Important preface: This article is written to bring more thoughtful dialogue to the issue of birth assistance for healthy pregnant mothers and their healthy birthing babies. It does not serve to slight any mother for any choice, nor does it presume in the light of some pre-determined health risks, that every birth can be easy, natural and safe. I fully and respectfully acknowledge the diverse range of medical problems that affect a percentage of birthing women which require medical intervention. I also believe that a very large percentage of interventions in the births of healthy mothers and babies, and thus their long-reaching consequences, can be avoided. From here, with a big open heart, I write...
This week, I'm a lucky lucky girl to be sitting in a room full of women (and a few men) interested or flat out committed to forwarding the cause of peaceful natural birth. I happen to be in Chile where the natural birth movement is just starting take off a bit. I happen to also be friends with an amazing birth advocate, doula and translator to Michel Odent. Thus, I have found myself once again (last year, I attended a doula course with Odent in Buenos Aires) in an inspiring conference on birth led by this most important of obstetricians, this time in a three-day conference called Womb Ecology (Ecología del Nacer in Chile) with much content coming from Odent's new book, Childbirth and the Future of Homo sapiens.
In the conference, we come back again and again to the topic of how we can help a mother in birth. The phrasing of the question itself is telling. This question reveals that we presume, as birth assistants or simply caring individuals, that a mother needs our help, or the help of another to give birth; that without assistance, she and her baby are at risk for some terrible thing or other. To paraphrase the deeply french-accented English-translated-to-Chilean Spanish words of Odent:
"We are culturally conditioned to believe that a woman cannot give birth without someone else. However, there are only two people who are obligatory: the mother, and the baby."
I heard it right, I promise, Frenchy English and Spanish and all.
For many of us in the modern world, the idea that a mother can give birth alone with a good outcome is shocking. The idea that we don't even need a midwife throws even the open-minde among us. Indeed, there is often a response to the affect of "that's crazy!" when one hears about the Unassisted Childbirth movement, otherwise known as Free Birth, or simply birth without medical assistance (since UC often includes a partner, or friend, or even doula). However, this conversation led by Odent of which I'm writing does not culminate with the idea that women should give birth alone (neither does it rule this option out). It does however beg to question the foundation of birth assistance, be it "natural" or medicated. Are we coming from a place of respect for the mother's innate ability to birth safely or are we coming from the place that a mother needs outside help, but of course?
Let's say we're able to come from the former, that we have full confidence in the healthy woman's body to birth well naturally, without complication (and I should add that we are therefore putting our faith as well in the baby, which certainly participates in her own birth), without assistance. From here, we can now ask, "Okay, but is there something one may do to support this very abled woman in her birth if she wishes us to support her in the process? And if so, what is this thing we can do?"
To answer this question, I'll share with you the recount Michel Odent gave of how his partner and very experienced paramana-doula Liliana Lammers answered. When posed the question by an expectant mother, "What is your role as a doula?" she replied simply and directly, "I am your bodyguard."
What does a mother need from us, from anyone? Protection. But protection from what? From slow and stalled labor? From placental rupture? From hemorrhage? From death? From the pain? What?
From the point of view of Odent and Lammers, the answer is fairly simple.
"A mother needs simply to be protected from whatever factor may interfere with her birth hormones and make her birth more difficult," Odent says. Simple, yes, but also a little vague, no? Lucky for us, there is a wealth of science-based evidence that points to the factors that make an otherwise naturally successful birth difficult (difficult here meaning wrought with extra pain and all the rare (but loud, scary) complications we hear about all over the place). The short of it is that we can support the brilliant, naturally-ocurring birth hormones responsible for initiating, progressing and culminating in, a safe birth for mother and baby (namely oxytocin, but also important are prolactin, melatonin and endorphins, among others) by eliminating any stimulus that stunts this flow. Nothing stunts the flow of birth (or love, or sex, or lactation – all things that rely on the same hormones as birth, by the way) faster than activating the neocortex, the thinking, rational brain.
So, we need to protect the mother (and the mother, herself) from anything that ignites the mother's thinking brain. Great. We need to support her sinking into her primal, reptilian brain, her other-worldly space from which the love cocktail that makes baby and mother work well together flows. Awesome. What things trigger that thinking brain? Spending time with Odent, Lammers and their gentle birth science reveals five important factors, five ambient conditions, that inhibit the birth process. These are the things we can protect a mother (and baby) from in service of safe, gentle, natural birth:
- Bright light
- Ambient adrenaline
Just like we need to turn off or dim the lights to invite the hormones of deep rest, and likewise how low light or darkness helps us sink in to connected intimacy with our partners, laboring in very low-to-no light helps a mother's melatonin disengage the neocortex and let oxytocin flow. We can protect a mother from bright light by turning out the lights, blacking out windows, and using soft candle-light if needed.
While many a mother may give voice to all sorts of things from a deep non-neocortex place during labor (Odent is fond of reminding us that when a woman is "talking crazy" in birth, she is doing especially well as she is outside of her rational thinking brain) talking to a laboring woman can interfere with the birth process. Receiving words of instruction (even encouragement), or being asked questions, encourages her to actively listen, analyze and comprehend, then probably formulate a response. This pulls her out of her reptilian brain and in to her thinking brain. When the birth space is silent or very quiet, and free of talking from others, she need not engage in hormone-inhibiting conversation. We can protect her from talking by not talking and helping others in the birth space to not talk to her or in her presence as well.
When I know I'm being watched, I am more aware of myself, of what I am doing, of my cultural conditioning around being observed (not least of which include "How do I look?" and "What does that person think of me/what I am doing?"). This observation and imposed awareness tends to keep a woman's rational brain in full function. It is very common for birth assistants to hover near a birthing woman, to demonstrate their support and make themselves obviously available. It is also common, in fact standard, for medically-trained birth assistants (doctors, midwives, nurses) to insert fingers or instruments into the vagina to check dilation, to use belly-based fetal monitors, and to discuss the "progress" of a woman's birth in front of her, reiterating their observation. Within the Odent course and teachings, I often hear reference of doulas resting in the corner of the dark room, entering that space very sparingly, or knitting somewhere out of the way. My birth doula arrived at my house when I was pushing (my labor started hard and progressed very rapidly), and she spent much of the delivery knitting on the couch. She made her presence known only when she read thoughtfully that it was truly needed. We can protect a mother from observation by staying out of her immediate surroundings and keeping others out as well, while reading the possible needs from a discreet and quiet distance.
If you imagine trying to enjoy a romantic dinner while shivering, or achieving orgasm outside in a cold breeze, you might imagine how being cold could shut down the warm, cuddling love cocktail that birth requires. Being cold makes us tense, it instinctually invites fear (which summons adrenalin, which ignites the neocortex, which shuts down the flow of oxytocin and company). Since staying warm is part of survival, a mother will prioritize getting warm (requiring problem solving) for herself and her baby, thus distracting the body from birthing. We can protect birthing mothers and babies from cold by keeping their space very warm during and directly after the birth (two hours minimum).
Ever sit with someone you know, feeling perfectly fine and peaceful, then notice you're feeling tense and a little agitated for no reason? Ever notice that this tension is coming from the other person, that you are in fact picking up the contagion of nervousness he is experiencing? This is fairly subtle, but is a proven scientific reality; adrenaline is contagious (not just extreme adrenaline, but subtler levels which accompany fear and worry, as well). As noted in the cold section and applicable to others, adrenaline ignites the neocortex. Adrenaline hormone is the antithesis, in fact rival, to oxytocin. Oxytocin will not flow when high levels of adrenaline are present, and will be inhibited with any presence of adrenaline. It may be helpful to note that scientists know that the flight or fight response triggered by adrenaline and cortisol are more easily triggered in men than in women. For this reason (combined with the issue of feeling observed), Odent urges birthing women to have their births supported by women (only women), especially helpful if these women are mothers who have had a good birth experience, thus less easily frightened by birth and acting as a mother-figure for the woman. We can protect mothers from ambient adrenaline by staying calm and relaxed, removing ourselves and others from the birth space when worry, fear or nervous energy is present.
Will any one of these factors, when present, completely take away a mother's ability to have a safe and healthy natural birth? No. Well, could be. The thing is, each of these factors increases the risk of complications because it interferes with the natural, effective mechanism of birth. So whether the presence of one factor reduces oxytocin levels in one woman by 10% or the presence of two others stunts birth hormones by 50% in another woman, is relevant only in that the more heavily present these factors, the more likelihood for dangerous complications. A partial or full lack of birth hormones can (and does) slow and elongate labor, increase sensation of pain, increase risk for fetal distress, raise likelihood of hemorrhage, and so on. Is it any wonder that in U.S. hospitals where little to no protection from these conditions is given to a birthing mother, there is a high rate of birth induction and augmentation with synthetic oxytocin (Pitocin) (some report a rate of over 80%)? I am beginning to understand why, and not just because the doctor may be in a hurry. I imagine my labor would have stalled stubbornly if I had entered a cold, brightly lit white space where anxious and hurried practitioners I didn't know watched and discussed things with me and about me, and where I was pulled from my surrender to sign forms and endure needle pokes, etc. (This is not an exhaustive list of issues I feel are pertinent to the discussion of the failings of hospital birthing situations, nor does it honor the attempts some institutions make to reduce some of these factors, I understand.)
To birth safe and sound, we need not have a "perfect" birth experience, neither experientially nor scientifically. However, one thing is clear to me: we need to protect ourselves, and to be protected in order to give ourselves and our babies the best shot at the benefits of gentle birth. I will not take the conversation further into the realm of how modern medicalized birth does not protect healthy women. I think the connections are fairly clear. I will instead urge us to become bodyguards for the generations of women we are among and to come, that we may bring forth life into this world more safely and soundly; that we may give ourselves and our children, especially our daughters, all the benefits of a birth designed by a nature not one single person, group or worldwide community can begin to understand, not fully.
I believe that how we give birth matters. It matters to us now, and it matters to the future of humankind. Being protectors to our mothers, in word and deed, is a good place to start. It is what they need most, and well within our means to give.