Birth Choices in Indiana

Until two years ago, the choice to give birth at home was virtually impossible for most women in the state of Indiana.  Of course, many families still went for this option, birthing illegally at home either with certified professional midwives [CPMs], lay midwives, or giving birth unassisted.

Home birth was not actually illegal; CNMs [certified nurse midwives] practiced in Indiana legally but the majority of CNMs work in hospitals and choose not to attend home births. In the United States, medical = big business.  Doctors are paid per head for delivering babies, instead of per hour for the time they put in.

Two years ago, after years of hard work by the Indiana Midwifery Taskforce, a large bill legalizing certified professional midwives [CPMs] was passed by Indiana government and signed into law by the governor. This legalisation has allowed women the freedom to easily choose home birth in the state of Indiana.

There has been a definitive amount of opposition to this bill, particularly from the Indiana State Medical Association.  If CPMs, working as highly qualified self-employed birth providers, were legalised with no holds barred, they immediately present a threat to obstetricians working unchallenged in a state that has a high infant mortality rate.  [Home births not included in these statistics.]

1548 is the "fix" needed for two unworkable parts of bill, necessary in order to implement the law the legislature already created two years ago. 

1548 is due to be voted on in the Senate Health Committee within the next 48 hours.  If you are at all concerned about the freedom of Indiana women to choose birth at home with a qualified provider, please call or e-mail members of the Senate Health Committee TODAY!!

Ryan Mishler - Senator.Mishler@iga.in.gov, 317-233-0930

Jean Breaux- s34@iga.in.gov, 800-382-9467

Frank Mrvan - s1@iga.in.gov, 800-382-9467

Mark Stoops - s40@iga.in.gov, 800-382-9467

Vaneta Becker - Senator.Becker@iga.in.gov, 317-232-9494

Liz Brown - Senator.Brown@iga.in.gov, 317-232-9807

Michael Crider - Senator.Crider@iga.in.gov, 317-232-9493

Ed Charbonneau - Senator.Charbonneau@iga.in.gov, 317-232-9494

Ron Grooms - Senator.Grooms@iga.in.gov, 317-234-9425

Rick Niemeyer - Senator.Niemeyer@iga.in.gov, 317-232-9490

Solomon

Just a few short weeks ago, I was nearly halfway through my fourth pregnancy.  At eighteen weeks, my midwife visited and was concerned when she couldn't find a heartbeat for the baby.  Days later, Dan and I sat in a darkened room for an ultrasound scan and saw our fifth child curled up peacefully inside, perfect but for his silence.  No heartbeat.

It's true that this was not a terrible shock.  I had felt something was wrong, for so many weeks.  As days of pregnancy had crawled by, the sickening nausea I experienced from the beginning was almost unbearable. I'd never had such stomach cramping and pain with the other three, even during the twins' pregnancy.  The kids and I had experienced symptoms of food poisoning in June after eating fruit that was part of a nationwide recall, and my "morning sickness" seemed to be entwined with normal "flu" symptoms until I couldn't tell the difference anymore.

The doctor was clear: this was not a miscarriage, and at nearly nineteen weeks, was not far enough along to be considered a stillbirth.  It was simply "fetal death", and as my body was choosing not to deal with it, labour would have to be induced.

Dan and I went to the local hospital Sunday evening after a day spent with friends, family, and our children.  We sat in quiet and near-darkness for hours.  Dan played his guitar and we spoke in hushed tones to each other and with nurses as they periodically came in to check on me.  In the end, I was only in proper labour for an hour, and gave birth to our tiny baby boy around 7am yesterday.  He was still in the amniotic sac, placenta fully attached --no complications or need for any other interventions-- it was a complete birth.

Not quite six inches long, weighing about 1 1/2 ounces, this little boy was small but clearly one of ours.  His long legs, big torso, and scrawny arms were an exact replica of his two oldest brothers!  Though I will never see him as they are now I can easily imagine him with auburn hair, freckled faces, and big grins, just like theirs'.

We called him Solomon simply because it means "peaceful", which perfectly describes how we've felt during this time.

My father built a box using cedar wood that Dan found in the woods last autumn.  Solomon, wrapped in blue flannel, rested in the box, and the kids placed treasures inside: a bird drawing from Righty, a long letter from Lefty, and a card from Coo.  Mr J wrote a note and shared some of his special things with his little brother: an English penny, a plastic ring, and three crystal "jewels".  

We buried baby Solomon in his little box, halfway between a white oak and a cedar tree.  Dan played the guitar and some of us spoke out our thankfulness to God for Solomon, in spite of his short life.  Wildflowers are everywhere at this time of year and we gathered handfuls of them to cover his box. The children decorated the mound that remained with chestnuts, acorns, sticks, and more flowers.

We sat outside on the ground nearby as the sun dropped down in the evening sky.  Golden sunshine  scattered ribbons of light around us and the quiet was peaceful.

Sadness is close, always nearby when we think about the unexpected death of our baby.  But a deep peace is near, too, always there.  The life of God inside us is the same breath that gave life to Solomon, and we are at peace knowing that Solomon is now with Him.

Dan and I are so thankful for our parents, who've been so helpful and supportive, and for our friends far and near.  Even though many of you are faraway, we've felt so much love from all of you. :)

All photos for this post were taken by Tracey Stanton.

Demonstration Day

Today was going-home day for my visiting American family members, and going-to-London day for Coo and me. We caught an early train and arrived in our capital city at quarter past seven this morning.  

Thankfully, London hasn't had the same snow we've experienced, so instead of trudging through snow, we were able to get around quite quickly and easily. Coo rode on my back in the mei tai for the first few hours and then opted to walk.  First, we gained our bearings and figured out where we needed to be for the demonstration. After that it was only 9am, according to Big Ben, so we ended up at Whole Foods in Piccadilly Circus, with coffee for me and a bagel for Coo.

A few weeks ago, I wrote about the need for freedom in being able to choose how we give birth.  In the UK, all midwives are trained professionals with the same qualifications, and members of the Royal College of Midwives union.  Currently, midwives who are practising independently of NHS trusts do not possess professional indemnity insurance and cannot offer an insured birth to their clients.  Midwives practising within an NHS trust are automatically insured by their trust.  In October, new EU guidelines will outlaw any practise by professionals who do not have PI insurance. As you can see, in a roundabout way this also effectively outlaws independent midwifery. Independent midwives in this country are trying to encourage the UK government to assist them in finding an affordable solution for their need for PI insurance, without forcing them to work for NHS trusts and ending their independent status. If guidelines change in October, insurance companies are the ones who will begin dictating midwifery practise, similar to the way their chokehold on the medical industry in the States also controls birth practise there. Seriously... insurance companies controlling our birth choices?!

Why do we have a need for independent midwives as well as NHS midwives, if both receive the same training? NHS midwives do their best, working within a system of often restrictive policies and protocols. I had two NHS births, both with wonderful midwives. Apart from one midwife with Coo, I had never met any of the midwives who were with me during those deliveries, until I went into labour. 

However with Mr J's birth, my independent midwife, Sarah Montagu, was the only medical professional I saw during my entire pregnancy.  I cannot stress how important it was for me to have the continuity of the same midwife throughout my pregnancy, who then was with me when I delivered Mr J --my first home birth.  I knew her well by then, and if she had told me I needed to transfer to the hospital I would have trusted her enough to go!

There were a few hundred of us, all standing outside the Houses of Parliament.  Described by some media sources as a "protest by independent midwives", the group was actually very diverse. Doulas and families who've used independent midwifery services were also there, as were midwives who work for NHS trusts.  Representatives from the Royal College of Midwives, The National Childbirth Trust, and other organisations supporting our right to choose our midwife joined in also.  [My three boys were impressed to hear that England footballer Theo Walcott's mother was there!]

We stood outside Westminster for some time, then walked down the road to Downing Street, where a petition was ceremoniously delivered.

Coo and I spent the afternoon at Whole Foods in Piccadilly Circus.  We had hot drinks with our new friend Karen and her little boy Rohan. Later, after Karen and Rohan had gone to catch their train home, Coo and I chose an early tea from the huge selection at Whole Foods and munched away on lovely healthy food [mostly --Coo did have some cake!]

Then we made our way back to Euston station and waited for three hours for our train home to the Midlands. Afterwards, I calculated that the money we saved by buying the cheaper, later train ticket was easily spent on extra cups of coffee for me and a biscuit for Coo during the wait! Never mind.  Coo and I had fun, making blanket dens in the station, colouring, writing, and later on the train --colouring more.  Finally, not far from home, Coo fell asleep after her fifteen-hour day!  She did so well, climbing stairs and riding up the tall steep escalators of the London Underground, not flinching once when the fast underground trains roared past us.  She walked as much as she could and didn't constantly ask to be carried.

I'm so thankful for my little girl, and she's one of the reasons why we were in London today.  I want her to have the option to choose an independent midwife someday, too.

Please visit HERE and sign the e-petition to save independent midwifery!

For those of you who are trying to understand the insurance conundrum, here's a statement from the Independent Midwives UK website: "Currently there is no professional indemnity insurance available to independent midwives, which means we are personally liable for any negligence claim made against us. Some commercial cover was available until 2002 but the premiums kept escalating, despite an excellent claims history, until an annual premium was around 20,000 [English pounds] per midwife. As this was more than many independent midwives earned, most were forced to make the difficult decision to cease practicing or practice uninsured. There is no insurance available to either independent or employed midwives that will pay out if 'things go wrong'. Insurance is there if medical negligence is proved against a practitioner having or not having insurance does not mean that your care is any safer. IMUK is campaigning to ask the government to find a workable and affordable solution."

Freedom for Birth

Just a warning for all of you who know me well.  I'm on my soapbox again!  But it is interesting, and an issue I'm very passionate about, so bear with me!

For all three of my births, I've been cared for by some excellent midwives.  Lefty and Righty's birth took place in hospital with kind, supportive NHS midwives.  Coo was born at home seven years later, also with NHS midwives present, and it was a wonderful experience.

But Mr J's birth, three years after the twins', was different.  Lefty and Righty's labour and delivery was induced, and as a result was long, complicated, and difficult.  They were born "naturally" in the end, but it definitely didn't feel very natural to me!  

When I became pregnant with Mr J, I really wanted a more physiological birth.  I'd become friends with a midwife who worked in the NHS, and at a birthday party for her daughter, met more of her NHS midwife friends, most of whom had small babies.  To my surprise, all of these NHS midwives had given birth with an independent midwife, at home.  I spent time talking with them and questioning them, and I realised that with Mr J, I was most likely to have the type of birth I wanted at home with an independent midwife.

Dan agreed with me, and Sarah, the independent midwife we chose based on others' recommendations, made her first visit. We liked her immediately. No insurer will offer professional indemnity insurance to independent midwives, so we signed a document noting that we were aware of that and were still happy to proceed with birth at home minus insurance.  

Mr J's birth was amazing.  [Read the full story here.]  Sarah was reassuring, quiet, strong, and just let me get on with the process. The entire experience was eye-opening and confidence-building for me.  Being able to choose my midwife for Mr J's birth made all the difference.

However...

In October of this year, new EU directives are being put in place that will make it illegal for independent midwives to work without professional indemnity insurance. Because insurance companies refuse to insure them, they will no longer be able to work independently.

The NHS midwifery system is brilliant. Most hospital births take place with no doctor in sight, the midwives fully in charge. The UK's advanced attitude towards women's birthing choices is the envy of many women in more restrictive countries. Wonderful MLUs [Midwifery-Led Units] are being opened all over Britain by the NHS. These birthing units offer labour and delivery in a relaxed, home-like environment for low-risk births.  Sounds great.

But...

Your baby is breech?  Sorry, hospital --and most likely C-section.  Twins?  Yep, hospital.  C-section for your last delivery?  Sure, we'll try a VBAC but only in hospital.  Fifth pregnancy?  Oops, no MLU for you; you're high risk.

So what if you feel you'd rather give birth at home, even with a higher risk pregnancy? And what if you know a midwife who has years of experience in safely delivering all of these types of high-risk home deliveries, but is not allowed to practise legally because she has no insurance?

Maybe you're not considered high-risk at all. What if you booked for a birth at the MLU but it's full to capacity on the night you go into labour and you didn't want to end up in hospital? What if you had a home delivery scheduled with NHS midwives but they can't send the required two midwives to you because of a staff shortage? What if NHS home births are eventually no longer offered because the MLU takes the place of home?

Ever heard of free-birthing?  If you haven't, you'll start hearing about it if the government has its way.  Many women, including myself, aren't willing to be told how we have to give birth.  And if we have no choice but to do so, would choose to free-birth rather than have our choices restricted to whatever the NHS deems appropriate for us. 

Think the fact that you don't have a choice doesn't matter?  Or that the idea of having freedom for birth choices is just not an issue here, because this isn't the USA or Hungary?  Over-medicalisation of birth is creeping up, even in the UK.  Michel Odent calls it the "masculinisation of childbirth".

Take fifteen minutes out and watch this, even if you feel it's an issue you have no interest in.  It's thought-provoking and sobering to see a simple freedom restricted in countries that claim to respect human rights.

Yes, I know... that was slightly over-the-top at times, especially for someone like me who is an introvert in activist's clothing and isn't into drama.  But the basic premise is very important: women should be allowed to choose the manner in which they give birth.  This is a simple issue of human rights!

Find out what you can do to help, and follow Choose Your Midwife, Choose Your Birth on Facebook to support independent midwives' right to practise. 

The Civil Wars... 13 March 2012

My Christmas present from Dan was tickets to see these guys play live in Birmingham this month.  

As the weeks passed, my first job as a doula loomed, and my mother-to-be was resolutely carrying these twins to full-term.  Her expected due date was the fourteenth of March.  Understandably, Dan began to worry that her labour would clash with our date out to see The Civil Wars play at the HMV Institute in Birmingham.

The evening in question arrived and no twins appeared to be on the way, so we left our kids with their brave babysitter and headed for the city to enjoy some live music. 

This was the opening night of The Civil Wars' first-ever headlining tour of Europe.  The crowd was eager and excited, and we were standing behind the loudest hecklers I've ever heard.  Enthusiastic Guy, right in front of me, couldn't stop drawing attention to himself.  He shouted, he wolf-whistled, he addressed the performers by name, and occasionally turned around to me to apologise: "I'm so excited I'm going to scratch the skin right off my face!!!!"  

Okay.  Fortunately, he calmed down after John Paul [of the performing duo] said rather pointedly, "I think that's enough now, dude."

To be honest, they were brilliant playing live... I can almost sympathise with Enthusiastic Guy.  

After the gig, suitably contented after such a great show, we walked through the chill late evening to the multi-storey car park where Roosevelt waited patiently.  Less than two minutes into our walk, Dan wondered aloud if I'd heard from Emma, my mother-to-be.

I opened my mouth and at that moment, from my coat pocket, my phone rang.  We continued walking as I pulled it out and heard Emma's voice on the other end telling me her waters had just broken.

Timing.  Sometimes it really is just everything.  Thanks, babies, for letting me have my Christmas present!

Thankful

"Over thirty years of experience as a midwife have not lessened my awe and respect for the efficiency and beautiful design of the female body as expressed in labour and birth.  In fact, the years only increase my sense of wonder about how well our bodies can work -- given the right circumstances.  The outcomes of our births... demonstrate how rare it is for complications and difficulties to occur when women are properly prepared for birth and when technological interventions are kept to a minimum -- that is, used only when necessary.  Ninety-four percent of women gave birth at home or at our birth center."

-Ina May Gaskin, from Ina May's Guide to Childbirth, speaking about The Farm Midwifery Center

I'm thankful that on Thursday, my lovely sister Emily was able to give birth at home to her second child, another beautiful dark-haired girl. I'm thankful for the wonderful people who were around her while she laboured, and for God's grace and peace on her and her family during the life changes they're experiencing right now.

[Thankfulness post inspired by Journey Mama.]

Another Birthday

His birth stands out so clearly in my memory.  It was a sunny, summery evening; sounds made by children playing on the street drifted in through the open window. So unlike today's muffled, grey August mugginess.  

Mr J, myself, and our other miniature human, Coo, strolled into town today for a trip to our local art gallery.  We spent less time playing in the children's room and looking at exhibits than we did gazing out the windows on the top floor of the gallery. We stared out over the town far below us, a jumble of old and new buildings with tiny people busily hurrying from place to place.  Mr J began talking about Doggieland, his imaginary place, telling me fascinating stories about Perdita, Chippy, and Fly.  Toy dogs to me... yet alive and real to him.

We enjoyed a hot drink together.

On our walk home, we watched the fire juggler.

We travelled on a Thomas train.

We took a photo of ourselves while saying hello to the concrete hippo in the town square.

And the water fountain, which is always dry!

Then we arrived home to a clean house thanks to the Daddy and The Boys.

Special days out don't have to cost a lot.  When you're turning six, £2 will do: one pound to drop in the fire juggler's hat and another for three rides on the Thomas train.

Birthday cake, of course, is free.

One of Mr J's gifts was a real magnifying glass!

:: Hello Baby :: a book review

Hello Baby

by Jenni Overend
[also published as Welcome With Love]

Rarely do you find a children's book as perfect as this.  The illustrations are realistic and yet still storybook-like, the narrative is simple yet complete.  The plot centres around a mother giving birth surrounded by her family at home.

Her small son Jack narrates clearly and from a child's perspective. "Mum's got pains in her tummy and that means her baby is ready to be born."

His mother goes for a walk in the wild wind to "help the baby along".  He observes, "I think if I was a baby listening to that wind, I'd want to stay inside Mum, floating in the warm water."

The midwife, Anna, arrives, as does Mum's sister, Auntie Meg. "She has a pot of soup and a bunch of yellow and orange poppies."

The constant theme reiterated throughout the book is that birth is normal.  There is no panic, no freaking out, even when the mother's labour progresses.  Jack's mum has already explained to him that she'll feel better if she yells and screams.  At one point, Jack answers the ringing phone while his mother is yelling.  "I yell, 'Mum's having a baby!' as loudly as I can, and I feel much better.  The person hangs up.  I would too, if I heard that noise on the other end of the phone."  Yep.  That's as intense as it gets.

My favourite part arrived at the end, when the entire family are having a camp-out in the living room after the baby's birth.  Jack can see the baby sleeping between his parents, which is where he wants to be.  "I sneak out of my bed and hop in next to Dad.  It's warm.  He cuddles me in.  I bet the baby's warm too."

Think there's going to be any jealousy issues between Jack and his new brother?  Not with parents as wise and loving as that.

I bought Hello Baby on the strength of the amazing reviews it was receiving on Amazon, but was surprised by how much it lived up to them!  All four children enjoyed this story from the time we first read it aloud.  Coo, particularly, fell in love with it and carried it around as her "book of the day".

It's worthwhile to note that some readers might find elements of this book unappealing, due to its realistic portrayal of a mother's labour and natural delivery.  The baby's birth is shown [not graphic but it's obvious where the baby's coming from!]

Also, I noticed that a few Amazon reviewers [.com not .co.uk] criticised the story's apparent location at a cabin in the woods as being too different and idyllically removed from the real world.  However, the author is from a remote part of Australia, where a home birth scenario like this would be more commonplace.

Sometimes different is nice.

And maybe someday, different will be accepted as normal.  I certainly hope so!

Sons of Thunder

"Do you have any history of twins in your family?"

Yes, that really is the question they asked me as I was having my first ultrasound scan during my first pregnancy! 

There are so many things I can think of now as a response to this loaded question.  Something informative? "The only way twins can be genetic is through the mother.  Some women have a pre-determined genetic tendency to release two eggs during ovulation resulting in fraternal [non-identical] twins." Or something rude? "If I did, what's it to you?" And last but not least: "So what are you trying to tell me?"

But I didn't say anything, not that I can remember.  What they were trying to tell me, and eventually did, was that they were seeing two babies.

I don't recall thinking very much at the time beyond wow.  As you do, when you're just 22, married for five months, and still growing accustomed to your adopted country of two years.  I was excited about becoming a mother even though it wasn't quite happening in the way I'd imagined.  I'd had this basic idea of walking around with one baby in a sling, an idea that soon began to slip away as I grasped the enormity of the situation.  Our tiny two bedroomed flat with its closet-sized rooms seemed to fit with the imaginings of parenting one baby. However, two?  My intention of having a home birth also faded away.  I was informed that under no circumstances would I be allowed to birth at home, as I was considered high risk.  

Even writing that now sets my teeth on edge with irritation.  I swallowed everything I was told, soaking it up and accepting it blindly.  Ironically, I'd always been the type of person to do my own research.  Sometimes I look back and wonder why I didn't ask questions.  I think it was partly because I was floating around in a dreamy haze of twin pregnancy hormones.  Also, life in the UK was new to me;  I was still under the impression that the people in charge could be trusted and knew what they were doing!

As much as I look back and regret that I went along, sheeplike, with the flow, I don't question what happened to me and wish to change it.  I'm thankful that I had the experience I did, as I feel it gives me a certain amount of empathy with mothers who've had pregnancies and deliveries that haven't gone as they envisioned.  

At thirty-six weeks, I went into the hospital for a routine check and was immediately admitted, as my blood test results were abnormal.  The decision was made to induce labour, as I appeared to have pregnancy-induced cholestasis, a condition in which your liver stops filtering toxins from your body.  If it takes place early in pregnancy, it can result in stillbirth.  I was hardly early on; thirty-six weeks is generally considered full-term for twins.

So, induction... heavy labour almost immediately... drugs given to control hyper-stimulation of my uterus... gas and air offered and declined... told if I did not have an epidural there was a high risk of having the first twin born naturally and the second born via C-section. In a panic, I chose the epidural.  In reality, they were both head-down and in the perfect position to be born naturally.

Panic.  Sadly, it was this way.  As I've learned in the eight years since birthing my firstborn boys, it didn't have to be like that.  But it was.

Looking back, I wonder why they were so determined to control the birth of my boys.  At no time did my babies show any signs of distress during their constant foetal monitoring.  A friend has since given birth to twins at the same hospital and was treated very differently.  Perhaps the additional six years is the key to the change.  

Anyway, our boys came into the world in the midst of noise and panic and many people -students, doctors, midwives- and they were beautiful.  Long-limbed, skinny, identical, with coppery hair and entirely different voices.  Lefty had a lion's roar and he ate like a gannet.  Sleepy Righty breastfed twice in the first twenty-four hours and his wail was mournfully, pitifully hungry.  After a threat from an impatient midwife about "cup-feeding him formula", the shift changed.  A much more sympathetic midwife arrived on duty and showed me how to breastfeed them at the same time.  Righty was able to eat properly after that, when he joined his brother.

And that is what I did.  For months.  Even when they screamed constantly after being fed, I thought it was normal. I fed them almost continually, and assumed it was par for the course with newborns when they vomited up half of what they were eating because it was too much.  I didn't know anything about colic then - didn't really know anything about it until after we had already soldiered through it and were out on the other side.  I struggled to keep up with all the other singleton mothers I'd made friends with through breastfeeding support groups and courses, not realising fully how different my crazy life was from theirs.  A few years later, when Mr J came along, the silence and calm surrounding his arrival showed me what life could be like with just one.

But our first two... they were born as they live.  Charging ahead, full-lunged, protesting, courageous, confrontational, questioning, knights of the Round Table or the Jedi order or of Gondor or Narnia, depending on whatever imaginary land they're living in at the moment.  Storm-chasers rushing out to meet the tornado face to face.  Our sons of thunder.

What is Physiological Birth?

Compiled notes from information sessions for doulas, with Dr Michel Odent and Liliana Lammers

We are at a turning point in the history of childbirth.  

There have been spectacular technical advances in the last few decades that push childbirth a certain way: towards routine operations and painless births.   At the same time, we are acquiring scientific knowledge that suggests that the way we are born may have life-long consequences.

It's a fact that the number of women who give birth to a child completely naturally -physiologically- is approaching zero.

Our knowledge of the meaning of natural childbirth is skewed.  We have a deep-rooted lack of understanding of true, natural home births.   All cultures have transmitted beliefs and traditions which can interfere with birth's physiological process, for instance: "You cannot do it yourself; you need someone to help you give birth!"  It's interesting to note that a subtle way to control is to help.  We need to realise that we cannot help, but we can hinder!

These cultural theories have even influenced "natural" childbirth.  The only way to remove ourselves from our controlled, culturally conditioned trap is to learn from modern physiologists, and to accept the recent discoveries provided by a variety of scientific disciplines.  

For instance, a baby needs its mother.  And yet, culturally, there is an almost ritual separation that takes place as the cord is cut, moments after birth, between baby and mother. This could easily be left for hours instead of separating right away.  Of most immediate importance after birth is a critical period of mother to baby attachment, as human babies naturally find the breast post-birth, and their bodies are instantly colonised with the mother's friendly microbes and bacteria.  The new baby is the only other person with the same antibodies as the mother.  

The dominant paradigm at the moment is controlled birth.  The new paradigm is the physiological concept of birth as an involuntary process.  The birth process must be protected from situations that can inhibit this involuntary process.  

So what does physiological birth look like?  These next few paragraphs sketch out an appropriate environment for a labouring woman.

1) Adrenalin and oxytocin are antagonistic to each other.  Women need to feel secure during labour so there can be a successful, continuous release of oxytocin, the hormone responsible for stimulating uterine contractions.  Oxytocin release is highly dependent, more than any other hormone, on environmental factors.  

2)  All emotional states are contagious.  The release of adrenaline is contagious; it's impossible to be in a complete state of relaxation when someone close to you has in increase in adrenaline.  [Adrenaline will stimulate the uterus' alpha-receptors, which inhibit the activity of the uterine muscles]  High levels of adrenalin also greatly increase the pain of the contractions.

3)  Our human handicap of "thinking too much" can get in the way.  During the birth process, the neo-cortex, the part of our brain that contains our intellect, must stop working!  Labouring women need to be protected from any sort of neo-cortical stimulation.  Silence...  Around labouring women, we must choose our words with extreme caution.  Our rational language, continuously going over the facts -for instance,"how many centimetres now?"-  can inhibit the process.  Don't ask questions of a woman in labour!  Simple baby-talk is much more appropriate.  Darkness... Light should be kept to a minimum. The "darkness hormone" -melatonin- reduces neo-cortical activity.  Observation... or lack of!  The neo-cortex is stimulated when we feel observed.  Careful with language, careful with light, make a woman feel secure without feeling observed.

The final stage of labour, after the birth of the baby, is the delivery of the placenta.  Immediately after the birth, the mother has the capacity to release a very high concentration of oxytocin.  This is vital and necessary for a safe and bloodless placental delivery.  What causes this release?  First, the mother must not be cold at the time of the birth.  Secondly, she must not be distracted.  [Typical distraction: cutting the cord!]  The mother needs the baby in order to release this peak of oxytocin and deliver the placenta.

The prototype of the person to be with a woman in labour is the traditional midwife/doula mother figure.  The disappearance of midwives is a symptom of a culture that fails to understand the physiology of birth.   The midwife is calm; she is present; she is quiet.  She keeps the husband out of the room if he is nervous or anxious.  If he is calm, he assists her in surrounding the labouring woman with normality.  "Pretend it's a usual day in your house."  She finds repetitive tasks -knitting, running a bath- with which to occupy herself, to bring further calm to the woman.  If it's night-time, she goes to sleep!  She works from her heart, not her head.

In a small minority of cases, labour doesn't progress.  It just doesn't work.  If the labouring woman's environment has been ideal [careful with language, careful with light, make a woman feel secure without feeling observed], this remains a very small minority.  It is easy, though, to create problems during a birth that can result in the need for interventions and put an end to the naturally occurring physiological process.

So...

Birth physiology.  Wow.

I've just finished three days of information sessions for doulas, and my head is crammed so full that I think I might need to write an essay in order to process it more fully.  I spent a total of twenty-four hours cocooned in the sunny living room of a North London Jewish home with twenty other women from varied cultural backgrounds. We drank in the rare sunshine and soaked up words of wisdom, facts, and theories from two sages who have an extensive history of experience in the world of physiological birth and obstetrics.

I will blog about it in more detail at some point, but for now my brain needs a break!

Five Years Ago

Mmmmn... making roast chicken for tea. Set chicken in the roasting tin, brush melted butter over the skin, lots of salt and pepper, a few sprigs of fresh rosemary in the cavity, pop in the oven.  Can't wait to taste it later.  Roasted vegetables in olive oil to go with the chicken: onions, cherry tomatoes, mushrooms, sweet potatoes, peppers, garlic.  Should have something else as well.  Emily and Abby's second day here in England so must feed them up... they're both looking thin.  Or maybe they just look thin because I have this huge bump on my front.

We'll have some steamed vegetables, too.  Fridge open... oh, there's a punnet of blueberries that will go off if I don't do something with them.  [uncomfortable... uncomfortable feeling... tummy dropping feeling... hmmm]  Rinse blueberries for freezer.  [uncomfortable feeling again...]  Could be going into labour.  Haven't a clue, really.  Induction and an epidural for twins three years ago isn't exactly natural birth.

Blueberries safely in freezer.  Chicken roasting nicely, vegetables too.  [uncomfortable feeling AGAIN...]  

This uncomfortable feeling thing is suddenly every ten minutes, then every eight.  It might be a good idea to call the midwife, and hear her thoughts.

She thinks she'll come over after tea; it will probably be a few hours yet.

Less than forty-five minutes later, I am phoning her because now they're every three minutes.

By the time she arrives, I've finished the tea preparations and handed food and twin responsibilities over to Daddy and Nanny.  I'm walking around in the lounge trying to figure out what to do with the birthing ball.  Sit on it?  The last thing on earth I want to do right now is SIT!

Birthing ball no longer important; it floats off into the fog of a few minutes ago.  Midwife wants me to go upstairs.  Everything is blurred; I am so thirsty; I drink lots of water and smell the good roast chicken.  I want to eat roast chicken... but I have to do this first!  All right, I'll have the baby first and then eat chicken.  Yum... can't wait.

Midwife on the phone.  Her daughter is cooking their Sabbath eve roast chickens and needs advice.  Midwife wants to eat her kosher chicken at home.  I want to eat my organic chicken downstairs.  Have to get baby out first then we can both eat chicken.

Midwife calls student midwife.  Come now or you'll miss the baby.  She calls Daddy upstairs.  Come now or you'll miss the baby.

Thanks to pleurisy in my lungs have to breathe through a lot of contractions instead of pushing.  Takes around forty-five minutes to push this baby out.  All that lovely roast chicken is being eaten by other people!

Congas suddenly go off downstairs as Righty feels a tribal urge to make some rhythm.  Baby suddenly pops out - hello, I heard the drums... were those for me?

It's another boy.  He has huge feet that fold upwards towards his knees.  He is very floppy and relaxed. Chilled. Watching everyone and everything.

He meets his brothers. I have a hot bath. Midwives and Daddy and Nanny have cups of tea and biscuits. Lefty and Righty snitch lots of biscuits when no one is looking. [this is later the ONLY thing they remember about Mr J's birth day]

I remember the happy feeling of a soft, warm baby to cuddle, and some lingering sadness, too.

For the chicken was all gone.  They had finished it off while I was upstairs giving birth.

That was five years ago today.

Mr J still has large feet, and relaxed limbs, so much so that sometimes, when they have let him down again, I wish the safety helmet that came with his birthday bicycle could just always stay on his head for my own peace of mind.

And Mr J is chilled, for the most part.  He has his painful moments: struggling with indecision in Starbucks; feeling small and incapable around two confident, able older brothers; suddenly realising that he has a baby sister instead of the dog he desperately would love to have.

But when others are kind and loving towards him, listening to him, investing time into him, he rewards them by shining with love so great and warm and all-encompassing that it's beautiful to see.