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.

Sources:

http://en.wikipedia.org/wiki/Learned_helplessness

http://www.noogenesis.com/malama/discouragement/helplessness.html

http://www.flyfishingdevon.co.uk/salmon/year2/psy221depression/psy221depression.htm

My Daughter's Birth

My first birth story, written soon after her birth (I removed her name from it, though):

Thursday, January 31, 2008

When I woke up I felt like some liquid was trickling out of me and thought that I might have been leaking amniotic fluid. I knew I had a midwife appointment that day, so I wasn't too worried about it. I was also having some contractions--they were about 10-15 minutes apart for a while, but then I didn't feel any for a while, and then I feel back asleep. I went to my appointment and the midwife Mindy did some tests to determine if amniotic fluid was present and they came back negative, but she said that the tests could just not be picking it up, and if I still felt like I was leaking later, I should call the midwife on call and probably go to the hospital to have them check it. She checked my cervix and said that I was 1.5 cm dilated and 80% effaced with the baby at -2 station, which is a big change from the previous week were my cervix was high and closed. I knew it didn’t really tell me anything, but was is nice to know I was making progress.

Friday, February 1, 2008

I woke up at 2:00 am and once again I felt liquid come out and my underwear was wet. I started having contractions that were definitely different from Braxton-Hicks contractions. I called Abby, the midwife on call, and she was with another patient at the other hospital where the midwives also attend births, but she told me to go to the hospital and get checked. I went in and got hooked up to the monitors and they checked to see if my membranes were ruptured. The test with the litmus paper said it still wasn't amniotic fluid. Some of my contractions didn't register on the monitor, but the nurse told me that happens a lot. I was dilated to 2 cm now and still about 80% effaced--so that was some progress. My blood pressure readings were a little high, but I think it was all the nerves and excitement. They called Abby, and she said just to give me a paper with warning signs of pre-eclampsia (none of which I had) and send me home until my labor was more advanced. The nurse used that thing that startles the baby to get a few more good accelerations on the strip, and then sent me home.

We stopped at the grocery store on our way home. We got some gatorade, candy, and a few other random things. I got a lot of contractions while we were walking and I delt with them just fine, but they did hurt. I came home and sat on my birth ball at the computer for a little while, and sitting like that was nice, bouncing seemed to help, too. At 6:00 am, I called work and let them know I wouldn’t be coming in because I was in labor (I knew I couldn’t take care of a room full of three year olds while having these contractions) Then I listened to my relaxation CD that came with the copy of the Hypnobirthing book I bought and went to sleep for a little while.

When I woke up a few hours later, I let Tiatia continue to sleep for a while and I ate breakfast, watched two episodes of Gilmore Girls on DVD and took a bath. I wasn’t having many contractions now. I ate lunch and Tiatia woke up. I decided I needed to do something, so I did a load of dishes, cleaned the counters in our little kitchen and swept the floor. Then I cleaned the mirror, counters, and sink in the bathroom. I guess my nesting instinct had finally showed up. My contractions seemed to pick up quite a bit with all of that moving around. I found it really helpful to breathe deeply and to bounce on my ball during them. Tiatia’s sister Heiporo invited us over for pizza, so we went and brought my ball with us. I felt like I needed to urinate after every contraction I had, and when I went to the bathroom there was bloody show every time. At one point, I lay down on Tiatia’s lap on the couch and fell asleep. I don’t know how long I slept, but I definitely needed it.

When we got home from Heiporo’s, my contractions seemed more frequent and they were intense. Tiatia suggested I get in the tub, so I did. The water was nice and relaxing. I found sitting sideways in the tub with my legs crossed to be comfortable, and during contractions I would lean forward against the side of the tub and breathe deeply. Tiatia got a cup and poured water over the parts of me that were out of the water. He got me a glass of water to drink, too. He had to work on some homework, and I was doing fine, so I sat in the tub by myself for a while. I wanted to listen to the playlist of relaxation music I had on the iPod, so Tiatia set up our iHome in the bathroom and I just sat there listening to the music and breathing, and by this time it was after midnight.

Saturday, February 2, 2008

I tried to keep track of how close together my contractions were with the clock on the iHome, but it got to a point were the contractions were too distracting to remember the times. I was also feeling a little nauseated at this point. When Tiatia came to check on me, I had him sit with me and write down the start and stop times for the contractions. They were averaging four minutes apart and lasting about a minute each, so after timing them for about an hour, I got out of the tub and called Claudia, who was now the midwife on call. She said it was up to me if I wanted to go to the hospital or not and that I’d probably be okay to stay home for a little while. She could tell from how composed I sounded that I was handling things fine. It was about 3:00 am by now.

Tiatia decided to put on a movie, so I tried to rest and watch the movie. I couldn’t lie down during strong contractions, though, so when I felt them, I got up and bounced on my birth ball. We watched the movie for about two hours (it was a long movie) and then I just felt like I wasn’t handling the contractions that well anymore. I think it was the lack of sleep that caused me to get the shakes. I think the contractions had spaced out a little now, but I was just feeling out of control, so we decided to go ahead and go to the hospital. Heiporo had volunteered to come with us to the hospital and help out, so we went and picked her up and headed to the hospital. It was almost 6:00 am when we got there and I got in to triage. They hooked me up to the monitors and took my vitals and all of that.

The time I was in triage is a bit of a blur. I remember the nurses checked me and found that I was still only about 2 cm, but was now fully effaced. They let me rest for a while because Mindy’s on call shift would be starting at 8:00 am so they said they were going to let her sleep a little longer. I listened to my relaxation CD and it helped a lot. Tiatia and Heiporo said that there were contractions measuring on the monitor, but I don’t think I really felt them. I don’t remember what the nurse was doing when she noticed a little puddle of fluid under me, and said “I think your water broke.” This time, the test was positive for amniotic fluid, so they had to keep me. While I waited for Mindy to get to the hospital, I rested again, listening to my music. This time the contractions spaced out.

When Mindy got there, she tested me again and I was, in fact, leaking amniotic fluid. I’m pretty sure I had been leaking since Thursday, but Mindy could count time of rupture of membranes as when the hospital had found it, 7:15 am. She told me that it looked like my contractions had slowed down, and said she may need to give me pitocin. I cried and told her that I really did not want pitocin, that I wanted to get up and walk around and see if activity could get my contractions going like it had on Friday and she said I could do that.

They got us checked in to a room. I think I was the only one there at the time, so they gave us the one with the view of the Mt. Timpanogos temple because Heiporo had said we wanted that one. The nurse was really nice and got me a birth ball (we had left mine in the car) and told me that she would do intermittent monitoring of the baby, which she did by holding the monitor on my belly with her hand (or letting me hold it there). She also said that if I did end up getting pitocin, I still wouldn’t have to stay in bed, even though I’d have to have continuous monitoring, because she could get me a telemetery monitor.

Tiatia and I walked laps around the labor and delivery floor for the next couple of hours. During contractions he would hold me and I would lean against him and try to relax. Sometimes I would take a break by sitting on the birth ball. When we were walking, Mindy stopped us and told us that she had a different doctor backing her up than she usually has, and this guy was more intervention-minded and not as familiar with the way she does things. He wanted her to start me on pitocin right away, and she knew he would want that, and that’s why she had taken a while to get to the hospital that morning, so she could give me as much time as she could to progress on my own. After my reaction to the idea of pitocin, she had told him that waiting six hours is just the way she does it. She said that with her usual doctors, she can get twelve hours, but she wasn’t going to push it with this guy. That meant I had until 1:15 to make progress, and then we had to do the pitocin.

At 1:15, I had still not progressed, despite all the walking I was doing. I was desperate to avoid the pitocin, and wearing myself out even more because of it. We also tried some natural oxytocin stimulation, but it didn’t seem to do much. Mindy told me that because the break in my membranes was high up, there was still a bag of waters between the baby’s head and my cervix, so she was going to rupture it. I agreed, since my water was already broken. I wish she would have offered to do that earlier, or that she had given me more time after that to progress on my own, but they hooked me up to the IV and got the pitocin started right after that. Mindy had explained that she uses pitocin very gently, starting with the lowest dose and gradually increasing if necessary, and that if my cervix starts to change, she could turn it off and see how I would continue on my own.

Well, they gave me the lowest dose, and I immediately threw up and started feeling very intense contractions, much closer together. I was still in the bed, and the nurse pushed on my knees during the contraction, which helped. She taught Tiatia how to do it, so he pushed on my knees for the next few contractions. Then somebody suggested I get on the birth ball, which I did. I found I could get through the contractions by bouncing and breathing deeply to the rhythm of the bouncing (in-bounce-bounce-bounce, out-bounce-bounce bounce). Tiatia sat behind me and bounced me with his hands so I didn’t have to use my legs to bounce. Between the contractions, they wanted me to lean back against him so they could get good readings on the baby’s heartbeat. I was fine leaning back, but then when the contractions started, I had to pull myself upright, which was a bit annoying. I think Tiatia may have asked me if I wanted my music, but I said no because I was very focused on what I was doing and music seemed like it would be a distraction, but I wish now that I had listened to it. I think it would have helped me relax and take my mind off the pain.

Tiatia suggested the tub at one point, and that I agreed to. Mindy was sitting with us most of this time, helping me breathe. She checked me and found I was still not progressing and said we needed to up the dose of pitocin. I freaked out and said I did not want her to that it hurt and I couldn’t do it. She said she could give me an IV med to take the edge off, and I said that if I got in the water and it didn’t help, I wanted something. They went ahead and increased the pitocin, and I got in the tub. The water helped a little, but not enough. I think that, psychologically, knowing I was getting more pitocin made everything worse.

Mindy called Tiatia out of the bathroom to talk to him. He came in and told me that I was doing so well, but we still had a long way to go and I was so exhausted from the lack of sleep and dealing with contractions for so long. He said that the back up doctor wanted to do a c-section for failure to progress if I didn’t show change by 6:00 pm. I think it was almost 4:00 by this point. He said that if I got an epidural, I’d be able to rest up for the pushing, which rest Mindy felt I really needed. With an epidural, they could also increase the pitocin as much as they needed to get labor really going. I agreed to the epidrual because I didn’t want to deal with the pitocin contractions anymore, I really did not want a c-section, and I just wanted my baby to be here.

It was tough to deal with the contractions until the anesthesiologist got there. I had given up the idea of doing it unmedicated, so I wanted the pain to be over. My mother-in-law got there after they sent for the anesthesiologist. She coached me on relaxing, and was so sweet, but I had given up. She had wanted to be there earlier, but she had to translate in Tahitian for the funeral of President Hinckley. I got out of the tub and got back on the birth ball for a while. I asked Mindy to check me before I got the epidural to see how far I got on my own. She said it was about 3 cm. Then the anesthesiologist got there. While he was setting up, I sat on the bed and Tiatia looked into my eyes and told me I was doing great.

I was happy with the epidural because it did not make me completely numb, but I couldn’t feel the pain from the contractions. The epidural was on my left side, so I had to lay on my right side to get it to spread to the right. They told me about the button that would give me more if I needed it, but said that if I suddenly started feeling something, to tell them before I pushed it so they could check me, because starting to feel something usually means you’ve made progress. They also put in a catheter and an internal contraction monitor, so they could know how strong the contractions were to better judge how much pitocin to use.

About an hour later, Mindy checked me and I was 4 cm, which was a change, but Mindy later told me it wasn’t as big of a change as she expected. I switched over to my left side. I think there was a reason (besides that it was comfortable for me) but I don’t remember. Tiatia got me the iPod and I listened to my music and dosed. Then I started feeling the contractions on the right side of my belly again, so I called the nurses and told them. Mindy came and checked me again, and now I can’t remember how many cm she said I was, but it was a big change—7 cm, I think. She had me change back over to my right side and said I should push the epidural button.

I rested some more, and then I started feeling pressure. I also noticed that my heart was racing. The nurse came in to check on me and I told her all of this. We figured the racing heart was just excitement. She told Mindy about the pressure, and she came and checked me again and I was 9 and a half cm. The next time she checked, there was still a little lip of cervix on my right side. My mother-in-law came in and had me concentrate on opening my birth canal during the contractions. Once the lip was gone, it was time to push. It was about 9:00 pm when I started pushing. Because of the epidural, I had to be in a semi-seated position for pushing, putting my chin to my chest and grabbing my thighs. They coached me to hold my breath and push to a count of 10, three pushes for each contraction. Tiatia supported one leg and the nurse held the other. I watched the progress of her head in the mirror. Mindy massaged and supported my perineum and had me switch to pushing to a count of 5 as Tehani’s head emerged. Then she had me stop pushing and we had a baby at 9:54 pm.

Mindy put our daughter on my stomach. She was having a bit of a hard time breathing, so Mindy clamped the cord (it had slowed, but not stopped) and Tiatia cut it, and they took her to the warmer so they could suction her and drain her lungs. Then they did all the procedures, weighed her and all of that, and wrapped her up and gave her to Tiatia. He and his mom took pictures of her. The placenta was delivered, and Mindy was stitched me up. I tore in three places, but they were all not very bad tears. My left labium was a tough stitch job because it was torn on both sides, but Mindy did great with it. She said I stretched great and that next time I give birth, I probably won’t tear at all. Tiatia brought me the baby and I got to nurse her soon after.

I am disappointed that I didn’t get the birth I hoped for, that I “gave in” and got the epidural. When Mindy came to see me the next day, she told me it is okay to morn the loss of the birth I wanted and was very understanding about it. She hated that she had felt it was necessary to suggest pain medication. I told her I was sad about it, but I really felt like I had made the best decision I could under the circumstances. I was exhausted and couldn’t do the pitocin anymore at that point. I also said I would choose a vaginal birth with an epidural over a c-section. She said she didn’t want it to seem like she was threatening me with a c-section to scare me into getting the epidural, but the possibility of a c-section was something we had to deal with considering the doctor who was backing her up that day. Mindy told me she was impressed at how prepared I was, and said that sometimes being prepared can work against you, as it did for me and the pitocin.

Our little girl is a beautiful baby and we love her very much. I didn’t get my perfect birth, but I got my perfect baby.

Views of Birth Reflected in Mirrors

Beauty is eternity gazing at itself in a mirror. -Kahlil Gibran

I watched my first baby being born with a mirror. I felt like it helped me to see that my pushing was making progress, and I think felt a a little more connected with what was going on, despite my body being half-numb. I like watching babies emerge because I think it's amazing to see the divine design of the female body at work. I was not offered a mirror during my son's birth, but it didn't really matter because, being able to really feel it, him descending and crowning was very real--an intensity I couldn't possibly escape, even though I sort of wanted to at the time. But looking back on it, it was actually kind of cool. For me, birthing as connected as possible to the experience helped me appreciate my body and gave me confidence in my strength.

Recently I was telling a group of women about how my doctor had waited for spontaneous rupture of membranes at my son's birth (my water broke when I had only a lip of cervix left) and I mentioned how sometimes babies are born "in the caul" (with membranes intact), and I said I'd seen a video of it and it was really cool. One woman, who chose epidurals for the births of all the children she's had so far, said that she had never seen a birth video showing a baby emerging before and she doesn't want to see what it looks like, at least not until she is done having children herself. She said that declines to use a mirror when it is offered during the second stage. My friend explained that she deliberately distances herself from what is happening to her body--she doesn't want to know. She even said that it is because she has the epidural and can't feel what is happening that she disconnects herself from it, and that if she were to have an unmediated birth, she might not feel the same way about it. She also admitted that she may be making what happens worse in her mind than it actually is.

This woman's words taught me that although epidurals don't usually result in a "drugged" feeling like that reported by some women who take narcotics during birthing, the drugs don't actually have to affect your mind to cause a state of mental numbness. Being numb and disconnected from the experience must drain birth of some of the best parts of it. Numbness is all on one level, while the process of natural birthing has highs and lows.

When reflecting upon this conversation, I remembered another conversation I had with different group of women, about 4 years ago, before my first pregnancy when my husband and I were newlyweds. I had done no personal research into the subject of birth outside of maybe watching TLCs "A Baby Story." I realize that this conversation may actually have shaped a lot of my original perceptions about childbirth, which I discussed in my previous post, My Journey to Natural Childbirth. I remembered a woman in this group also saying she declined to use a mirror during her child's birth, that she did not want to see it happening. She had an epidural and trusted that the episiotomy her doctor performed was necessary. I also remember her saying that she was afraid of giving birth at first, but she explained that by the end of her pregnancy she was so miserable the idea of giving birth "didn't seem so bad."

These two conversations, which both mentioned not using mirrors during pushing, about 4 years apart and with women in 2 different states, reflected very similar views of birth--the view that birth is a "necessary evil"--something no one really wants to experience, but must because the baby has to come out somehow. This idea that the act of giving birth is undesirable would support withdrawing from it as much as possible, physically and emotionally. The view of birth as a medical procedure fits with this idea--it is justified to be squeamish about a medical procedure like surgery--I know I wouldn't want to know what was happening to me during surgery, and I avoid watching surgery on TV. I think our medical establishment has actually influenced us to think of birth, even if it is vaginal, as something like surgery. This may explain where the very small population of women opt for true maternal request cesareans are coming from, whether they give birth vaginally or surgically doesn't matter, because there really isn't much difference between a cesarean and a birth-by-machine. Medicalization of birth makes it scary, removes it from the realm of things women are expected to know about, and makes it something it is okay to be removed from.

If, however, we think of birth as a normal, natural process, then it makes sense that women might want to see it. Midwife Ina May Gaskin has suggested that we need to see images of other women birthing before doing it ourselves in order to know what our bodies are capable of and not be afraid. The woman who shared her experience 4 years ago has no idea what her body is capable of--she neither felt nor saw her baby come out of her and the doctor who performed her episiotmy sent her the message that her body is not capable of naturally stretching to allow a baby to pass through. These numb and mirror-less births, were the baby comes out of the mother's body without her really experiencing it, perpetuate the fear of birth because it remains an "unknown" to women, even those who have done it, and it is normal to fear the unknown.

Perhaps women's attitudes about mirrors in birth reflect back to us the truth about what the birth experience means to them?

My Journey to Natural Childbirth

Before I got pregnant with my first baby, what limited knowledge I had about birth led me to two conclusions: 1) birth is painful, but 2) there are drugs for it. I thought everyone got epidurals. I didn’t understand why anyone wouldn’t. I thought “why would you have pain when you don’t have to?” I certainly try to avoid pain whenever possible. I figured that if epidurals were as common as they seemed to be, they must be pretty safe. I thought an epidural would be the only way to make childbirth not be a completely horrible experience. I believed God must have created epidurals so that women wouldn’t have to suffer.

It's hard to say exactly what opened my mind to the idea of natural childbirth. A lot of it came from my experiences posting on online forums. The internet has a way of exposing people to new ideas. I discovered that people still do natural childbirth. I also went to a seminar at Babies 'R' Us by an instructor of the Mongan Method of HypnoBirthing talking about the theories behind hypnosis for childbirth and recruiting for her class. I decided that I could do natural childbirth.

Then I started reading. And reading and reading. One article that was important in my decision process was The Hidden Risks of Epidurals by Sarah J. Buckley. It showed me that epidurals were not as simple as I once thought. Also on my reading list were The Thinking Woman's Guide to a Better Birth by Henci Goer, Active Birth by Janet Balaskas, and Ina May's Guide to Childbirth by Ina May Gaskin.


All of this reading radically changed my point of view about childbirth. My new conclusions were: 1) God created birth as a beautiful and delicate process, 2) people interfering with that process unnecessarily can easily through it off track, leading to complications and a need for more interventions, and 3) women who plan for and accomplish natural childbirth often have wonderful and empowering experiences.