Second stage: pushing naturally

When a woman’s cervix has opened to around 10 cm, her body starts transitioning into the pushing stage of labour. I say “around” 10 cm because I don’t advocate routine vaginal exams on mothers in labour, and I’m sure that some cervixes only open to 9 cm, and that’s enough, and some open bigger than 10...it’s all going to depend on what the baby needs to come out. I feel that the interference of making moms recline in order to check for full dilatation is unwarranted, causes discomfort at this important time in birth, and leads to more coached second stages. Instead, we need to trust that the mother will not harm herself by pushing as her body wants to.
Classic signs of transition, such as shaking and close, hard contractions, can help us to anticipate that a mom might start pushing soon. After this point, some mothers have a rest and their contractions space out for a little while. I find that most moms who have a physiological second stage have a short time of crisis just before their body starts its expulsive urges. They say things like, “I can’t do this” and “I don’t know what to do”. Sometimes they ask us to tell them what to do. I think the most appropriate thing to say to a mother at this point is, “I am here for you. You will figure it out.” If she can get through a couple of contractions like this, and surrender to the process, she’ll be pushing soon.
Some moms scream through their pushing, which is counter-intuitive to those of us who learned that moms must hold their breath and push in order to avoid “wasting” energy. I’ve learned that most moms who have a physiological third stage are loud, that they don’t put their chins to their chest but sometimes look like they are trying to pull themselves away. These are all things that the traditional medical community discourages or looks upon as unproductive, but again, if you leave these mothers alone and just BE PRESENT with them, they often push out their babies efficiently.
Some midwives advocate having mothers “breathe through” contractions as the baby crowns, in order to avoid tears. At my local hospital, the nurses encourage the mom to keep pushing through the burning. I think both approaches are harmful. Again, we need to allow the mom to do what her body is telling her. Trust me, most moms automatically slow down as the baby crowns, then get frustrated and push through the burning. I think it’s better for the mom to do what she feels like and that we need to let go of our thinking that we can, in all cases, prevent tears and perineal damage. Some moms are going to tear, but if we let the mom follow her body, I suggest we will see less tearing.
To sum it up, it’s important at this point to be hands-off and allow the mom to figure it out. If she’s looking to you for direction, she’s likely going to miss the subtle cues her body is giving her to help her baby descend and rotate. If she knows you trust her and her body, your presence will reassure her and let her surrender to her experience. It is a powerful feeling, pushing one’s baby into the world, and it’s made all the better by attendants who respect the amazing strength and ability of mothers.

For some great discussion of physiological second stages, please see the following:

Honoring Body Wisdom by Pamela Hines-Powell
Pushing for First Time Moms by Gloria Lemay
The "Rule of 10" Versus Women's Primal Wisdom by Lydi Owen
Michel Odent on the "fetus ejection reflex"
Pushing- leave it to the experts at Midwife Thinking's blog

Pic of the week

Postpartum Tips

This is BRILLIANT. Mamas-to-be out there, heed this advice! I've never taken enough time to rest after the births of my three children. Stay in bed, feed your baby, be in bliss. Have someone else look after YOU. Sleep and dream through those early weeks!

3 Steps to Recovery by Nicole D.

Why I do what I do....with a little ranting prelude

I'm so tired of hearing about ECing. I actually realized today that I avoid discussing how much I love my cloth diapers because I'm afraid of hearing the loud chorus of confident "advertisors" for ECing. Okay, maybe not afraid, but perhaps not interested in that much negative energy being flung my way, perhaps?

Maybe this is the way disposable diapering moms feel. Like, please fuck off, cloth diapering mothers, I don't want any reminders of how I'm spoiling the planet and poisoning my child, or to have one more person tell me how easy it is to wash stinky, disgusting diapers.

Interesting, eh? Now, I know I've been guilty of thrusting my views on people and they've probably suffered much indignation as a result. Just today I realized that all my pro-breastfeeding talks left some clients with the idea that I'd judge them for their decision to supplement with formula. I support them 100% (and please no comments, you don't know the story), but I am sad that they worried I'd tell them they were making bad choices, or judge them. I know I come across too harsh sometimes, and I apologize. Going forward I'm going to try to make sure that what I discuss resonates with me and that I share it in a way that enlightens and empowers people. So with that, I come to yet another statement on birth, the biggest calling of my life. I love, respect, adore it and want to know more about it. I realize it is a mystery, and probably always will be because:

It is the stuff of magic, those early months of silence. You know this child exists, but it seems such a long way off as to nearly not exist at all. Then you feel the stretch of your belly and little squirms are known to secret places within you. And on it goes. Until the day your baby comes through into this world from the only world he or she has ever known. THAT day is of utter importance. It is a day of thunder and festivals and the greatest of joys. A day of dropping to your knees in submission and awe. A raw, bright, fiery gentle day. For your baby, it is a day of squeezes and breezes and an explosion of sound, light and space. It is the first time your child loses his physical tether to you, and relies entirely on your emotional connection. A hard vulnerable lovely day. Though the logical brain in me analyzes, catalogues and evaluates, births make me weep. And so I plea with passion. Because I must. Someone is listening.

Belly Cast

I had the pleasure of making this belly cast for a client of mine. It has a silver tag on the belly with a quote from Mahatma Gandhi:

Where there is love, there is life.

Gratitude.

I've been sitting on the couch with my baby girl, 11 mos, watching her eat a slice of watermelon (American friends: "couch" = "sofa"). She's gnawing away with her one bottom tooth, loving the texture, the chill, the taste of that piece of fruit. Little rivers of juice stain the front of her white flannel diaper and pool on a receiving blanket. Some small pieces sneak past the blanket and she grinds them into the upholstery with her feet. I wipe them off with a baby washcloth with a little water on it. And I realize that I really love my couch. I love it because it's a solid piece of furniture and it was a free item, rescued from the side of the road. I couldn't believe what great shape it was in when my mom showed up with it- a large sofa-bed sectional in a lovely sage green. I'll never feel guilty about getting it dirty, and it's given us all such a comfy place to sit and hang with friends and family. We all fit here with room to breathe: two adults, an 11 year old, a seven year old and a baby, and often my cat. I love this couch.

I'm grateful for the clients who've brought me into their births. What an honour. I learn something new every time: something about myself, something about human strength and character, and something about how birth works.

I was at another birth last night. My darling partner/hubby/boyfriend (egads I wish we had better words to describe our significant others!) spent a sleepless night too, grabbing a few winks here and there when aforementioned 11 month old cried for her mama. He is a brilliant, supportive, fantastic, fascinating man, and I feel incredibly blessed to have him in my life.

I realize a little more each day how lucky I am to live in this place and time. I truly feel like I have freedom to do the things I want to do and be the person I want to be. I have the luxury of choice, from the mundane choice I made tonight to order in takeout, to the life altering choice of having my babies the way I want. I live in a small city with a low crime rate and an excellent quality of life, and I feel safe and secure. I have access to wonderful foods from all over the world. I have a good income. I can wear whatever I want. I am so lucky to have instant access to clean water, any time of day. I have free medical care should I need it. Wow.

Maybe I am just high on the experience of witnessing another beautiful little soul come into the world this morning, but I don't think so. Sometimes I just get overcome with wonderment and gratitude, and maybe sharing it will spread a little of that awesome feeling. So here's my little call out to the Universe: THANK YOU.

g

FreE-learning: Facilitating Online 2010

I've decided to join this free online course. It looks like it's going to be challanging and will push my limits, AND as today is my birthday, it only seems fitting to embark on something new.

Information on joining Facilitating Online 2010 here.

Where does all the trash go? Attempting to go "lo-garbage"

When I was little, I was a Sesame Street junkie. I can remember watching it on wooden-encased cubes of TVs that were bigger than I was. Oscar the Grouch always mystified me: I envisioned apartments and circus caves and more under his traschcan. Of course there must be lots of room for all our garbage, if Oscar had such a wondrous subterranean world. Couldn't we just hide it all?



I have to wonder if this wasn't an attempt by my parents' generation to try to soothe us youngsters: environmentalism was born when they were in high school and college so there had to be some inkling in the back of their minds that consuming and discarding can only work for a finite time before we are wading in rivers of garbage. Were they trying to keep us from worrying?

I remember trying to find ways to reuse items around me as a child. It was almost as if I knew, from an early age, that there is something wrong with just throwing things out, and I loved reading Laura Ingalls Wilder's books- these were people who didn't have much and USED EVERYTHING. I remember being cognizent of the fact that her family didn't overconsume and that they weren't leaving a lasting trace on the earth around them. I've seen my own children struggle with the idea of throwing things away. I wonder if their reluctance is actually their attempt at preservation, a hidden human consciousness that my children are still young enough to hear?



I've always had a high disposeability consciousness, I guess. For years I've stuffed it down, ignored the little voices in my head that say "You've got to change this. The human race needs to change, big time!"

So I'm going to try to change. I'll be checking in here every once in a while as I attempt to make our household "lo-garbage", a term I coined after I decided that I'm not ready to (would I be able to?) go "no-garbage".

Doulas and Homebirth

This is my response to the Navelgazing Midwife's blog post entitled "Doulas and homebirths":

Thanks for the new post Barbara. Attending hospital births definitely drains me and I am always grateful and honoured on that rare occasion when I am asked to attend a homebirth. For me, personally, I think it would be impossible to attend a UC as "just the doula", unless the lady you are serving is a trained midwife herself who really wants someone skilled at counterpressure :) . I get asked for a clinical opinion by doula clients all the time, both before and during birth. I usually answer such questions with a few different schools of thought on the subject and suggest clients discuss with their care provider. I try to be clear when I am stating my opinion. At a UC, the doula can't do this: her client is looking to her as having the higher authority in birth, just because of her many experiences. I think most women will be looking at their doula as "the expert", no matter how much the doula tries to help them see their own power. Birth is a vulnerable event. As a UCer, I think if you hire a professional to come to your birth, you are now having an assisted birth. When giving unassisted birth, any concerns or questions that come to your mind must be addressed by you, the mother. You are the highest authority at this birth. Once you hire anyone, including a doula, you are now using that doula as a midwife. I hope this little ramble makes sense.

Principles

There are two sets of principles.
They are the principles of power and privilege
and the principles of truth and justice.
If you pursue truth and justice
it will always mean a diminution of power and privilege.
If you pursue power and privilege
it will always be at the expense of truth and justice.

- Norman Finkelstein

Tribute to c-section mamas

Warrior Woman,

You dreamed of a glorious birth
And with a mix of excitement and trepidation you
Entered the temple of sickness and dying and
New life.

As the waves crashed over you
A rejoicing built up inside you
But
Something changed the plans

And so
You made the sacrifice
You saved yourself and your baby
The only way you knew how

Now the trust birth camp
Whispers in your ear
Twas for nought
You were duped

Your stomach knots up

The grannies and the girlfriends
Cheerfully say
You have a healthy baby
What more could you want?

You seethe inside

Don't forget
That you are a warrior
Who made a choice
A wound for your child

You are stronger now
Your scar tries to tell you
I am tough, you can be too

And you have days
Like any soldier
When you remember the fear
The helplessness
Was it my fault?
Did they lie?
You struggle for answers in a
World of greys
And pray for a different birth
Next time

Honour your scar
She is part of you
Forgive her as you
Forgive youself
Caress her and thank her
Trust her to watch over you and
Your future babies

Let the Goddess hold you as you
mourn
heal
weep
rejoice

And carry the strength of your birthing sisters
Into the temple once again.

© 2009 Amy Gow

Some conclusions on midwifery

I've thought about this for most of the last decade. When I first heard of the term "midwife", I immediately thought of a caring, wise woman helping out at a birth. Simple, right? Then for a few years I espoused the idea that surely, women were better off in other countries because they had midwives (somehow or another in those years I was always talking about how progressive Europe was). And then, for a long time, midwives today aren't like midwives in the past: of course they carry oxygen! They have everything short of forceps, epidurals and c-sections! And then I had a midwife-assisted birth that ended in panic, and I came full circle back to the simple idea of a "caring, wise woman helping out at a birth".

I live in New Brunswick, Canada. Our province passed midwifery legislation in 2008. We have yet to recruit any midwives (in Canada, you can only be a licensed midwife with a four year bachelor's degree in midwifery, offered at a handful of universities in the country, none near us). Before legislation, there were unlicensed, private midwives who did a tiny number of births. There were a tiny fraction more who just did it at home unassisted or with friends who were not considered midwives. Tiny, tiny number. Although there was always a certain fear that they might be prosecuted, this never happened, and there was no legislation prohibiting midwifery. Once midwifery legislation passed, our Health Minister at the time stated that all midwife-assisted births would take place at hospitals, with the "possibility" of homebirths sometime in the future. WTF? Then, there was also the comment in the paper by a midwife who headed up the push for legislation, where she said that anyone who now attends births without a license will be doing so illegally.

I actually preferred it when midwifery was in the "grey area" here. (As an aside, our Medical Act clearly stated that midwifery was NOT practicing medecine without a license until 1982, when that section was removed.) Women have been sold the line that legislated midwifery will allow women of all social classes/financial means access to midwives, as they'll be covered by our universal healthcare. That isn't the case in other provinces that have done this- women who access midwifery care are more likely to be white, university grads, professionals with good incomes. There are, of course, exceptions, but that is the majority. In Quebec, I recently heard that midwives will not attend primips. WTF?

Some would argue that some licensed midwives would go against their licensing body in order to provide a woman with a VBAC, or breech birth, or multiples. I can't agree to this statement. As I understand it, wouldn't that put them at risk of losing their license? Isn't there some oversight? Well, they argue, if a woman really wants an unhindered birth, she'll find a way to get one with the "right" midwife. How far does a woman have to go to find someone who is willing to help her with her birth? For years, I took personal credit for the fact that I had a successful, natural vaginal birth in the hospital with my first born...in retrospect, I recognize that I was incredibly lucky to stumble upon the doctor who provided my prenatal care and attended my birth. Many other local doctors say they believe in natural birth, but I would estimate our c-section rate to be about 25% and our epidural rate must be about 75%.I was incredibly lucky to stay home until I was 7 cm dilated. Part of it was mental preparation but most of it was luck, because I meet women every day who prepared their asses off for their natural births and ended up with anything but.

I had an unassisted birth last year. Part of the reason I gave birth unassisted is because there are no midwives here. I am on several UC forums, and it always saddens me when women, like me, are making the ultimate decision to UC because they don't have access to a midwife. It makes me sadder still when they are choosing to UC because no midwife would attend them, due to risk factors/licensing requirements/etc. I honestly feel that most women who are seeking a midwife-assisted homebirth have researched themselves to death about whatever their risks/problems/worries are. If they are seeking you out, YOU MUST BE THERE! And by YOU, I mean please, someone, answer their call. When it really comes down to it, what women really want is a sister to love them, trust them, protect their space. If you are doing that, no one will need to license you, and a certificate on your wall doesn't make you a midwife. The fact that you surround your mothers in love and protection does.

It is now after midnight in my timezone, the witching hour. I once read an interview with Ina May Gaskin, and she said something that really stuck with me. I wish I'd kept the quote, because I've never been able to find the interview again. This is what I understood from it:

We have to remember that we are the great-great-granddaughters of the women who survived the Witch Hunts. We know how to cut down, criticize and accuse our sisters. We will turn them in if it means our survival. We bow to male dominence, and a male god.


I think it's time we start moving in a different direction, one that honours and respects the real needs of women and values the women who practice this profession.

Slow Sunday

What a great day. The sun's been shining and it's warm outside. Took the kids swimming at our local pool with my best friend and her baby- we all had a great time and my smallest one had a great nap afterward.

I found a wonderful piece of furniture at ValuVillage on Friday. It looks like a chest of drawers, but the top two drawers don't open-instead you open the top of the chest and you have a disguised cedar chest. The bottom two drawers are shallow but are also lined with/made of cedar. I love it. The only downside of the whole thing is that the staff at the store managed to scratch the top of it fairly badly between Friday and Saturday, when I picked it up. I was thinking about refinishing it anyway.

Pizza's coming out of the oven in a few. Kids are watching classic Sailor Moon. Hubby's got his eyebrows knit together, pondering his latest blog post or some such thing I guess. Happy July 4th to my American friends. Good night.

Dedication

Let this blog be a place for me to express my true, uninhibited self.
A place of creation.
A tribute to darkness and light.
Let it create peace, love, forgiveness and joy.