An Encouraging Thought

I recently started reading the book Teaching Natural Birth. In it, the author shares this thought about the importance of teaching families about birth:

"We are not 'hobbying' or 'playing house.' We do this not because we like people or like babies, but because there are earthshaking issues involved in the way our culture is giving birth and raising its children...We are playing for keeps and the stakes are high. We are professionals. We matter. Always and indescribably."

I do not view teaching birth classes as a "hobby." I view it as my career/profession. I have noticed a tendency of people outside the "birth world" to look upon it as a hobby however. Reading this quote was a nice reminder that my work is important!

--Molly Remer

Control & Birth

One of the things I explore in birth classes is feelings about wanting to be "in control" or "staying in control" during birth. I ask couples to consider what "losing control" would mean to them and what the benefits of "losing control" might be.

I really enjoy this section from Childbirth with Insight about control and birth:

[with regard to prepared childbirth films and class] "...are instructive rather than enlightening. They confirm a particular teaching method by advocating roles and techniques. Such films obscure the fundamental holistic experience of birth. Couples are not aware that the power of giving birth involves individual surrender to its uncontrollable nature. It is understandable that expectant parents become anxious about their abilities to maintain the kind of control that is expected of them, given that no such control of natural forces is possible--or desirable."

"The actual experience of contractions, like other intense bodily sensations, is extremely difficult to describe...The more completely an expectant mother can experience labor as a unit of body and mind, the more easily she can flow with the process of birth...the more a woman tries to be in control, the more she fears the inevitable loss of control..."

Opening for Birth

The December 2001 edition of the IJCE contains an article titled "The Pelvis Revisited" by Elizabeth Noble. An interesting article overall, I particularly enjoyed the language of the section titled Opening for Birth:

"Birth is what women do. Women are privileged to stand in such power! Birth stretches a woman's limits in every sense. To allow such stretching of one's limits is the challenge of pregnancy, birth, and parenting. The challenge is to be fully present and to allow the process because of inner trust. How can women find their power, claim it, and stand firm in it throughout? The vertical position comes again into prominence. Women must 'stand up' for what they want and 'on their own two feet' by refusing to take their birth 'lying down'! Being upright is essential for pelvic power--psychological strength, pelvic mobility, gravity's assistance, pelvic pump efficiency, and the hygienic downflow of bodily fluids."

In the September 1999 issue, the article Belly-Dancing Through Pregnancy: A Way to Give Birth and Not Be Delivered by Gaby Mardshana Oeftering caught my eye. In it, she also addresses the needs to build inner trust and to open to birth through physical movement and an active approach to birthing:

Midwifery Memoirs

I recently finished reading and reviewing a great new midwifery memoir, The Blue Cotton Gown by Patsy Harman. This book was written by a CNM who no longer attends births, so it was about the rest of midwifery--the well woman care side. It was very good and I really recommend it.

A few months ago, I also read the very excellent Lady's Hands, Lion's Heart, another new midwifery memoir (this one had lots of births and also lots of drama!). It is was extremely good and I really loved it. The author, Carol Leonard, was also one of the founding members of MANA, so the book chronicles the birth of MANA as well as her journey as a midwife. Interestingly, her husband was a doctor as is Patsy Harman's in the book above. Perhaps that pairing is more common than what I might expect! See www.badbeaverfarm.com for more information (my full review is reprinted there as well).

Also newly released in 2009 is Labor of Love, written by the CNM who was shadowed in the film The Business of Being Born.

If you get the opportunity to read any of these books, I think you'll enjoy them!

--Molly Remer

Perpetuating incorrect information

I was a little embarrassed to learn this week that, "People do NOT remember 10 percent of what they read, 20 percent of what they see, 30 percent of what they hear, and so on. That information, and similar pronouncements, are fraudulent. Moreover, general statements on the effectiveness of learning methods are not credible—-learning results depend on too many variables to enable such precision."

I have read this information in quite a few training manuals and books and have shared such information myself more than once (I think even in an article!) So, it was surprising to discover that this information on retention is an urban legend. Now that I think about it, I'm positive that I heard it for the first time in graduate school (one of the 30% of things I heard that I remembered...;-)

The article explaining the origins of this myth can be found here: http://www.bobpikegroup.com/articles_view.asp?columnid=3618&articleid=53796

And I learned about it from the Passion for Birth blog: http://childbirtheducation.blogspot.com.

--Molly Remer

The Future

I enjoyed reading an article called "The Future of Midwifery" by Judith Rooks and Kitty Ernst in the December 1999 edition of the IJCE (I'm still working my way through the big binder of old issues and still enjoying every one!). The conclusion of the article was as follows:

"It is said that the best way to predict the future is to create it. Creative forces come from our souls, our beliefs, our values, our moral and spiritual strength, and from the scientific evidence available to us at any given time. If we are to meet the challenges ahead, each of us must weigh authoritative pronouncements and popular opinions against the available scientific evidence, temper it with our own beliefs and values, and chart a course drawing on our collective moral and spiritual strengths. Change is often shaped not only by what we do but by what we do not do. The future of midwifery and our children's care in childbirth is in our hands today. To be silent is to speak. To do nothing is to take action." (emphasis mine)

Sometimes it seems as if I am saying the same things over and over and trying to reach people who may or may not want to be reached. I found the above quote a good reminder that continuing to pursue change in birth practices is a worthwhile endeavor.

--Molly Remer

Childbirth Educator as "Midwife"

I've been enjoying a true treasure this week--a big binder full of back issues of the International Journal of Childbirth Education. The issues start with the late 90's and continue through 2004.

I wanted to share two of the many things I found engaging about these issues. From the Sept. 1999 issue in an article called The Challenge of Change: Making Mother-Friendly Care a Reality in Childbirth Education by Mayri Sagady comes a discussion of educator as "banker" or "midwife":

"[the concept of]..traditional education as 'banking.' This is where the role of the teacher is to 'make deposits of information' into the student's mind. The student's job is simply to 'store the deposits'...the teacher as midwife [is explained as] 'Midwife-teachers are the opposite of banker teachers. While the bankers deposit knowledge in the learner's head, the midwives draw it out. They assist the students in giving birth to their own ideas, in making their own tacit knowledge explicit and elaborating it'...Within the field of childbirth education today, there are surely both 'bankers' and 'midwife-teachers'"

Then in the December 1999 issue in an article by Celeste Phillips called Family-Centered Maternity Care: Past, Present, & Future, she offers three challenges for 21st century birthing educators:

+"Help men and women understand that birth itself has the potential to change lives for the better."

+"Give women a sense of fulfillment and tremendous accomplishment."

+"Give new parents a strong connection to the very essence of life."

These are formidable--and exciting--tasks! I think it is important to examine our own birth education programs to see how well we are meeting these challenges and also to strive to serve our clients as midwife-teachers rather than as of bankers of information.

--Molly Remer

Honesty in Birth Preparation

Last month I read a book by Elizabeth Noble called Childbirth with Insight. This book was published in the 80's, but has a great deal to offer birth educators of today.

One if the sections I particularly liked addressed the issue of being honest with childbirth education students about common obstetric practices:

"...instructors in the community cannot afford to discuss obstetric practices in ways that will aggravate local hospitals and obstetricians if they wish to fill their classes. One childbirth educator comments, 'Imagine if we told couples how it really was...perhaps we'd lose fewer teachers from our group.' No wonder many of these dedicated and enthusiastic teachers suffer 'childbirth preparation burnout.' They are caught in a triple bind. If they describe accurately how birth is managed in some hospitals, couples would become very fearful. If expectant parents anticipate a warm and flexible birth environment and find that such is not the case in the hospital they use, their disappointment is inevitable and bitter. If the instructors advocate childbirth without drugs or anesthesia and these are needed, parents may harbor feelings of guilt and failure."

The author concludes this segment of the discussion with a very potent and powerful message to birth educators:

"Each instructor must teach what she knows in her bones to be true. A dynamic teacher is constantly changing, becoming more self-aware. At the same time, couples must be warned that almost all hospitals and doctors have expectations based on the mechanical model of birth." [emphasis mine]

Fathers' Roles at Birth

Research has indicated that men at birth take on one of three roles: that of "coach" (20%), "teammate" (20%), or "witness" (60%). I've observed both in person and in birth films that this seems accurate. Many men seem to be likely to fall into an "observer" (witness) type of role during birth, instead of a more hands-on one. This can be disappointing to women, or to the men themselves, who pictured a more active role in the birthing process. Particularly in filmed births, I note the father of the baby sitting by a woman's bedside and holding her hand, or patting her back at most.

I recently finished reading a brand new book called Fathers at Birth by Rose St. John (www.fathersatbirth.com). This book greatly expands the role of the father at birth to that of "mountain" and "warrior." The mountain is strong, stable, calm, still, and supportive. The warrior is alert, responsive, focused, and protective of the birth space and laboring woman. He is there to serve.

In the opening chapter of the book, the author says, "If families are to remain strong, men and their roles as partners, husbands, protectors, and fathers cannot be considered dispensable or superfluous. both partners are diminished when the value of a man's contribution is marginalized, minimized, or not acknowledged. When the man's vital role during labor and birth is understood, both men and women are empowered."

I greatly enjoyed reading a book that explores and expands the role of men at birth. In addition to serving as a helpful resource for men who wish to be active partners in the birth process, doulas will find helpful tips and tricks in the book, and childbirth educators will find language and ideas for reaching out to and better connecting with the men in their classes. It is also a nice addition to any birth professional's lending library.

--Molly Remer

Fathers at Birth

Just learned about an exciting new book called Fathers at Birth and wanted to share a link to the website (www.fathersatbirth.com). As a childbirth educator, I have a special interest in how to truly prepare fathers for birth and so I'm really looking forward to picking up new ideas and resources from this book. In the introduction to the book the author shares a typical "taxicab delivery story" in which an unprepared taxicab driver is called upon to assist a woman giving birth in the back seat en route to the hospital (no one's ideal birth scenario!). The author says:

"Just like the driver, an expectant father is already equipped to attend his partner during childbirth (emphasis mine); the secret is switching modes. The driver has to shift out of his angst and habitual way of thinking so he can see and respond to the situation as it is. Not how he wants it to be. He has to show up and play it as it lays."

--Molly Remer