It took me 10 years give or take to get my midwifery license. During that time, I encountered block after block in my attempts to get to the number of births I felt like I needed to be confident in my skills. I worked with two wonderful homebirth midwives who graciously took me to their births and stood aside while I practiced my own midwifery skills. But during the time I wasn't working with them, homebirths in particular were scarce and hard to come by. I was told by several midwives that my skills weren't adequate or that I needed to start my training over completely (after 200 births!) because the experience I had wasn't "useful." I was determined to be a midwife though and I also knew that they were incorrect. They had made assumptions that simply weren't true. 

In the time since I've gotten my own license, I've also felt a new calling, a calling towards bringing more women into the birth world. For some people, when they work really hard for something, the desire ends up being to make sure that everyone else has to work as hard as they did. For me, I feel the opposite. I want to make it easier for women to attend births. I want it to be easier for women to become skilled doulas and midwives. I want birthworker retention rates to sky-rocket, rather than plummet. 

Recently, I had the honor of having 2 women at a homebirth with me. One had never been to a birth before and one had been to less than 5. I say it was an honor because I love being the one who introduces women to birth. I love their new energy that they bring to the birth. I love their eyes as they see something miraculous for the first time. I love it when they see a woman being empowered by her birth team, a woman who is working with her body and her baby. I love it! 

Apparently other midwives often don't feel the same. They want to make sure that you are "serious" about becoming a midwife before you can enter the birth room. They don't generally take doulas to births with them unless the client hires them privately. I don't see it that way. I don't personally care if you just want to come to one birth or if you come to a birth only to realize that this is not the kind of work for you. That's ok! How else would you know? I don't care if you want to be a doula, a nurse, a midwife, a doctor, or you just want to see a birth. If you want to be at a birth and you are willing to participate, that's all I need! 

Midwives talk all the time about how we've got to change the birth world. What better way to change it than to get more women to see it. All it takes is a woman going to one homebirth and one hospital birth to see the drastic difference in care and treatment. I dare say, we might see a huge spike in homebirth rates if we all allowed just one person a year to attend a birth with us. I don't care if this woman never goes to another birth. If seeing a homebirth gives her confidence to do a homebirth herself, then my job is done. If seeing another woman birth gives a woman the trust she needs to also birth naturally, my job is done. 

Once upon a time, women witnessed many births before they ever birthed themselves. Many of our grandmothers and definitely our great-grandmothers were involved in births before they themselves birthed. When you've seen it happen, when you've seen what it takes and how women act, when you've experienced the feeling in the room, birthing comes naturally to you. I'd like to see a shift back towards more traditional midwifery which includes women supporting women. 

So what does all of this look like? The first thing I teach my ladies who want to attend a birth with me is that whether or not they can come to a birth depends on whether they are invited by the clients or not. My clients are having an intimate experience and they deserve to be surrounded by people they feel confident in. Merely wanting to come to a birth doesn't necessarily qualify you! That being said, I haven't found a birthing mom yet who didn't open her heart up to another woman who wants to experience a birth. It's very empowering isn't when another woman wants to develop her confidence by watching you birth victoriously? 

The second thing I teach these ladies is that they are not there to take over the father's role or to get in the way of the intimate dance between the parents. Certainly, there is the occational father who admits he is not going to be very good support for his partner. But by and large, fathers are the best support of a laboring mother and they are proud and excited to provide that support. Everything that you do at a birth should be to support and compliment the support that dad is providing.


I also tell women that this isn't A Baby Story or Birth Day. You can't just sit on the couch and watch! Be prepared to fix food, make sure the mom has something to drink, provide massage and encouragement, and to make sure dad has everything he needs to feel comfortable just being with mom. Also be prepared to take over if dad needs a nap! And be prepared to help clean up afterwards. This family just had a baby and their energy should be focused on their baby, not on cleaning up after their homebirth! My goal is to leave the house cleaner than when I arrived. 

You might notice that I've said "the ladies" who want to come to births with me many times. I've never taken a man to a birth with me but I don't see why it couldn't happen. As a man, you are probably less likely to be invited to a birth but the right man for the right family, I don't see why not!

I've often asked myself why I seem to be one of the only midwives who is willing to bring "newbies" to births. It seems to me that something is broken in our midwifery education system. Roadblocks are set up and many who try to pass will not make it through. Why? It's not usually because they don't have the drive, knowledge, or desire to get it done. It's usually because of these roadblocks. For instance, I have a friend who was apprenticing at the time I was finishing up my apprenticeship. She spent 2 1/2 years with one midwife. She went to nearly every birth with her and countless prenatals with each of the clients' whose births she attended. She studied endlessly, and honestly she is still the person I would credit as having the most book knowledge of any apprentice. And yet, she is no longer working towards being a midwife. After 2 1/2 years of hard work, she never once got to catch a baby. Not.Even.One. To me, that is inexcuseable! Another midwife in town once said something to me that really resonated. She said "We let dads catch babies all the time and they don't have any 'experience.' Why would we say you have to do X number of births or complete XYZ or show me that you can XYZ before you can catch one of my client's babies?" My clients usually catch their own babies but I certainly don't see any reason why a woman who attends a birth with me can't catch a baby if the mother and father are amenible. 

It's not about catching babies though, it's about being in a sacred birth space. It's about providing support and encouragement so a woman can have an empowered birth. It's about learning how to incorporate your energy into the sacred, electric birth energy without disturbing the mother. It's about seeing the power that woman have within themselves. I guarantee you that just seeing one homebirth before a woman ever births herself leads to greater confidence, greater understanding of the process, and better birth choices. 

Because of all of this, I am launching a Doula Mentorship Program. It has always seemed crazy to me that we send women who want to become doulas to a weekend seminar and then expect them to be able to be doulas. Sure, some women will muddle through, as I did. But 95% of these women will not be attending births in 5 years. I bet a huge part of the reason why is lack of support. When you attend a birth, particularly a difficult birth, you need to be able to talk to someone about it. You need a mentor who can give you pointers on how you could do better. You need a mentor to point out the things that might have gone wrong and give some potential reasons why. You also need someone to tell you all the wonderful things you did right! I believe that simply attending a weekend training does not properly prepare you to be a doula. Instead, how about attending a weekend training and then getting some on-the-job training? Hands-on learning is the best way to ensure that new doulas really understand their role and purpose. It gives them the confidence that they need to go out in the birth world and make a real difference! 

I'll be posting some things this upcoming week with more information about this new program. In short, if you are wondering if you can come to a birth with me, as long as my clients agree to have you at their birth, the answer is YES! You can come to a birth with me! But you have to do me a favor afterwards. In return, you need to go out there in the world and educate women about their birth choices. You need to get out there and be willing to change the world. If you get invited to a birth, you've been asked to be the guardian of a really sacred experience and you in turn need to share that with other women. Together, we can all change the world of birth! Let's BE the change we want to see!    

12 years ago, I was living in Jamaica and working as a midwife. I remember vividly walking to the hospital for the first time where I was to work. I walked the four or so blocks through the crowded town square, surrounded by a plethora of brightly colored dresses. Happiness and health seemed to abound. And then I noticed it. There were women breastfeeding everywhere! Every woman I saw seemed to carry a baby or small child lovingly on her hip. I saw them sitting at the taxi stand, feeding their 2 and 3 years olds. The inside of the maternity ward of this open-air hospital was mostly undecorated except for the numerous posters declaring "Breastmilk is the best milk for your baby!" I remember thinking to myself that I'd never seen a poster like that on a maternity floor in the US! 

During my time there, I inquired about breastfeeding rates. The head nurse, who tended to be a bit brash, told me in an almost scolding Jamaican accent "ALL of our mothers breastfeed, girl!" And the longer I stayed, the more I saw that this was in fact true. Only once was there a baby who's mother had undergone a cesarean (one of the few I saw while I was there) who's baby was eventually given formula. This particular mother was very ill with an advanced case of pre-eclampsia. I held and comforted her baby for 8 hours after the cesarean and, only after 8 hours when it was evident that her mother couldn't yet breastfeed her, was a syringe with formula brought to me to feed her baby with. This was the one and only time this baby had anything but her mother's milk and they made sure the baby had been breastfed successfully for several days before they discharged the mother. 

Since I am a midwife, I find that many, many mothers of all different ages confide in me that they couldn't breastfeed. It's not what the media often portrays: The mothers who "say" they couldn't breastfeed when in actuality they didn't really want it. No, these moms recount to me the great lengths they went to to provide their baby with what they knew was best, only to not be able to provide that. I can't tell you how manh mothers have confessed in me a deep feeling of inadequacy and self-doubt. They often report feeling incredibly guilty, inadequate, and distrustful of their bodies. 

But, the problem is NOT their bodies, or their breasts, or even their desire to breastfeed. The problem, is much, much larger than that! I read an analogy once that seems to fit this situation. If there was a river and people were continually being swept down stream, instead of merely pulling those people out of the river, shouldn't we go back up stream to see WHY so many people are falling in? 

So why are so many women in America unable to breastfeed? Let's follow that river back upstream and look at some of the issues: 

1.) Induction: When you are induced, your baby isn't ready to be birthed yet. Your body isn't prepared for a baby yet. That and the fact that induction is most often accomplished through hormonal means. Pitocin is the most commonly used drug to induce labor. It is the synthetic version of oxytocin, which is your body's hormone that is used to start labor. It is also the hormone of bonding and love. Our body's hormones are in delicate balance. And breastfeeding is a complex dance of hormones. The introduction of synthetic hormones in large quanities seriously interrupts this dance! Aside from that, pitocin causes the body to retain fluid. Most moms who have been induced will report the elephant ankles that happen for days post-birth. This is due in part to excessive pitocin. This fluid imbalance alters breastmilk composition and affects the baby's ability to latch on properly.

2.) Seperation of moms and babies: Babies are meant to stay with their mothers. In fact, babies are meant to stay with their mothers, map her body, and find the breast themselves. But removing the baby even for a few minutes confuses the baby and interrupts this process. Often, by the time they get back to their mother, they are too hungry to actively seek the breast. Some professionals would say that, yes babies should stay with their mothers unless there is a problem with the baby or the mother. I disagree. I think if either the baby or the mother is having a problem, the very nature of the symbiotic relationship of the mama/baby dyad makes it such that they can help correct each other's problems. A baby can help stop a hemorrhage and a mom can help regulate her baby's breathing and heart rate. Whether or not a hospital thinks it is necessary to remove a baby who is in trouble, they certainly should not ever remove a baby for the routine things that they commonly find necessary. I can't tell you how many times I've seen a mom not be allowed to hold her baby right after birth because the staff needs to weigh, measure, clean, diaper, and give a shot to a newborn. This most definitely adversely affects the first breastfeeding which in turn affects the whole breastfeeding relationship. In addition, washing the newborn washes the scent of the amniotic fluid off of his hands, a scent that he uses to help find the breast.

3.) Epidural and narcotic use in labor: Anything that enters the body can affect the delicate dance of breastfeeding. Contrary to popular belief, epidurals DO affect babies. The medication crosses the placenta in small doses and then needs to be broken down by the baby's immature liver. This results in increased cases of jaundice and causes the baby to have to direct his body's resources to the liver, instead of breastfeeding and digestion of breastmilk. Narcotics affect the baby much more directly. Narcotic and epidural babies have been found to be more sleepy for up to 2 weeks after birth. A sleepy baby may not self-wake when they are hungry and may not have the energy to latch-on properly. It's a vicious cycle. The baby is too sleepy to wake to feed. Then they are too hungry to wake to feed. Then they lose weight and have even less energy so when they nurse, they do so very weakly and get very little milk. Then comes the suggestion of formula!

4.) Lack of care-provider confidence in breastfeeding and reliance on formula to "fix" a breastfeeding problem: The assumption is often that mothers and babies know NOTHING about breastfeeding and they both have to be taught how to do it. This couldn't be further from the truth. But, even among lactation consultants, there is this strategy to teach breastfeeding that actually complicates it unnecessarily. Turn the baby this way, hold them in this way, grab your breast in this way, flip their lip, check their tongue, blah, blah, blah. This confuses moms and babies. Moms tend to develop a mistrust in themselves and their babies because of this kind of instruction. In addition, pediatricians, nurses, and yes even lacation consultants often rely on the use of formula to "fix" breastfeeding problems rather than actually working on breastfeeding. If a baby hasn't been nursing well, perhaps due to being sleepy from narcotics, instead of giving the mom confidence and assistance with breastfeeding, they often say there is no other option but to give formula. This completely undermines the parents' confidence in breastfeeding. Then, of course, there's the "stealth bottle" as I like to call it. The nurse who takes your baby for testing and brings them back full and happy after giving them a bottle that you didn't give them permission to give. The introduction of even ONE bottle in the first few days of life can alter the breastfeeding relationship so dramatically as to cause the stop of breastfeeding entirely.

5.) IV fluids: Many, many mothers receive IV fluids during their labor. IV fluids over-hydrate a woman's body and alter the electrolyte balance. Couple this with pitocin (which causes the fluid to be retained for a long period) and you've got a serious case of "elephant ankles" as well as engorged, hard to latch on to breasts and an altered composition of breastmilk. 

6.) Starvation during labor: Most laboring moms are not allowed to eat anything during their labor, as per hospital policy. I might add that this is not supported in any way by science! (That's a whole other blog post though!) It takes 2100 calories, a whole day's worth, to just open the cervix. That doesn't include the movement, perspiration, increased respiration, grunting, pushing, etc. that is needed to birth. Starving a woman during this time basically ensures that she won't have the energy to do what her body needs to do to birth. And it means that her body will be playing catch up postpartum. The woman's body's first concern is self-preservation, not preservation of the baby, so her resources will go to her body, not to breastfeeding. Any mother who has tried a low calorie diet while breastfeeding will tell you this. Low calorie intake = less breastmilk and sometimes no breastmilk. 

7.) Cesarean: 1/3 of women in this country walk out of the hospital with a cesarean. The reason why cesarean birth often affects breastfeeding is that all of these other things we have talked about are likely to happen in during the birth and postpartum period. Women having cesareans are often in labor for many hours beforehand, without eating, and then are not allowed to eat for 24 hours following the cesarean. That means a mom might have been starved for 48 hours or more. They have even stronger doses of anesthesia including pain-relievers that are meant to stay in the system for at least 24 hours post-birth to combat the pain of the surgery. They also often have stronger doses of pitocin and are given larger doses post-birth. They are given large amounts of IV fluids before, during, and after the birth. They also tend to lose at least twice as much blood as in a vaginal birth which diverts the mother's energy to recovery instead of breastfeeding. Nearly all cesarean babies are seperated from their mothers for at least an hour after the birth and skin to skin contact is rare for at least several hours afterwards. The incision site makes it more difficult to find a comfortable position for breastfeeding that encourages a good latch-on. The reasons go on and on. 

8.) NICU: If a baby goes to the neonatal intensive care unit, they are often not allowed to breastfeed or eat at all for a period of time. I've found that the NICU staff are much more trusting of bottle-feeding than breastfeeding because it is more quanitifiable. In fact, a midwife friend of mine told me about a story of a baby who's mother insisted on breastfeeding him while he was in NICU. The only way they would allow it was if they pumped the baby's stomach after every feeding to "measure" the amount of milk the baby got. This doesn't happen often but it does illustrate a general distrust in breastfeeding that is prevalent in the NICU. Policies often make it nearly impossible for a mother to breastfeed, especially if she has had a cesarean. Some NICUs have "hands on hours" which also means there are "hands off hours" during which a mother is not supposed to hold or breastfeed her baby. This might be necessary for micro-premmies, but it does not help full term or close to full term babies. Remember too that even one bottle could potentionally be the downfall of breastfeeding for that baby so the mother only needs to be out of the NICU for one feeding to cause problems. 

9.) Circumcision: When a baby is circumcized, particularly within the first 24 hours of life, their resources are again diverted to healing their wound instead of nursing and growing. People often state that they want to circumcize their baby as soon as possible because they don't want them to remember the pain of it. It IS painful, it doesn't matter when it happens in their life. The difference is that merely 24 hours after the birth, the baby isn't solid about breastfeeding and they don't know to use the breast for comfort. Waiting even a few days can make a huge difference. Or consider keeping your baby boy intacted. 

10.) Lack of support in our society: Whereas a Jamaican woman walks around seeing breastfeeding babies and toddlers everywhere, a woman in the US might go her whole young life without seeing another woman breastfeeding. If it's done in public, it is most likely done under the cover of a blanket. In addition, we have a plethora of mothers who have had one or more of these above things that prevented them from being able to breastfeed. Pregnant moms are told by their closest friends and family members about how breastfeeding was so difficult or impossible for them. Of course, none of these women know WHY they couldn't breastfeed. So the assumption becomes that it's hard to breastfeed, you might easily fail, your body might not make enough milk, etc. 

Of course, there will be women who read this and say, "I had all of that stuff and breastfeeding just came easily. They brought my baby to me and he latched right on, it was easy!" No, these situations do not mean that you won't be able to breastfeed. In some cases, having all of these situations might not affect breastfeeding at all but in some cases having just ONE of them will. I tell people all the time that some babies will take a bottle in the first 24 hours or even several bottles and still breastfeed no problem. Some will go easily back and forth from breast to bottle. But some will have one bottle and never nurse correctly again and they don't come out with a tattoo announcing their inability to bottle and breastfeed interchangibly. 

So what's America to do? First of all, I'd like to see more moms openly breastfeeding. Breastfeeding in public is a protected right in our country. You can't be kicked out of any place for doing it and the more women we have doing it openly, the more accepted it will become. I'd also like to see more education about why breastfeeding sometimes doesn't work and a real effort being made to stop these things from happening in the majority of births. There may be some births where these things are unavoidable but the vast majority of births should be free of these types of interventions, just as they were in Jamaica where their breastfeeding at discharge rate was 100%. Finally, I'd like to see the monetary relationship between hospitals and formula companies completely dissolved. Your "breastfeeding bag" they give you at the hospital that contains formula, uh-uh! No way! What better way to say "This might not work out for you" than that? Ladies, we've got to start leaving those bags behind and telling the hospitals that we don't want them! That free bag is not worth it! (It says Emfamil anyway!) Instead, let's keep birth as natural as possible. Let's get moms the support they need before, during and after the birth of their baby. Care-providers need to ensure that moms are educated about the benefits of breastfeeding and their body's natural ability to do so. Probably the biggest change we could make to affect breastfeeding success is simply to never remove the baby from the mom. Even if she's had interventions, if the baby stays with her and she is given confidence about her and her baby's ability to breastfeed, that will solve many problems right there. But if she's had interventions AND the baby is removed for several hours, it is unlikely that the situation will be easily overcome. And finally, we've got to get the word out about why breastfeeding sometimes doesn't work. The breast is best slogan has done wonders for helping women see why they should breastfeed but in the end it has only served to make women feel guilty for not being able to do it. It's not just a woman's choice. In fact, it often ISN'T her choice to formula feed. So moms, if you read this post and saw yourself in it, RELEASE THE GUILT! It wasn't your fault! It wasn't that your body didn't want to breastfeed your baby. There were many reasons why it didn't happen, and most of them didn't have anything to do with you!   
 

I remember vividly how it felt when that pregnancy test showed two distinct lines proving my suspicions, that I was pregnant with my first baby. I remember that extreme mix of emotions, mostly excitement and elation admittedly mixed with a little "What have we gotten ourselves into?" It was such an awesome time in my life, so filled with idealism.

I love my first time mamas. Of course I love all my mamas but the first-timers are special to me. Mostly because I can see in them the same idealism that I remember feeling throughout my first pregnancy. Optimism, wonder, and excitement surround them.

Yet, I can't tell you how many times a woman has sat across from me at a prenatal in tears because of some comment that a family member, or friend, or co-worker, or often times a perfect stranger has said to her. Somehow it's like the pregnant belly gives people permission to say what they would never say under normal circumstances. There she is, this soon to be new mama, in the grocery store when some elderly lady makes a beeline for her. "When are you due?" she asks innocently. "Soon!" the woman replies with excitement. "Oh, I hope you don't have my labors. They had to <insert ridiculous complication here>. It was horrible! But best of luck to you!" as she wheels her cart away. Gee, thanks lady.

If anyone has ever been to a baby shower, you know that they are breeding grounds for horror stories. The first baby shower I ever went to, I was shocked, just shocked, at the way women were presenting their birth stories. At the beginning of the shower, this soon to be new mama was radiant and beautiful. She was incredibly excited for her birth that she had carefully planned for. First it was the inquiry from all the other women. "So what are you planning for your birth?" All open-ended like no matter what you said it would be fine. "Oh, I really want to go natural." Then the exchange of glances between all the women and the barage of negativity begins. "Yeah, that's what I said until I felt that first contraction and I was like 'get me my epi!'" "You won't be able to handle it. Think of the worst pain you've ever felt and times it by 1000 and that's what labor feels like." "Yeah, I wanted a natural birth too but then I went in for my induction and it was soooooo excruciating. My baby almost died! Then I almost died! It was horrible!"

As the discussion went on, I could visibly see this new mom fading into that negativity. Fear and tripidation crossed her face. Her shoulders slumped. She crossed over into fear and worry. A few weeks later when I attended her birth, I wondered if she was thinking about all those stories when she just could not progress, couldn't let go, couldn't get past a certain point. Was that why???

When I was midwifing in Jamaica, I was struck by the seemingly opposite birth culture. The nurses told me that in their country, if a woman has a scary birth story, she is not supposed to share it with childbearing women. In their culture, they believe that telling negative stories will impact the mother negatively. Gee, ya think? Here, it's the opposite. We wear our scary births like a badge. When a group of women gets together and the subject of birth comes up, it's often a contest as to who can tell the scariest, worst birth story. In Jamaica, it was all "You were in labor for 3 hours? Well I was only in labor for 2 and it didn't hurt at all."

Recently a friend of mine who had a really difficult birth told me about a friend of hers who is recently pregnant. She said that she almost felt sorry for the woman because she didn't know what was coming to her. While I understand and honor her feelings, I certainly hope she didn't share them with that mama! I might add, this particular woman herself grew up hearing a lot of negativity about birth from her female family members. We will never know if that early influence affected her own birth experience.

From my vantage point, I think we are actually creating pain and complications in birth because of this type of negative support. If all you've ever heard is a scary birth story, why would your experience be any different? When I taught childbirth classes at the hospital, I would ask for a show of hands of people who have heard what they would consider a good birth story. In nearly every class, there would be only 1 or 2 people who raised their hands. How terrifying! You are about to embark on a journey of which you have heard nothing but scary things! 

What if, instead, we offered true support to women. You don't have to lie about your experience. You could always say something like "It's hard work but I know you can do it." or "Labor takes everything you've got but you've got what it takes." or "It's very intense but I have confidence in you." Can you imagine the difference in the way the new mama would feel about her impending labor if those were the statements made at baby showers?

This all makes me wonder why women do this? Why does that granny in the grocery store feel the need to beeline over to you just to tell you her horrendous birth experience from 50 years ago? Partially, I think it's because after women have their baby in this country, no one talks about their birth to them. One of the biggest reasons you should have a doula with you throughout your birth is so you can process your birth experience afterwards. You can talk to someone who was there through it all, ask your questions, and make sense out of what did happen. It doesn't need to be a negative birth experience to need to be processed. It's a life-changing experience and we all need to process it in a healthy emotional way, not put it away and never discuss it...until we pull it out at the next baby shower we attend.

In some ways I think women tell these stories because it's like saying "This horrible thing happened to me and if it doesn't happen to you, that means it didn't have to happen to me either." Of the 450 some odd births I've been a part of, the vast majority of them have been mostly positive experiences for the parents. Very few were the scary horror stories we so often hear. Surely in the general population, there are plenty of good birth stories to be told. But they don't get told. Why? They are not encouraged at all.

I learned very quickly that you don't just launch into your "my birth was so awesome" story with just anyone. It's like for some reason my good experience is an insult to your scary one. So out comes the explanations. "Your hips are bigger than mine", "You must be made for birth", "Your baby wasn't as big as mine", "You just got lucky", "I guess you had something to prove." Those are all statements that were said directly to me following my own births.

In actuality I did not "get lucky." I spent months preparing physically and emotionally for my births. Especially for my second and easiest birth, I spent at about an hour each day of the pregnancy bonding with my baby, ridding my mind of negativity, and envisioning my ideal birth. Other women will have a better birth experience than most because they hired a doula, or had a compassionate midwife with them throughout labor, or took a hypnobirthing class or whatever they need to do to "get there." I think those births are often the most insulting to women who have had a negative experience because it implies to them that they could have saved themselves a whole lot of grief if they'd just done XYZ. I don't mean to imply that doing any of these things will guarantee a better birth experience because it might not. It's just the act of doing something to prepare rather than the typical "I read What to Expect When You're Expecting" preparation that many women do in our country.

I've learned over the years to share my positive birth stories compassionately, so as not to insult anyone else's experience. I've also learned to teach women to highlight the good in their experience, whether the overall experience was positive or negative to them. Wouldn't a negative birth story sound so much better if it was at least prefaced with "I loved how hands-on my husband was. I felt so close to him during it, even if we did end up having a cesarean." I've also learned that a significant number of those scary birth stories that get shared at baby showers are so scary to the women because no one ever explained to them what happened. A compassionately placed "They needed to do XYZ because your baby was in serious trouble. Having a heart rate that goes down to 50 is not normal and your baby needed help." That very comment right there will change someone's perception of what happened to them. It won't make it all roses but it at least injects some positivity into the equation. 

For all those first time mamas out there, we have to be oh so careful what we say to them. Pregnant women, and especially first-timers, are incredibly open emotionally. They can absorb things so easily. What feels like an off-handed story to you can turn her blissful birth into a nightmare. It is THAT powerful! For example I had a mom who genuinely needed pitocin (we had tried EVERYTHING else) but stubbornly refused. I asked her what she was afraid of and she recounted to me a story that a friend had told her at her baby shower. It was most definitely a horror story that revolved around pitocin. Everything you say can get in her head and that will be floating around during her own birth.

I encourage everyone to think back to that feeling you had before your first birth. Remember that time when you first found out you were pregnant. Remember the dominant feelings and remember the smaller ones. Remember how vulnerable you felt! A first baby brings about quite a few emotions, doesn't it? Now, before you set foot in a baby shower or walk up to a soon to be mama in a store, remember this feeling and honor that feeling in her. Let her leave your presence feeling better than she did before. Let her have her own experience and be kind to her. She needs that kindness. She's about to give birth for the first time and she needs your positive support!

Recently a friend of mine (Hi Kim! <waving wildly!>) asked me what the big deal is about prenatal care. As she said, every month she waited in the waiting room for an hour and then got weighed, measured, and was out the door in minutes. The only thing anyone ever told her was that everything looked healthy. End of story. She said all she heard before she got pregnant was how important prenatal care was and she didn't really understand what the big deal was having experienced it. Of course, we both also discussed the fact that she had healthy and normal pregnancies but...wasn't there supposed to be more to it than, "Everything's healthy. See ya next month."
 
YES! There is absolutely supposed to be more to it than that. If you've ever been pregnant before, you can probably attest to the fact that there's a lot of physical changes but there are just as many emotional ones! Prenatal care needs to be wholistic care that considers the whole woman, physical, emotional, and spirtual. Reducing the whole process down to a couple of measurements is degrading and insulting to what women are actually doing, growing a baby, making a whole other human being, and becoming mothers all at once. 

Prenatal visits are billed to insurance companies as being 15 minutes in length. 15 minutes! I find it hard to believe that a woman, the whole woman, could ever be evaluated in 15 minutes. That thought also led me to wonder how many women a typical doctor sees in a day? 20? 30? Does he or she remember their patients or do they need to use their chart to remind them?

A large part of what I do depends on what I remember from the last visit. These are not things that can be charted very easily but are subtle differences. I get to know each baby by feel. I talk to them and I tell them what I am doing each step of the exam. It's so hard for me to believe that I could be as good a midwife if I was seeing 20 patients or more a day.

The more time I spend talking to the parents, the more they open up to me. They feel more and more comfortable with me and my presence in their home. And I believe they need to feel comfortable with me because I will be the one at their birth. It won't be, "If you have your baby on Tuesday between the hours of 8pm and 8am then I'll be your midwife!" I'm your midwife no matter what day it is, there's no surprises here. It will be me! Birth is such an intimate experience. I can't imagine going through it with strangers.

Yet it has happened. Most women get a 15 minute visit if they are lucky and their care providers only have time to look at numbers on a chart. That is how women get misdiagnosed or how women slip through the cracks. A client of mine was told by her hospital midwife that she was "overweight when she started pregnancy." I doubt she knew who she was talking to because that woman is a personal trainer and certainly NOT overweight in any sort of unheathy way. She wasn't looking at the woman though, she was looking at the numbers. This happens all the time with pre-eclampsia diagnosises. Women are told they have pre-eclampsia or are sent for further testing before anyone asks them what they ate last and how long ago that was. Guess what? She's been sitting in your waiting room for the last hour, starving!
 
It's called prenatal CARE for a reason. Women need to be cared for, nurtured, listened to, and supported. They need to be able to ask all of their questions, without feeling like they are keeping you from another appointment. They need to be able to voice their fears and concerns without judgment. They need to have a place to come with their partner to devote just to talking about this baby and this birth. They need to have a place to let out their frustrations about what their mother said, or that stranger said, or how everyone is asking why she hasn't had the baby yet. These things are all part of prenatal care. And I bet you dollars to donuts this kind of wholistic care leads to better birth outcomes.   

I've been attending births for about 13 years now and over that time I've been to around 450 births. They've been all different kinds of births. I've seen homebirths, hospltal births, birth center births, births in a hospital in Jamaica that had little equipment or medications, births that were triumphant, and births that were traumatic. I've seen and experienced a lot!

I've been asked to share my experiences and knowledge by many people over the years. So what kind of information do I usually share with people who ask? It depends on who they are. I understand I can't sell homebirth to everyone and I don't try to. For those who choose to birth in the hospital, I encourage them to do the following things:

~Educate yourself: You wouldn't even walk out on a showroom floor at a car dealership without researching it first. Knowledge it power!
~Ask questions before each and every test or procedure is suggested. (BRAIN: Benefits?: What are they? Risks? What are they and how likely are they to happen? Alternatives? Is there anything we can try first? Instinct? What is my instinct telling me I should do? Nothing? What if we do nothing?)
~Hire a doula: A doula is like a guide in uncharted waters. No matter how many books you read or how many classes you take, you can still feel unprepared for labor. Your doula is like the cliffnotes version of your childbirth class right there in the labor room with you! She provides comfort and information to both of you and you should not birth without one! Why? You will be treated differently with a doula by your side. They know they can't just do whatever they want, you have a witness. 
~ Question whether your provider is the one for you: Don't just keep going back to someone you aren't 100% comfortable with. There are lots of options. Again, it's just like buying a car. You'll feel better about your choice if you researched your options and then made your choice.

For people who are interested in birth center or homebirth, I like to share the following things:
~ For most out-of-hospital births the same midwife who you saw for prenatals will be there at your birth. No strangers, no surprises.
~ Prenatals with an out-of-hospital midwife are more family-centered and encompass both your physical and emotional development throughout the pregnancy. Doctor or hospital-based midwife = 1 hour in waiting room, 7 minutes with your provider, MAX. Out-of-hospital midwife = 1 hour actual face-to-face time, MINIMUM, no waiting.
~ Birth feels different when you are in the comfort of your home, able to do whatever you want to do, eat whatever you want to eat, and are attended by people you know and trust. In this situation, it feels managable and you feel in control.
~ Birth is safe at home: My joke is that we don't just show up with a birth drum and a feather, though we bring those too! We bring equipment that any small hospital might have. We're also specially trained to be able to detect potential problems ahead of time and handle any emergency that arises. Emergencies rarely if ever happen without warning. Reputable studies show that homebirth is just as safe or safer as hospital birth and involve significantly less interventions.
~Your baby will be treated with respect and will not be taken from you...EVER!
~Postpartum visits take place in your home because...you just had a baby!

It all sounds incredibly reasonable to me! And let me tell you, this knowledge doesn't come from books. It comes from experience! I'm not a zealot. I don't have these ideas for no reason. They are based on my experiences and I tell you, if you had my experiences, you would feel the same way I do. I've often thought if people could see what I've seen, they would see the problem! So I thought I would write about some of the things I have seen. Each and every one of these things actually happened. Don't worry, I'm not telling horror stories! I'm also not being selective about my experiences to try to paint a certain picture. The specific situations I am discussing are the most typical births I have attended, not exceptions to the rule.

Some people ask me why I'm such a huge proponent of homebirth and I like to say, "Because I've seen birth in the hospital!" The response is the same for countless others that have been where I have.  I've seen birth after birth in the hospital where women are treated routinely. This is a once in a lifetime event in their life but to that nurse or that doctor, it's Tuesday, just one more day until my day off.

I've seen what happens when women don't question their doctor as to WHY they are being induced. When they ended up with a cesarean for "failure to progress" the nurse said it was because the mom's body "wasn't ready yet. Why did you come in for an induction anyway?"

 I've seen what happens when a couple gleefully tells me about how their doctor or hospital-based midwife is going to be on-call "just for us!" Uh...no, sadly they are not!

 I've seen what happens when a woman specifically asks for no male providers and is greeted upon admission with a male doctor as he proceeds to do a vaginal exam without permission, before he's introduced himself.
 
I've seen what happens when a couple decides it's not necessary to go to a childbirth class and then has no idea what the doctor is talking about. "What's a cervix?"

I've seen what happens when a woman feels like birthing at home is "wierd" and "people might think I'm wierd if I do it"...and then she doesn't feel comfortable at all in the hospital environment.

I've seen what happens when a dad thinks he can definitely handle doing all of the labor support for his wife without a doula...and 42 hours later is he exhausted and regretful.

I've seen what happens when a woman doesn't really like her doctor but she's afraid his feelings will be hurt if she changes providers. Guess what? He's 100x as bad in labor as he is in the office. 

I've seen couples be terrified into doing something they know in their heart they don't want to do because someone finds it necessary to "pull the dead baby card" as I call it. You should never have to threaten a patient into doing what you want them to do by telling them their baby could die if they don't.

I've seen women have 20 or more vaginal exams during the course of her labor, by many different people. Her vagina is supposed to be a sacred place at any other time of her life but this is BIRTH! Put your feet up in the stirups and let everyone in the hospital in there!

I've seen women be forced to lie down when it is excruciating for them to do so for.no.reason. I've seen those same women finally submit to an epidural because they can't take it any more.

I've seen nurses act more like drug pushers than nurses. "Are you sure you don't want an epidural now? How about now? Come on, everyone's doing it."

I've seen endless parades of staff coming through a room to examine the woman with the wierd whatever. Yes it's a teaching hospital but this woman is trying to give birth!

I've seen women yelled at and told they don't know what they are doing. "You'll never figure out how to push if you don't listen to us!"

Nearly every birth I've seen at the hospital ended with the entire room yelling "Push!!! 1,2,3,4,5,6,7,8,9,10 Now PUSH AGAIN!!!" Next time you're doing something difficult, see if that helps.

I've seen a doctor say if he doesn't cut her, her baby will never come out and will die in the birth canal. The baby was born 1 minute later without assistance.

I've seen a doctor who refused to deliver a woman unless she was on the bed. Thankfully the father caught the baby before he hit the floor as she was walking to the bed with her baby crowning.

I've heard the cries of a woman begging to be given her baby and then heard the nurse say "It'll be just a few minutes. I have to weigh him, give him his shot, give him his eye ointment, diaper him, and swaddle him. THEN you can have him." She just birthed a baby after losing her first one and you are going to deny her the first 30 minutes of that baby's life for WHAT?
 
I've seen babies go to the Neonatal Intensive Care Unit (NICU) for silly hospital policies such as: The baby is under 5lb, albeit 1 oz under, and the parents are VERY short, small people. The baby is under 37 weeks, albeit 36 weeks and 6 days...The baby's temperature is .1 degrees too cold, we have to take her to NICU. Believe me, if you are a baby, you want to do everything you can to avoid NICU!

I've seen NICU staff tell parents that they can only hold their fullterm newborns 1 out of every 3 hours, not because it is for their baby's health but because it's NICU policy. I've come to understand that NICU's "Hands On" policy actually means hands OFF.

I've seen moms forcibly stretched by doctors doing "perineal massage" (not the real perineal massage, this is no massage!) who then tell the woman that pain she's feeling is from the baby's head. 

I've seen women talked into scheduled cesareans rather than being given the support they need.

I've seen women be talked into repeat cesareans because of the risk of uterine rupture. That same doctor then induces a mom with a previous cesarean, upping the chances of rupture from .5% to 3%. I guess the doctor doesn't care about that .5% as much as she emphatically stated.

I've seen a woman at 10cm be forced to under-go a repeat cesarean because she didn't follow hospital protocol in coming to the hospital at the first sign of labor.

I've seen the nurse turn on pitocin when a woman was 9cm, calm, and relaxed. As the nurse said, "She's not hurting enough to be 9cm."

I've seen an entire staff of a hospital not provide any assistance when the mom threw up on herself after they forced her to chug 2 liters of water. Not a towel, not a mop, not a napkin.

I've seen a couple be pressured into amniotomy at 5 cm (manual rupture of the baby's protective amniotic sac) to screw an internal monitor into their baby's scalp because the baby forcibly kicked the belts of the external monitor every time they put them on. Smart baby I say!

I've seen a woman be given an epidural when she was 10cm and pushing just because the anesthesiologist hadn't been able to get to her until then. She then spent 2 1/2 hours trying to push her baby out who was in distress and needed to be born. She had absolutely no feeling except that helpless feeling of knowing her baby is in trouble and she couldn't help him.

I've seen a woman arrive at the hospital at 10cm with the baby's butt crowning, then rushed back for an "emergency" cesarean where the baby had to be pushed back up to be delivered. All of this despite her protests "I don't want a cesarean! If the baby is coming, can't I just push and give birth vaginally? Please let me birth my baby! I don't want a cesarean!"

To be honest, this list is but the tip of the iceberg of the things I have seen in my 13 years as a doula and midwife.   

I've seen some nice births in the hospital too but those only happened when people did those things I mentioned before. They educated themselves, hired a doula, chose the best provider for them, and asked questions before deciding on any test or procedure.

In those situations, I've seen a woman say things like "Oh you need to assess my baby? Well you can do that while I am holding her, thank you!"  

I've seen a woman who slapped the midwive's hands away when she went to do a vaginal exam without permission and declared "Don't touch me! I'll let you know when and if it's ok."
 
I've seen a dad get angry at the nurse for forcing his wife to lie down, despite the midwife's written orders that she could be off the monitors. He yanked the belts off of her and threw them at the nurse when he (yes the nurse on L&D was a man) refused to take them off. (I always tell parents that you catch more bees with honey but in this situation, it was very effective!)

I've seen a dad who openly questioned the lab results of his newborn girl who was in the NICU and then told the doctor that if she tried to lie to him again, he was moving his daughter to a different NICU.

I've seen a mom refuse to go home when she was discharged and her baby wasn't. She spent the next 7 days and nights in NICU with her baby, happily and cheerfully going against the policies that would prevent her from holding or breastfeeding her baby on-demand, the policies that had NOTHING to do with her baby's health.

I've seen parents who asked questions every step of the way on their birth journey and made every decision that led up to their cesarean. They never felt out of control or forced to do anything because they had educated themselves and made decisions based on the information and their own instincts. They never questioned the outcome, ever.

I've seen women birth their own babies, even in the hospital.

I've seen a dad crawl right into bed with the mom and tell the nurse (jokingly but also serious) "I guess I'm your patient too. If she wants to be cuddled, I'm going to do that for her no matter what anyone else says."

I've seen a couple patiently wait 48 hours after her water broke at home and then announce to the doctor that yes, it had been 48 hours but they had been monitoring for infection and were not going to come in for an automatic induction. She birthed 3 hours later.
 
I've seen a woman who had to be induced at 37 weeks be offered a cesarean because an induction would be likely that fail and would probably take at least 3 days. With the power of her mind, she willed herself into labor and gave birth painlessly 5 hours later, much to the shock of the doctors!

The commonality with all of these births is that the couple knew what they wanted and they were insistant that they were going to get that. They expected and demanded integrity of the staff. Most of them were extremely nice about it but left absolutely no question as to their own intentions. I like to remind people that these people work for YOU, not the other way around!

Homebirths are a stark contrast. Rather than good birth outcomes being few and far between, they are the norm. The majority of births at home are quick, involve very little if any pain, and result in a securely attached mom, dad, and baby. The difficult ones are the ones that are few and far between. When a woman births at home, she is in her own space and she feels she can do whatever she needs to do, without having to ask permission.

At home I've seen a woman smiling, joking, and happy at 10cm. As in, you could barely tell she was in labor.

I've seen a woman silently breathe her baby out and then announce to everyone, "The baby's out now."

I've seen a young dad bond instantly to his baby as he helped bring her into this world.

I've seen a mom say after every surge "That one felt sooooo good."

I've seen a mom bring her baby to the surface of the water and say "Hi Baby! I love you so much that I'll never let anyone take you away from me! EVER!"

I've seen babies who never cry the whole 4 or 5 hours I am there after the birth. Why cry? They have everything they need!

I've seen babies make their journey completely on their own to the breast and latch on, without assistance from mom.

I've seen a baby completely birth himself, without mom's assistance. As mom said "He's coming! But I'm not pushing, HE is!" Babies are smart and they are strong!

Every time I am at a homebirth, I think to myself that this is how birth is supposed to be! Women birthing without fear, surrounded by loving support. Babies coming into their parents arms, feeling love and peace as their first emotions, instead of fear and pain. Families supported in their home environment and encouraged to make their own decisions, rather than listening to the decisions of their provider. Families supported through their transition, creating strong, emotionally stable, loving bonds. This is how birth is supposed to be! I'm not biased, I'm RIGHT!!!

I'll admit it. I'm a 16 and Pregnant addict! Of course, anyone that knows me knows that I'm into just about anything with pregnancy or birth in the title. After watching one recently I was struck at how roughly the baby was handled right after the birth (which is very routine from the hospital births I've seen) and how completely unbothered the parents and grandparents were about this treatment. I've seen it at least 100 times. The baby's emerges, he is roughly rotated (a job he can do on his own by the way!), extracted from his mother's body, flipped over on the doctor's forearm, bulb syringe roughly inserted up his nose and in his mouth, and then flopped over into a waiting nurses arms. The nurse proceeds to take him over to the "baby station" where he is placed under the brightest of bright lights and his skin is roughly scrubbed until no trace of vernix remains on his skin. A tube is inserted up his nose and then down his throat to suck out any remaining mucus. A shot is given in his thigh and antibiotic eye ointment is rubbed into his eyes, blurring his vision. Through all of this, he screams in fear, pain, calling for his mother. She's the only things he's ever known. Where is she? Unfortunately, she is watching helplessly from her hospital bed. As was the case in this 16 and Pregnant, too blissfully unaware that this is NOT ok. She looks on lovingly, in awe, and seemingly doesn't notice her baby's anguish. 

I don't blame the mom or the father or the grandparents who all witnessed this post-birth treatment and did nothing. I think we've become desensitized to this kind of treatment. Just turn on any Baby Story or Birth Day. Walk into any birth room at most hospitals in the US and you see it. You'll see the blissful, loving look the moms have on their faces while their baby screams. It's part of our culture. The baby comes out and they SCREAM right? How many times have you heard "We were really holding our breath there, waiting to hear the baby cry. Then we knew everything was ok!" 

After I saw that show, I thought to myself that outside of birth, that kind of treatment would be unacceptable. If someone roughly grabbed a mom's baby out of her arms and proceeded to change the baby's diaper in the same manner, you better believe a Mama Bear will come out! Why is birth so different? Is it because she's in a birth haze? Is it because she feels she has no power? Or is it because every show she's ever seen has shown newborns being treated that way and therefore it must be NORMAL. Or worse yet, NECESSARY. It's not!

Do babies need to cry? Actually no. Many of them do not or only cry for a short period of time. Some of them do come out "telling their birth story" as I say and bless us with their cries for some time after the birth. They aren't crying because they are in pain though and there's a big difference.   

This baby was born in a home waterbirth. She never cried though her heartrate and resperatory rate were even and normal. Her lungs quickly cleared of fluid. She connected with her parents for a few minutes, reaching for them silently and calmly. After a few minutes, she simply snuggled in and went to sleep next to her mother's breast. Our little joke was that she didn't cry at all until about 2 hours after the birth when her older brother bothered her and then she let us know that she DID know how to cry! I believe this is the hallmark of a baby who is respected during birth.

During my prenatals, I talk to the babies. I let them know who I am and what my intentions are. It might sound silly but I just narrate to them what I am doing. "Oh hi Baby! How are you today? I'm just going to feel around to see what position you are in. This is exactly the right position Baby! Good for you!" Remember that fetal hearing begins as early as 10 weeks. Sure, maybe they can't understand the words that I am saying but they hear my intentions to treat them as an individual, capable of feeling emotions. They understand that I have no intention to hurt them. I also encourage both parents to talk to their baby regularly. I have found that women tend to have shorter labors if they explain the birth process to their baby.  

During the birth, I imagine that there could be no better experience for the baby then being received by his parents. Philosophically, I've always liked the idea that the parents were the ones who created the baby and they should be the first ones to touch him.

In homebirths, we have a baby station too. It keeps the newborn warm and fed and loved. It's his Mother! I rarely use a bulb syringe because babies are very, very good at clearing up their own mucus. Try sticking one of those up your nose and see how it feels! I've done that so I only use a bulb syringe if it will truly be helpful and only after telling the baby what I am doing and why. 

As long as the baby is transitioning normally (as nearly all of them do), I would never even consider doing a newborn exam for at least an hour after the birth. During that hour, he needs to be with mom and dad, skin to skin, being fawned over and stroked. Mom needs to do that too! It regulates her blood pressure and releases huge amounts of the bonding hormone oxytocin. 

If a baby isn't transitioning very well, he still needs to be with his mom. It goes against every rational argument that a baby who isn't oxygenated properly should be removed from his oxygen supply (his umbilical cord) and taken away from his mom, the very person who has sustained him thus far and who can actually stabilize him herself. If I need to intervene, I do it right on the mother, with the mother and father talking to their baby. 

This is homebirth. Mothers, fathers, and babies treated with respect. My deepest wish is that this respect becomes part of our culture. That when you see a baby treated with respect, THAT seems normal. I want parents to see that rough treatment of their newborn for exactly what it is...ABUSE! Every baby deserves to be treated with respect and dignity. Every parent needs to demand it. Every careprovider needs to ask themself if they inflict pain and suffering on newborns. Even if it is unintentional, that treatment is the baby's first experience with life on Earth. Respect and dignity. Every birth. Every baby. Every time! 

There's a certain look people give me when I mention Ecstatic Birth. You know the "You are talkin' crazy talk now!" look. A couple of months ago a male friend of mine who has 2 young kids called and left a message with me after he had heard my voicemail message which mentions Ecstatic Birth classes. He was like "And yeah...I'd kinda like to talk to you about this ecstatic birth thing and like how...that would be...possible." It was a laugh out loud moment!

So what do I mean when I say that a birth was ecstatic? I think of the hormonal blueprint that nature intends to be in place during birth. When birth is undisturbed and the mother is not fearful, birth is ecstatic. When birth is disturbed and/or the mother is fearful, birth is less than ecstatic!

Let's talk about what happens during labor. Contrary to popular belief, the uterus does not "squeeze" the baby out. That's not how it works. A contraction, or surge as I prefer to call them because let's face it, it just sounds better, is the action and relaxation of 2 muscles. For the next couple of moments, bend and straighten your arm. When you bend your arm, your bicep contracts and your tricep relaxes. Does it hurt to do this? A uterus contracts the exact same way.

The uterus is made up of vertical muscle fibers and horizontal muscle fibers. The vertical muscles are meant to contract and draw up the bottom of the uterus to open the cervix. The horizontal muscles are meant to relax around the cervix. Their job of holding the cervix shut for 9 months is done! During a surge, the horizontal muscles relax and the vertical muscles pull the uterus up and the cervix open.

Now let's look at how hormones affect this action during labor. There are basically 2 ways labor can go hormonally. There's the fearful, adrenaline filled way and the calm, relaxed, feeling good endorphin way. We'll start with the fearful way.

Let's say that a woman grew up hearing birth stories that scared her. She had never heard of a birth being anything but excruciatingly painful. Then, she gets pregnant and goes to the doctor. There are all these tests and procedures that imply that pregnancy isn't safe. Worry sets in. Labor starts and she is scared for the baby's life, afterall, everything that has led up to this point has told her that pregnancy and birth are not safe. She goes to the hospital early in labor, the transportation of herself during labor being the first disruption in the birth process. She arrives at the hospital and is asked to fill out paperwork, answer a bunch of questions, and pee in a cup to ensure that she is healthy. "Do you have a living will?" the nurse asks. This is a routine question that they must ask. She's thinking, "Am I going to need one?" "What's your pain level on a scale of 1-10, 10 being the worst pain you've ever felt in your life?" "I guess...a 5," she says as she thinks about what it will be like to get to 10. She is strapped onto the fetal monitor and an IV is started "just in case." In case of what? is the lingering question in her mind. Now, left alone with her partner in a brightly lit room, surrounded by equipment that implies that birth is dangerous, unable to move around freely, now is where labor gets painful.

What has happened is that her body has dumped adrenaline into her system. Adrenaline sounds at first like it might be a good hormone for labor but the opposite is true. Adrenaline intensifies feelings of pain. Physically, when adrenaline is released it tells the body that this is not a safe place to let the baby out. The horizontal muscles around the cervix contract instead of relax so the vertical muscles press ever harder onto a cervix that refuses to open. The body begins to use the baby's head as a sort of battering ram to try to pry the cervix open. Ouch for both parties! The woman's body goes into preservation mode and much of the oxygenated blood is shunted away from the uterus to all of the vital organs in the mother's body. Less oxygen means 2 things. 1.) The baby has less oxygen and is much more likely to go into distress. and 2.) The uterus has less oxygen to work therefore it hurts more and works less effectively.

Hormonally, having adrenaline coursing through the body inhibits the release of 2 hormones, oxytocin and endorphins. Oxytocin is the hormone of labor and is necessary to produce effective surges. Endorphins counteract feelings of pain and help women cope with labor effectively. Basically her body has been given the message that it is not safe to birth here. Back when we lived in the wild, this response was incredibly necessary because a woman might need to stop labor in the presence of a predator. In this modern birth situation, one of 2 things will happen. If her body feels she is past the point of no return, the baby will be born quickly but not without a lot of pain and a feeling of loss of control by the mother. She will birth without the benefit of her body's feel good morphine-like drug, endorphins. The most likely situation that will arise though is that oxytocin is inhibited and labor ceases. It will begin again when she feels calm and safe again. My record for this happening was 5 times over a 5 day period. Every day the woman would labor at home beautifully only to have labor stop when she arrived at the hospital. She would go home, labor beautifully some more until it seemed progress had been made and then return to the hospital a centimeter or so more dilated. But labor always stopped at the hospital. Finally on the 5th day of her labor she arrived at 5cm and her body took off in labor as if it had tried waiting her out as long as possible but now it made the decision to just birth the baby as quickly as possible.

Fortunately for the hospital, they don't have to wait around for women to release oxytocin. If they did we might see a lot more doulas comforting laboring women, coaxing them to relax. There's this little drug called Pitocin which is synthetic oxytocin. Sounds great right? It's *just* like what your body releases...not quite! Normally oxytocin and endorphins go hand in hand. When oxytocin is released, it amps up the surges but endorphins are released to counteract any pain sensations. But, when pitocin is given through an IV, endorphins are not released. The woman is left with ever increasing surges, stronger and closer together than her body would ever give them to her, and she has none of her natural pain-killers on board.

Now you see why birth is portrayed as the "I HATE YOU! YOU DID THIS TO ME!! GIVE ME DRUGS NOOOWWWW!" fiasco that the media so loves. How many of you have even lived it? I hear these stories all the time and when I used to do hospital births, it was how I saw birth most of the time. Now let's look at the other calmer, gentler way that Mother Nature intends for birth.

Let's take the same woman who has grown up hearing scary birth stories. But somehow in there some where she decides that homebirth is for her. Maybe she heard just one homebirth story or read just one thing about it but she knows it is how she wants to birth. Throughout pregnancy she sees her midwife for at least an hour every prenatal and is able to discuss her hopes and fears. Her fears are neither discarded and shunned nor nurtured and given fuel. They are discussed, information is given, and plans are made. Every appointment the woman hears about another woman who had a triumphant birth. Information is given about every test and procedure. Her and her partner discuss and decide upon each test, procedure, and treatment. The decisions are theirs alone and they are respected. She and her partner take a childbirth class, read,  watch videos, and learn together how to be calm and relaxed when the big day comes. When labor arrives, they tune into each other. They keep the lights dim, they cuddle and sway, her partner whispers words of encouragement. The surges are each stronger than the last and labor progresses quickly but they are never stronger than the mom can handle. The midwife arrives quietly and integrates herself respectfully into the woman's birth space. After looking deeply into her midwife's eyes for reassurance, the woman feels that all is well (because it is!). Soon she feels her body change rhythms and powerfully turn to pushing her baby out. It is strong and powerful but the woman feels that she is too. She births her baby gently, quickly, efficiently and the biggest flood of hormones in her entire life begins.

Physically what happen when a woman feels safe and secure during labor is the uterus floods with oxygen. The baby is supplied with plentiful oxygen-rich blood and the uterus is able to work effectively with minimal effort. The horizontal muscles around the cervix relax perfectly so the vertical muscles merely need to gather the uterus upwards to gently open the cervix. When this happens, labor need not be painful at all. In fact, you'd be surprised how many women tell me that it wasn't painful at all, hard work but not painful.

Hormonally, the two buddies oxytocin and endorphins walk hand in hand, each feeding off the other. More oxytocin = more endorphins = more oxytocin = more endorphins. Can you imagine a birth in which a woman coped better and better as labor progressed? I see it all the time. Most notably I had this homebirth client who was a first time mama. She was really needy and whiny in the beginning of labor. "Oh my back! It hurts so much" etc. I started to worry about how she would cope as labor progressed. Much to my surprise, the woman who needed constant reassurance during early labor had progressed into a stronger and stronger woman as her labor progressed. By the time she was pushing, she was completely silent and within herself. Most first time mamas look for reassurance when their body starts pushing but not her! I knew she had been pushing the past few surges but imagine my surprise when she suddenly said out of the silence "He's out. The baby's out." and she calmly reached in the water and brought her baby to the surface. Afterwards she said the beginning was hard but after that it felt like she was "on a high" and like she "could do anything." She said she felt completely in tune, instinctive, yet in control. This is what Mother Nature intended! 

Mother Nature's next secret is the true secret to ecstatic birthing. When mom has birthed this way and remains for the most part undisturbed postpartum AND she has her baby with her at all times, her body begins the biggest hormone dump of her life. She is flooded, literally flooded with oxytocin. Here's something I didn't mention before: Oxytocin, while being the hormone of labor, is mostly the hormone of LOVE. Think back to a time you fell in love. What did you feel in your body? That was oxytocin! It is also the hormone of bonding and guess what? It is the hormone is orgasm! That's right, your body releases oxytocin to bring on orgasm. So now, a few minutes postpartum, the woman's body is flooded with this lovey-dovey hormone. Suddenly, and it is quite sudden sometimes, the mom is gushing about her baby, exploring every inch of him. "I love him SO MUCH!" she says over and over. And thus she and her baby are bonded for life, her milk comes in sooner, she feels that all is well in the world. In short, she is ECSTATIC!