Wednesday, June 30, 2010
Oprah is currently searching for contestants for her "Your Own Show" reality series, which will be a competition to win their show idea a spot on Oprah's new network. Kerry Tuschhoff, founder and president of Hypnobabies, submitted her audition video to the contest, but the video must makes it into the top 5 most voted-for videos for her to be considered for the realityshow. Please watch her video and vote for her show idea, Every Mother, Every Baby. If you don't mind registering for the site, comments on the video would also be helpful so that everyone can know why you support the idea. Voting lasts until July 3rd!
The more votes the audition video gets, the more attention this issue will gather, so please pass the link on!
Sunday, June 27, 2010
As I was considering these factors and trying to decide what to write this blog post about, I remembered this video from last year's The Big Push for Midwives Issue Briefing for members of Congress showing Jennie Joseph, LM, CPM talking about her birth center, The Birth Place, in Orlando, Florida.
It's pretty clear that The Birth Place has drastically fewer racial disparities than her area's average. She attributes the difference to their care being more accessible to the uninsured, but I think that is only part of the story. I believe that the obstetric model of care, which is the norm in the U.S., is failing black women. Here are some components of the midwifery model that I believe may better meet their needs:
- Focus on Preventing Complications with Healthy Lifestyle - While obstetric practices generally focus mostly on screening for pathology, midwifery care includes extensive counseling on nutrition and exercise during pregnancy. This approach integrates prevention of problems.
- Individualized Care - Midwives strive to make their care specific to the needs of individual women instead of providing one-size-fits-all care that may be more suited to one race than another.
- Holistic Treatment - Midwifery care treats the whole woman, not just her body. Prenatal care that is only a medical check up is a missed opportunity to resolve other issues that could contribute to disparities, including social and emotional stresses in the woman's life.
- Longer Prenatal Visits - The average length of a midwife visit is significantly longer than one with a physician. This allows more time to focus on these issues and develop a trusting caregiver/client relationship.
- Relaxation Practice - Birth centers do not offer epidurals, so midwives at a birth center would encourage women to prepare for a natural birth. In fact, State of Florida Law requires that birth centers counsel their clients to receive appropriate childbirth education. This preparation usually involves relaxation practice, which can be helpful for dealing with stress.
- Empowering Education - Midwifery supports women in being educated and involved in decisions about their care instead of letting the birth professional make most of the choices for them. This can help them learn to take responsibility for themselves and their babies, both during and after the childbearing cycle.
Thursday, June 24, 2010
It just didn't seem right to me. I didn't like the idea of having a medication to prevent a complication that only might happen. This was part of my reasoning behind changing providers and hospitals. My CNMs told me that with an unmedicated birth, third stage pitocin is often unnecessary, so my birth plan said I didn't want it unless I started to hemorrhage. I ended up being induced with pitocin for that birth anyway, so it didn't matter.
When I moved to a new area while 3 months pregnant with my son, I called the hospital where I was planning on birthing for a recommendation for a provider who would be supportive of natural birth (they recommended Dr. I., who was awesome) and the nurse and I talked about the policies. She said that if I really didn't want an IV, they could do the postpartum pitocin as an IM injection instead and told me that in her 10 years as a nurse, she had never seen a woman not get pitocin after giving birth. When I met with Dr. I., I talked to her about this, and she brought up that breastfeeding really should work just as well as pitocin. She said she would support trying breastfeeding first.
So, then, I had an unmedicated birth, but they had to take my baby to the warmer to give him oxygen. Dr. I. waited until the placenta was out to see how much I bled, but it was too much, so I got both pitocin and methergine--I think it is possible that doing it later is why I needed both.
I wondered if perhaps I'm just a "bleeder" and will need pitocin for all of my births. I don't have a problem with it if it is actually necessary. Then Gloira Lemay shared with me an Australian article called Optimising psychophysiology in third stage of labour: theory applied to practice. I read the full article (link is to the abstract). I believe these authors are on to something, and I would love to see more research on this topic. You can read an interview with one of the article's authors at the Science and Sensibility blog.
The basic idea is that studies of "active management" and "expectant management" haven't really studied truly physiological third stages. The authors theorize that in order to produce the oxytocin surge necessary to help her uterus contract sufficiently to avoid hemorrhage, the mother needs to focus on her baby, holding him skin to skin, in a calm environment with little distraction. This is certainly different than how my 3rd stage was with my son, and I think it is likely pretty rare in a hospital setting.
In natural childbirth education, and especially with hypnosis, we try to help women produce the right natural chemicals in their bodies to promote smooth (and even comfortable) birthing in the first and second stages (though the second seems to be more difficult for some of us). There is scientific evidence that the mind and body are connected and our thoughts and feelings have direct effects in our bodies (the research of Dr. Candace Pert on neuropeptides is one example). We strive for a relaxed, comfortable state of mind to promote oxytocin and endorphins in the first two stages--it makes sense that the same sort of mental state would be necessary for a natural third stage. Third stage is still part of birth, and it's important for both women and their caregivers to recognize this.
The belief of the L&D nurses I have spoken with seems to be that an unmedicated third stage with a small amount of bleeding would be an exception. It seems to me that under the right conditions, a gentle, hands-off approach could make postpartum hemorrhage the exception rather than the rule. According to Gloria Lemay, it works.
In order to accomplish a natural third stage, separation of mother and baby must be avoided whenever possible. This is easy if you don't cut the cord right away. Check out Navelgazing Midwife's recent post on the gross practice of using shoestrings to clamp the cord in unplanned out-out-of-hospital births. And for more on keeping mother and baby together, check out the recently posted Healthy Birth Blog Carnival #6: MotherBaby Edition
be sure to check out my new follow up to this post: Physiological Third Stage, without the "as long as"
Sunday, June 20, 2010
Learned helplessness results from being trained to be locked into a system. The system may be a family, a community, a culture, a tradition, a profession or an institution.He explains that systems sometimes distort their original purposes, but people are still expected to function in the system, because the system itself has power.
Initially, a system develops for a specific purpose. But as a system evolves, it increasingly tends to organize around beliefs, perspectives, activities and taboos that serve the continuation of the system. Awareness of the original purpose fades and the system starts to function automatically. It calcifies. The beliefs, perspectives, activities and taboos shift in subtle (and sometimes not so subtle) ways, to ensure continuation. And those beliefs, perspectives, activities and taboos are trained into the people that comprise the system.
The system uses shame and the withdrawal of attention to instill a fear of survival. Simultaneously, the system presents the view that power resides in the system, not the individual. The combination creates a dependence on the system for survival. Gradually, the system is internalized and the person identifies with it -- he sees himself the way the system sees him. His sense of who he is is defined by the system. (We see this tendency very clearly in the professions -- "I'm a doctor, so I do x, y and z" or "I'm an attorney, so I do x, y and z.")"The system" could here refer to a maternity care system, in which physicians are expected to act one way and patients another. The system developed for the purpose of helping mothers and babies, but in some ways, it has shifted its focus to perpetuating itself, by keeping the system functioning and keeping the way it functions the same.
McLeod next explains how learned helplessness perpetuates patterns of abuse within systems (such as boyfriend/girlfriend relationships or families).
Whenever we are subjected to abuse, physical, emotional or spiritual, two patterns form inside us: the victim and the abuser. Our experience of being abused lays the basis for the victim pattern. Our experience of how abuse can be meted out lays the basis for the abuser pattern. Both give rise to learned helplessness, though the learned helplessness manifests differently. In the case of the abuser, learned helplessness might manifest as "Something just took over; I didn't mean to say or do that." In the case of the victim, it might manifest as "I don't know why I put up with it but I can't seem to do anything about it." In both cases, we are expressing passivity with respect to the patterns operating in us. In both cases, we are confessing helplessness.In the functioning of a maternity care "system", the provider is in a position of authority and the patient is subservient. We follow the patterns of behavior that the system expects from us because our brains recognize this as normal. We have been trained to believe that people in authority are there to help us and that we should listen to them. So, even if our own research or personal beliefs tells us otherwise, we may still go along with what our provider says (or even what we believe they think) we should do--agree to have a test done, schedule an induction, have a vaginal exam, push in the bed, whatever--because we are passive in respect to the system. It is not a fear of the care provider per se, but a fear of doing something that doesn't fit in the construct of a system. The system makes us feel powerless to act differently than its pre-determined role for us.
McLeod's article says that the only way to overcome learned helplessness as passivity to a system is to sever all ties with the system.
Thursday, June 17, 2010
The term learned helplessness originates from the research of Martin Seligman and Steve Maier at the University of Pennsylvania in 1967. Seligman and Maier used shock harnesses on dogs in three groups. Group 1 was the control group, who wore harnesses but received no shocks. Groups 2 and 3 both received shocks from their collars and both had levers they could push. In group 2, the lever stopped the shock, but in group 3, the lever didn't do anything--those dog's collars were activated by the levers controlled by group 2 dogs. The group 3 dogs stopped trying to push the levers and developed depressive symptoms. Then, the same dogs were put in another situation where they were the dogs could stop the shocks by jumping over a low partition. About two thirds of the dogs from group 3, did not try to escape the shocks. They had learned from the previous experiment that they were powerless against them.
Learned helplessness is used to explain depression in humans. When people come to believe that their actions have no impact on their environments ("no matter how hard I try, I always end up with the same negative result") or they come to see failure as a result of some intrinsic flaw in them ("I couldn't do it because I can never do anything right"), they lose motivation because they believe that they have no power to influence their lives.
I believe that a culture that has an over-reliance on epidural-managed childbirths promotes learned helplessness in women. My doula friend Judi Hull told me that childbirth education that highly promotes epidural use "take[s] ... women's power away from them." She feels that going through the experience of childbirth unmedicated can be self-esteem building for women. Medically controlled childbirth takes away from women not only control of the process of birth, but also power to overcome the obstacle of birth using their own tools. When women feel that they "can't" do childbirth without medical help, what else might they later feel they "can't" do? If women develop a dependency on anesthesiologists to get them through birth, how does this influence their ability to think for and act for themselves as mothers and women?
In my next post, I will share some more ideas about how learned helplessness can develop and how it functions in maternity care systems.
Tuesday, June 15, 2010
The OCD Project Supertrailer
In the tailor, you see a clip where the patients are writing down their fears about what might happen if they don't do their OCD rituals. On the episode, Dr. Tolin has them read what they wrote into a tape recorder. He then uses these recordings as voice-overs for videos he makes called "fear movies"--images depicting their worst fears. He has them watch these films wearing a heartrate monitor, as increases in heartrate indicate anxiety. The films play twice, and during the first run, all of the patients had increases in heart rate in response to seeing their fears. Their rates stabilized when the film ended and then when it played again, their heartrates remained stable because it became less scary after they had seen it--exposure decreased anxiety.
This exercise reminded me of the Fear Release exercise in Hypnobabies, which involves visualizing watching your fears on a screen. I realized that part of how this exercise works is that by seeing our fears, we become less afraid of them.
Monday, June 14, 2010
Friday, June 11, 2010
It is normal to fear the unknown. For most first time pregnant women, birth is a huge unknown. Not only have we never done it, we may not even have ever seen it done. In North America today, I think it's highly unlikely that the average woman has ever been at a birth before giving birth. She also won't see uncensored images of vaginal birth in any public media. So, unless her school showed birth films in health class (mine didn't) or she takes a childbirth education class, seeks out birth videos on the internet, or watches a birth documentary such as The Business of Being Born, she may not even have seen a baby birthed before she is expected to do it. As I discussed in a prior post, some women seem to think that viewing a birth would disturb them, so they don't seek out any birth videos.
Add this that the fact that virtually every pregnant woman reaches a point in her pregnancy where, looking at her much-changed body, she realizes her baby is going to have to come out, but to her it just seems impossible that it could. It really is an unbelievable thing, even for those who have seen it and done it. That's kind of the miracle of it. Much of the medical system, however, seems to believe that it really is impossible without their help, and they are also afraid of the rare and very scary things they've seen or heard of going wrong, and they pass that fear on to women to add to their fear of never having done it and thinking there is no way her body can do something that seems impossible. Medicalization of birth also increases the "unknown" factor--it is something for educated doctors and nurses to know about, not average women.
Fear of Pain
It is also normal to fear pain, because pain is usually an indication that something is wrong, and we find it unpleasant. Our young pregnant women has heard others talk about how birth was painful for them and that they would never think about doing it without medication (or they did and it was a bad experience), and this just compounds the fear. She has probably seen birth shows on cable TV, which edit birth footage in ways that focus on the dramatic, because they are in the business of making exciting television, not of educating women about what birth is and can be. She probably has also heard a few stories of births where there were complications--maybe a vacuum delivery or an unplanned cesarean. She may fear something going wrong or having something strange done to her. Many women also feel fearful when they are in an unfamiliar place, surrounded by strangers, as is often the case with birth today.
Effects of Fear on Birth
We know that fear causes the body to release chemicals that can stop the birth process. This makes sense from an evolutionary perspective--a tribal woman wouldn't want to give birth if a tiger was chasing her, but as is explained in the book Birthing From Within (not a hypno-friendly book, by the way), the body doesn't know how to distinguish between real and imaginary tigers, it only knows fear. Fear also increases our perception of pain and prevents us from enjoying birth.
So, what is our average (and now thoroughly terrified) first-time pregnant woman to do?
Most likely, she'll figure that she has a highly-skilled doctor and well-equipped hospital that will keep her and her baby safe because they're the experts, and she'll decide she will get an epidural, so she won't need to worry about pain. It is likely that her preparation won't go much beyond this. She will still have other fears to deal with, though. For example, what if she's afraid of needles?
Fear of Needles
Fear of needles is pretty common. I see nothing unreasonable about having a fear about a sharp object penetrating one's skin to introduce foreign substances into one's body. I realize that needles do a lot of good in medicine, but the idea of them is just disturbing to me. It is sometimes fear of needles that leads women to seek out natural childbirth.
The best answer to the fear problem is childbirth education. And by childbirth education I don't mean most hospital-sponsored classes where the woman learns a little (but usually not enough) about what is going on in her body, what routine medical procedures to expect (without letting her know she has the right to refuse all of them), and that epidurals are usually safe and not anything to worry about. I mean childbirth education that is free to tell you what the hospital doesn't want you to know.
Most natural childbirth classes address fear in two ways. They tell women that they can give birth without medication, just like women did before medication existed, and teach them pain coping techniques which helps increase their confidence and overcome their fears about pain. Some of these techniques rely on freedom of movement, so these classes usually encourage women to consider declining unnecessary routine medical procedures that interfere with movement (such as IV fluids and continuous monitoring). They also address fear of the unknown by teaching about the natural process of birth, as well as explaining how medical interventions might affect the process and giving information about the risks and benefits of these procedures and encouraging women to choose for themselves whether to accept them or not. Feeling like they are involved in decisions about birth helps women feel less afraid.
Fear of Medical Interventions
However, the downside to teaching about medical interventions (both in classes and other places such as books/films/internet groups) is that sometimes this education has the unfortunate side effect of creating fear of medical interventions. So, fear of pain, birth, and the unknown, are replaced by fear of hospitals, pitocin, and iatrogenic complications. Remember, fear interferes with birth, no matter what the source or intention. Going into birthing with any kind of fear is not healthy. And there is always a possibility that a woman will need medical intervention in her birth, and if that happens, we don't want her to be afraid of it. I recognize that fear of pitocin had negative effects in my own first birth.
I want women to be able to make birth decisions without fear. The presence of fear makes it difficult to use the other things we need to make decisions--our logic and our intuition. Sometimes natural childbirth sources are guilty of some of the same fallacies as the medical side of things. Those who believe in liberal use of medical technology in birth will focus on a few rare complications as reason why a woman shouldn't choose a homebirth, a VBAC, minimal monitoring, no IV or heplock, etc, while ignoring the majority of births that go right. Natural birth advocates sometimes focus on the rare scary complications of epidurals and cesareans, without mentioning that the majority of women who choose an epidural or need a cesarean have no major problems. It is important for women to understand the risks of interventions, while at the same time understanding that there are times when the benefits of these interventions clearly outweigh the risks.
I feel that the best type of childbirth education would present information in a way that doesn't scare women, but provides them with unbiased information that allows them to make informed, and not fearful, choices. Good childbirth education also has ways of helping women overcome their fears. Hypnobabies includes a fear-clearing exercise that works very well for this. Some other ideas can be found in this post by Felice at The Gift of Giving Life.
Friday, June 4, 2010
The judgmental attitudes begin even before we even officially become mothers, during pregnancy and birth. Pejorative rhetoric abounds in comment threads on internet articles and blog posts regarding birth issues such as midwifery, homebirth, VBAC, and high cesarean rates. One term that is often thrown around is selfish. It's "sefish" to try to avoid medical intervention `because it's putting your experience above the safety of the baby, it's "selfish" want pain relief because *that's* putting your experience above the baby's safety, it's "selfish" to want to avoid a c-section out of fear of surgery, it's "selfish" to opt for a c-section out of fear of damage to the vagina, it's "selfish" to have a homebirth because of the risks, it's "selfish" to schedule an elective induction because of the risks, it's "selfish" to go past 40 weeks, it's "selfish" to want a homebirth, it's "selfish" to want a care provider you know at your birth, it's "selfish" to want a VBAc...the list goes on.
The truth is that having a baby is one of the most unselfish things a woman can do. Women usually make their choices based on what they believe is best for their babies and for themselves. There are differences of opinion on what actually is the best choice, but it is never selfish for a woman to want to be involved in decisions that affect her and her baby. It is also not selfish to enjoy the process by which your baby comes into the world. Many women really enjoy natural childbirth and find it empowering and rewarding (and no one should automatically assume they are not one of these women). Other women choose to enjoy their birth using pain medication. I have given birth both ways, and enjoyed each in its own way. Neither was selfish.
Natural childbirthers are often accused of having elitist attitudes. They say that we think we are better than them because we had a natural birth, and seem to think that the only reason we did it was so that we could rub it in their faces that we are superior. Although I do see some of the elitist attitude, I feel our motives for sharing our stories are being misconstrued. It's not meant to be a "look at me, look at me, I'm so awesome because I had a natural birth and you didn't" thing. It's meant to be a "I did this, it was awesome for me, and it can be for you, too" thing. I think it just doesn't come across that way because of knee-jerk defensive reactions, which are then met by more defensiveness, and a bunch of angry name-calling ensues.
As natural childbirth advocates, we are sometimes guilty of labeling everyone who doesn't make the same choice as "uneducated about her options." This is not always true, and even in cases where it is, it is insulting. People don't often listen to things that people who insult them are trying to say. Women who seek to "advocate" for natural childbirth will not get anywhere with name-calling. The more we respond to insult with insult, the more everyone will be insulted. I would like to hope that we can rise above the petty "mommy wars" and share our experiences and information in ways that don't belittle, accuse, or insult.
Wednesday, June 2, 2010
I don't think I realized it at the time, but it is likely that the Lord led me on my quest of knowledge during my first pregnancy. The motto for BYU, the church-owned university I attended, is "The glory of God is intelligence" (from D&C 93:36). I believe that my desire to find greater knowledge and truth about birth was directed by the Spirit, since all light and truth come from God. Looking at it now, it's hard to see how the Lord could not be involved in such a drastic transformation.
My first birth itself had some very spiritual moments. I remember feeling kind of sad after the epidural was in because it wasn't what I planned, though I realize that, under the circumstances, it was really a blessing that I could get the epidural and get some rest. I listened to my iPod after I got the epidural, and chose at that time to listen to a collection of instrumental arrangements of hymns by Lex De Azevedo. I remember the soothing music giving me peace and helping me sleep despite my conflicted feelings about the situation. Because the birth took place on a Saturday at a small hospital, we got our pick of the rooms on the floor, and chose the one with a great view of the Mt. Timpanogos Temple. There are large windows in the maternity rooms, and the drapes were open when I gave birth at 9:52 pm and the temple was all lit up. I looked at the window while I held my daughter on my belly with the cord still attached, the delivery lights in the darkened room lit us up in the glass, and the temple glowed on the other side. I think it will be very special to tell my daughter that she was born under the glow of the temple.
During my second birth, I did not think much about spiritual matters. I focused on listening to my Hypnobabies tracks and using my hypnosis techniques. For much of my first stage, I feel Hypnobabies helped the atmosphere be more reverent because it kept me calm. Second stage was very intense, but the sudden change from feeling overwhelmed by the intensity to the complete joy of having my baby in my hands and knowing I had done it was very similar to how some people describe spiritual events like conversion or repentance/forgiveness.
17 And it came to pass that as I was thus aracked with torment, while I was bharrowed up by the cmemory of my many sins, behold, I dremembered also to have heard my father prophesy unto the people concerning the coming of one Jesus Christ, a Son of God, to atone for the sins of the world.20 And oh, what ajoy, and what marvelous light I did behold; yea, my soul was filled with joy as exceeding as was my pain!21 Yea, I say unto you, my son, that there could be nothing so exquisite and so bitter as were my pains. Yea, and again I say unto you, my son, that on the other hand, there can be nothing so exquisite and sweet as was my joy.
I believe that all pregnancy and birth is spiritual. It involves working with God to bring a new soul into this life so that an individual can progress on the path to exaltation. It is the expanding of a family unit and, in the case of first births, it is the moment when people become parents. These are very spiritually significant things. I feel we can make birth more of a spiritual experience for us if we try, and I hope to do so even more with my future pregnancies and births.