dancing with the devil

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It’s been almost two years since I have attended births regularly as a doula. I wish I could have continued supporting women during my nursing/midwifery studies, rubbing their backs, wiping their brows, holding them through transition, and watching in amazement as they pushed their babies into the world, but life as a student has not left me with the kind of time necessary to provide full-scope doula support. Not that I haven’t been immersed in birth in many other ways. I spent 170 hours on a labor and delivery floor as part of my nursing training, and now that I am one-semester deep into my midwifery studies, I am preparing to dive deeply back into the world of supporting birthing women, this time with hands outstretched, ready to catch (or to help women catch their own) babies.

I am often asked why I decided to become a midwife, and while it would take pages enough to fill a book to fully answer that question (the reasons are many–and they are ever-evolving), my life as a doula provided the final push I needed to take the plunge and pursue this path. I loved connecting with women, hearing their stories, their dreams, their deep desires for their families for their babies, for themselves. I loved their determination and confidence in their bodies and in their babies. I loved being a sounding board where hopes and fears and doubts could be expressed openly without judgement. I loved watching her step into the fullness of her power and ask, with clarity, for exactly what she needed. I loved watching partners and family members supporting her choices, holding her (physically and emotionally), loving her, and experiencing first hand, the magic that is birth. I loved the moment when she realized that this power rushing through her body was hers–her power, her body, her baby. I loved so many things about bearing witness to this intimate moment where life transitions from one medium to the next.

But there exists a hidden darkness in my decision to become a midwife. As a doula, I went with women no matter where or with whom they chose to birth. I was there to support them emotionally, physically and to provide education where I could, but I had no control over the hospital protocols or the behavior of their health care providers. As a new doula, I naively believed that if I did my job correctly, I could shield them from some of the less savory aspects of the modern paradigm of birth. I was wrong. Just plain wrong. For every beautiful, calm, empowered birth I witnessed, I also witnessed arrogant displays of power, manipulation, control, and heinous demonstrations of physical and emotional abuse, played out upon the bodies and psyches of women. It is hard to describe in words what it feels like to be a bystander during subtle (and not-so-subtle) expressions of abuse. At one birth, a mama I was supporting, was relaxing in bed, fully-dilated, waiting for a strong urge to push. The room was calm and dark with the thick, still air that permeates at 2am. The labor had been long, and this moment of rest was much-needed after hours of hard work and pain that this mama pushed through. She was breathing deeply, her husband and I taking turns talking through visualizations of opening buds and calming waters. In a moment that felt like the uncontrollable wave of a tsunami, the nurse, a large, gruff woman who, for the duration of our time in the hospital, refused to acknowledge my presence (even when I asked questions), came into the room, and without asking, pushed my clients legs apart, drove her fingers into her vagina, and instructed her to start pushing. My client yelped in pain, a look of panic and confusion on her face, while her husband and I implored the nurse to stop. I remember the feeling of being invisible, of opening my mouth to speak and feeling my words disappear into thin air, unacknowledged, as if they’d never been spoken. The nurse wouldn’t even glance in my direction as she kept up her assault. It was as if time was standing still. I felt utterly and completely powerless to stop this aggression. Shortly after came the doctor, who took over in instructing her to push. The physician was un-phased, unmoved by the site of my client writhing in bed, close to tears as the nurse lorded her physical power over her. From there, my memory goes fuzzy. When did the assault stop and effort of pushing the baby out begin? Why was it necessary to force this moment rather than allowing it to unfold from within my client’s body? How is it that any human being could witness this display and see it as normal? There are many questions I could pose, but the question that lingers for me is why couldn’t I stop this from happening. I felt tremendous guilt for lacking the power and force to be able to stop what I had seen. I wanted desperately to erase this experience from all memory. Weeks later, this mama shared that she felt like she was being raped during her birth.

Let that sit with you…raped. during. birth.

There are too many women walking away from their birth experiences feeling that their bodily integrity has been compromised. What is going on with birth that this kind of behavior is ever acceptable? I have stories upon stories that rival this one. While some center around more subtle abuses of power–like coercing women in to making specific health care choices by suggesting that their babies will die otherwise or questioning their statements of pain (one mother I worked with yelled while pushing her baby out, “it feels like my insides are coming out (which it does!),” to which her physician responded, “no it doesn’t! stop being ridiculous!”) –each story is representative of a larger problem–that there is a struggle for control going on, and the battleground is rooted firmly on the back (or in the womb, as it were) of the mother.

Had I only been privy to the beauty and bliss that empowered birth can offer, I may not have felt so compelled to become a midwife. The deep satisfaction I felt working as a doula was unparalleled by other joys I felt in my life. But the dark moments, the sickening feelings of being a powerless witness, were too much for me to bear. My choice to become a midwife has been largely driven by deep belief that all women deserve to be treated with respect during their births, that mothers, whose bodies are the alpha and omega of the birth experience, are the only ones who have the right to absolute power. Of course women invite others to share in the experience–sisters, mothers, aunts, doulas to share birthing wisdom; midwives, nurses, doctors to impart knowledge and expertise from the body of evidence that exists and to hold a safe space for the birthing woman to do her work; family members and friends to support her, rejoice with her, to love her. Of course women are concerned with the their safety and the safety of their babies. In no way should promoting safety lead to the conclusion that pregnant women need to hand over complete control of their bodies to an individual or an institution. And in no way does aggression or force or coercion or physically controlling women make birth safer. When the mother’s physical, emotional, psychological and spiritual integrity is honored, preserved and respected, the highest safety prevails.

The irony of my journey towards becoming a midwife is that parts of my journey have taken me squarely into the belly of the beast, and I have found myself dancing with the devil, so to speak. Sometimes we have to confront that which we oppose so we can work to transmute it. I could have chosen a different path to become a midwife, forgoing training as a nurse, and focusing solely on out-of-hospital birth. In fact, I have deep respect for those who have chosen such a path, and some days, I feel crazy for having chosen differently. But when I was called to midwifery, I knew this would be my way. I felt wholeheartedly that women choosing to give birth in hospitals deserve practitioners who believe in them, who believe in birth, and who are fully committed to bucking the system, and ushering in a new paradigm of birth. There is a much larger conversation to be had about how our current system has unfolded and what can be done (not only by midwives and doctors, but also by women, and by the larger systems that drive the current paradigm), but that discussion is for another day.

For now, I try to relish the vast beauty of birth and let my darker memories continue to fuel the fire of my motivation. Doulas are, in many ways, the eyes and ears of modern birth. The pain and abuse they witness are often left unspoken, not only to protect the integrity of their clients, but also to shield themselves from having to re-live the guilt, sorrow and powerlessness they often feel. We need their eyes, their ears, their perspective. We need doulas to bear witness and to speak of what they have seen. We need their stories so we can begin to wake up to a new reality of birth.

Throwing out the Baby wth the Bloomberg

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What happens when lazy media happens to good people? It has happened to all of us at one point or another–I certainly know I am not immune. As in the case of the recent media frenzy about Mike Bloomberg’s initiative to improve city-wide breastfeeding rates, significant health care issues can become so obscured that people begin fighting battles that don’t exist. While there are a handful of thoughtful, informative articles out there, the vast majority of pieces have catered to fear-mongering and politician-bashing, promoting the idea that this initiative is about little more than government control of women’s rights. These articles make no mention of the fact that these proposals by Mayor Bloomberg are adapted directly from recommendations of the Centers for Disease Control (CDC) and World Health Organization (WHO), nor do they tell you that infant death rates drop dramatically when breastfeeding recommendations are followed, or that the instance of childhood asthma, diabetes and cancer can all be reduced by promoting and protecting breastfeeding.

In light of all of this, I’m throwing my two cents into the ring in the hopes that some of my research on the subject can provide the kind of evidence-based information so sorely lacking in the most widely read newspaper articles on the subject. I am uploading a policy brief I wrote for a class of mine last Fall. I ended up doing an immense amount of research on the subject, and while the paper is addressed to Georgia state legislators, it has not been sent out for publication or use at this point. First, though, here are some thoughts I posted on Facebook in response to a friend’s comment on the subject today (in fact, this conversation has been the inspiration for this blog post):

“If I may offer just a bit of an alternative perspective. I don’t agree with any decision being withheld from women, and it does seem that the way Bloomberg has handled this situation is problematic. BUT, the way that formula has been distributed in hospitals for the past few decades has not at all been about the health of women and babies…it’s been about the health of the profit margin of the formula company. Formula companies have, for years, provided monetary incentives to hospitals for passing out their products. The early days of breastfeeding are difficult and new mothers are very vulnerable to every piece of advice being given out. Nurses haven’t traditionally been trained to give good breastfeeding support (it’s quite complicated and involves a lot more than just putting the baby to the breast). Instead, the health care industry has been VERY quick to push formula as an alternative to breastfeeding, even giving formula to babies whose parents have expressly asked that it not be used. When a medical institution gives out a product, it implies that the mother isn’t breastfeeding correctly, or that she may not have the necessary “stuff” that her baby needs. The result is that the US has abysmally low breastfeeding rates, despite all of the evidence that points to the profound long-term benefits of breastfeeding for both mother and baby. A LOT of the issue is that US women don’t get enough time off from work to sustain breastfeeding for long enough, but research has shown that our hospitals have not been giving good enough education and support. Patients in every other medical area, from heart disease to cancer to autoimmune diseases should demand that their health care practitioners are practicing to the evidence and making the best treatments available. If a sub-par treatment is being used more than the most effective one, steps should be taken to improve the use of the most effective treatment. We should also demand this for our new mothers. No one will keep her from using formula if she so chooses (and formula will absolutely be offered if breastfeeding isn’t a physical possibility), but she should be fully educated about what the research says. We know A LOT more about the benefits of breastfeeding now than we did even 10 years ago. Patients deserve to make fully informed decisions based on the evidence. I wish this issue in NYC had been framed better. Saying that we are “locking up” formula doesn’t really give people the fully story, and makes them feel like something important is being withheld. But passing it out freely has been for the benefit of big business, not for the benefit of moms and babies. In any case, sorry for the long rant, but the picture from inside the hospital walls is a very different one that what is being portrayed through the media.”

Below, you will find the policy brief I wrote last October, along with a hefty list of resources. I believe in giving women evidence-based information. When she is armed with appropriate and truthful information, she can then make a truly informed decision. That is the definition of choice.

Policy Brief

Toward the Improvement of Maternity Practices in Infant Nutrition in Georgia

“The time has come to set forth the important roles and responsibilities of clinicians, employers, communities, researchers, and government leaders and to urge us all to take on a commitment to enable mothers to meet their personal goals for breastfeeding.”—Regina M. Benjamin, M.D., M.B.A. Vice Admiral, U.S. Public Health Service Surgeon General Surgeon General’s Call to Action to Support Breastfeeding

Executive Summary:

Despite ample evidence to support the infant, maternal and community benefits of breastfeeding, implementation of evidence-based practice has proven challenging for U.S. maternity facilities. Modern birth and postpartum practices, such as the routine separation of mother and baby post-birth, inappropriate interruption of breastfeeding to accommodate hospital policy and procedure, and lack of timely follow-up care after discharge have translated into well-rooted barriers to the optimal breastfeeding environment. Other factors, including the media’s representation of bottle-feeding as normative, lack of family or social support, and the routine distribution of free infant formula samples have also contributed to lower than recommended breastfeeding rates throughout the United States (Policy, 2005).

Evidence-based practices known to encourage and increase breastfeeding rates are well known and well rooted in the literature; yet, Georgia State policies lack the specificity and urgency so desperately needed to encourage consistent adherence. Given the projected benefits that improved breastfeeding rates will have for the long-term health of mothers and babies, as well as the economic benefits for both families and communities, vigorous advocacy for improved hospital practices is warranted. The State of Georgia has shown consistently poor performance in the area of breastfeeding initiation and duration (CDC, 2011). The time has come for the State of Georgia Department of Public Health to follow in the steps of the Surgeon General by issuing both a call to action and the implementation of more viable policy for the improvement of statewide breastfeeding rates.

Breastfeeding’s Benefits and Challenges:

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of the infant’s life, citing research that highlights noteworthy benefits of human milk consumption for mother, baby, community and environment, including:

  • Decreasing the incidence and severity of a wide range of infectious diseases worldwide (Policy, 2005)
  • Reducing U.S. postneonatal mortality rates by 21% (Policy, 2005)
  • Decreasing rates of sudden infant death syndrome within the first year of life
  • Reducing type 1 and type 2 diabetes mellitus, lymphoma, leukemia, and Hodgkin disease, hypercholesterolemia, and asthma in older children and adults who had been breastfed (Policy, 2005)
  • Reducing rates of overweight and obesity (Nommsen-Rivers, 2004)
  • Elevation of IQ scores in breastfed infants (Policy, 2005)
  • Decreasing maternal postpartum bleeding (Policy, 2005)
  • Decreasing the maternal risk of breast and ovarian cancers, anemia and osteoporosis (Policy, 2005)
  • Earlier return to prepregnancy weight (Policy, 2005)
  • Reducing health care costs for mothers and babies (Policy, 2005)
  • Reducing economic costs related to purchasing infant formula and bottle-feeding supplies (Policy, 2005)
  • Fewer missed days of work on the part of breastfeeding mothers (Policy, 2005)
  • Potential for decreased annual health care costs of approximately $3.6 billion in the United States (Policy, 2005)

While the World Health Organization (WHO) explicitly opposes the distribution of free formula samples to postpartum women at the time of hospital discharge, and the Centers for Disease Control (CDC), the American College of Obstetricians (ACOG), and the Government Accountability Office (GAO) all recommend against the practice, U.S. hospitals have been slow to sever relationships with the distributers of infant formula. In the state of Georgia, 98% of hospitals continue to distribute free sample packs of formula, exposing an estimated 94 % of Georgia infants to formula. The distribution of infant formula by medical institutions and staff tends to imply endorsement of the product’s superiority to breast milk (Rosenberg, 2008)). One study concludes that women who received discharge packs including infant formula were more likely to breastfeed their infants for fewer than 10 weeks as compared to those women who did not receive the discharge packs (Rosenberg, 2008).

The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have responded to the growing need for improved breastfeeding rates worldwide by sponsoring the Baby-Friendly Hospital Initiative, which recognizes those facilities who provide optimal lactation support. This recognition is based on adherence to specific criteria established by WHO/UNICEF: Ten Steps to Successful Breastfeeding for Hospitals (Lang, 1998). Maternity facilities and birth centers worldwide can seek the Baby-Friendly designation, which involves rigorous external evaluation to ensure that criteria are adequately met. Since the establishment of the Baby-Friendly Hospital Initiative, more than 15,000 facilities in 134 countries have been awarded the designation. The United States boasts only 119 of those designations, and the state of Georgia has zero facilities that have achieved such recognition (BFHI, 2011).

Ten Steps to Successful Breastfeeding for Hospitals, as established by WHO (BFHI, 2011):

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
  7. Practice “rooming in”– allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

The positive impact of Baby-Friendly practices has been well established in the literature. One study examined results from a National Survey and found that breastfeeding rates in U.S. Baby-Friendly hospitals had breastfeeding rates above state, regional and national rates. These results persisted in a variety of settings and pertained to both initiation and exclusivity of breastfeeding. This elevation was also consistent across demographics, showing improvement in breastfeeding rates even for those populations that have traditionally exhibited low rates of breastfeeding (Merewood, 2005).  Another such study looked at the influence of Baby-Friendly practices on the duration of breastfeeding, and concluded that, “Evidence supporting greater maternal exposure to Baby-Friendly practices, especially exclusive breastfeeding, in substantially extending breastfeeding duration was clearly present in our findings (Tarrant, 2011).”

CDC and Healthy People 2020 Recommendations for Breastfeeding Promotion:

Acknowledging the numerous health benefits breastfeeding has for mothers and babies, the Centers for Disease Control has taken an active stance in promoting and supporting measures to increase nationwide breastfeeding rates. In 2007, the CDC began issuing the Breastfeeding Report Card, detailing state and national trends in breastfeeding, and created the Maternity Practices in Infant Nutrition and Care (mPINC) survey to provide detailed information and recommendations to each state (CDC, 2011). The 2009 mPINC survey for the state of Georgia reveals the following inadequacy in the area of breastfeeding policy:  a scant 5% of Georgia state maternity facilities have comprehensive breastfeeding policies that comply with the recommendations of the Academy of Breastfeeding Medicine (CDC, 2011). In addition, the state of Georgia falls well below the objective breastfeeding rate targets set forth by Healthy People 2020, as well as below U.S. national averages in every category:

Objective: MICH-21: Increase the Proportion of infants who are breastfed

Breastfed:

Healthy People 2020 Target

U.S. National Average

Georgia

Ever

81.9%

74.6%

71.6%

At 6 months

60.6%

44.3%

36.7%

At 1 year

34.1%

23.8%

18.5%

Exclusive at 3 months

46.2%

35.0%

27.1%

Exclusive at 6 months

25.5%

14.8%

10.1%

* Table adapted from Breastfeeding Report Card—United States 2011 (CDC, 2011)

Implications and Recommendations for the State of Georgia:

The Georgia Department of Public Health promotes breastfeeding as the preferred method of infant nutrition and acknowledges its support for the Healthy People 2010 and 2020 Goals for improving breastfeeding rates and duration across the State of Georgia. Likewise, the Georgia Department of Human Resources has released a position paper on breastfeeding that iterates the sentiments of the American Pediatrics Committee on Nutrition and echoes the policies set forth by the World Health Organization (State of Georgia, 2011). Despite these positive gestures in support of sound breastfeeding promotion, Georgia’s poor performance in the realm of breastfeeding initiation and exclusivity implies that these statements may not be adequately conveying the appropriate level of urgency needed to encourage real change. The Centers for Disease Control (CDC) suggest that, “State health departments are a valuable resource that can provide technical assistance to hospitals seeking the Baby-Friendly Designation (CDC, 2011).” The CDC also suggests that state infrastructure should support the designation of adequate numbers of full-time equivalents (FTEs) responsible for ensuring appropriate breastfeeding support. Currently, the state of Georgia boasts only two such FTEs (CDC, 2011).

The U.S. Preventive Services Task Force determined that a comprehensive and multifaceted approach is vital to successful breastfeeding intervention (Godfrey, 2010). To effectively address the consistently inadequate breastfeeding rates in the State of Georgia, specific, multifactorial policy needs to be written and implemented. Such policy should include the following:

  • Active endorsement of the Baby-Friendly Hospital Initiative and the Ten Steps to Successful Breastfeeding for Hospitals (Merewood, 2005)
  • Provide support and technical assistance for achieving designation as a Baby-Friendly facility (CDC, 2011)
  • Actively oppose and discourage the distribution of free formula in hospital discharge packages (Merewood, 2010)
  • Financial incentive for those hospitals refusing to distribute free samples of baby formula
  • Increase the number of full-time equivalents responsible for ensuring appropriate breastfeeding support (CDC, 2011)
  • Pay for hospital staff across Georgia to participate in 18-hour training courses in breastfeeding (CDC, 2011)
  • Produce and promote active media campaigns detailing the benefits of exclusive breastfeeding and media portrayal of the act of breastfeeding

Conclusion:  It is clear that Georgia must make strides towards improving breastfeeding initiation and duration. The health benefits to mothers and babies, and the theoretical reduction in long-term health care costs associated with breastfeeding should provide the impetus for prioritizing this issue. Policy makers must do more than lend words to this issue; they must create the opportunity for change by incentivizing those measure that have been proven to create change. With adequate funding, appropriate policy, including helping maternity facilities achieve the Baby-Friendly designation, Georgia can anticipate significant improvement in this vital preventive health measure (Vital, 2011).

Resources

BFHI USA (2011). Baby-Friendly Hospitals and Birth Centers. Retrieved from http://www.babyfriendlyusa.org/eng/10Steps.html

BFHI USA (2011). The Ten Steps to Successful Breastfeeding. Retrieved from http://www.babyfriendlyusa.org/eng/03.html

Centers for Disease Control (2011). Breastfeeding Report Card—United States, 2011. Retrieved from http://www.cdc.gov/breastfeeding/data/reportcard.htm

Godfrey, J., & Lawrence, R. (2010). Toward optimal health: the maternal benefits of breastfeeding…. Ruth A. Lawrence, M.D. Journal of Women’s Health (15409996), 19(9), 1597-1602. doi:10.1089/jwh.2010.2290

Lang, S., & Dykes, F. (1998). Education. WHO/UNICEF Baby Friendly Initiative — educating for success… the first of a two part series. British Journal of Midwifery, 6(3), 148-150. Retrieved from EBSCOhost.

Merewood, A., Grossman, X., Cook, J., Sadacharan, R., Singleton, M., Peters, K., & Navidi, T. (2010). US Hospitals Violate WHO Policy on the Distribution of Formula Sample Packs: Results of a National Survey. Journal of Human Lactation, 26(4), 363-367. doi:10.1177/0890334410376947

Merewood, A., Mehta, S., Chamberlain, L., Philipp, B., & Bauchner, H. (2005). Breastfeeding rates in US baby-friendly hospitals: results of a national survey. Pediatrics, 116(3), 628-634. Retrieved from EBSCOhost.

Merewood, A., Patel, B., Newton, K., MacAuley, L., Chamberlain, L., Francisco, P., & Mehta, S. (2007). Breastfeeding duration rates and factors affecting continued breastfeeding among infants born at an inner-city US baby-friendly hospital. Journal of Human Lactation, 23(2), 157-164. Retrieved from EBSCOhost.

Nommsen-Rivers, L. (2004). More evidence of the protective effect of breastfeeding against childhood obesity. Journal of Human Lactation, 20(2), 255-256. Retrieved from EBSCOhost.

Policy statement. Breastfeeding and the use of human milk. (2005). Pediatrics, 115(2 Part 1), 496-506. Retrieved from EBSCOhost.

Rosenberg, K., Eastham, C., Kasehagen, L., & Sandoval, A. (2008). Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. American Journal of Public Health, 98(2), 290-295. Retrieved from EBSCOhost.

Spatz, D. L. (2011). The surgeon general’s call to breastfeeding action-policy and practice implications for nurses. Nursing Outlook, 59(3), 174-176. doi:10.1016/j.outlook.2011.03.006

State of Georgia Department of Public Health (2011). Georgia Department of Human Resources Position Paper on Breastfeeding. Linked from http://www.health.state.ga.us/programs/nutrition/breastfeeding/index.asp

Tarrant, M., Wu, K. M., T., Y., Y., Sham, A., & … Dodgson, J. E. (2011). Impact of Baby-Friendly Hospital Practices on Breastfeeding in Hong Kong. Birth: Issues in Perinatal Care, 38(3), 238-245. doi:10.1111/j.1523-536X.2011.00483.x

Vital signs: hospital practices to support breastfeeding — United States, 2007 and 2009. (2011).

Here is a link to one of the inflammatory articles I mentioned earlier:

http://www.examiner.com/article/bloomberg-s-lactation-plan-promote-breastfeeding-by-locking-up-baby-formula

conception

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Having worked with pregnant and laboring women in some capacity for six years now, I desperately wish I had started this blog at the moment of my awakening. And it was just that: a flash of insight and deep knowing. A light bulb that, once illuminated, changed my view of birth (and of the world) forever. Hindsight is a clever trickster, though, wearing down the jagged edges of our life’s journey, insinuating that we have always known the end of the story. Standing in the chaos of our most profound decision never feels quite so clear, though. So, while I tell my story with the knowing that I can never re-create the naked truth of how this path unfolded, I can point to those moments that altered my trajectory in life or that altered my perception in some palpable way.

My introduction to midwifery was just such a moment. In truth, I had no prior interest in or knowledge of pregnancy and birth (and frankly, I didn’t really care to learn). I stumbled, quite literally, into the world of birth. What a happy accident that was! My dear friend and massage therapy colleague urged me to join her for a workshop about prenatal and postnatal massage taught by a midwife/doula/massage therapist. In addition to this one-weekend course, we signed up for a second weekend workshop called Labor and Birth: In Your Hands with the same midwife. I had no idea this course would be my first introduction to the word “doula” and to the midwifery model of care. I proceeded blindly.

The universe has an uncanny sense of humor. Prior to these workshops, not only did I have no interest in working with pregnant women, I actively refused to offer prenatal massage at the spa where I worked. I was terrified of pregnancy and birth, and I had no frame of reference for what to do with their bodies during a massage. All of my technical knowledge revolved around the non-pregnant body. I was comfortable. Why, you ask, would I go to a massage workshop solely designed to prepare me to work with prenatal and postnatal women? The wildly unsexy answer is that I needed continuing education hours to maintain my good standing with my professional organization. The other motivating factor was the fact that my sister had recently shared the secret of her first pregnancy with me. The knowledge of my sister’s growing baby was just the push I needed to put aside my fear, and go. I wanted to be able to do something to participate in this mind-boggling event. Massage was the only useful tool I had.

What I learned during the two weekends with this extraordinary midwife was nothing short of paradigm shifting. At the time, I was a 27 year old woman who had given no thought to the wonder of my own body. I knew almost nothing about my femaleness and what it was designed to do. I was a prime example of a young woman who had fully absorbed the cultural fear surrounding birth. Until that point, I seriously questioned my desire for children because of my intense fear of the pain associated with the task of birthing (not to mention the general chaos and unpredictability of the actual children birth would produce). I sat, stunned, as I learned about the true physiology and psychology of labor and birth. It was the first time I considered the fact that birth was a journey, a normal process during which the mother not only gives birth to her baby, but to herself as a mother. It had never dawned on me that the experience of birth could be…empowering.

First came the feelings of wonder and awe.

Then came the outrage…

I learned not only about our miraculous design, but also the many ways in which modern medicine has ignored and interfered with that design, to the detriment of both mother and baby. As a massage therapist, I was already keyed in to the fact that our current medical paradigm is more of a symptom management/emergency management model than a system that honors and harnesses the inherent capabilities of the human body. My passion was in educating my clients and helping them to take an active role in their own care. So many people I knew were passive recipients of medical care, with little understanding of their own bodies or the ramifications of the care they were receiving. I had no idea how profound was this disconnection in the world of childbirth. The way in which we dis-empower women and expose them to harm in the name of “medical management” (or control) began to look barbaric instead of heroic.

The second weekend of class began, and I was still trying to wrap my brain around all I had learned. We sat in a semi-circle around the room, and the question was asked by the midwife: why are you here? why do you want to support laboring women? I had no idea how to answer this question. I hadn’t made the leap from learning about the physiology of normal birth to wanting to attending births. I was the only member of the class for whom this was true. Every other woman in attendance spoke eloquently about her desire to become a doula. They spoke of birthing their own children and how the experience compelled them to support women through this journey. As my turn approached, my mind scrambled: what’s a doula!!?? I don’t know why I’m here! When I opened my mouth to speak, out tumbled a self-conscious explanation about my preliminary thoughts about becoming a physical therapist…possibly one who specializes in pregnancy. I continued to talk, but my mind went completely still. The voice inside me, my higher self said, “You are a midwife.” Time stood still, and I felt, what I can only describe as a light bulb flashing in my head. It felt like a flood of knowing. Everything in me resonated, vibrated and tingled with the thought.

Despite the clarity and transcendence of that moment, my normal state of consciousness, replete with fear, self-consciousness, and doubt came rolling back in like the tide obscuring the shore. I dismissed my awakening as mere boredom with my mundane life, and tried to convince myself that becoming a midwife would be too challenging. I didn’t want all that responsibility. I didn’t want to work that hard. I like sleep, for goodness sakes! I thought perhaps I was turned on by the mystique of midwifery. I have always had an inkling for those things unfamiliar to most of society. I was, after all, a massage therapist. Today, massage therapy is enjoying a more mainstream reception, but even a short decade ago when I began my studies, this was not the case. I remember my sister, who is a physician, looking at me with disbelief and a flat, annoyed expression when I informed her of my decision to go to massage school. She pulled me aside one day, asking, “So, you want to touch people for a living!?” The horror and disapproval in her voice was unmistakable, “why don’t you just go to medical school?” I was undeterred.

I ignored the voice that had spoken so clearly, telling me I was a midwife. I was scared. Instead, I began to read every book about normal birth I could find. From Gayle Peterson’s, Birthing Normally to Penny Simkin’s, The Birth Partner to Ina May Gaskin’s Spiritual Midwifery, I simply could not get enough. I couldn’t talk about anything else (much to the exhaustion of many of my close girlfriends, who endured hours of conversations about birth). I thought about attending births, but where to start? Who would want me, a relative stranger, to witness her birth? I had absolutely no idea. So, I kept reading.

Within a few months, my friend, who had coerced me into taking the workshops with her, discovered that she was growing her own little one. She was planning a home birth, and she graciously shared with me every piece of information she found during her research. I became her prenatal massage therapist, meeting her once a week for bodywork sessions throughout her pregnancy. Witnessing her transformation throughout her pregnancy was miraculous. I fell in love with pregnancy, and the way it worked magic on women. Uncomfortable? Yes. Unpredictable? Yes. But also, raw and strong, and so energetically alive.

I would not attend my first birth until over a year after attending the workshops. Another year passed before I witnessed the second birth. During those two years, I waged an internal war over whether or not to pursue midwifery. I had many subsequent moments of awakening and knowing. I have learned that when the universe is serious about leading you down a particular road, the message will show up repeatedly, in many forms, but always with the same visceral sensations. I remember moments, riding the subway, reading about birth, and feeling my body start to shake, tingles beginning at the top of my head flushing down my face and through the rest of my body: such powerful energy moving through me!

Eventually, I became doula, dipping my toes into the birth pool to see if I could handle it. What followed was one of the most magical, blissful and intense periods in my life. For three years, birth, itself, became my textbook, and the mothers and babies I worked with became my heroes. I discovered a powerful birth community in NYC and met numerous women who continue to offer deep sisterhood and connection as I proceed on this journey. Throughout the nearly 50 births I attended as a doula, I gathered strength and stamina, and deep self-awareness, and finally felt ready to take my first steps toward midwifery. The process of my becoming a midwife is unfolding even as I write, and will be told in great detail in future posts.

As I recall the events that led me here, I realize that my awakening was my conception as a midwife. The seed was planted. The three years that followed were filled with exponential growth, the same kind of growth necessary for an embryo to metamorphosis into a human baby. I would not have survived had I taken the leap into midwifery from my workshop seat. I was not ready for extrauterine life. I needed time in the womb. I needed to grow.

taking the long way

Standard

If you talk to my mother, she will tell you that I was trouble from the start. I was a ‘posterior’ baby, meaning that instead of settling my head into the optimal position in her pelvis during birth, with my squishy face pressed towards her sacrum, I chose to turn my back (literally) on convention, and do things my own way. This, of course, meant a longer, more painful, and ultimately more complicated birth for my mother and for me; and it foreshadowed the way I would approach much of my life’s journey.

Babies who decide to take the birth journey in the occiput posterior position are not pathological or abnormal–they represent a variation of normal. Yet, they often need more time to make their way into the world. Contractions have a tendency to fluctuate in their regularity, oscillating from periods of rhythmicity and predictability to perplexing stretches of time during which a seemingly well-established labor patterns dwindle and space out into an occasional, but powerful contraction. Why does this happen? How is it that the body, once laboring, doesn’t continue on a linear, ever longer, ever stronger, ever predictable path until the arrival of the baby? Because the baby is the one running the show! When the posterior baby finds that he needs to negotiate a different path, to make minute and precise adjustments to nestle the head into the perfect spot in the mother’s pelvis, time is needed. The baby is charting his very own course into the world, and he buys time by slowing the labor until he is ready to proceed. When he feels like he can move forward, the mother’s body responds by resuming regular, progressive contractions. This is mother and baby working symbiotically. And so it was with my birth. My mother’s contractions slowed to a halt. I needed time to find my way.

American birth being what it is (and what it was even then), the slower pace of my birth was deemed pathological, and something had to be done. My mother was given pitocin, a very commonly used synthetic hormone that causes uterine contractions to  happen at the pace and strength of the practitioner’s choosing. With long, strong, pitocin driven contractions pushing labor forward, I moved down the birth canal quickly–more quickly than I might have chosen on my own. My heart rate dropped dangerously low, and my mother’s obstetrician, noting my poor positioning, reached in and turned my head, expediting my birth.

While we may not have fully conscious memories, replete with visual pictures and sounds, from our births, I do believe we carry that primal, formative experience with us for a lifetime. Labor and birth is the first opportunity we have to assert our will on the external world (we, of course, have been exerting our will on our maternal environment from the moment of our conception), and it is the time during which our first impression of this new environment is made. Is it safe? Is it made of love or fear? Is it gentle or aggressive? How fully can I express myself? Etc.

It may sound absurd to examine one’s own birth in search of the origin of one’s behavioral patterns, but the longer I live, the more I see how my birth journey has played out repeatedly. I often need time to step away from the linear path, to contemplate, to deliberately choose the most appropriate way forward; and I often get stuck in this decision making process, struggling to move from the thinking process into the doing process, and feeling overwhelming pressure to “get there faster!!”  I recall overwhelming feelings of paralysis, as if waiting for some external force to make the decision for me (which often it has). My initial steps into midwifery were no different. I knew in 2006, after taking my first class with a midwife, that I was being called to do this work, and yet, it took a full 5 years for me to take the leap.

Despite the time it has taken me to move from point A to point B, birth has been my healer, my therapy and my guru. It is no coincidence that during the three years in which I attended births as a doula, many of my clients carried babies in the posterior position, who like me, needed time and patience to chart their course. Life has a way of teaching us what we most need to learn. I slowly became aware of my deep rooted patterns and brought them to the surface for examination. I also learned that, with awareness, ancient patterns can change. Even behavior that has been deeply imprinted can be examined, explored, understood, and set free.

Taking the long way is no longer my burden to bear, but my birthright. In accepting the part of me that needs to take her own way, to chart her own course, to determine her own timing, I have reclaimed my right to make my own decisions.