Losing our intuition...

I have noticed a trend lately and it isn't a good one. It is one that masquerades as a beneficial and supportive. It appears to be the fruits of better access to information and support. However, it also breeds guilt, confusion, and worst of all: the loss of intuition.

New mothers are sitting ducks for "helpful" advice. Well-meaning friends, family, strangers, and professionals spew advice freely without any concept of how much the mother has already digested that day, let alone that week. These mothers are exhausted, worried, and confused. They digest all this information and even search for more. They post to groups online, they search for research, they read blogs, they very quickly become over saturated.

I am not one to always reminisce about the "good old days", but I have been helping women long enough to remember when having major breastfeeding issues was a rare event. I can't help but wonder if we are just retaining moms who would have given up earlier, or if we are creating problems in situations where women would have just "muddled through" and been fine. I want to be happy that we have so much help accessible for women, but I wonder if professionals are causing life for new mothers to be overcomplicated. I also wonder if professionals are just not taking into account how many other "professionals" may be involved in the care of this woman, not to mention how many friends, strangers, and websites that she may be consulting with to further confuse the issue. Soon, we find that this woman who is more dedicated than average, is no longer accessing commonsense or intuition, she is just following directions to the detriment of herself and her baby.

I don't have an answer. I do have a suggestion. When you are pregnant, and especially when you are postpartum, pick one source of information and remain in touch with your intuition. I often tell women, "pick the source of advice that best resonates with you and that will best fit the needs of you, your baby, and your family. Follow that advice, listen to your own gut, and then, after that, if you need more help, coordinate with both advisers to avoid confusion.

Mothers need to feel like they are the expert on their own baby. Providers should be careful to assist mothers and support them in feeling like they are, in fact, an expert and avoid creating a sense of dependence. Friends and strangers should remember that they do not have the complete picture when they open their mouths to give well meaning advice that may cause more confusion.

The longer I do this work, the less I say. This is not because I care any less. It is because I have realized that what I say means less than helping a mother find her own way.

The Legacy of Birth

It was a normal prenatal visit late in pregnancy. It was that time in pregnancy when we talk about where she 'is' emotionally, in preparation for her upcoming birth. This particular client is pregnant with her second child. We have talked about her history before, but I know that as pregnancy progresses, so does our perception of a number of things. Her last birth did not go as she had hoped. In light of this, I wanted to explore her feelings and emotions with her to see if there were any areas that we can be aware of as we approach the end. We discuss her vision for her upcoming birth and she states that she hopes that she will be able to deliver her baby outside of the hospital, but fears that she will have to transfer. I am incredulous; before me sits a young, healthy woman having a normal pregnancy. She is strong and intelligent. She has taken care of herself all the way through her pregnancy. She has done everything “right”. Yet, she is riddled with anxiety over being prevented from giving birth without the need for intervention. Why? After further discussion, it comes to light that she has a family birth 'legacy', a legacy that has affected her mother and sisters.

A lot of us have birth legacies. We hear that, “None of the Smith women can have vaginal births because we have tiny pelvises”, or that, “Just like my mother, my water never breaks on its own”, and many, many other myriad of legacies that never cease to puzzle and amaze me, as a midwife. Sure, there are times when family history plays a very important role in prenatal care. There might be an indication for further testing for genetic conditions, or rare physical defects, but almost never will we need to give up any hope of a normal birth because our mother, aunt, cousin, sister, and so on did not have one.

What struck me the most about this conversation was that though these legacies are most often presented without any credible scientific evidence, they are powerful enough to strike terror in the heart of a woman who is otherwise rational and intelligent and who did all her research prior to to choosing a midwife for out of hospital birth. Despite the lack of evidence to support them, she embraces the unfounded theory readily. In my opinion, this is because pregnancy and motherhood makes us vulnerable. In every other aspect of our lives we might be in charge and in control, but in this, we are vulnerable. We think we know what to do. We find a provider that we trust to help us in pregnancy. We eat right, we exercise, and we take classes.  However, we don’t know exactly how to negate negative messages, or to find strength in what all seems like theory. We don’t know have to have faith in our bodies because we don’t know what that means and we don’t know what to do with the legacies.

I was told that I wasn’t athletic from a very, very young age. Why?  My mother wasn’t athletic and her mother before her, and her mother before her. At some point, it all stopped being individual and became a legacy. This legacy was so strong that believe it caused me to be clumsy and awkward while attempting sports. I loved being outside, I loved to play. Yet, there I was; one of the kids who was chosen last for the team. It wasn't until later in life when I started challenging the theories, of my own personal legacy, that I decided to give athleticism a try. I found out that, though I would never make it to the Olympics, I was ‘pretty okay’ while performing a lot of activities. In fact, I can’t imagine life without being active anymore. I am sorry that I didn’t take advantage of my youth to enjoy sports. I have learned that in reality, I didn’t lack athletic ability as much as I lacked confidence. It is much the same in birth. I see women who have done everything right; yet, they believe that they failed on some level because they didn’t do it the way they expected to (even though they might have had unrealistic expectations). I see women who never really try to have a normal birth because they expect to fail. I see women who want so badly to have normal, but feel that they are ill equipped because of legacy.

So, what is the answer? How does one sort through powerful negative messages? I asked my client this question and I thought her answer was profound. She said, (and I paraphrase) “We have to first recognize that they are negative messages." This is the absolute truth. Seeing something for what it is truly makes it lose its power over us. When we look at a negative legacy up and down and call it out for being just that: a negative legacy, it no longer has a claim on us. We realize that our story is our story. Birth does not have to be predestined any more than athletic ability. Some of us are rare and wonderful in our ability to overcome. Some of us are gems who will surprise everyone. Some of us no longer believe in the lies that women have been told for centuries about our bodies.  

Let me tell you what I have learned about birth: Waters will break when they are good and ready to (maybe not until after the baby is born). Babies will come when they are good and ready to. Women who are tiny will give birth easily to big babies. You will have all the tools you need to give birth to your baby.

I speak in strongly because this truth is more probable than improbable. This is my challenge to you: start a new legacy. Start a legacy in which your daughters and granddaughters will never question their body’s ability to give birth. Start a legacy in which they will never question their body’s ability to signal the need for intervention. Start a legacy where we, as women, believe that each woman, baby, labor, etc. is individual. These are the birth legacies we need and with them we can gradually replace all the many ways that we have been lied to about the strength and ability of our bodies. This will never mean that every birth will go as we hope, but it will definitely mean that each pregancy brings with it opportunity rather than limitation. I am so hopeful, that I write this before I know the end of my client's story. I believe in her body. I believe that she has the tools that she needs to have the ending that she wants. I also believe that if it does not go as planned that it will not be because of her negative legacy, it will be the example of the perfect way that our bodies signal their need for assistance and that in the very intelligent and wonderful way that she knew to surround herself with people who would listen and believe in those signals and would act accordingly. The truth is that we need to make our legacies be the gift that the true definition of the word requires. Gifts should never be negative. Legacies should be strong and empowering. Choose to give birth in a way that honors your predecessors, but defines your own legacy. You and your baby deserve to have your own story and I can't wait to hear it. 

A very personal poem

Mother

A decade ago I sat outside

I looked for beauty

I would find enough to justify little gifts from God

Hummingbirds who took the bait

Blue jays who played in the trees

 The place that I created; a little spot to hide the rest

Big enough that if you set your gaze just right

You could only see beautiful

Sometimes I sat and did nothing but find the beautiful

I would become filled with wonder

 That the woodpecker joined me for coffee

That the eagle circled overhead

I pretended that there wasn’t any darkness inside that door

Sometimes I was inspired enough to write things that nobody would read

To sing even when I was told to be quiet

I laughed and danced and loved

Sometimes, if I were really lucky, they joined me

I hugged and kissed them all

I wondered if they would ever know

How big my heart grew when I looked at them

How lucky I felt to have them

Its how I was able to go on

I was given these little gifts from God

Signs that it was all okay

Now, in the courtyard

There are only things that I have placed there

The little deer that belonged to grandma

The wind chime I bought as a token of freedom

I haven’t charmed the hummingbirds just yet

But, there is peace here

There is never a need to escape from what is inside the door

There is never a need to play the game of finding gifts from God

Now, when I am inspired I sing, write, or dance

I have no critics

They still lack an understanding of the way my heart grows when I look at them

They are not all here for me to hug and kiss

My heart aches for more, but rests in the knowledge that they have better now

There is no veil over the truth

Someday, if I am really lucky, they will all join me

And we will see the beautiful

It's not about us...

Even the most humble of birth servant will have a time when they feel that they "saved" a mom or baby or both in the course of a birth. This feeling may be more truth than fiction. The wise eye of experience or intuition may catch on to the red flags and spur appropriate action that changes the course of the event from tragedy to triumph. This is why we have midwives, right? To safeguard the birth and save lives, right? Wrong.

The truth is that we are simply there. Our passion for our work, our study, our innate and learned abilities are not the key. The key is that the mother-baby unit will nearly always reveal that attention is needed to those who pay attention. We should be marveling more over this wonder than praising those who preside over the birth in the role of professional. In this knowledge, we should be able to step back even more. To allow the birth process to unfold without unnecessary interruption and to feel that we are needed more to protect the physiological process than to manage it.

The bigger job of the midwife is to assist the mother during pregnancy in believing that her body is capable of wonders beyond her imagination. To prevent her from being mired down in details. To support her in tuning into the the spiritual and biological magic that is developing within her. Her body has the tools it needs to make this safe and functional. The real trick is to teach her how to get out of her own way and to embrace the mystery of it after she accepts the science.

The pitfall in birthwork is that our culture is so far from supporting mothers in that journey that we are tempted to create cookie cutter solutions to a problem that stems from our own births. Can we believe in something that we ourselves have never experienced? Can we promise something that can be nearly impossible to comprehend?

We not only can, we must. Our survival depends on it, as dramatic as that sounds. We need humans running around this planet who were marinated in Oxytocin. We need mothering that stems out of ecstatic birth. This is not to say that the births that go awry are tragic because we are blessed to live in an age where we can actually prevent tragedy in birth and we should. It is that we should not go around preventing tragedy when nothing was wrong. We should not save anyone who does not need saving.

I like to imagine myself in the role of midwife as the servant. Maybe I have sharp skills and a vast knowledge of normal birth, but I would rather be outside the room because she will be better off without me, or standing nearby showing her I believe that she is fine, or laying next to her quietly to show her I am not going anywhere, or sitting at her feet amazed at what I get to witness when I do almost nothing.

The things we should never forget...

A few days ago, I caught a beautiful baby girl. It ended up being a very intimate, quiet birth with just myself, the mother, and the father present. This mother hadn't been quite sure that she was as far along as she was. She was reliving her previous birth which had been very different. She wasn't sure she could trust herself, but I trusted her. I listened to what she said which spoke volumes even in her pithy text messages. I went to her and shortly after I arrived her baby was born.

As I sit watching this mother cuddle her new baby, I think back to a birth a few years ago which took place just a block away from the house I was in now. I caught a beautiful baby girl. She was the first baby I ever caught. I was a student, I was given the chance and the trust to catch this baby. I sat in awe next to the birth tub and watched the beautiful woman labor peacefully in the early morning hours in her tiny little home. Her husband, the midwife, and her friend were all nearby. I had got a chance to know and love this lady. I was so happy to just be there and now I was catching! Her baby was born into the hands of both her husband and mine. She was beautiful and perfect. I did all that I could to give this mother the best care possible. What a good day it was.

This latest mother was so grateful that I had come when I did. Her husband was a little shaky with excitement and said he wouldn't have known to do some of the things I did. I reassured them that they would have been fine and that I believe we are always were we are supposed to be. I knew to come because I was supposed to be there. Nothing more than that. I was grateful that I was there too, not because they wouldn't have been okay without me but because I love what I do and yes, sometimes I do make a difference.

So now, I am a grown-up midwife. I pack up my bags, check mom and baby one last time. Hug and kiss everyone good-bye and drive home slowing down a little as I pass the little house where I first learned to trust women and in return was allowed to hold in my hands what is most precious to them.

One night...

She sat down at the hotel bar between two tired businessmen. This wasn't something she normally did, but she figured she should celebrate her achievement. She had wanted this all her life and had worked solidly for three years to make it happen. She ordered a martini and began to have polite conversation with the men.

As the evening went on, she began to converse more with the man to her left. They discussed career, children, marriage. He shared with her how the course of his life had went. She shared with him hers. There was not a hint of flirting between the two of them. After the second martini, she shared some of the struggles she was having in her personal life. He listened intently and asked questions. He predicted that within a year she would know what direction to go in. She didn't know what to think about that. To her, there seemed no answer.

After the effects of the third martini began to hit her, she excused herself and went to her room. She laid on the bed and thought about the conversation with the man. She couldn't remember the last time a man had listened to her with interest even though she had been married for many years. She began to sob. She felt consumed with loneliness. She cried herself to sleep.

The next morning she got on a plane and went home. She thought about her reaction to the man. Though she felt sad, she put it aside. She worked hard in the next several months to grow her business and it constantly amazed her that her dream had become a reality. Still, she dreaded going home. If it were not for her children she wouldn't have.

Some 20 months later she was painting her office while singing along with her favorite music. She was thinking back on the past couple of years and all that had happened. She remembered that night in the hotel and what the man had said. She was stunned to realize that she had made the decision to leave that unhappy marriage almost exactly to the day a year later. Her life had changed tremendously. Some struggles still remained. There were remnants of the abuse that she had suffered left. However, she was deeply happy that she had gathered the last bits of self-preservation left in her to move on. She had realized that no matter how uncertain she had been that night that within her there was a woman who was strong enough to face whatever challenges were ahead in order to have what she deserved.

Silently, she thanked the man.

I never wear Birkenstocks..Confessions of an uncrunchy midwife

I have never worn a pair of Birkenstocks. I am not attracted to them and I know that they wouldn't fit my long, narrow feet very well. I think this is surprising to folks who meet me for the first time expecting a super crunchy hippie to be welcoming them to her office (People also expect to see a very old woman because my name is Bettie-I am often a source of confusion). I am not a hippie at all, well maybe I am by the true definition of the word but I don't own anything that is tye-dyed. I don't even think I know how to spell tye-dye (tie?). Anyhow, I am just me.

This, at times, is an advantage to me as a business woman. Many women are considering out of hospital birth who are not crunchy at all. They do not fit the stigma of the homebirthing mother. They meet me and breathe a sigh of relief because they can relate to me. Other times, I admit that I feel like a fraud. What would my clients think if they knew that I keep Capri Suns and GoGurts stocked in my fridge when they are dutifully drinking Kombucha for its probiotic value? I drink Kombucha, by the way but my panty is full of inconsistencies.  I would rather drink a beer than wheatgrass. I like to shave my legs and armpits. I dye my hair and wear make-up and get pedicures. This is all sorta disappointing for the crunchy crowd, but they usually get over it. I can usually speak their language. I get where they are coming from and why. I respect it immensely.

There was a time when I could have been considered a midget crunchy. I used to cloth diaper my babies, grind my own wheat, baked all of our bread, make everything from scratch. I grew a garden and hung my clothes on a clothesline. Then, a series of illness and difficult pregnancies put an abrupt stop to all that and my days of pseudo-crunchiness were over. The kids ate Little Debbie snacks instead of homemade cookies sweetened with sucanat. I try not to think about what the health drawbacks are to that. I simply can not afford to purchase pre-made foods which are healthy and I don't have the time or energy to do all that anymore. I learned that making a wholesome dinner on the evenings I can and providing fresh fruits and veggies are probably good enough. Good enough is good enough sometimes.

Homebirth is not about being crunchy, it is about what makes sense and what works. Homebirth was a natural occurrence for all women until the last 75 years or so when women began to be convinced that being somewhere else was safer. Queens had their babies at home, perhaps they were better attended than their peasant counterparts, but probably not. They were fussed over to the point that they were unable to give birth in a natural way at all. Still, they were home. Regular housewives who never heard of a hippy had homebirths. I still meet old ladies who were born at home, it was just the way. Why do we suddenly believe that the only women who give birth at home are selfish hippies who want a "birth experience" rather than just women who sense that everything would work better if they were left alone to let their body and their baby guide the way? Homebirth works because women are comfortable and are able to allow their hormones to guide the labor process in a way that is usually impossible in a hospital setting. This interference is a risk factor any way you slice it. Of course there are benefits to having an OR nearby, but really for the 90% of women who wont need that OR it is probably not worth that interference. Only 1-2% of all complications would require an OR fast enough to make a homebirth risky. Why are we placing so much fear in women over their choice of location to birth when those risks are so low?

I have never been a hospital hater. I gladly send my clients to be evaluated by physicians. I try to never forget what I don't know. I know that I am well versed in the ways of normal birth; not high-risk birth. I am vigilant about looking for cues that a mother and baby need help beyond my expertise. In fact, sometimes I have sent ladies in who probably could have skipped that extra visit, but I would rather not take a chance. Homebirth Midwifery is not about taking chances in my book. It is about allowing pregnancy and birth to unfold the way it should and knowing that if you are careful not to become complacent you will see the red flags to alert you that medical attention is required. This is why I do all the routine lab work and monitoring prenatally. I would rather ruin a mother's dream of a beautiful homebirth than take the chance that she will regret her decision to have that homebirth against the odds. It isn't worth it. Birth can absolutely be risky at times, but I firmly believe that most women will not need medical intervention. Most women will give birth at home without incident. This is my experience and the experience of my sister midwives.

Let's remove the labels and consider homebirth as something that works and is normal. Let's not fight about it. If people are freaked out about having their baby at home and want an epidural, then let them. It isn't a competition and we are not required to police the choices that other adults make which have nothing to do with us. Instead, just quietly go about the business of having your baby in the way that works and makes sense to you. It will rub off on others without you needing to do a thing. Find yourself a midwife whose philosophy makes sense to you and in whose wisdom you trust...no matter if she is wearing a long tie-dye skirt and Birks or stilettos. Trust your body and your instincts. Let go of the perfect birth and do what works.

I may not be crunchy, but I do marvel at the beauty of birth and the women and babies who I take care of. I am amazed time and time again at how well the process works. I trust in it because I have also seen that when it isn't working we will know if we are humble enough to pay attention. I am blessed to be in this profession. Sorry about the Birkenstocks, I just like flip-flops better.