are you qualified to birth?

A fellow mum I know was given a stroller by her mother-in-law.  Her mother-in-law said "I'm going to get the most expensive stroller I can find, because that will be the best one."  The mum thought this was ridiculous (though was suitably appreciative of her lovely and free-to-her stroller).

I wonder if our consumerist approach to baby gear has extended into health care and maternity care as well.  We buy expensive strollers when many parents would happily just strap their babies to themselves with a piece of cloth.  We feel pressured to buy fancy diapers - disposable or cloth - when many parents are satisfied with simple flat or prefold diapers, or eschewing diapers altogether and using elimination communication.  The floors of many - I'd propose most - North American homes with an infant are littered with bouncy chairs, Bumbos, playards, swings with music players, infant "gyms", play mats and exersaucers.  The very brand names of many of these products encourage us to buy by implying these items will keep our baby safe, educated, entertained, and loved.

Complicated and scientific-sounding infant formulas and baby foods suggest our own milk or homemade food doesn't quite suffice, and may leave our children wanting for space-age nutrients which will grow bigger, better, smarter children.  Cribs are marketed as the safest place for an infant, while articles are published likening concientious bed-sharing families with negligent drunks and junkies who inadvertently kill their infants while high or intoxicated in bed with them.

So much time and money and thought has been put into the research and development of these products, and I truly believe that, in the beginning, it was done with the best of intentions in every case.  We have come to believe in these products so strongly, though, that I believe we have lost sight of their real purpose, and forgotten that we really are capable of surviving without most or all of them most or all of the time.  I would argue that these "parent helpers" have tricked us into believing that our own touch, our own bodies, our own instincts, our own love and attention, fall short of our children's needs.  We aren't qualified to parent.

So, too, with maternity care.  All of the technology, the medical procedures, the instruments and tests, have become so ubiquitous that we believe they are necessary for a successful pregnancy and delivery.  We believe prenatal care is essential to having a healthy baby, when in fact it is a symptom of an environment in which the mother is most likely healthy.  A woman who is able to receive prenatal care generally has sufficient access to clean water, nutritious food, housing,  and is adequately informed to know how to care for her pregnancy.  Listening to a baby's heart tones or taking fetal measurements by ultrasound or palpating a mother's belly doesn't keep the pregnancy healthy, or improve its progress, though it's certainly reassuring to the parents and to the HCP that all is well.  Somehow, though, we as a society have come to see such care as essential to having a healthy baby, rather than trusting the healthy body of a healthy mother to properly grow the infant.

Too often I hear doubt in the voices of mothers as they discuss upcoming or past births, saying they "hope" they can give birth, or that it would "be nice" to have a natural birth, while in the next breath saying that they'll try not to be too disappointed should trouble arise.  We are warned by everyone around us to prepare our minds for a surgical deliver "in case", to give birth with an obstetrician in a hospital "in case", to agree to a few interventions just "in case".  We approach birth without really believing - really and truly believing - that we are physically capable of the act.  It isn't surprising, then, that so few women manage to accomplish the task without some sort of alleged assistance, assistance that, very often, leads to a cascade of interventions culminating in caesarean section.  We aren't qualified to birth.

The United States has an epidural rate of 90%, an induction or augmentation rate of 85%, and a caesarean rate of nearly 32%.  So long as we continue to operate under the premise that we cannot birth, these numbers will not improve.  As with any challenging task, the most elemental factor in determining whether one will succeed is believing that one is capable of accomplishing it.  So long as we do not believe every woman can birth - and not just those extreme, natural birthing mamas; you know, hippies like me! - we will assuredly be correct.

the power of a four-legged creature

Hello, my blog, how I've missed you!

I wish I could give you a detailed rundown on the sessions at the 2nd International Breech Birth Conference as Rixa did on her blog.  Unfortunately, I wasn't able to attend any of the daytime sessions (one of the drawbacks to a toddler who exclusively breastfeeds is that leaving her for more than a couple of hours ata a time is pretty impossible) so I'll instead direct you here and here to read about the events at the conference.  From what I've read and in speaking to those who attended, it was just awesome and the arguments and evidence in favour of vaginal breech really gave the obstetricians and care providers pause.  One obstetrician, quoted by Rixa, expressed delight and excitement to begin attending hands-and-knees breech births.

While I didn't attend the conference itself, I did have the opportunity to attend the two evening events: Birth, Karen Brody's play, on Thursday evening, and a storytelling session with Ina May Gaskin on Friday evening.  I enjoyed the play, though I think the cast was tighter and more polished when I saw the play at its debut performance back during the original run in August.  It was particularly encouraging to see a greater male presence in the audience.  In August, there had been only a very few men present, whereas the audience at the remount in October was at least a quarter to a third men.

On Friday evening, Ina May spent the majority of her time somewhat focused on breastfeeding as her latest book, Ina May's Guide to Breastfeeding has just been released.  Her thoughts on breastfeeding and breastfeeding culture were very interesting.  There was a lot of laughter, particularly as she related the story of an Amish woman with extremely inverted nipples, and some of the suggestions Ina May made to her for dealing with the issue.  She related that she wasn't sure what limitations Amish principles had on the practices of the bedroom, so she wasn't sure how her suggestion that the expectant mother's husband suck on her nipples would be received.  She mentioned two ideas suggested in an old French textbook on breastfeeding: that an "intelligent" maid be found to suck on the woman's nipples to draw them out, or to find a large puppy (I kid you not) and put the puppy to the breast.  Ina May supposed that, by comparison, having one's husband suck on one's nipples would likely seem pretty tame and acceptable.  She noted in her talk about breastfeeding that four-legged mammals very rarely have difficulty nursing.  Baby creatures, more often than not, are able to nurse immediately after birth and without trouble, and mothers generally fare best when allowed to follow their natural inclinations to nurse.

During the second half of the storytelling session, questions were submitted by the audience. Some were very specific and related to particular issues in birth, such as CPD and VBAC.  One though, was quite thought-provoking.  Ina May was asked, "Of all your accomplishments, which one makes you most proud?"  She considered for a moment, then responded that learning from Guatemalan midwives the practice of rolling a mother onto hands-and-knees to resolve a shoulder dystocia and publicizing this maneuver (it's refered to, officially, as the Gaskin maneuver) makes her extremely proud.  I can only wonder how many infants have been safely birthed because of the judicious use of this maneuver, how many lives saved and how many mothers saved from unnecessary and risky surgery.

In talking about the Gaskin maneuver, Ina May said something which really struck me.  She paused for a moment, looked a little wistful, and said "we just need to make the mother a four-legged creature."  She had mentioned earlier that it took decades of working with mothers and infants before she noticed that newborns can crawl.  They can - even at only 5.5lb, Glynis was able to crawl up my chest for weeks after her birth - but, Ina May noted, only when they are placed face-down.  When we lay a newborn on her back, as is so commonly done immediately after birth, the infant is incapable of crawling or moving.  In laying the baby on her back, we steal her power and her autonomy, however limited it may be in the first moments out of the womb.

It is the same with birthing mothers.  When we lay a mother on her back, we take away her power, her means of autonomy, her control.  The Gaskin maneuver has been studied and found to be extremely effective in relieving shoulder dystocia and allowing the birth to proceed normally.  I read recently a supposition that it may be the act of rolling the mother over her side which helps dislodge the infant's shoulder, and that the final birthing position on hands-and-knees may be immaterial to the ultimate success in the birth.  If there is one thing that birth practitioners simply must appreciate, though, it is that we cannot separate the physiological events in a birth from the psychological ones.

A successful birth requires not only adequate positioning of the infant in utero (adequate, rather than ideal, because babies can and frequently are born in a posterior presentation, though it is far from ideal, just as babies can and are also born breech) but also the confidence and courage of the mother to effect the birth.  We cannot expect women to birth if we tell them they are incapable of doing so.  When we lay a mother on her back and immobilise her legs, even as we tell her "this is the way to birth" we are telling her body and her mind that she is powerless, she is impotent.  But roll her on her hands and knees so that she can sway, she can tilt, she can move, even if only a little, and we give her back her power, her autonomy, her self.  We put HER back in control of her birth.  We allow her the same dignity afforded an elephant, a dog, a horse, a gorilla, and the opportunity for her to find within herself the same strength, the same wisdom each animal mothers possesses.  How, then, can it be any wonder that such a maneuver is so frequently successful?

resources and reaching out

I don't think I mentioned the lovely message I got over Facebook from a friend of mine.  It was several weeks ago, now.  My friend is young, only 21, and one of my opera compatriots.  She has said on several occasions, and repeated in her message, that she doesn't intend to have children.  More power to her for knowing what she wants to do with her life and her body: parenthood isn't necessarily for everyone, and that's just fine.

Despite her plan not to have children, she thanked me for writing this blog and posting links to articles and blog posts on birth to my Facebook page.  In part, she wrote, "Thank you for putting it out there. Even if people are slow to see the truth, it needs to be out there - that way, when people ARE ready for the information, it's there. And thank you for making it accessible, and educating me in the process."

Isn't that lovely? Isn't it reassuring that there are young women who understand the magnitude of these issues, who appreciate that birth and bodily autonomy and chauvinism are a universal concern?  I wrote her a long and grateful response, including,

I can't tell you how much I admire you for informing yourself on issues that may not now, or may never, directly concern you (the really birth-specific issues, like cord-clamping for instance). Every person who informs him or herself becomes a resource, a source of knowledge for every other person. So even if you never have children, some woman or baby may benefit from you having taken the time to learn and then share that information. And that is an encouraging thought.

This young friend of mine enthusiastically replied that she wants to be a resource, to share knowledge and information.  How delightful!  For generations we have separated birth from regular life, making it of concern only to those who are actively having children or working in the birth 'industry'.  It should not be this way.  There are many wonderful, gifted midwives and doulas who have never had and may never have children.  That doesn't prevent them from listening to women or acting based on centuries of knowledge as well as modern research.  Information and education are for everyone.

It's one of the messages of Debby Takikawa's film (nota bene: didja see her comment on my post about her film?  How cool is that?!): birth is a further reaching concern than we currently think.  It affects us all.  How we approach birth and babies and women's bodies and personal choice is very, very indicative of the state of our society.  What does our current approach say about us?  That we are fearful?  That we are disrespectful?  That we are paternalistic and patriarchal?  That we are dismissive?

And what do we want to say?  That we are courageous.  That we are faithful.  That we are respectful.  That we are dignified.  That we are caring.  That we show concern.  That we are open to new possibilities.  That we welcome miracles.

Breastfeeding: a mother's story

I was asked recently to write an article about my breastfeeding relationship with my 16 month old daughter.  It was published in the current issue of Women's Voice, a quarterly online publication.  With permission, I'm republishing it here.

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In the first days and weeks following our daughter’s birth, breastfeeding posed such a challenge, such an immense difficulty, that I could not have guessed that we would be fortunate enough to still be breastfeeding even a few months later, let alone well over a year later. Now my daughter is 16 months old, and still nursing. Not only is she still nursing, she is, in all her toddler-hood, still exclusively breastfed. She eats no solid food at all.

It was a difficult road to get here. Born at 36 weeks gestation, she refused to latch well, barely opening her mouth. Everyone checked for tongue-tie, but no cause for her difficulty was ever found. I began a long and constant relationship with an electric breastpump, a machine I grew to both adore – it was, after all, establishing, increasing, and maintaining my milk supply better than my daughter was – and loathe. I was on various herbs and eventually prescribed Domperidone, which I took in handfuls daily. At long last, at almost 7 weeks postpartum, with a child who had still only gained about one pound more than her birth weight of 5lb 8oz, we drove to Toronto to meet the great man himself, Dr. Jack Newman. He looked at my daughter, helped us latch, looked me in the eye and said, “You’re doing fine.”

Three days later, Glynis opened her mouth. Later that week, I took our breastpump back to the lactation consultant who had rented it to us. Soon I was off the Domperidone as well. We were finally on our own, and I was elated.

As the months passed, our nursing relationship became stronger and more confident. We were pros. I could – and would – nurse her anywhere and anytime. I nursed her in coffeeshops. I nursed her in the park; is there anything more sublime than nursing outside in the afternoon sun? I nursed her while taking Communion at church, right in our pew. After our terrible, debilitating struggle, one through which I wept more tears than any mother should while loving her newborn, we had settled into a comfortable and delightful pattern of natural nursing. We had no schedules, I watched no clocks: I just nursed her whenever she needed or wanted.

Eventually the day came at about 7 months old when we offered Glynis her first solid food – it happened to be roasted sweet potato wedges. But she wasn’t interested. What was truly remarkable was that she remained entirely disinterested in solid foods as the days, then weeks and finally months went by. Her first birthday came. There was to be no crazed picture of a tiny child smeared with chocolate and icing for her baby album: she examined the icing and then entirely ignored the cupcake which sat before her.

But she nursed! She nursed quickly, and slowly; she nursed at length, and in tiny snacks. She nursed first thing in the morning and to sleep in bed at night. She remained, as ever, round and pink, plump and robust: the very picture of health. At her final well-baby weigh-in, the nurse looked at her, lying in her diaper on the changing pad, kicking and playing, round and adorable, and shook her head: “She’s perfect. That’s a perfect baby.”

And so we continued. As my friends and acquaintances weaned their babies and toddlers, as I read of the horrible backlash against breastfeeding and breastfeeding mothers, as I encountered terrible stories and commentaries in which the mothers of nursing toddlers and older children were denigrated and insulted, slandered and shamed, we continued to nurse.

When this magazine goes live, Glynis will be 16 months old. She is, at the time of writing, still exclusively breastfed. She has virtually no interest in solids – though she did nibble a grape earlier today – and my milk is her sole source of nutrition. I like to say that after so many weeks of worrying that we would never have an easy, relaxed nursing relationship, she’s more than paying me back for persevering.

Glynis, my husband and I are surrounded by children who eat entire meals, who feed themselves with forks and spoons, who consume hard biscuits and meats and sandwiches and vegetables. It is unfathomable to most everyone we know that she is entirely satisfied on my milk alone. It is equally unfathomable that we are all happy with this arrangement: surely I must need a break! In truth, there are days when I would relish handing her a fistful of Cheerios to keep her occupied while I eat my own lunch or finish reading something or get some dishes washed. And I’m a little envious of the parents I know who are learning what foods their toddlers love, who laugh as their children feed themselves awkwardly and enthusiastically.

But I know that Glynis’ day will come. Moreover, on that day, I will know that I did not rush her, did not push her or her body to try something for which she was not yet ready. And I will know that I allowed her to be as close, as connected, as intimate and as much a baby as she’s needed to be, for as long as she’s needed.

Through this extended and extraordinary nursing relationship, I have gained a profound respect for my body. I was able not only to grow a tiny baby, but to nourish and grow a toddler, on nothing but my milk. It is truly remarkable to me that we are, to quote Ina May Gaskin, so “wonderfully made” that the food of our bodies, the milk of our breasts, is enough to sustain and satisfy even an energetic, active and growing child. This is an important and valuable lesson for us, as women and mothers, to remember: our bodies are able to accomplish amazing things, if only we will let them.

Believe it

I am an opera singer.  I've been singing amateur opera for just over four years now, and began my training back in 2004.  Before I began training, I had been singing folk and contemporary Christian music for years.  I have been told that my voice is lovely, easy to listen to, very enjoyable, and have been asked by professionals if I have perfect pitch.  But every time I open my mouth to sing, I doubt myself.  Every.  single.  time.

Why? Because when I was 21, a 'friend' (note the sarcastic quotation marks) told me that my pitch was usually flat.  At that time, I was singing with a band at a monthly church service for young people.  The thought that my pitch was consistently off and being mic'd, subjecting the entire congregation to bad singing, was totally mortifying.  I was entirely riddled with self-doubt after that day.

It was since then that I began my classical voice training, and and since then that I've had greater and greater successes with my singing.  It was since then that it was suggested that I may have perfect pitch, or at least perfect relative pitch.  But still my 'friend's' words echo in my ears. Your pitch is usually flat.

When I had my first lesson with my vocal coach, I asked her at the end: how do I sound?  She said I sounded nice, and that I should definitely continue pursuing singing.  Then I asked her: So, I'm not flat?  "No", she responded, looking perplexed.  "Why would you think that?"  I told her, "A friend told me I was, once".

"No," she said again, looking horrified. "No.  That's not true.  Don't believe that.  Anyone who tells you that is no friend.  No.  You have a lovely voice.  Just forget you ever heard that.  That's a terrible thing to think.  No."

Why am I telling you about this?  What bearing does it have on, well, anything to do with birth or pregnancy or birth choices or even breastfeeding?  One sentence, spoken by someone whose opinion is of very little weight or value to me, spoken nearly a decade ago, which has since been repeatedly and consistently refuted, continues to haunt and shake me.  I continue to doubt myself.  I continue to doubt my abilities.  If such a small matter can weigh so heavily for so long, how can we then withstand all the noise which tells us that we cannot birth?  How do we arm ourselves against the onslaught of anxiety and pessimism which is so common and so debilitating in our society today?  How do we protect ourselves, our babies, our births, against the voices which would have us believe that we are incapable, that we are reckless, that we are somehow dysfunctional?

I can't honestly say that I know.  I don't know precisely how I was able to withstand those voices, that noise, that fear.  I do know that I believed, without a shadow of a doubt, that I could - and would - birth my baby without intervention or 'help' (again with the sarcastic quotation marks).  Perhaps a belief in one's ability to birth goes deeper than an appreciation for our talents.  Perhaps our ability to birth is so much more primal, so much more fundamental to who we are, not as individuals, but as human beings, as mammals, as creatures, that our belief has more substance than were it merely a personal talent.

My optimism, however, is not universal.  Too often I speak to expectant mothers who say they are going to try for a natural birth, who express doubt, not only in their ability to withstand pain, but in their very ability to actually birth their child.  Too often I hear of women who have been told - and have been convinced - that their pelvis is too small, their uterus too weak, their body too fat, their constitution too fragile.  And how terribly often do I speak to women who have likewise been told and believed that their breasts are too small, too large, their nipples too flat, too inverted, too large, too small, their breasts incapable of producing milk, and that they are unable to breastfeed and should simply not try.

How can we imbue other women with this confidence?  How can we eliminate generations of our undoing?  I try by speaking truth and confidence to the women I meet.  And I write this blog.  All in the hope that it will help.