Saturday, May 19, 2007

Open Letter to Childbirth Professionals Of All Persuasions

We birth professionals seem to be settling for the easy answers. The causes. The propaganda. The comfortable absolutes.

I think, though, that absolutes in something as uncertain as birth are worth about as much as dental floss at a Willie Nelson concert. If I indulge in any during this post, consider them for what they're worth -- about as much as any other absolutes (not very much).

But principles, ah... I think principles (which admit a multitude of "right" answers) can be worth a great deal. Principles such as validation, empowerment, personal sovereignty, respect...

I keep thinking that one very important thing in birth and birth preparation is to always validate the woman's experience, whether in past, present or future tense. For this reason, I am uncomfortable with both the "Pain is good! Embrace it!" and the "Birth can be easy and comfortable." mentalities. Because, like so many dichotomies, it feels false. Neither one is right. Neither one is wrong. And most women's experiences with birth lie somewhere in the middle.

In an effort to acknowledge the full range of women's experiences, I try to be careful in my classes. Though I call the skills we learn "pain-coping techniques", I am careful to make it clear that a woman may experience the sensations of birth as pain or stretching or pressure or fullness. Or she may experience them as none of these or all of them at different times or many of them at the same time or as any other sensation or group of sensations.

For those of you who are thinking "Wait, but by using the word pain, you introduced into her subconscious mind the idea that birth might be painful." I invite you to take a step back and think for a minute.

Did I really?

First of all, how many women are there in our society who have not (in arguably a much less balanced presentation than the above) been exposed to the idea that "childbirth equals pain" before their sixteenth birthday? I admit that there may be some. But truly, how many? By using the word pain, I have actually acknowledged what has probably already been in her self-conscious for quite some time. And by acknowledging this and then introducing the idea that she MAY experience birth as pain, but she may also experience it in many other ways, I have actually expanded her possibilities in birth. And at the same time, have I not validated and brought to light an unacknowledged idea that may be controlling her preparations for birth? (And when a woman seeks out a childbirth method that promises "easy, comfortable birthing", isn't it possible that she does so because she has already heard that birth is painful and she doesn't want it to be that way for her?) I feel that by validating what she believes is true (that childbirth can be painful), she is much more likely to accept that other things can also be true (childbirth can be comfortable).

Feel it out in your own body (yes, I'm highly kinesthetic. For you visual types "Look at it this way." For the auditory folks, "How does this sound to you?").

I tell you that something you believe is true AND that there are other things that can be true.
I tell you that your truth is wrong and that other things (usually my ideas) are right.

Which are you more likely to believe?

Second, who am I to tell a woman what she will or will not feel when she doesn't even know it yet? Even worse, who am I to invalidate what she actually DOES feel and her OWN WORDS for describing it?

It goes both ways.

Yes, if I tell her that it is going to be hard work, then I may very well sabotage her out of a belief (and the manifestation of that belief) that her birthing will be easy and comfortable. But what if I tell her that it can be easy and comfortable if only she prepares well enough and that birth should be this way, if it weren't for all those pesky problems. Then, when SHE experiences her birth as difficult or painful, she is either a failure (because she did it wrong or didn't prepare) or she is a victim (hypnosis failed her or her doula failed her or her care provider failed her or nature failed her). How crappy is that?

You see, birth is not about us as birth professionals. It is about HER, the birthing woman. HER EXPERIENCE. HER WORDS. HER POWER. By making it about us or our "birth philosophy of choice" are we not robbing her? I agree that in setting forth the idea that birth is always painful, we are robbing her of possibilities. But what of setting up a goal of "easy and comfortable" in a setting over which one has little to no control?

I think hypnosis is a fabulous tool for birth. I have seen it work first-hand many times. In fact, the "sensation-management skills" ;) taught in Birthing From Within (which is my "birth philosophy of choice") are deeply based in self-hypnosis, and many other of its processes are also hypnosis based. I even think that introducing the idea that easy, comfortable birthing is possible (even likely, given ideal circumstances) is great.

What feels wrong to me is the setting up of "shoulds" instead of "cans". "Shoulds" limit. "Birth should be this way, but sometimes things go wrong." "Cans" empower. "No matter what happens, you can do it." If easy, comfortable birthing is the way it "should be", then when it is not achieved something must have gone WRONG.

Why does anything have to be wrong? Why can't we just see things as being the way they were meant to be? Or even better, why can't the happenings of birth just BE. What is. What was. What will be. No attaching labels of good or bad, wrong or right, failure or triumph.

If a woman enters the path of birth and comes out the other side, is that not enough? Does it really matter what happened in the middle so long as she was allowed sovereignty over her body and her inner experience of birth?

Many "natural-birth" promoting women often harp on about how the obstetrical system "breaks" birth by intervening in a natural process, through words, attitudes and actions. We complain about how medical people view women and their bodies and the birth process as "broken", something needing active management and fixing.

Are not we guilty of the exact same thing when we say that "something went wrong" because a woman had a c-section or felt pain (even excruciating pain) or decided that she wanted an epidural? Are we not labeling that birth, that woman, as broken? When we say "trust birth" or "trust the birthing woman" do we really mean it? Or do we just mean "trust birth when it is easy, comfortable, vaginal and natural" or "trust the woman when she makes the choices that are based on our idea of evidence-based, well-prepared, idyllic birthing"? Wouldn't trusting birth mean trusting it no matter what? Trusting that the birth of a woman who births a baby by c-section after many hours of valiant pushing is no more broken than the birth of a woman who pushes a baby out her vagina in the water at home. Why does it have to be that, if birth doesn't fit our picture of ideal, something must be fouled up? Why not just let it be, celebrate what worked. What was.

If hypnosis worked for five minutes or five hours, hypnosis WORKED. If moaning worked for three contractions, moaning WORKED. If screaming "Oh, God, I'm going to die!" worked for the last ten minutes of pushing, it WORKED for the last ten minutes of pushing. Who are we, as birth professionals, to take that away from a woman, to invalidate her experience. It was, it is. She did what she did. Nature did what it did. What benefit is there in placing blame -- anywhere?

Sure, we can acknowledge that we all have preferences. Most of us wish that all births would go smoothly, be easy, be painless or at least easily manageable. We probably all WANT every woman to be able to birth easily, for her care provider to not overstep his or her realm of authority into the birthing woman's authority over her own body, for every baby to be healthy and breastfeed easily.

I don't twiddle my thumbs in my classes thinking, "YOU can have an easy birth, but YOU are going to have the 95 hour labor from hell followed by an emergency c-section just to prove my point that you CAN do anything." Of course not. But I feel that I must look a woman in the eye, listen to her words, her experience, her fears, her wishes and help her discover and expand her resources, her strengths, her knowledge and self-confidence until SHE feels ready to face that 95-hour labor from hell followed by an emergency c-section. Then, if she is faced with that experience, she can do it.

And if she has an easy, comfortable birth then she is doubly blessed. First, by the strength she gained in her preparation and second, by the easy birth. And perhaps the easy birth is the lesser gift, because an easy birth only happens once (or maybe even a few times). But the things she learned about herself, the skills she gained, will probably never leave her and can be there for her to access if she has the "postpartum from hell" or the "illness from hell" or even, simply the "Monday at work from hell."

Now, please don't think that I think that I have all the answers or that "my way is right" or that I even think I know what I'm doing or can be sure that everything I just said is true.

What I do feel very strongly is that birth is NOT about me. It is not about hypnosis. It is not about Birthing From Within or Bradley or Lamaze or evidence-based-care.

Birth is about women and babies.

What I want most to do in my work (and what I feel women need most) is to assist each woman in finding whatever it is that will allow her to feel prepared to face ANY experience that comes her way, to strengthen her through any means SHE feels will work and then, to embrace and welcome her to the other side without judgment and to acknowledge her strength in having made it.

I imagine that most of us want the same thing, but we (myself included) get distracted so often by the peripheral details.

Lets all try to do better, okay?

With Love and Respect,


Duchess said...

Thanks Heather
and thanks again for the book. I think we are going to take birthing from within classes. The Duke is still pretty resistant to non-meidcal practices (he being a medical professional himself) but we are working through that and I think these classes would help. Any suggestions?

Kim said...

Very, very well put my friend.

Duchess said...

you've been tagged- see my blog

Kris said...

You wrote that so well. Thank you. I totally again.

DramaMomma said...

I think you are an amazing writer. I wish I had such talent.

I get where it is from you speak. I used to be so invested in my clients outcomes. Then one day I realized, if it doesn't play well, then she still gets the blame and not the credit for the effort made. That is when I started coming what I say is "full circle".

Keep writing. I have been checking your blog waiting for more bites from you!