Language and Birth

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Words matter. They settle deep in the psyche and impact our emotions, our beliefs – our overall outlook on things. This is never truer than with pregnancy and childbirth. All pregnant women, but especially a woman pregnant with her first child, is in new and unchartered space, and the people who surround her and the things they say impact her labor and first experiences as a mother.

Mind your words around a pregnant woman, and especially around a woman in labor.

Anthropologists and communication scholars write about two different paradigms of birth. Robbie Davis Floyd, Texas anthropologist and author, writes and lectures about the “technocratic” and “ecology” models of birth, arguing that there is freedom and space in the ecology model, but that in the technocratic model, the woman’s body is seen a machine and the baby as the product. Other researchers write about the “obstetrical” model, which includes the surgical training of obstetricians, versus the “midwifery” model, which includes the midwifery model of care and the importance of continuous support for the laboring woman. In each model you see a different lexicon of words.

For instance, who actually “delivers” the baby? It’s more common in the obstetrical/technocratic model to hear that the physician delivers the baby. But, the original use of the Middle English verb to deliver was passive. The Oxford Dictionaries site points out that “a woman was delivered of a child. When active use first arose, the midwife or doctor was the agent, and the woman the object: ‘they sent, and beg’d I would deliver her’ [1676].” In the beginning, deliver referred to the woman’s experience, whether liberation or rescue from the labor, or the woman freed from the burden of pregnancy. Next it moved to the active form that focused upon the woman’s agency in her birth experience, and today it has moved the main action to the attendant. “Dr. X delivered my baby.”

At the core, within the midwifery model, pregnancy is viewed as a natural life event for childbearing women. And out of that belief, words such as power, trust, love, empowerment, choice, and energy are often used to describe pregnancy and birth. There might be references to the power of nature/ birth or the power of the mother’s abilities in labor. Doulas and midwives use words such “rushes” or “waves” or “surges” to refer to a woman’s contractions, words that conjure up the image of a powerful ocean crashing against the seaside or strong electrical currents. And the midwife serves as facilitator, not director, in the mother’s natural life event.

By contrast, within the obstetrical model, pregnancy is viewed in terms of norms, with the male body as normal. Floyd takes this idea further by saying the woman’s body is seen as machine, the baby as product, and that pregnancy is something to be controlled: the doctor or midwife “deliver” the product through their control over the process with words like induce, intervene, and medicate. If the norm is to not be pregnant, then the labor needs to be actively managed. The action is focused not on the woman who is in labor, but on the staff who perform the management.

Somewhere in between is the reality of birth, right? There are times when a labor or pregnancy can move outside the norm of regular birth. While the woman’s body is designed for giving birth, labor can get complicated. In that case, the obstetrical model, with its emphasis on management and intervention and the provider in action, is a necessary model. But, given that approximately 90% or more (some researchers believe the more accurate number to be 95%) of women can give birth, can deliver their babies without intervention, why are obstetrical/technocratic words so commonly used? And why does it matter?

Women in labor are highly sensitive and intuitive. For example, if a woman is in active labor, moving quickly through the stages, and arrives at the hospital only to hear a nurse tell her that she won’t be giving birth until the next morning, guess what? The labor slows and the baby is born in the morning. If a soon-to-be-grandmother is anxious about the birth and present in the delivery room, the slightest slip of the tongue can have a negative impact on the laboring woman. If she says, “All the women in our family have cesareans, you’re no different,” the labor will be harder, the woman will have to fight against the negativity, and if not adequately prepared or supported, she might end up with a cesarean that may or may not have been needed if the words that surrounded her were positive and affirming. If a nurse tells a mother who is ready to push that the doctor needs to arrive to deliver the baby, the mother may lose her sense of agency over the delivery and the contractions may slow or the pushing become difficult.

The power of suggestion takes on a heightened meaning during birth.

In an article on the Birth International site, Abby Sutcliffe writes:

During labour, women are particularly alert to what is being said by caregivers. Even though she may look as though she is lost is concentration during contractions, the labouring woman will hear, often acutely, what is being said around her. She looks to the midwife for confirmation that she is doing well, particularly with handling the pain. A few well-chosen words of encouragement and support can be far more effective than [medication] in achieving relaxation and confidence in the labouring woman. The midwife at a birth has great influence on the woman’s reactions and impressions, so be careful not to introduce your own feelings and biases into the room. This woman is not a “poor thing” who won’t cope without you — she is a strong, innately capable woman uniquely designed for giving birth easily, safely and enjoyably. If you truly believe this then you won’t need to watch your language, you will already be consciously feeding this information back to through your language and responses.

Birth is a highly personal experience. Each laboring woman brings into the birthing room a personal story that includes the past birth experiences of the women in her family, her own hopes and fears, and any other past experiences that impact the natural process of birth, such as past sexual trauma or body image issues. Birth is a natural life event, a part of a women’s greater sexuality and biology. The words that she hears can help or heed her progress; it’s up to the people who surround her to make it the most positive and successful experience possible. Care providers: pay attention to the words you use around a pregnant or laboring woman. Family members and support team: think before speaking—everyone in the labor room should examine their own biases and experiences, their own fears, or even trauma that may not have been dealt with in the past. For the laboring woman, words really do matter.

Pregnant women deserve to feel supported and respected – empowered – to deliver her baby. No matter the final outcome—whether natural, or a birth with medication or a cesarean section—positive language in the birthing room puts the woman at the center of the action, so that she is in the best position to successfully deliver her baby.

 

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How to Get Healthy and Stay Healthy During Pregnancy

 

maternity-pictures-1_carmenhibbinsEach woman arrives at a new pregnancy from a different starting point. One woman may have planned for months to get pregnant, taking vitamins, eating healthy, and exercising. Another might be classified as medically obese and is worried about how that will affect her pregnancy—should she lose weight or focus only on eating healthy? While yet another may have, not intending or wanting a pregnancy at the time, been drinking heavily or using illicit drugs. Of course, most women are somewhere in the middle. Ultimately it’s most important that a woman work at getting as healthy as possible, so that she and the baby have the best outcomes.

So how does a woman who is already pregnant get healthy and stay healthy? And what are the risks if she isn’t healthy?

Lets look at the central tenets of a healthy pregnancy:

Good nutrition

Eating right helps to build a strong and healthy baby, and it helps the pregnant mom as well. A healthy diet can help to prevent high blood pressure, preeclampsia, gestational diabetes, and premature labor. A healthy diet can help to ensure against the baby growing too big, which could lead to a difficult birth.

Earlier this past year, we outlined a healthy diet for pregnancy. Be sure to eat plenty of protein and whole grains, and focus on color and variety in your fruits and vegetables during pregnancy. Good sources of protein include meats (limit seafood because of the high mercury content in many sources of seafood), dairy, eggs, nuts, beans, and seeds. And the less processed and milled the grains, the better. Drink plenty of water and salt to taste. Eat small, nutritious meals often. And, most of all, limit sweets and high-sugar-content food and drink.

A good prenatal vitamin is important for a healthy pregnancy as well. Prenatal vitamins are specially formulated for a pregnant woman’s needs. In particular, the pregnant woman needs at least 400 mcg of folate (higher if a BMI over 30) and Vitamin D. Folate in the first trimester helps the baby’s developing nervous system and strengthens the mom’s immune system. Vitamin D also helps with the mom’s immune system and helps the baby to develop strong bones and teeth before and after the birth. Vitamin D can be continued postpartum and can help to decrease the risk of postpartum blues.

What if a woman has a high BMI when she finds out she’s pregnant? There is no evidence that dieting to lose weight is good for mom or baby. In that case, she should focus on the healthy pregnancy diet, balancing the pregnancy needs for quality protein, whole grains, and plenty of fruit and vegetables. Many women who struggle with weight before pregnancy discover that eating healthy for the pregnancy helps them to maintain a healthier weight during and after the pregnancy. Most moms-to-be who have a higher BMI at the start of pregnancy can expect to enjoy a healthy pregnancy.

Exercise

Exercise helps the pregnant woman prepare for birth by strengthening and toning her body. It can also help to manage weight, and, combined with a healthy diet, can lower the risk of giving birth to a large baby. The adage is that if a woman already has a regular exercise practice, she can continue the practice. But, if the mom is new to exercise, low-impact exercise with a gradual endurance plan is just as beneficial.

The shift in the woman’s center of gravity and increase in joint laxity can make exercise more challenging. Water sports, such as swimming or low-impact water aerobics, can help support the pregnant woman’s body. Mild exercise in general can help the woman meet the greater oxygen demand that pregnancy creates. However, too aerobic of an activity can decrease her oxygen consumption and lower her overall oxygen volume. Ultimately, exercise can make pregnancy more comfortable and shorten the woman’s labor, and even reduce the need for interventions.

Exercise can also:

  • Reduce back aches
  • Reduce constipation, bloating, and swelling
  • Boost energy levels
  • Help with mood
  • Help with sleep
  • Prevent excess weight gain
  • Promote strength and endurance, which in turn helps the mother in childbirth

If the pregnant woman hasn’t exercised in awhile, but would like to add an exercise routine during pregnancy, she should start slowly, beginning with five minutes and building her endurance by five minute increments until she reaches a thirty minute practice.

What exercise should be avoided during pregnancy? Some forms of exercise are not advisable, such as:

  • Exercise that forces you to lie flat on your back after the 1st trimester
  • Scuba diving, which puts the baby at risk of decompression sickness
  • Water skiing, surfing, and diving, which cause you to hit water with a great deal of force
  • Contact sports such as ice hockey, basketball, volleyball, or soccer
  • High altitude exercise (less oxygen for you and the baby—and risk of altitude sickness, which causes headache and nausea)
  • Any activity that could cause direct trauma to the abdomen, like kickboxing
  • Hot Yoga or Pilates
  • Sports with a high risk of falling, such as downhill skiing, gymnastics, or horseback riding at fast speeds

A regular exercise practice during pregnancy can lead to an exercise practice postpartum, which can help the new mom shed weight and regain muscle tone and strength for her non-pregnant body. Exercise should be avoided for the first month while the woman establishes breastfeeding and recovers from the birth.

Education

In addition to prenatal counseling with a maternity care provider, there are several ways a pregnant woman can educate herself about pregnancy and childbirth:

Childbirth education (CE) classes

CE classes can help the pregnant woman stay focused on pregnancy-specific issues, such as nutrition, lifestyle practices, and preparation for childbirth. Some options for childbirth education classes include: Hypnobirthing, Birthing From Within, Bradley, Lamaze, Birthworks, Centering Pregnancy, Sacred Pregnancy, and others. Local doulas and midwives often have extensive lists of local childbirth education providers, and some midwives offer childbirth classes at birth centers and in their communities.

Books

Books are a powerful way for the pregnant woman to prepare for birth and to learn coping mechanisms for the changing nature of pregnancy. Some favorites include: Spiritual Midwifery, Ina May’s Guide to Childbirth, Diary of a Midwife, Birth Without Violence, Birth with Confidence, and Homebirth Cesarean. There are also literary memoirs about pregnancy and birth, and pregnancy loss that can be powerful and impactful narratives, depending on a mother’s perspective and needs.

Documentaries

Documentaries about pregnancy and childbirth often include interviews with experts, snapshots of individual women’s labors, and commentary on an overall maternity care system. Documentaries, if appropriate, can help children understand an upcoming birth and help pregnant women (and couples) make decisions about what they most want from the birth experience. Some of the better documentaries include The Business of Being Born, Orgasmic Birth, The Face of Birth, Birth Into Being: The Russian Waterbirth Experience, and Pregnant in America. Check out this TED talk by Ina May Gaskin, the international childbirth luminary midwife.

Support

Rhea Dempsey writes about the “circles of influence” that surround the pregnant woman—from friends and family to the wider culture. These circles ultimately impact the woman’s pregnancy and birth experiences.

The people with whom the pregnant woman surrounds herself make a big difference in how healthy, physically and emotionally, the woman will be during pregnancy. The following are important questions to ask:

  • Is the pregnant woman’s home a safe place?
  • Does she have emotional support?
  • Is she more concerned with the anxieties and fears of her mother, her sister, her husband, her friend, than her own?
  • Is the pregnant woman able to decide how and where she wants to birth based solely on her needs and wants?
  • Is her maternity care provider supportive of her wishes?
  • Can she ask questions without fear of belittlement or of her fears being minimized?
  • Does she have access to healthy food and clean water?

A healthy pregnancy hinges on physical elements such as a safe place to live, the opportunity to exercise, access to healthy food and clean water, and good prenatal care, but it also hinges on emotional health, and support is central to a pregnant woman’s emotional health. Support often means more listening than talking, and support means something different for every woman. And, ultimately, after pregnancy, the birth is most about the woman and her baby, not the people who surround her. Sometimes the best support is the most minimal support, support that allows the woman to decide how she wants to birth and who she wants to support her during the birth.

Getting healthy during pregnancy will mean something different for each woman. For instance, a woman who struggles with alcohol and drugs may need to first focus on addiction recovery. After she is clean and sober, she can move on to good prenatal care and nutrition, as well as creating a circle of support that is healthy and best for her and the baby. For a woman who doesn’t have good nutritional habits, getting healthy may mean focusing solely on nutrition and exercise. And for a woman who lives in an unsafe home, getting to safety may be the first step toward a healthy pregnancy.

Focusing on the main tenets of a healthy pregnancy will help a woman get healthy and stay healthy throughout pregnancy, with great benefits to both mother and baby.

Gratitude

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Gratitude is the fairest blossom, which springs from the soul – Henry Ward Beecher.

The old adage, “Avoid politics at family gatherings,” is particularly prescient for the 2016 Thanksgiving holiday. Some have family members who enjoy political arguments or the ability to get a rise out of those who hold different beliefs. But if this political season has taught us one thing, it’s the importance of civility, respect, and graciousness.

Don’t take the bait.

The Thanksgiving table may not be the place to convert hearts or minds. Make a choice instead to focus on the history of the holiday. At the heart of the historical day is a story of survival, friendship, and the setting aside of differences to break bread at one table. The literal history of the first Thanksgiving continues to be debated by historians, but most Americans can agree that the holiday each November is a time when we come together to remember the hardship of the early Americans settlers and the Wampanoag tribe who shared their wisdom and skills. Without the help of the indigenous peoples of America, the settlers would have starved.

Our modern tables are often filled with rich desserts, casseroles, and farmed turkeys. The settlers’ table was likely set with a lean venison and goose or fish, nuts, and stewed fruits, cornbread and squash. There wouldn’t have been flour for pies, nor sugar to sweeten desserts. I wonder—were they able to communicate? Did a settler or Native American serve as translator? Was there more silence than conversation as they sat at one table to share the harvest?

I try to imagine what it felt like to be so far from an ancestral home, hungry, hope fueling the courageous act of sailing across a giant ocean to find religious freedom and peace—what it felt like to see strangers arriving on the shores of ancestral lands. I imagine that what guided their hands as they baked cornbread over a fire, turned a wild turkey on a spit, or buried squash in the embers, was thankfulness. Their stomachs would be full that day; their children would not be hungry. Because of the friendships forged across language and cultural barriers, they spooned gratitude along with the stewed apples and chestnuts. It was a delicate thing, this gratitude – something that sprouted from new experiences, vulnerability, and interdependence. I would imagine there was even fear sitting between the indigenous people and the new settlers. But break bread they did.

This year, when the country is feeling more divided than ever, it’s imperative to strip Thanksgiving dinner down to its barest, naked element. To remember the simplicity of that first Thanksgiving meal. Navigating a political discussion may mean simply stepping away from the lure of a heated discussion, setting aside personal fears or judgment in order to focus instead on the central tenet of the holiday: thankfulness. Consider these wise words from Dalai Lama XIV:

Every day, think as you wake up, today I am fortunate to be alive, I have a precious human life, I am not going to waste it. I am going to use all my energies to develop myself, to expand my heart out to others; to achieve enlightenment for the benefit of all beings. I am going to have kind thoughts towards others, I am not going to get angry or think badly about others. I am going to benefit others as much as I can.

Focus instead on the new recipients of the Presidential Medal of Freedom. On the inspirational words of Michele Obama, “…Our motto is, when they go low, we go high.” Focus instead on the food that fills the table. On the plump, roasted turkey; on the warm cornbread or rolls; on the ease with which so many are now able to fill the table. Remember the gratitude the settlers served with stewed apples and roasted chestnuts. Each time you pass a dish or offer a serving of food to a relative, focus on the Latin root of the word gratitude, gratus, pleasing or thankful. Set aside worries and tensions, and steer conversation to topics that expand the heart and bring your family together. Remember the interconnectedness of the people who didn’t share a common language, but broke bread together. Because sometimes, breaking bread is the most important thing we can do.

Official 1864 proclamation by President Abraham Lincoln

7 Tips For Telling Your Family You’re Planning a Home Birth (and what to do if they’re not happy about it)

“You’re going to do what? A home birth? What, are you crazy??? Oh…my…what…the…are you CRAZY???”

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Yeah, I think that was the response when I first told my family I was going to have a home birth. Me, the home birth midwife. Yep, I had to break the news to my parents, too. Of course, I wasn’t a home birth midwife then. At the time, I was a stay-at-home mom who had already had 3 hospital births. They thought I’d pretty much lost it. First it was the breastfeeding and the cloth diapers. Then it was becoming a La Leche League Leader. Then it was the babywearing. But this? This??? They just couldn’t wrap their minds around this. How could their college educated daughter, the one who could afford “real” medical care, the one who demanded an epidural for her last baby (yes, that woman)… how could she take such a huge left turn and do something as “backwards” and “reckless” as give birth at home? She’s probably going to eat her placenta, too. (Umm, no, not then, but I would now!)

To be fair, I probably had similar thoughts when I was pregnant with my first baby and knew nothing about midwives and home birth. I had all of the usual misconceptions and stereotypes in my head that most people have. I had no idea that midwives really knew their stuff, and that it was generally the more educated women who made the choice to give birth at home with midwives. If I had known then what I know now, I would have given birth to all of my children at home.

This conversation with friends and family about our choice to give birth at home is a hard one. Sure, we can throw back our shoulders, put our hands on our hips, and defiantly state “If you don’t like it, tough. It’s my baby, my body and my choice.” It’s absolutely fair, truthful, and within your rights to say that. With the exception of a few Internet trolls and others who don’t know how to keep their noses out of your business, most people who feel like it’s their place to state their opinion about your choice are people you probably love. They’re your family and friends, and they’re people you’d like to be able to have in your life long after your baby is born. They’re people you probably want to have at your Thanksgiving table for many years to come. With that in mind, a little more tact and empathy is in order. Even though where and with whom you give birth isn’t anyone’s business but yours, your family’s concern generally comes from a place of love and concern for your safety. Know that their hearts are in the right place, even if their words are not. Here are some ideas that will hopefully help you as you work through the conversation with your family and friends.

  1. To thine own self be true. Know your reasons for choosing a home birth. People will ask you why, and it’s good to be able to articulate your reasons clearly and confidently. If you can’t communicate your reasons, it will be taken as a sign of uncertainty about your decision, and people who are very strongly opposed to your choice will see that as an opportunity to criticize your plan.
  2. There’s a lot of birth trauma out there. When you talk about having a home birth, you’re going to hear ALL of the horror stories. “_______ almost died because of ______. Good thing she was in a hospital.” Of course, a lot of those horror stories were caused by interventions that only happen in a hospital, but people don’t understand that. So, what’s a good response? Acknowledge how scary that situation was. It was real and it deserves to be acknowledged. One possible response could be, “Thank goodness she had such a skilled doctor! Doctors are so important for high risk births like that! My midwife is very skilled at low risk birth and has a plan for transfer if my birth becomes high risk like ______’s birth was. Her backup doctor is great, just like Dr. _____.”
  3. Consider your audience. Understand that people will already feel judged because their choices were different than yours. Don’t add to that. For example, if your sister had all of her babies by scheduled c-section, don’t say something like “babies born by c-section don’t bond with their mothers like babies born vaginally.” Conversation over. Instead, when you know you’re going to have this discussion with someone you think will feel particularly singled out or judged, it might be good to just name the elephant in the room. She might appreciate that. Maybe starting by saying something like, “I’m not sure how to have this conversation with you. I love you and I’m really excited about this and I want to share this with you, but I worry about how this is going to make you feel.”
  4. People like what they know. Less than 1% of the babies born in this country are born at home. You can’t expect all people to easily embrace something that is so far from the norm. It may be helpful for your family to know that you will be receiving regular prenatal care, including labs and ultrasounds (if that’s your plan), from a licensed health care professional. Let them know your midwife will be monitoring you and your baby during labor, making sure you continue to be low-risk and appropriate for a home birth. Words like prenatal care, labs, ultrasounds, licensed health care professional, low-risk, and monitoring, are all words of comfort for family members to hear.
  5. If you sense hostility, back off. Hostility will cause people to dig their heels in deeper. No matter what they say, you’re not changing your plans, and no matter what you say, they’re not changing their opinion. Sounds like a no-win situation. Continuing the conversation at this point will not be productive, and will only serve to cause bad feelings on both sides. Show your good judgment by ending the discussion. “It’s clear we both feel very strongly about this. I’m done discussing this with you for now.” And then, do not discuss it any further unless you feel that person is ready to have a calm conversation. If it becomes hostile again, end it. Don’t continue to take the bait.
  6. Offer information, but don’t push it. It’s not your job to educate the world about home birth. Honestly, nobody cares. If they did, they’d see how great home birth is and more people would be born at home. People are content with the status quo, and nobody likes a zealot. Be ready with answers, talk about how great your midwife is and how much you’re enjoying your visits, maybe mention how great the outcomes are in Europe in the countries where home birth with midwives is common, but then leave it alone unless people ask you for more detail. While you may be totally amazed at how low the c-section rates are with midwives, most people unfortunately care more about what color you’re planning to paint your nursery.
  7. Some people will never come around, and that’s OK. You may find that some of the people you love will remain completely opposed to your decision. This may bother you a great deal, but there isn’t a whole lot you can do about it except just set it aside. Honestly, the proof is in the pudding. After your home birth, it will be hard to dispute that your choice was a good one for your family.