They always come out

If Sofia Pedro of Mozambique can give birth in a tree above rising floodwaters, you and I can give birth, too.

Read the full news story here.

Feathering your nest

All mammals seek a safe place when the time comes to give birth. This may be due to the role played by prolactin, the "nesting hormone". Your cat might choose a cozy closet. Where would you make your ideal nest?
 

A secluded treehouse?

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A sheltered courtyard?

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 A tiny forest cottage?

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A lush tropical garden?

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Thinking of the different settings that appeal to you, what elements do they have in common? How can you create the same inviting atmosphere in the real-life circumstances under which you will be giving birth?

The Pros and Cons of Everything

 Well, almost everything. That's what is offered at ProCon.org, a serious and interesting website which aims to promote "critical thinking, education, and informed citizenship by presenting controversial issues in a straightforward, nonpartisan, primarily pro-con format."

The Health & Medicine section might be of greatest interest to my readers. Among other things, it contains a page on children's vaccinations with a huge array of information.

Beyond specific content, this is also a useful site for those thinking more about how we make decisions -- a skill transferable across the whole spectrum of life's questions. So the page "Golf: is it a sport?" might be just as useful.  :)

Is ignorance bliss?

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A surgeon's skilled hands may make the difference between life and death.

But a survey commissioned by the American College of Surgeons finds that, on average, a person expecting to undergo surgery spends less than an hour researching their surgeon or the procedure.

A new car requires eight times as much research, apparently. Huh. Source

In a sentence

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(By the way, the original WWII 'Keep Calm' poster was rediscovered by someone at Barter Books, a wonderful second-hand book shop near my old home in Northern England, so I have a special fondness for it. Over and out.)

Choose well

Several times a week as I whiz down I94, I pass an advertizing billboard with this slogan on it. "Choose well," it advises simply, next to the logo of a big local hospital. The implication is that if you're sensible you'll decide to go there next time you are in need of hospital care.

This ad is clearly targeted to people like me for whom informed decision-making is an important part of life, and it got me thinking. It's clever, because "choose well" has several implicit meanings, including "make a choice carefully", "choose to be well" and "choose the best". The conflation of these different meanings in the ad implies is that a good choice is interchangeable with a particular selection: if you choose well, you'll choose us, of course!  The slogan thus becomes a wolf in sheep's clothing, solicitation in the guise of informed decision-making.

This ad has the same undertone we sometimes experience in our encounters with medical caregivers, too -- not just when we drive past their billboards. "You'd be smart to... [let me induce you at 40 weeks/consent to the amniocentesis/come to the hospital as soon as labor starts]" implies, "You wouldn't be smart if you didn't." 

Worse, we sometimes simply hear the caregiver speak of his or her plans to treat us, as if our thoughts and feelings were not a factor at all. The thought seems to be that if we have the opportunity to object and do not, that fulfils the requirements of shared decision-making. At the other end of the spectrum, a medical caregiver may act as a partner, presenting us with a list of options with their accompanying risks and benefits, and allowing us space to make decisions ourselves. Here's the spectrum as I see it, in table form:

	Implied consent	'Informed'  consent	Informed choice	Informed decision-making
How the dilemma is presented	No choice is offered	Choice is acknowledged but the 'best' choice is pre-determined	A range of pre-selected options, benefits and risks is presented from which you can choose	You determine the range of options to consider and the caregiver helps you get the information needed
Care provider might say...	"Here's what we're going to do" (unless you object).	"You could always select Choice A but we'll be better off with B."	"Which would you prefer, Choice A or Choice B?"	"Would you like to do anything? What do you need to help you decide?"
You might say...	"Okay."	"Well, I guess we'll go for B."	"Hmm."	"I'd like to wait and see."
Relationship between parties	Novice-expert	Liability-insured	Consumer-provider	Partner-equal partner

Studies show that women are most satisfied with the birth of their children when they are most involved in decision-making (and this is a more influential factor even than whether they experience pain) (Hodnett 2002). But involvement in decision-making can take different forms. Some women want to do all their own research and specify each detail. Others prefer to outsource their medical decision-making, along with its associated responsibilities, which can sometimes be heavy. This is also a valid choice, and it can also work well, as long as the outsourcing is itself a considered decision.

What does "choosing well" look like to you?

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"Choose well. Your choice is brief, and yet endless."

--  Johann Wolfgang von Goethe

Reference:
Hodnett, Ellen D. "Pain and women's satisfaction with the experience of childbirth: A systematic review". American Journal of Obstetrics and Gynecology Volume 186 Issue 5 (Supplement) (2002): S160-S172.

Just when you think you're getting the hang of it...

Choosing where to give birth in Milwaukee metro?

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Click here to access the 2012-13 edition of the excellent publication, MetroParent:New Baby, a Milwaukee-area resource for families. On pages 12 and 13 you'll find a side-by-side listing of local maternity hospitals. You can compare services they provide and, crucially, their statistics. Memorial Hospital of Burlington gets top points as the only area facility with a Caesarean rate within the 10-15% range recommended by the World Health Organization. Hooray! (Of course, no Caesareans are performed by the midwives who attend births at home and in the Well-Rounded Maternity Center of Menomonee Falls.) Meanwhile almost a third of all babies were born by C-section at St. Joseph's Hospital in West Bend. These cannot possibly all be necessary surgeries. Wop-wop, St. Joseph's.

A good reminder

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"It is not the mountain we conquer but ourselves." 

-- Sir Edmund Hillary, who with Sherpa Tenzing Norgay was first to reach the summit of Mount Everest in 1953

 

The meaning of birth

What is birth? On one level, you can explain it in terms of circulation, dilation, bones and fluids, and this is the plane on which the medical model operates. However, there is something about childbearing which invites us to go deeper, to search for a spiritual meaning. The discovery that we are in the process of bringing new life into the world is often a time of inner growth, even for those people who did not previously consider themselves particularly ‘spiritual.’

In a way this is not a great surprise. After all, birth is not just reproduction, a physical event, but the appearance of a new child of God. Each person is a mini-Incarnation, an intricate tapestry of body and soul. "He whom the entire universe could not contain was contained within your womb," says one ancient Christian hymn addressed to Mary the Theotokos (“God-birther”) – and there is a flavour of this great mystery in our own childbearing, too. That I can cradle in my own body something as infinitely precious as a human being is literally almost too much to bear.


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And the child being knitted in the womb is not the only astonishing new creation. The woman carrying that child is in the course of being made anew, as well. She gives birth to her own new identity as a mother painfully, through greatly humbling experiences. Physical comfort; restful sleep; the way she perceives herself and others perceive her; supposedly routine activities like tying her shoes; the sense of independence; eating habits; her previous shape and size… all must give way to make room for the needs of the new little person. What Saint John the Forerunner said about Christ, she can say about the child in her womb: “He must increase, but I must decrease” (though it’s an odd sort of ‘decreasing’ that makes you feel the size of a hippopotamus!).

The true struggle here is not so much with physical pain but with the spiritual discomforts it occasions. These might be called inner growing pains. Growing in humility is never fun on the ego. It is what the Scriptures call dying to ourselves. Yet here is the crux. This is exactly the way in which we become fully alive. Giving ourselves is the only way we can find ourselves. Only when our lives are projected outward in an open and giving stance, rather than inward in a self-serving and defensive posture, is true relationship, true life possible. “Humility is the greatest power because it moves the axis of life away from [ourselves] into God. It is no longer [we] who make the universe revolve around [our] ego; but it is [we] who place [ourselves] within the sacred proximity to God, and thus find [ourselves] precisely in [our] place.” (Evdokimov 1994:88)


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 The shape of self-giving love is thus a widening circle. Like a fractal, this shape looks the same viewed from afar as it does zoomed in: an expanding universe, a growing uterus, a yawning cervix, a mother’s arms, an empty tomb. To birth a child is to participate in the same divine energies which created the world. This is true whether we labor unmedicated at home or have a Caesarean in hospital before labor starts.

I believe this is the truth behind the meaning of what Ina May Gaskin writes: “Every birth is Holy. I think that a midwife must be religious, because the energy she is dealing with is Holy. She needs to know that other people's energy is sacred. Spiritual midwifery recognize that each and every birth is the birth of the Christ child. The midwife's job is to do her best to bring both the mother and child through their passage alive and well and to see that the sacrament of birth is kept Holy.” (2002:270)

Viewing life this way, parenthood has not just a deeper meaning, but a transformative meaning. It becomes a metaphor for the rest of life, a sacramental lens through which we understand and experience everything.

 

References:

Gaskin, I.M (2002) Spiritual Midwifery 4th ed. Summertown, Book Publishing Company.

Evdokimov, P. (1994) Woman and the Salvation of the World. New York, St. Vladimir's Press.

 

Note for applying this to the role of a doula:

In labor like at no other time in life, women are simultaneously at their strongest (most creative) and their weakest (most self-giving). The work of a doula is thus twofold. First, we protect the laboring woman in her vulnerability – this is the most visible part of the job involving ice chips, back rubs and communicating with medical caregivers. Second, we honor the nobility of the holy task she is undertaking – this is generally invisible, but it may be felt in the atmosphere of respectful admiration a good doula creates around her.

Welcome to my blog

Birth is both miraculous as joy and common as muck (or should I say meconium?). A bit like the rest of life, really. I look forward to sharing with you my reflections on this marriage of the mundane with the sublime in my own work as a doula and childbirth educator. Good to have you aboard.