that can inhibit the safety and satisfaction of birth, and childbirth preparation can help dis-arm these ideas. We know that the experience of natural birth is so much more than pain. But let’s not swing so far that frank discussions of pain are being avoided for fear of promoting fear while false-ideals are being romanticized.

For the vast majority of women, pain is a common, normal part of childbirth which does not prevent the experience from being positive and empowering. As birth advocates, I would like to see more encompassing ideas promoted about childbirth pain. I want women, especially first-time mothers, to be told that pain is a likely possibility, and that they are strong, they can cope and they will be supported. I want women to get the message that if they experience pain during birth, they are not alone, they are not inferior or unenlightened, and they have not failed.

Pain in childbirth has purpose. Pain triggers a release of beta-endorphins, analgesic hormones with euphoric effects, which contribute to the altered state of consciousness of natural labor. The experience of pain in this altered state is shifted. In fact, the altered state of consciousness typical of undisturbed labors is a great example of how women’s bodies support them in the birth process. The release of beta-endorphins because of pain during labor stimulates the release of prolactin, which in turn, helps put the finishing touches on infant lung maturity and primes breast tissue for breastfeeding. Looking at it from that perspective, rather than viewing pain as a betrayal, pain can be seen as a catalyst for a healthy birth.

Pain in childbirth comes in waves. In-between contractions, there is rest. The cyclical nature of a normal labor pattern is yet another inherent coping mechanism that makes pain during birth tolerable. We often think of pain as unrelenting and constant because that’s how we experience pain in other circumstances, such as with injury. But that is not what pain in childbirth is like. The breaks between contractions give women a chance to communicate a need, shift positions, or relax deeper. It also provides an emotional opportunity to integrate the experience, and to stay present with the birth experience. Take contractions one at a time.

There are many things mothers can do to cope with pain. Birthing in a setting and with a provider who encourages women to act on their instincts is a good place to start. Women know how to breathe, they know when they want to change positions, they will say so if they are hungry or thirsty. If they want to be in a dark quiet space, that’s because low lights and minimal use of language helps them maintain the hormonal and neurological balance that keeps labor flowing.

Pain gets women moaning. Vocalizing is a powerful tool for coping with pain. It’s Ina May Gaskin who has educated us so well about the value of a low moan during contractions, which she terms the” law of sphincters.” Making low moaning sounds opens up a birthing mother’s throat and relaxes her jaw, which in turn, helps open up the cervix.

An important piece of a soon-to-be-mother’s preparation for natural childbirth is cultivating trust in her support system. In other words, she needs to be able to know that, because she is likely to experience pain, the environment and the people surrounding her will be encouraging of her process.  She doesn’t want to be rescued, she wants to be supported. The environment she births in needs to allow for freedom of movement, a decent amount of privacy, and should be equipped with basic equipment that can provide access to desired pain management tools, such as a birth tub, a shower, a hot water bottle, a place to squat, a bed to rest in, and food to keep her energy up. The people around her should be aware of her desires for her birth, reasonably able to read her cues, and comfortable with (rather than personally triggered by) her experience of pain. She may want massage, counter-pressure, simple words of encouragement, a cold rag on her head, companionship, supportive suggestions, or music. When her needs for support are met, she will be in less pain. When she can anticipate good support, she can let go of some anxiety or fear around the pain of childbirth before she goes into labor.

Birth, however it happens, is a rite of passage. Authentic rites of passage often include some sort of physical challenge, and a psychological stretching of what we believe our limits to be. My message to women preparing for birth is this: birth hurts, but you can do it. You are strong enough. You are supported. You will step up to receive what your birth experience asks of you. I believe in you.

 

 

[1] such as Dr. Grantley Dick-Reid, Dr. Robert Bradley, Ina May Gaskin, Elena Tonetti-Vladimirova, and Marie Mongan.

Preparing Young Siblings for Home Birth

sistersMuch advise exists about how mothers and fathers can prepare for home birth, but what about siblings? Many parents resonate with the idea of having their child or children present to witness the birth of their sibling. Even if they aren’t there for the “crowning moment,” siblings often experience some part of labor or fresh newborn moments. With so much attention put on the new baby, it can be reassuring to siblings that they are welcome to be a part of the family birth experience in some way. When children are prepared for both the normalcy and the intensity of natural birth, their presence can be a sweet gift for the whole family.

Just like birth itself, sibling attendance at home births can’t exactly be planned in detail, but preparation for a range of possibilities is beneficial. The better prepared and accommodated siblings are, the less distracted birthing moms are with worry about their older child or children. Here are some ideas to help you prepare your toddler or young child if you are desiring family birth experience:

Watch animal birth videos!

Start talking about birth on a level kids are interested in and may be less intimidated by. There’s something so normal about animals being “biological,” even little kids can get it. It’s an easy way to start some great conversations! You-tube is full of animal birth videos, but preview them first to make sure they aren’t too intense. I have included a few that I like at the bottom of this blog.

welcome with loveRead Books

My favorite children’s book about home birth is called Welcome With Love by Jenni Overend and Julie Vivas. There are others out there, but this one steals the show.(And/or watch Birth Day with them, a 10-minute DVD of the kid-friendly home birth of Naolí Vinaver Lopez in Mexico with siblings in attendance.)

Tell them their birth story.

Show them their own birth photographs or newborn pictures. Sharing stories about their birth and babyhood sets the perfect personal stage for kids to learn and ask questions. And, it can remind them of how treasured their own welcoming was!

Sing the labor song.

Demonstrate to kids what it might sound like to hear their mom in labor. Let them hear moaning or pushing sounds and sing out the rhythm of labor in a playful way.Tell them how important vocalizing can be to a woman giving birth, so the sounds don’t come across as scary during the labor.

Tell them about blood.

Don’t shy away from telling kids that blood is a normal part of childbirth. It could be a lot worse for them to see it at the time and be alarmed.

Do art.

Let them explore ideas acacia birth artabout childbirth with markers or puppet shows. This picture was drawn by a 6 year old after she saw her sister being born.

Give them a special job at the birth.

Depending on their age, special jobs might be to help cut the cord, put the first hat on the baby, pick out the first blanket to bundle the baby in, be the one to call grandma after the baby is born, discover the baby’s gender, or be the first to tell the baby his or her name.

Offer choice and flexibility.

Be sure to give your child age-appropriate choices about what they want to witness. Don’t be attached to them having a role or presence beyond what their own sense of comfort dictates. Some children are more comfortable being present for the early part of labor, some kids just want to meet the new baby very soon after birth. Some kids sleep through labor entirely. And others want to say sweet somethings to their laboring mama, be present when the baby comes out, or even examine the placenta! And don’t forget the birthing mother’s needs! She might prefer her other children are not present for some, most, or all of the labor.

Find a sibling doula!

It can be really helpful to include a person your child trusts whose job it is to take care of the older sibling/s during the birth. This person should not be attached to being at the birth at all times, because if the right thing for the child is to leave and come back (or not) then that’s what the caretaker does. Labor can take a long time, and you want a caretaker for your child who is willing to take them to the park, feed them, keep to sleep schedules, and even provide another place to be besides the home where the birth is happening. Also, for the time when the child is present for the labor and birth, the caretaker is someone who can answer the child’s questions and reassure them. If complications arise, this person is the one trusted to shield, remove, or comfort the child. A very important job!

Enjoy a few animal births! An orangutan, a dolphin, and a lynx cat.

 

Postpartum Matters

Pregnancy is not an illness, right? And birth is normal. So why is the postpartum period associated with recovery? What’s the fuss about rest and keeping the baby in the home?

Often, women want or feel pressured to resume chores, errands or exercise shortly after birth. Some have other young children to care for, and not enough support to make it possible to lay around for weeks. Sometimes it feels so great to NOT BE PREGNANT anymore that mothers forget to honor what their bodies are still doing (making milk, bleeding, undergoing hormonal transitions, etc). Additionally, other people in the home, guests, spouses, mothers or in-laws, consider the quick resumption of normal activity to be a sign that all is going well for the mother after birth. But not so fast…

5 Reasons Rest and Recovery are Important after Childbirth

  1. Long-term Pelvic Floor Health.  Pregnancy and childbirth can weaken women’s core abdominal and pelvic muscles. In the first few weeks after birth, before these muscles have had a chance to strengthen, prolapse of pelvic organs such as the bladder or uterus are more common. Rest is helpful to prevent prolapsed organs and allow some tone to return without the pressure of gravity. Just minimal movement from resting, sitting up in bed, nrrsing in different positions, and getting up to shower or use the bathroom, will allow you to begin using core muscles that have been underused during the latter part of pregnancy. This gradual re-toning of the abdominal and pelvic muscles should be accompanied by gradual return to activity. Vacuuming the carpet or carrying laundry up the stairs in the early days of postpartum is inviting too much strain on muscles and tissues before they are ready to support that kind of activity. Even if you don’t experience any symptoms of prolapsed organs (incontinence, pain or pressure, constipation), early activity after childbirth can impact your long term pelvic floor health.
  2. Breast Milk Production. Breast milk supply is established in the early days of the postpartum period. Milk usually “comes in” on the third day and can take a week or more to regulate. When you are in bed with your baby, skin-to-skin, you are more likely to establish an ample milk supply and learn your baby’s hunger cues. New mothers and baby’s bodies ‘whisper’ to each other through hormones, pheromones, and response to touch and stimulation. This body communication, which requires relaxed, close contact, paves the way to a good latch and a balanced supply of healthy breast milk.
  3. Postpartum Bleeding. Placentas are usually about the size of salad plates, and the implantation site inside your uterus needs time to heal. As your uterus shrinks, it clamps off the blood vessels that fed the placenta. The blood-rich inner lining of the uterus sheds after birth. All the while, your uterus is shrinking back to its pre-pregnancy size. Postpartum bleeding can continue for up to 6 weeks postpartum. However, with rest, bleeding often ceases after just a few weeks or less. In fact, the duration and amount of bleeding postpartum can be used as a barometer of sorts, giving you feedback about how much activity you are ready for. If you see bright red bleeding or spotting return after it had diminished, or continue bleeding for several weeks, you are doing too much.
  4. Bonding With Your Baby. Create a ‘Babymoon,’ time specifically focused on bonding with and getting to know your newborn. Bonding is not optional; babies need to bond to thrive, even to survive. Bonding behaviors, such as rocking, feeding, talking to, holding, touching your baby and staring into your newborn’s eyes, literally develop your baby’s nervous system and contribute to brain growth and development. Sometimes falling in love with your newborn is instant at birth, and other times, it is caretaking of the newborn that slips parents into this emotional wonderland. Be sure that fathers, partners, and other family members participate in bonding and caretaking as well.
  5. Honoring Your Transition. Becoming a mother is a transition on many levels, physical and emotional. Some physical changes are sudden, such as hormonal shifts and body adjustments. Becoming a mother can also shift a woman’s identity and her relationship roles to other family members or friends. Sometimes these transitions are smooth and blissful and sometimes they are very challenging, and most of the time they are a little bit of everything. You will appreciate some time afterwards to integrate and process the transitions. It’s so easy to burst the ‘postpartum bubble’ by letting the mundane or hectic daily life creep back in too quickly during this special time. Celebrate being taken care of while you are taking care of the new baby! Resting and recovering from childbirth isn’t necessary because childbirth is an illness, it’s a necessary because it honors women, babies, and families during this worthy time.

 10 Tips for Childbirth Recovery

  1. Plan to rest. Here’s a formula to consider: One week mostly in bed, one week mostly around the bed, and a week or two in the house. Many traditional cultures employ a 40 day resting ritual for new mothers. Another idea is to primarily rest for the duration of your postpartum bleeding, plus three days (to be sure it doesn’t start again).
  2. Say yes to help. Allow and recruit support. Talk to your partner and family members before you give birth about your needs and desires for this time. Have friends and family bring meals, let visitors take your garbage out when they leave, arrange for other trusted adults to take your toddler to pre-school. Hire a postpartum doula or a housecleaner, or ask for these services as a shower gift.
  3. Nourish your body. Breastfeeding requires good hydration and good nutrition. Go for good fats, such as avocados, fish, butter, coconut milk and oil, which contribute to your baby’s brain growth through your breast milk. Leafy greens and red meats can help mothers recover from blood loss. Dried fruit and plenty of water can contribute to softer stool if constipation is a concern. Dates can help shrink the uterus and limit postpartum bleeding. Colorful vegetables such as yams and beets can help boost milk supply, as can oats.
  4. Avoid heavy lifting. A good rule of thumb is not to lift anything heavier than your baby for the first several weeks. This can be especially challenging to mothers with other young children. It is easier to accomplish when you are mostly in bed, and can encourage other children to come cuddle or sit beside you.
  5. Bind your belly. Postpartum belly-binders are marketed as slimming devices, but the real value is in helping you re-tone your abdominal muscles and keeping your organs in place. You can use expensive belly binders, a long strip of linen or cotton, or a think ace bandage. The idea is to support your abdominal muscles (especially if they have separated during pregnancy) and support the position of your shrinking uterus. Round ligaments that keep your uterus in place take a long time to shrink back to their pre-pregnant size, and binding your lower belly helps make up for that slack.
  6. Stay warm. Many traditional postpartum rituals and healing practices employ some type of remedy that returns heat to the mother’s body to help rebuild blood and chi and establish a good milk supply. Eat warm foods, wear socks, and drink nourishing teas such as Raspberry Leaf-Nettle infusion. Consider postpartum moxabustion treatments (sometimes referred to as “mother roasting,” or a postpartum massage with warmed oil. Chinese medicine ascribes warming properties to placenta capsules.
  7. Use herbal compresses on your perineum. Put an absorbent pad on your bed, soak a wash cloth or cloth diaper in a warm herbal infusion, and place it against your perineum for 15 minutes or so. Comfrey and/or calendula can be soothing on the perineum, especially if you have torn or have sutures, but even if you haven’t. For hemorrhoids, try Butcher’s Broom and Witch Hazel Bark, and move the compress more towards your bottom.
  8. Sleep when your baby sleeps. You’ll hopefully have years of infant naps to look forward to get some alone time or get-things-done time, but in the first few weeks, join your baby in a nap-filled existence. You may be up a lot at night with your baby, you probably lost at least one night of sleep during childbirth, and you may not have slept well during the last few months of pregnancy.
  9. Tell your birth story. Write your birth story. It’s a big deal to give birth. Women need to process their birth with good listeners. Whether women are elated, in awe of the experience, or struggling with a disappointing or traumatic birth experience, birth is profound. It’s tender; it’s powerful; it’s vulnerable.
  10. Maximize skin-to-skin time with your baby. Skin-to-skin contact has been proven to help the baby regulate body temperature, breathing pattern, glucose levels and heart rate, contribute to good weight gain, and establish a good latch for breastfeeding. Consider skin-to-skin contact with a parent to be the native habitat of a newborn.