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Crowning

When a woman’s eyes

roll wild in their sockets

like those of a frightened foal

when you look into her face

and see nothing

but raw animal instinct

stripped bare of all culture and pretense

look between her legs

and you will find her labia bulging

with the mound of new life

you will see the baby’s head crowning

a glistening, pulsing moon

fragile as a soft-boiled egg

wrinkled as a walnut.

But alas

while you are distracted

by the dramatic birth

of the baby

you will miss

time and again

the more subtle secret birth

that happens simultaneously.

You will miss

the birth of the mother

the death of the ego

and

the resurrection

of humanity.

 
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Posted by on April 7, 2012 in Birth Poems

 

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Labour Pain

Women often ask me: Okay, so how much does labour really hurt? Well, how long is a piece of string? It depends. Labour pain seems to be unique and subjective. Every woman experiences it differently. For some women, labour pain is excruciating, especially towards the end. Others say they expected worse. It was intense, but it was manageable.

Medical researchers haven’t come up with much support for the pain threshold theory. It seems that the amount of pain you’ll experience depends not on your ‘pain threshold’, but rather on something else. Question is, on what?

If I’m asked the ‘how sore is it really’ question in my antenatal classes, I ask a question of my own. I say: “Labour is a lot like sex. The hormones and body parts involved are very similar. Is sex painful or pleasurable?” The first few women normally say that it is pleasurable. But is sex always pleasurable? What about rape? It is probably one of the most painful experiences a woman’s can experience in her life. Why? What makes it painful?

The answer I’m looking for, of course, is resistance. Sex becomes painful when a woman resists it. The same tends to be true for labour. Sure, the baby can be in a position that causes additional pain, like when he is lying posterior, but in general labour coping tools and techniques are all designed to minimise resistance.

Klaus and Kennell writes:

“Every aspect of labour support must start with the idea of reducing stress – mental, emotional and physical. The goal is to enhance the woman’s ability to relax. The body’s stress system is called the sympathetic nervous system, which produces what we call the ‘fight or flight response’. The opposite of the sympathetic nervous system is the system that creates calm and a feeling of well-being called the parasympathetic nervous system. The hormones of the sympathetic nervous system are epinephrine and norepinephrine. The parasympathetic nervous system produces a hormone called oxytocin. Reducing the stress response enhances the body’s own production of oxytocin, as well as natural opiates called endorphins.

When the woman can relax, oxytocin strengthens the contractions of the uterus. It also allows the muscles to function properly, the longitudinal muscles to expel the baby and the lower uterine muscles to relax, stretch, and open to release the baby. When a mother’s body is tense, the opposite occurs; the upper muscles of the uterus loosen and stop contracting, and the lower muscles tighten to retain the infant. This is perhaps nature’s way of stopping labour if the mother has to flee from a frightening experience … The fight-or-flight response occurs and the body gears for defense, sending blood to other organs of the body. If blood flow is reduced to the uterus, the uterine muscles constrict, causing the circular muscles of the cervix to tighten up, and dilation is impeded [and remember, the less blood flow to the uterus, the more pain]. Also, there may be less oxygen sent to the fetus. When the vertical muscles of the uterus continue their attempt to expel the baby, and the cervix resists, the baby’s head pushes against tense muscles. This causes more pain and lengthens labour.

When labour is not impeded by undue stress and fear, the woman’s own natural oxytocin is secreted from the posterior pituitary gland into the bloodstream. At the same time, her brain also secretes oxytocin to other areas within the brain itself. This has four effects. First, it markedly increases the pain threshold, so that the mother has reduced sensitivity to pain. Second, it results in drowsiness. Third, it results in some relaxation or calming, and finally, after the birth it helps the woman feel closer to the baby.” (The Doula Book, Klaus, Kennell & Klaus 2002: 70).

In other words, relaxation creates a positive feedback loop. The more relaxed the mother is, the better her secretion of oxytocin. In its turn, oxytocin leads not only to stronger and more effective contractions, but, paradoxically, also to less pain! The key to a less painful labour is increasing relaxation and reducing resistance.

But how do you reduce resistance? My top ten tips are:

  1. Practice relaxation techniques before labour, preferably with your partner. You can take a course like Hypnobirthing or The Mama Bamba Way, you can buy CDs on the internet, or you can practice yoga, meditation and/or visualisation. These techniques will all teach you how to relax into the intense experience that is labour, instead of resisting it.
  2. Support yourself with people that you love. Research has shown over and over that a mother who is supported experiences less pain. Consider hiring a professional doula to take some of the pressure off your partner and to support him as well.
  3. Ensure that you are labouring in an atmosphere that feels safe and comforting. If you are one of those people who tense up as soon as you step into a hospital, you should consider birthing at home or in an Active Birth Unit.
  4. Use water to relax you and to relieve pain. A birth pool is probably second only to an epidural in terms of pain relief. It really can provide extremely effective pain relief.
  5. Remember that your breath is your best friend in labour. You don’t need to learn a lot of complicated breathing techniques. You just need to breathe in a natural and relaxed way: in through your nose, out through your mouth. Try to make your out-breath a little longer than your in-breath and purposefully relax and let go while breathing out.
  6. If you find labour painful, tell yourself that this is healthy pain and that you welcome it. We are so used to resisting pain, to taking pain killers and rushing to the doctor. We are used to seeing pain as a message from our bodies that something is wrong. In the case of labour, however, pain has a purpose.
  7. Take it one contraction at a time. You can handle this one contraction, can breathe through an intense minute or minute and a half. What you may not be able to do, is cope with the idea of the contractions that have gone before this one (I’ve been in labour for fourteen hours!) or with the ones that are still to come (How long is this going to take?). The moment you start thinking of the past or the future – the moment you step out of the present – you are in trouble. See each contraction as one less, not as ‘oh no, not another one!’.
  8. Keep your mouth, your neck and your shoulders soft. It is almost impossible to hold tension in your body if these areas are soft. Blow soft raspberries with your lips, roll your neck, ask your partner for a shoulder massage in between contractions. Some soft, smoochy kisses will also do the trick.
  9. Make low-pitched sounds from deep in your belly. This increases endorphin release. If you find yourself crying ‘no’ and shaking your head from side to side as a contraction starts, try doing the opposite. Chant something like ‘yes’ or ‘open’ instead. Embrace the pain instead of resisting it.
  10. Use tools that will get you out of your normal state of consciousness into a more embodied, instinctive state. Lower the lights or close your eyes. Play relaxing music and move rhythmically with it. Dance with your partner. Spiral your hips.
 
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Posted by on March 12, 2012 in labour and birth, Natural Birth

 

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Beginner’s Mind

“But I’ve never done this before”

Says a dad in the second row

From the back.

The big one with the brown beard

who secretly reminds me

of a friendly bear

with thick reading glasses.

“How will I know what she needs?

How will know how to support her?”

That’s why you need a doula,

I want to say.

Someone who has been there before.

But I don’t

Because I sense

That a dad brave enough to ask these questions

In front of the whole antenatal class

Is probably a dad

Who will understand

the secrets

of supporting

a woman in labour.

So I sway a little

On the big yellow birth ball

I like to sit on

When I teach

I think a little

About what it takes

To be with a woman

During birth.

“You will know what to do”

I tell him

“If you are really there

truly present

Each moment

In that room.

Do not think about

The breakfast you never had

Do not think about

That meeting you’re gonna miss

Above all

Do not think about

The rugby

The cricket

Or anything involving balls.

Take off your shoes

For the ground on which you’re standing

Is women’s holy turf.

Switch off your cell phone

and let that room

let that woman

become your entire universe.

Watch her closely

And you will know what to do

Listen to her

With more than your ears

And you won’t say

Stupid things

That’ll get you in trouble.

No, don’t write it down!

Just listen

Practice with me

Practice being present

In this moment.

Do not think

That your lack of experience

Is a handicap.

I am not a better doula

Hundred births down the line.

In fact, I might be worse.

For beginner’s mind

Is a shimmering pearl

Of magnificent value.

Not knowing

Being open

To things as they unfold

Are way more precious

Than tools

Tricks

And techniques.

You cannot go wrong

If you love her

You cannot go wrong

If your intentions are pure.

Leave your expectations

At the door of the labour ward

And enter the birth room

With your cup empty as a beggar’s.

When it is all over

And your back and shoulders ache

As if you’ve carried her

Belly and all

The entire way

Across the desert

She will turn to you and say

‘I couldn’t have done it without you’

And you will answer

‘But I did nothing

My love

You did it all.’

Trust me,

Nothing

Will be more than enough.”

The dad looks at me

Bemused

Befuddled

His mouth opens and closes

Like a goldfish

Flapping his fins

On the dry threadbare carpet.

He never finds his voice.

But Thabo

From the front row

who is not shy

his hand goes up.

“That was some speech

That was inspiring

Now I was just wondering:

Would all of that

Be in the notes?”

 

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Women

From the deep recesses of sleep

Another strong, incredible woman after the birth of her second baby

I drag myself to assist at the birth

of a woman I’ve never laid eyes on.

Candlelight

whispered encouragement

only women in the room

reverently gathered round the bath

to worship our fair goddess of fertility.

Somewhere far from here

the baby’s father

sleeps peacefully next to his new love

just as the two children

from his old one

sleeps in the birth room next door

while their mother strains and sighs

while their grandma frets and fusses

while their auntie rubs her sister’s aching back

and snaps digital pics.

“I can’t!”

the woman cries

and four pairs of female hands

stretch towards her

to transfuse their strength.

Into the warm water

slips a chubby pink baby

onto her mother’s chest

where she turns her head

to take in all the faces

belonging to the admiring voices.

“You did it!”

we cry

our eyes wet with tears.

Two hours later

the woman walks

to her tiny white car

straps her brand new baby

into an old car seat

and makes sure that her boys

are comfortably settled

on the laps of their grandma and aunt.

As the muezzin’s mournful voice

begins his morning call to prayer

she slides behind

the steering wheel

and drives herself

and her family

home.

The midwife and I

wave goodbye

until the battered white Corsa

disappears in the dark.

We turn to each other

shaking our heads.

“Women!” we marvel.
“Women

 

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What is Normal Birth?

Here is one of my favourite quotes about birth:

The question is disarmingly simple, like asking: ‘What is love?’ I open my mouth to answer quickly, then close it again, suddenly humbled by the realization that the answer is complex, emotional, elusive, rich, deep and varied.

Images flash in my mind – I see beautiful, wet babies in their mothers’ arms, I smell the birth smell and feel the holiness that hangs in the air; and I feel the wonder that rises in the presence of the wise and ancient process that is beyond human design or control.

Normal birth is the mother who stands up beside her bed where she has just given birth, faces me with her baby in her arms, her eyes flashing fire and triumphantly shouts: ‘I did it!’

Normal birth is the woman who dances the slow birth dance and sings the low birth song. It is the woman who is naked and not ashamed.

Normal birth is the woman who, though she has never been there before and did not know she knew the way, finds her path to the deep and quiet place within herself where her intuition and faith lie hidden and ready to feed her soul.

Normal birth is the woman who births in her own power, dignity, beauty, grace and strength. It is this mother and this never-seen-before baby working it out together for the first time.

Normal birth is what I trust this mother can do. It is what I believe in, cherish and humbly protect. It is the gift we give the mothers we serve and the gift they give their precious babies. It is the real life miracle I witness again and again with an ever-growing sense of privilege and joy.

Lois Wilson, American midwife (in Midwifery Today)

 
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Posted by on February 25, 2012 in labour and birth, midwives, Natural Birth

 

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The Beauty of Labour

It never ceases to amaze me how different women look from their everyday selves when they are in strong labour. If they are able to surrender themselves to the process, that is. If a woman is really into her labour, her face might take on an angelic – if exhausted – glow. Her features become softer and more natural. She starts to look, I think, more like herself. As she drops her pretences and masks, the loveliness of the creation process itself shines through her. Life itself flows through her, unhindered.

You might ask me if her appearance really alters or if she only looks different to me. This I cannot tell you, for I possess only my own eyes with which to see. And, of course, beauty is in the eye of the beholder. Love for something or someone will radically change its appearance. I would not be exaggerating if I told you that I fall in love with the labouring mothers that I attend. Not in a romantic or sentimental or weird way, but in the way you fall in love with a tree or with a poem if you are truly present to it. So present that all else drops away. One can call it a mystical or spiritual experience, I suppose. The strict borders between sacred and profane definitely soften during birth, and the everyday dissolves into the otherworldly to such an extent that it becomes impossible to separate the two. And when the baby is finally born, and fed, and when I have listened to the new mommy telling her story as she experienced it, when I step out of the room to go home, the spell is broken. Almost broken. A faint afterglow remains with me, yes, and the best way to prolong this afterglow – the best way to preserve the memory – is to write it down as soon as I can. Through writing, I can almost – almost – relive an once-in-a-lifetime experience.

 
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Posted by on February 22, 2012 in labour and birth

 

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Happy Valentine’s Day, Dear Midwives!

Not too long ago, I finished my third medical romance (in Afrikaans, under my pen name). Like the first two, the story centres around a midwife in private practice. She is asked to deliver the baby of a celebrity couple – at home. I wanted to call this book Vroedvrou vir die Sterre – Midwife to the Stars. My publisher accepted the book, but not the title. According to her, the term ‘vroedvrou’ (in English, ‘midwife’) is not very romantic. I accepted the change with good grace, acknowledging that she knows best about all things publishing and book sales, while I’m just a doula who knows about birth.

Still, if you ask me, being a midwife is a pretty romantic thing to do with your life. Oh sure, there are late nights, missed birthday parties and Christmases, ringing phones in the middle of the night. There’s blood and poop and other bodily fluids. There are (sometimes) screaming women and disrespectful colleagues. But mostly, there is love.

Think about it. What constitutes our very first experience of this world? Our primal experience of love? It is our birth, of course. Whose hands are the first to touch us, the first to convey welcome or abuse? The hands that deliver us. Those hands imprint upon our bodies and our souls what love and tenderness should feel like. Often, the very first voice we hear is that of the midwife or the doctor ‘catching’ us. Lucky is the baby delivered by a midwife’s gentle hands, placed with awe onto his mother’s chest, welcomed with the words: “Here’s your baby, look at what your love created, isn’t he beautiful?” In that moment, the midwife’s love births not just a baby, but a family. A mother. A father. A new soul.

The word ‘midwife’ comes from the old English and means someone who is with woman. Sheila Kitzinger describes the role of the midwife beautifully in her book, Rediscovering Birth:

“In all cultures, the midwife’s place is on the threshold of life, where intense human emotions – fear, hope, longing, triumph and incredible physical power – enable a new human being to emerge. Her vocation is unique. The art of the midwife is understanding the relationship between psychological and physiological processes in childbirth. Rather than being the provider of a technical service to support a doctor, or someone who scuttles around getting ready for an obstetrician and clearing away after him, her skills lie at the point where the emotional and biological touch and interact. She is not a manager of labour and delivery. Rather, she is the opener of doors, the one who releases, the nurturer. She is the strong anchor when there is fear and pain; the skilled friend who is in tune with the rhythms of birth, the mountain tops and chasms, the striving and the triumph.”

Sounds romantic, doesn’t it? French obstetrician Michel Odent reminds us that, until recently, human mothers could not give birth without releasing a “complex cocktail of love hormones”. The most important of these hormones are oxytocin (the hormone of bonding), endorphins (the hormones of transcendence and bliss) and prolactin (the mothering hormone). He warns: Today, in many countries, most women have babies without releasing these specific hormones. The questions must be raised in terms of civilization. This turning point occurs at the very time when several scientific disciplines suggest that the way human beings are born has long-term consequences, particularly in terms of sociability, aggressiveness or, in other words, ‘capacity to love’.” Midwives, in my opinion, are the ones most skilled at creating a space in which love hormones can flow. They are an essential ingredient of the “cocktail of love hormones”. This is why women often have lifelong bonds with their midwives.

Thank you to all the wonderful midwives of the world who embody love. Thank you, in particular, to the midwives who delivered my babies (Sue and Riana) and the babies of my doula clients (especially Heather, Esti, Erna, Margot and Cornel). A special thank you to Robyn Sheldon, the ‘mother’ of The Mama Bamba Way. You have inspired me so deeply that I had to write three stories about your profession. You truly are my heroines. Happy Valentine’s Day! May the love you’ve given away so bountifully come back to you a thousand fold.

To all the midwives, moms and dads viewing this post, please don’t go away without leaving a comment. I’d love to hear from you.

 
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Posted by on February 14, 2012 in books, midwives, writing

 

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