Birth of a Notion
Story and photos by Jessica J. Savage
Sitting in on a natural-childbirth class with my 24-year-old daughter, I realized why 25 years ago my then-husband and I became Republicans.
President Reagan's overall message seemed to be about less government interference and empowering people to make their own decisions about their lives: "I don't believe in a government that protects us from ourselves."
We totally bought into because it was the same approach we were taking to the birth of our first child.
Although I can't say the same thing about the Republican Party, thankfully, a quarter-of-a-century later natural-childbirth education instruction is still based on the same principle.
"Ninety percent of women could have natural childbirth by being conscious of their decisions and making informed choices," says Kamy Shaw of Art of Birth & Wellness midwifery care in Las Cruces.
Childbirth education is based on the principle of parents taking responsibility for the choices they make on decisions ranging from the large—such as who their health care provider will be and where the birth will take place—to smaller matters such as waiting until the cord stops pulsating to cut it and whether to circumcise baby boys.
"The medical model holds care providers responsible when things don't go right," Shaw says. "We hold them accountable. But people need to stop suing doctors for things they should do themselves."
As a midwife, childbirth educator and parent, Shaw believes the most important aspect of childbirth is not whether to have the baby without medication for pain, but for parents to realize they are consumers about to make some of the most important decisions of their lives. Parents sometimes find it easy to put themselves into the hands of a provider who facilitates the process by taking on the responsibility of making all the decisions.
So why shouldn't health care providers make all the decisions about pregnancy, labor and delivery, when they're the ones with specialized knowledge about childbirth? Shaw cites two reasons: one, pregnancy and childbirth is a normal human condition, not a pathology; and two, childbirth in the United States has become fraught with fear.
"There's a need for clients to reduce fear about birth," Shaw says. "I've seen birth outside the US, and women just don't need childbirth classes because they inherently know they were born to do that."
In the first childbirth class, pregnant women and their partners or labor support persons are given a selection of crayons and colored pencils and asked to write down or illustrate their fears and doubts about birth, which are then shared aloud to the whole class.
Class participant Lacy Oleary, who with her husband John drove each week from El Paso to the Bradley Method of Natural Childbirth classes at Shaw's center, says she'd heard her share of horror stories about birth, including from her grandmother, who was left alone to give birth. "It's the fear of the unknown, not knowing what to expect," she says.
For Shaw herself, the switch from viewing birth as an event with a multitude of things that could potentially go wrong came when she stopped seeing it through her midwife eyes: "I had to experience my childbirth as a mother." When Shaw was pregnant with twins, her own midwife wanted her to give birth in a hospital, but she opted to give birth in a birthing center. To prepare, she took Bradley natural childbirth classes, which reduced her fears and gave her the confidence to make the choices she wanted to make. The following year she became a Bradley instructor herself.
"You think differently as a mother, not like an obstetrician who is focused on complications," Shaw says. "A mother makes decisions from her heart with intuition. It's influenced my practice. It's allowed me to let my clients be more intuitive."
Each week, students learn about the natural process, which relies more on the relationship between the pregnant woman, her partner or labor support person, and the health care provider than on technology or medical intervention. The process actually makes students realize the importance of their choice of health care provider.
"I challenge people to get a provider they trust," Shaw says. "Work with a provider who will meet your needs, whether it's a hospital or home birth. Women need to be where they feel safe."
John Oleary says one obstetrician he and Lacy went to used scare tactics to persuade them to have the labor induced, followed by a Cesarean section. "He said women who give birth vaginally end up peeing all over themselves when they get older."
Class participant Emily Sanborn, who also drove each week to class in Las Cruces from El Paso with her husband Bob, says she went to three obstetricians but wasn't finding what she was looking for. "I finally realized the reason I couldn't find an OB I liked is because I really wanted a midwife."
Sanborn felt she would need lots of support during her labor, which turned out to be 32 hours long, and wanted a midwife present, yet the obstetrician's role is to mainly be present at the end when the baby is born. "I realized that if I trusted the labor support, why not use them for the whole thing, for the whole time?"
Although Sanborn labored at home and planned to give birth there, after 32 hours of labor, her midwives said the baby was in just enough of a transverse (sideways) position that the baby couldn't come through the birth canal. She was transported to a hospital where physicians again tried to turn the baby but to no avail. Her baby had to be delivered by Cesarean section.
Still, Sanborn says she felt a peace about laboring at home surrounded by supportive people and wouldn't have changed that at all. "I spent a lot of energy planning for the birth, creating a birth plan," she says. "But you also have to accept what happens."
Another couple, Captain David Garay and his wife Heather of Holloman Air Force Base, decided to take the childbirth classes while they were still here, but have made arrangements to have their baby at a birthing center in Simi Valley, near Edwards Air Force Base where they will be transferred this month. "I've already talked to [the new midwife] on the phone five or six times," Heather says. "We have a good relationship."
When class participant Lindsey Weaver was in college, she recalls, she went on a field trip to see a real commune for a class she was taking. They visited "The Farm" in Tennessee, made famous in the childbirth classic Spiritual Midwifery by Ina May Gaskin. She visited the Farm's birthing center and was instantly taken with it. "I knew I wanted that. I thought, 'This is like someone's house.'" So when Lindsey and her husband Erik conceived, she knew she would be planning a homebirth.
Natural childbirth advocates letting nature take its course as to when the woman will go into labor that leads to the vaginal birth of the baby, without intervention unless medically necessary. The classes prepare pregnant women and their partners or support person, who serve as coaches, to be proactive about all aspects of the pregnancy and where it will lead. Through the series of weekly classes, students learn about proper nutrition, special exercises for pregnancy, special concerns of pregnancy, relaxation techniques to be used to reduce pain in labor and practiced in class, the coach's role, the normal stages of labor and delivery, creating a birth plan, preparing for and avoiding potential complications, breastfeeding and the post-partum period.
Although 12 classes are recommended on the Bradley Web site, Shaw teaches an eight-week series of classes, which is still much longer than most hospital-offered programs. Sanborn says, "You have time to get in touch with the different feelings you're having—your fears, expectations and hopes."
Good nutrition is emphasized as the foundation of growing a healthy baby, eliminating complications, quickly recovering from childbirth, and being able to breastfeed the infant. Shaw preaches the importance of a balanced, high-protein diet (100 grams per day) that includes a variety of complex carbohydrates such as whole grains, fresh fruits and vegetables including green leafy ones, as well as dairy products. Each week, class participants sign up to bring a healthy snack to share.
Exercise is important, too. Heather Garay says she maintains an exercise regimen of walking her dogs several miles a day, plus swimming and water aerobics three or four times a week. Sanborn says she was used to running, hiking and yoga, but took up a prenatal yoga class during pregnancy.
In class women learn exercises for strengthening the pelvic floor, such as squatting and "Kegels," as well as exercises and positions designed to take some of the weight of the heavy uterus off the mother's bladder.
The classes are liberally punctuated with videos showing natural-childbirth labors and deliveries. Shaw says she considers these more important that investing in other gadgets and pictures used in some childbirth classes.
Erik Lindsey says the visual images have helped to desensitize him from his queasiness about birth. "The first few times were hard, but seeing the videos—now it's easier."
During one class all the pregnant women were given an ice cube to hold while they attempted to relax their bodies, as a way of teaching them the primary technique used to deal with labor contractions—relaxation.
"The whole approach to labor is being in tune with your body and being conscientious," Sanborn says. She and her husband practiced the ice-cube technique at home, as well as guided relaxation. She says she used every technique and position they knew of during her long labor, adding, "I had the confidence to do it without medication because I knew women had withstood this kind of pain."
All the couples in this class were first-time parents and had never witnessed a birth. Preparation turns the inexperienced into confident teams armed with the knowledge to embrace the birth process. "Every woman needs to believe she has what it takes to give birth, because fear paralyzes," Shaw says.
Husbands also need confidence that they can coach their wives in labor. "You knew how to talk to your wife to get her pregnant, you know how to talk to her to get the baby out," Shaw quips during a class.
So what does natural childbirth look like? During early labor the pregnant woman can participate in light activity, nourishes herself with light meals and stays hydrated by drinking fluids. As contractions become longer and closer together, she continues to be mobile for as long she feels comfortable. As a contraction begins, she stops moving, relaxes and breathes, focusing on her abdomen, while her support person coaches her through each contraction.
As labor progresses and the contractions continue to become longer and closer together, she enters active labor, which requires more focus, and her activity decreases. The health-care provider monitors fetal heart tones through a stethoscope and occasionally performs a vaginal exam. As the cervix, which is the opening to the uterus, fully dilates, permitting the baby's head to enter the birth canal, labor reaches a point known as transition, the most difficult part of labor.
After pushing the baby out, the fully alert mother receives her infant—also alert and ready to bond—into her arms. Mothers who breastfeed their babies can go home within hours of giving birth, if they are in a hospital or birthing center.
Shaw contrasts natural childbirth with her view of medical-based childbirth, which she describes as "fear-based with a plethora of interventions. It's psychologically pounded with all the things that can go wrong. They don't see birth as a natural, everyday, eating and breathing process."
Interventions, ranging from induced labor without medical necessity to restricting activity, often lead to further inventions including pain-relieving medication and Cesarean section, the midwife maintains. Among the medical practices Shaw considers interventions are too many vaginal exams, constant fetal monitoring, restricting the mother's movements including walking, restricting food and fluids, and restricting the mother's position during labor and pushing.
The key to change is making expecting couples conscious consumers who know they have options, she says. "I'm in favor of a nonviolent communication process that is non-blaming," she advises couples working with health care providers and their staff. "No one wants to work with someone who is always saying they're 'not' going to do this or that. Acknowledge these are hard-working people with a huge load. You get more flies with honey, be appreciative, express your desires and don't blame. There were a lot of non-conscious consumers before you and now you have the opportunity to change that. Make choices for a reason instead of letting doctors make choices for you unless it's a true emergency. How many natural births would come out of that?"
Students enjoy Shaw and being in her class. "Kamy is enlightening and funny," John Oleary says.
"We learned the pros and the cons," Heather Garay adds. "If we take medications we know what will happen. We learned the how and the why of the whole process. Knowledge is power. It's better than going in cold turkey and not knowing I had options. I learned who I am and what I stand for. We all have nine months to do it."
Looking back to 25 years ago, President Ronald Reagan had words of wisdom about the government and its role in the lives of its citizens. By substituting the word "government" with "health care providers" we see the principles of conscious childbirth in this reworking of his words:
"It is not my intention to do away with health care providers. It is rather to make them work—work with us, not over us; stand by our side, not ride on our back. Health care providers can and must provide opportunity, not smother it; foster productivity, not stifle it."