The idea of active management of the third stage has never sat right with me. Even before I developed my interest in natural childbirth. When I was pregnant with my daughter, I was taking one of the hospital classes I talk about that are not so great. The nurse who was teaching the class told us that after our babies were born, we would be getting pitocin in our IVs to help the placenta come out and help the uterus clamp down to put pressure on the placenta site to prevent too much bleeding. I asked if you can decline it and she acted like that would be a stupid thing to do, because why would you want to risk bleeding too much and before we had it a lot of women died from hemorrhage.
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"
Showing posts with label psychology. Show all posts
Showing posts with label psychology. Show all posts
Thursday, June 24, 2010
Sunday, June 20, 2010
Learned Helplessness Part II
As I was searching the net for info for my first Learned Helplessness post, I came across an article on a Buddhism site by Buddhist teacher Ken McLeod that talks about learned helplessness in systems run amok.
McLeod next explains how learned helplessness perpetuates patterns of abuse within systems (such as boyfriend/girlfriend relationships or families).
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.
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
Learned Helplessness
In my studies of early childhood education in college, I learned the term learned helplessness. In education, we usually used the term to describe children who constantly ask others for help and say that they "can't" preform tasks on their own.
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.
http://www.flyfishingdevon.co.uk/salmon/year2/psy221depression/psy221depression.htm
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.
Sources:
http://en.wikipedia.org/wiki/Learned_helplessness
http://www.noogenesis.com/malama/discouragement/helplessness.htmlhttp://www.flyfishingdevon.co.uk/salmon/year2/psy221depression/psy221depression.htm
Tuesday, June 15, 2010
More on Overcomming Fears: The OCD Project
Recently, my husband and I were watching VH1's "The OCD Project," which documents a 21 day treatment camp for people with obsessive-compulsive disorder run by Dr. David Tolin. OCD actually has a lot to do with extreme irrational fear. Much of the therapy in the show involves them facing their fears.
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.
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.
Tuesday, May 11, 2010
Understanding "Painless" Childbirth
This post is inspired by a recent conversation on my natural childbirth forum, as well as a few birth stories I have read from Hypnobabies moms who were surprised to find that their pressure waves felt "painful" to them. It also is a response to something I stumbled upon while browsing the archives of a natural childbirth blog, in which the author said she would not want to have a painless birth.
So, what is up with "painless" childbirth?
A few women are rumored to have "painless" births without special preparation. I think this is probably pretty rare, but the fact that it happens is notable. The majority of women who refer to their births ans "painless" or "pain-free" are women who used hypnosis.
I think this is something that is commonly misunderstood, and I admit I didn't understand it when I was preparing for my first birth. I read the book Hypnobirthing by Marie Mongan, and listened to the CD that came with it a few times. As I understood it, Mongan was teaching that all "pain" in childbirth was a result of the fear/tension/pain cycle, meaning birth will not be painful if you are not afraid of it. I believed that what we experience in birth is a direct result of what we expect, so I chose not to expect pain. I was really oversimplifying things, and I was in for a rude awakening.
When I started having contractions (I refer to them as "contractions" here because that is what I called them at the time--I didn't buy into the idea of changing the words then) I admitted that "they hurt," but it was very manageable. They went on for quite a long time, going away and coming back, and then I was given a very low dose of pitocin, and those contractions really hurt. I was still able to cope using movement and deep breathing for a while, but I was really miserable. I do recognize that there was a psychological element to this pain. In my mind, something external (pitocin) was inflicting pain upon me, instead of it being caused by my own uterine muscles contracting. This, as well as exhaustion and pressure to dilate due to risk of infection, made it much harder for me to cope.
I think that I, as a first timer, espoused a common misconception about painless birth: believing that your birth will be painless just because you've heard of it and believe it's possible. I didn't think I needed to do anything to have a painless birth; I thought it would just happen because birth is not "meant" to be painful (right, Dr. Dick-Read?)
My understanding of this changed when I did the Hypnobabies program for my second birth. I don't know if there is really a difference in the two programs' views or if my experiences caused me to have this new understanding. I don't know if birth is really "meant" to be painful or not, but I do know that it involves a stimulus that the majority (at least in our culture) of women's brains interpret as "pain," which is generally experienced as a negative thing. Good hypnosis for childbirth provides a system for changing your mind so that the stimulus is interpreted as not painful, so that it can be experienced more positively. For me, with my second birth, experiencing it positively involved a conscious choice on my part.
Both Hypnobirthing and Hypnobabies use a technique of renaming some of the words commonly used in childbirth. This is a strange practice and, I admit, it's a little cumbersome at times, but many women find it helpful to avoid negative associations their subconscious may have with the words. One example is avoiding use of the word "pain" and using "discomfort" instead, because it is not as negative of a word. Some could argue that "painless childbirth" is about semantics, but it's really about what you choose to believe.
I believe that most women who have unmedicated births are able to find a way to experience the stimulus of the sensations of childbirth as not a bad thing, even if they do experience them as painful. In embracing a "pain with a purpose" ideology, women are choosing to tweak their understanding of the word "pain" (which is usually a negative word to describe a sensation that occurs when the body is being harmed) to include a kind of pain that is good. This essentially means changing the negative connotation of the word "pain" to be positive in this particular circumstance, while with hypnosis, we simply change the word, eliminating the negative connotation altogether.
I think some people, when they hear "painless," assume that means not feeling anything--that the "hypno-anesthesia" would be like an epidural and make them numb. It doesn't work this way. Hypno-anesthesia is very strong endorphins. It's like when you cut yourself or you twist your ankle and at first it hurts a lot, but then it doesn't hurt as much, that's endorphins. They soothe and dull pain, but they don't take away sensation. With a pain-free unmedicated birth with hypnosis, you would still feel your baby being born, it just wouldn't feel like pain to you.
Sometimes the talk of feeling "only pressure and tightening" in Hypnobabies leads women to expect that birthing waves will feel just like Braxton-Hicks waves. This is not true either. Braxtion-Hicks are just tightening sensations, for me, birthing waves (and also the pre-birth waves that can occur irregularly for weeks before the actual birth) have an extra level of intensity--what I now call a "downward pressure" which signaled to me that my uterus was now working to begin moving my baby down instead of just flexing itself for the exercise.
One of the changes in the new 6th edition of Hypnobabies is the re-recording and re-naming of a track that used to be called "Painless Childbirth" to "Easy, Comfortable Childbirth." Hypnobabies appears to be moving away from using the word "painless," which, considering all of the misconceptions about it, I think is a good move. I feel like "comfortable" is a more accurate description of how Hypnobabies helped me. Whatever sensations I felt (some of which I may have called "painful" under other circumstances), I knew they were normal and was able to not be afraid of them, which allowed me to feel calm and confident and not out-of-control or panicky (except during the cervical lip and the pushing, but I have theories about that). I wouldn't say I was "in pain," because for me, being "in pain" never involves that degree of serenity and self-composure.
I know there are some women for whom surviving the pain of childbirth provides a sense of accomplishment. It makes them feel like they are "hardcore." I, on the other hand, am not "hardcore," nor do I want to be. I can get a sense of accomplishment from seeing that I did something most people experience as very painful, and it was mostly comfortable to me, and I did it with my mind!
So, what is up with "painless" childbirth?
A few women are rumored to have "painless" births without special preparation. I think this is probably pretty rare, but the fact that it happens is notable. The majority of women who refer to their births ans "painless" or "pain-free" are women who used hypnosis.
I think this is something that is commonly misunderstood, and I admit I didn't understand it when I was preparing for my first birth. I read the book Hypnobirthing by Marie Mongan, and listened to the CD that came with it a few times. As I understood it, Mongan was teaching that all "pain" in childbirth was a result of the fear/tension/pain cycle, meaning birth will not be painful if you are not afraid of it. I believed that what we experience in birth is a direct result of what we expect, so I chose not to expect pain. I was really oversimplifying things, and I was in for a rude awakening.
When I started having contractions (I refer to them as "contractions" here because that is what I called them at the time--I didn't buy into the idea of changing the words then) I admitted that "they hurt," but it was very manageable. They went on for quite a long time, going away and coming back, and then I was given a very low dose of pitocin, and those contractions really hurt. I was still able to cope using movement and deep breathing for a while, but I was really miserable. I do recognize that there was a psychological element to this pain. In my mind, something external (pitocin) was inflicting pain upon me, instead of it being caused by my own uterine muscles contracting. This, as well as exhaustion and pressure to dilate due to risk of infection, made it much harder for me to cope.
I think that I, as a first timer, espoused a common misconception about painless birth: believing that your birth will be painless just because you've heard of it and believe it's possible. I didn't think I needed to do anything to have a painless birth; I thought it would just happen because birth is not "meant" to be painful (right, Dr. Dick-Read?)
My understanding of this changed when I did the Hypnobabies program for my second birth. I don't know if there is really a difference in the two programs' views or if my experiences caused me to have this new understanding. I don't know if birth is really "meant" to be painful or not, but I do know that it involves a stimulus that the majority (at least in our culture) of women's brains interpret as "pain," which is generally experienced as a negative thing. Good hypnosis for childbirth provides a system for changing your mind so that the stimulus is interpreted as not painful, so that it can be experienced more positively. For me, with my second birth, experiencing it positively involved a conscious choice on my part.
Both Hypnobirthing and Hypnobabies use a technique of renaming some of the words commonly used in childbirth. This is a strange practice and, I admit, it's a little cumbersome at times, but many women find it helpful to avoid negative associations their subconscious may have with the words. One example is avoiding use of the word "pain" and using "discomfort" instead, because it is not as negative of a word. Some could argue that "painless childbirth" is about semantics, but it's really about what you choose to believe.
I believe that most women who have unmedicated births are able to find a way to experience the stimulus of the sensations of childbirth as not a bad thing, even if they do experience them as painful. In embracing a "pain with a purpose" ideology, women are choosing to tweak their understanding of the word "pain" (which is usually a negative word to describe a sensation that occurs when the body is being harmed) to include a kind of pain that is good. This essentially means changing the negative connotation of the word "pain" to be positive in this particular circumstance, while with hypnosis, we simply change the word, eliminating the negative connotation altogether.
I think some people, when they hear "painless," assume that means not feeling anything--that the "hypno-anesthesia" would be like an epidural and make them numb. It doesn't work this way. Hypno-anesthesia is very strong endorphins. It's like when you cut yourself or you twist your ankle and at first it hurts a lot, but then it doesn't hurt as much, that's endorphins. They soothe and dull pain, but they don't take away sensation. With a pain-free unmedicated birth with hypnosis, you would still feel your baby being born, it just wouldn't feel like pain to you.
Sometimes the talk of feeling "only pressure and tightening" in Hypnobabies leads women to expect that birthing waves will feel just like Braxton-Hicks waves. This is not true either. Braxtion-Hicks are just tightening sensations, for me, birthing waves (and also the pre-birth waves that can occur irregularly for weeks before the actual birth) have an extra level of intensity--what I now call a "downward pressure" which signaled to me that my uterus was now working to begin moving my baby down instead of just flexing itself for the exercise.
One of the changes in the new 6th edition of Hypnobabies is the re-recording and re-naming of a track that used to be called "Painless Childbirth" to "Easy, Comfortable Childbirth." Hypnobabies appears to be moving away from using the word "painless," which, considering all of the misconceptions about it, I think is a good move. I feel like "comfortable" is a more accurate description of how Hypnobabies helped me. Whatever sensations I felt (some of which I may have called "painful" under other circumstances), I knew they were normal and was able to not be afraid of them, which allowed me to feel calm and confident and not out-of-control or panicky (except during the cervical lip and the pushing, but I have theories about that). I wouldn't say I was "in pain," because for me, being "in pain" never involves that degree of serenity and self-composure.
I know there are some women for whom surviving the pain of childbirth provides a sense of accomplishment. It makes them feel like they are "hardcore." I, on the other hand, am not "hardcore," nor do I want to be. I can get a sense of accomplishment from seeing that I did something most people experience as very painful, and it was mostly comfortable to me, and I did it with my mind!
Sunday, April 18, 2010
Maslow's Hierarchy of (Birth) Needs
At a church meeting I attended recently, a speaker brought up psychologist Abraham Maslow's Hierarchy of Needs to make a point about serving others. It had been years since I thought about Maslow's Heirarchy, but I was familiar with it from the AP Psychology class I took in high school and I think it was also covered in the Child Development course I took as a requirement for my Bachelor degree in Early Childhood Education. This course was actually where, as a college freshman, I first learned that placentas come out. I don't know what I thought happened to it before--guess I figured it was just a permanent part of the mother's anatomy or something. Perhaps public high school curricula are a little lacking on the subject of childbirth?
Maslow arranged the needs this way because he believed that certain types of needs must be met before other needs manifest. In other words, if more pressing needs like needs for food, sleep, and safety are unmet, then the person can't be very concerned with higher needs, like belonging and confidence.
Here is an explanation of each level of needs, quoted from this site.
However, I've never heard the psychology of birth explained in terms of unmet needs before. If we assume that meeting the needs on Maslow's Hierarchy is essential to a woman's emotional well-being, and hence, important for both the physical progress and the woman's experience of birth, then it's easy to see why some births go smoother and are better experiences than others. A lot of what is common in birth in America actually denies women of their needs.
In the average hospital birth, women are usually denied food and sometimes denied drink (physiological needs) and given an intravenous drip and ice chips instead. Women can't feel safe (safety needs) in the hospital if they fear strangers, unfamiliar places, needles, or bodily injury from episiotomy or cesarean. Traumatic birth stories sometimes mention the woman feeling alone, deserted, or unloved (social needs) when she was taken away from loved ones to be preped for surgery or left to be "watched" by a fetal monitor. Sometimes women are disrespected (esteem needs) by being ordered around, spoken to demeaningly (you can find a lot of examples of these two at www.myobsaidwhat.com), or not being free to move. With so much frustration of women's needs, no wonder there are so many unsatisfying birth experiences.
If you were to look at my birth plan from my son's birth (unmedicated hospital birth), you would find evidence of my needs to be able to drink, to feel safe, and to be respected. Perhaps social needs explain the results the various doula studies. Wanting a birth environment that allows these needs to be met certainly explains why some women choose out-of-hospital births.
Emjaybee, in a post at the Unnecessarean, recently asked so what does "good" look like? I think that the ideal birth environment would be one that supports the fulfillment of women's needs. This means one with unrestricted access to food and drink, one that is non-threatening in both appearance and practice, where women who want continuous emotional support can have it and there is no restriction on the presence of family members, and where caregivers are religiously respectful of the woman's autonomy, decisions, space, and person--where thy ask permission instead of stating their intentions and they avoid any unnecessary disruptions or interventions.
For women who are able to have all their needs met at birth, it can be a highly satisfying event, maybe even, I suggest, a self-actualizing experience.
In my high school psychology class, we discussed the different theories of psychology--Freud's psychoanalytic theory, behaviorism, etc. We divided into groups, each representing a theory. I chose to join the Humanist group. Basically, the theory of Humanism is that people are like seeds with the potential to grow into something great if all of their needs are met. For plants, the needs are soil, water, sunlight, etc. Maslow attempted to explain what human beings need with his Hierarchy of Needs, usually depicted as a pyramid like this:
www.abraham-maslow.comHere is an explanation of each level of needs, quoted from this site.
- Physiological Needs
- These are biological needs. They consist of needs for oxygen, food, water, and a relatively constant body temperature. They are the strongest needs because if a person were deprived of all needs, the physiological ones would come first in the person's search for satisfaction.
- Safety Needs
- When all physiological needs are satisfied and are no longer controlling thoughts and behaviors, the needs for security can become active. Adults have little awareness of their security needs except in times of emergency or periods of disorganization in the social structure (such as widespread rioting). Children often display the signs of insecurity and the need to be safe.
- Needs of Love, Affection and Belongingness
- When the needs for safety and for physiological well-being are satisfied, the next class of needs for love, affection and belongingness can emerge. Maslow states that people seek to overcome feelings of loneliness and alienation. This involves both giving and receiving love, affection and the sense of belonging.
- Needs for Esteem
- When the first three classes of needs are satisfied, the needs for esteem can become dominant. These involve needs for both self-esteem and for the esteem a person gets from others. Humans have a need for a stable, firmly based, high level of self-respect, and respect from others. When these needs are satisfied, the person feels self-confident and valuable as a person in the world. When these needs are frustrated, the person feels inferior, weak, helpless and worthless.
- Needs for Self-Actualization
- When all of the foregoing needs are satisfied, then and only then are the needs for self-actualization activated. Maslow describes self-actualization as a person's need to be and do that which the person was "born to do." "A musician must make music, an artist must paint, and a poet must write." These needs make themselves felt in signs of restlessness. The person feels on edge, tense, lacking something, in short, restless. If a person is hungry, unsafe, not loved or accepted, or lacking self-esteem, it is very easy to know what the person is restless about. It is not always clear what a person wants when there is a need for self-actualization.
However, I've never heard the psychology of birth explained in terms of unmet needs before. If we assume that meeting the needs on Maslow's Hierarchy is essential to a woman's emotional well-being, and hence, important for both the physical progress and the woman's experience of birth, then it's easy to see why some births go smoother and are better experiences than others. A lot of what is common in birth in America actually denies women of their needs.
In the average hospital birth, women are usually denied food and sometimes denied drink (physiological needs) and given an intravenous drip and ice chips instead. Women can't feel safe (safety needs) in the hospital if they fear strangers, unfamiliar places, needles, or bodily injury from episiotomy or cesarean. Traumatic birth stories sometimes mention the woman feeling alone, deserted, or unloved (social needs) when she was taken away from loved ones to be preped for surgery or left to be "watched" by a fetal monitor. Sometimes women are disrespected (esteem needs) by being ordered around, spoken to demeaningly (you can find a lot of examples of these two at www.myobsaidwhat.com), or not being free to move. With so much frustration of women's needs, no wonder there are so many unsatisfying birth experiences.
If you were to look at my birth plan from my son's birth (unmedicated hospital birth), you would find evidence of my needs to be able to drink, to feel safe, and to be respected. Perhaps social needs explain the results the various doula studies. Wanting a birth environment that allows these needs to be met certainly explains why some women choose out-of-hospital births.
Emjaybee, in a post at the Unnecessarean, recently asked so what does "good" look like? I think that the ideal birth environment would be one that supports the fulfillment of women's needs. This means one with unrestricted access to food and drink, one that is non-threatening in both appearance and practice, where women who want continuous emotional support can have it and there is no restriction on the presence of family members, and where caregivers are religiously respectful of the woman's autonomy, decisions, space, and person--where thy ask permission instead of stating their intentions and they avoid any unnecessary disruptions or interventions.
For women who are able to have all their needs met at birth, it can be a highly satisfying event, maybe even, I suggest, a self-actualizing experience.
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