States of being are not highly valued in a culture that places a high priority on doing.  Yet, true presence or ‘being with’ another person carries with it a silent power – to bear witness to a passage, to help carry an emotional burden, or to begin a healing process.

I have not hesitated to be in the presence of others for whom I could ‘do’ nothing.

I am still pulled by the need to do more than be, yet repeatedly struck by the healing power of connection created by being fully there in the quiet understanding of another. 

I believe in the power of presence, and it is not only something we give to others.  It always changes me – and always for the better.

–Debbie Hall, excerpted from

This I Believe: The Personal Philosophies of Remarkable Men and Women, 2006

Take a moment to consider:

• How does this apply to labor support? 
• To counseling skills? 
• To parenting? 
• To marriage and friendship? 

You’re not alone – fear and anxiety are normal and even useful.

Will I be able to handle the pain?

The baby will come out one way or another, no matter how you relate to the pain.  So, by definition, the pain of having a whole little person come out of you is TEMPORARY.  The pain means your body is working.  Unlike other kinds of pain, it comes and goes in waves, and it doesn’t mean you have to FIX anything. 

Vaginal birth requires your cervix to open up (first stage: dilation), which usually feels like an ache low down in your belly that comes and goes in a predictable rhythm.  Your job is to relax as much as you can and let the muscles do their work.  Then your baby moves through the open cervix and down through your pelvic bones and vaginal tissues (second stage: pushing).  Your job then is to use your diaphragm muscles to help the baby move down and out during contractions.  What hurts in first and second stage is the stretching of muscles, bones, and tissues.  (Third stage, the placenta, is easy.)

I’ll just have an epidural.  

After weighing the benefits and risks, you might request drugs or anesthesia.  These can lessen the pain, but you’ll still have to deal with some pain and some hard work.  If you expect painlessness, you’ll probably be disappointed.  The more you can RELAX, the easier it will be, epidural or not, cesarean or not.

All cultures have developed rituals for softening and opening the channel, not fighting all that stretching and pressure.  Many untie knots, open windows, clear pathways.  Many keep the mother upright and moving so gravity can help the baby find its way.  Most surround the mother with reassuring fellow mothers. Some breathe deeply and envision a soft and open vessel.  These practices can all support the hormonal and physiological process.

You do have within you a lot of resources: your ability to soften, open, work with your birth team.  Thoughtful, realistic preparation and loving support can help us women prevent trauma and discover our inner strength, even if the birth is complicated or includes cesarean surgery.  See if the two-minute experiment is useful for you.   

What’s the two-minute experiment?

You don’t have to do this perfectly:  Breathe in all your fear, exploring it, getting to know it, noticing how it feels in your body.  Silently breathe out the word “calm.”  Try that 10 times. Did you notice that you’re still who you are?

Next, try this 10 times: breathe in the word “open,” pretending that both the word and your breath are flowing around the inside surface of your pelvis and birth canal and even your tailbone, and breathe out the idea “soften” everywhere, including your face and shoulders.  Did you like that? 

Every time you think about giving birth, do that!  Or, even simpler, just mentally melt your body like butter in August, and your mind and muscles will follow.  Or take a nice bath.  Or just pretend you’re taking a nice bath.  

Note: If that exercise upset you, you may need to do some healing work about past trauma in that part of your body.  You are not alone!  Sadly, it’s very common.  Seek support!  Read Penny Simkin’s When Survivors Give Birth.  Consider discussing it with your care provider. 

Will the baby and I be okay?

This is the big question, right?  Very, very probably, yes, even if you give birth all alone in a stuck elevator or something.  But nothing in life is guaranteed, and birth does carry some risks.

It’s your RESPONSIBILITY as a parent to know a lot about pregnancy, birth, postpartum, and babies.  If nothing else, read Pregnancy, Childbirth, and the Newborn cover to cover (there’s Penny Simkin again), or Our Bodies Ourselves: Pregnancy and Birth.  Learn about nutrition, pregnancy changes, prenatal care, and normal birth.  Learn to “speak the language” so you can make informed decisions about complications, interventions, options for pain relief, baby tests and medicines. Learn how to care for yourself and your baby in the first weeks.  Then cheer yourself up with this fear-buster: Ina May’s Guide to Childbirth. 

Learning what can go wrong just makes me more scared!

Those fears have a purpose – they’re trying to get you to do your homework. 

Know this: Complications are rare.  Health care is now able to solve problems that would have been disastrous for our ancestors.  If you have access to good nutrition, clean sanitation, adequate birth control, and well-trained care providers, you can relax a lot, and save your energy for helping to insure that everybody in the world can enjoy the same.

If persistent fears are bugging you, try this: IDENTIFY your fears – name them, examine them.  TALK about them with somebody nonjudgmental and safe.  LEARN all you can about them – that will help you to dispel “fear of the unknown.”  DO all you can to prevent them from coming true.  PLAN how you would cope with trouble and who would help you.  AFFIRM whatever is the opposite of your fear, like “I will give birth in a way that is perfect for me,” “my baby and I are radiant and healthy,” “my body is so strong and flexible,” “I will love my baby and myself no matter what.”

The highly publicized, poor OECD ranking of Canada and the U.S. is almost entirely attributable to the selective registration in other countries of extremely preterm infants who survive, and the systematic under-registration of those who don’t,” says Michael Kramer, one of the study’s authors and until recently the Scientific Director of CIHR’s Institute of Human Development, Child and Youth Health.  “It is also important to note that this is not necessarily a reflection of the quality or access to health care for pregnant women in Canada and the United States. Correcting for this problem, as is recommended by the World Health Organization, will show [our countries perform] extremely well.”

Edgeless space
Sleep, awake, drifting
silence, darkness, warm simplicity

Gradually you become aware of:
movement
muffled sounds
soft edges

Now you’re feeling crowded.
You find the place where your head feels best
You try to stretch out
You react to movements and sounds with movements of your own
You notice slight changes in the light: red, black

You hear the watery sounds of digestion
You feel the rhythms of breathing, walking, making love
You have weight,
and when your universe tilts, you try to get more comfortable. 

You swallow.  You blink.  You pee. 

Your limbs are folded.
You feel your legs and arms against your belly
Your hands find your face.

You recognize voices
Your mom, she talks and sings all the time
Other voices vibrate deeper, softer
other voices higher and faster

Sometimes you feel really squished for a long minute
Sometimes you sleep, soft, soft, soft
Sometimes you feel hyped up
Sometimes things bother you and you get mad and punch
Sometimes you just wish you could find a comfier position
And then you sleep, soft, soft, soft

Now something new is happening. 
Waves of pleasure, hormone hugs,
A chemical conversation.

Now the hugs are a bit much.
Now the hugs are more frequent, and they’re annoying. 
Now they take all of your attention.
You try to stretch.

Underneath it
you have a sense that it will be all right.
Your universe loves you.
But your universe is squeezing too much.
It’s getting kind of scary.

This goes on for so long
that you can’t remember what came before.

Oh!  Squeeze, fight, wiggle, punch, worry.
It stops.  You sleep.

Oh!  Pressed into a little ball, you feel so little.
It stops.  You search for a new position. You find one. 

Oh!  There is nothing but this alarming wish to escape.
It stops.  Exhausted, you conk out.

Oh!  Now, a headache. 
You are vaguely aware of sliding forward
But your head is too squashy to think about it.  

A pause, but the headache stays.
You want to sleep.

Oh, again, there is no escaping this!
Pressure, everywhere, your head hurts.
There is noise, your mom is roaring

You try to move through this tight tunnel.
Like a swimmer pushing off the side of a pool,
You kick both legs out straight.

Oh!  Your head moves forward and you are so startled
That you don’t appreciate that it’s the first time in months
That you’ve been able to straighten your legs.

Oh,  Here’s something new. 
The headache is subsiding,
And you feel something you will later learn to call cold air
On the top of your head.

Oh!  An astonishing shove,
A peculiar movement
Your chin comes up off your chest
Your neck has never done this before

Your whole head is released but cold and airy
Your water world has been left behind
You feel something around your neck
You feel fingers, so different from soft wet walls
You hear sounds so much louder than ever before

Whoa, as in stop stop stop!
Your senses are overwhelmed,

And yet, you’re curious
So you open your eyes and you see
Something neither red nor black

Whoa, as in wow, that’s amazing.

Oh!  All squeezy again!
Your shoulders hurt and then they feel okay
Now the water world is gone altogether
The cold and airy world is your home now

Sound!  Light!  Color!  Skin!
A terrifying feeling of edgelessness and gravity.
And into the very center of it,
The searing of the first breath –

That was too crazy. 
You wait as long as you can
Before the next breath
And you try to keep it small

But it pours into you. 
This is really hard to get used to.
You’re glad you don’t have to master it all at once.
You’re still getting oxygen from your mom.

Oh!  You hear the loudest sound ever!
You wonder if it’s coming from you.
It startles you and so you cry again.

You try an experiment.
You just breathe.

You’re worried about what might happen next.
All this has been so unpredictable, unpleasant, unfamiliar.
You are heavy.  You flail against the new air.

But then something nice happens.
Your skin meets your mom’s skin.
It’s 98.6 and like a waterbed.
A soft soft blanket covers you. 

Here’s another surprise, another nice one –
Your mom smells good. 
You’ve never smelled anything before, and this is okay.

You calm down. 
You are breathing, how new!

Your mom’s voice is familiar but clearer now.
She holds you kind of like when you were inside her.
She likes you and she’s glad you’re here.
Your hormones are having a nice conversation.
The other voices are soft and kind.
You let yourself rest. 

Once you had no desires, no sleeping, no waking, no sound.

Then you were

                                            interested.

Then you wanted only to stretch out.
Then you wanted only to escape.
Then you wanted only to make the suffering stop.
Then you wanted only to feel safe.

Now you want only to merge with your universe again.
Here you are, back in your mom’s embrace.
You let her love wash into your deepest self again.

You let curiosity rest a minute
Before you look around again
And marvel.

A birth plan is best used as a tool for COMMUNICATION with your partner and your care providers, well before the baby is due.

And always, you will dance between PREPARING for the birth of your dreams and cultivating ACCEPTANCE of all outcomes.

Birth works best when you can… TRUST your body: do your research and practice your skills. TRUST your care providers: choose them carefully, communicate well.

Step 1. Develop SKILLS you will bring to your birth. How will you work with your body, your baby, and your partner to facilitate the baby’s journey, no matter how the baby is born? (Good skills can improve health and comfort in all situations, from a planned cesarean to a surprise on the bus.)

Step 2. Find out if your care provider already offers a birth planning worksheet.

Step 3. Use books, educators, websites, and other resources to complete the questionnaire “How Do You Feel About…” with your partner.

Step 4. Discuss both your skills and your preferences with your care provider. Discover any discrepancies between your preferences and their care protocols, and communicate prenatally until you have a mutual understanding. Again, the goal is to cultivate a mutually TRUSTING relationship. You may consider changing to a different provider, or you may consider revising your preferences.

Step 5. Write a concise Skills and Preferences note to be attached to your medical record and also kept in your birth bag. It should include what skills you BRING to the birth, what options you PREFER, and a statement of your willingness to ADAPT to changing circumstances.

How Do You Feel About…

• Prenatal ultrasound
• Prenatal genetic testing
• Hospital birth, birth centers, home birth
• What/who might help you in labor
• Electronic fetal monitoring
• Drugs like Pitocin to start or speed up labor
• IV fluids
• Vaginal exams in labor
• Analgesics (drugs for pain) Anesthestics (like epidurals)
• Moving around in labor
• Episiotomy
• Cesarean section
• Cutting the umbilical cord (when? who?)
• Skin-to-skin contact right after birth
• Breastfeeding, bottlefeeding
• Erythromycin ointment in baby’s eyes
• Newborn Vitamin K and PKU testing
• Newborn immunizations
• Having the baby with you or in the nursery
• How long to stay in the hospital
• Circumcision

9/30/11 Authors’ Reading from “Home/Birth: A Poemic” at Neilson Library, Smith College, Northampton MA, 7 pm.

10/1/11 Events at The Springfield Pulse Gallery, 11 Pearl Street, Suite 230, Springfield MA. 2-5 pm: Birth Art Exhibit; 7-9 pm: Screening of “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing” followed by a discussion with filmmaker Vicki Elson.

10/9/11 The Connecticut branch of the American College of Nurse Midwives is celebrating Midwifery Week in New Haven with workshops (CEU’s available) and a screening of “Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing,” 11am-3pm. CTmidwives@gmail.com for registration and information.

I’ve already filmed a mom of 6 boys, a homebirth mom of an 11-pounder, and a hilarious actress.  There are 100 survey responses so far. This is fun! I think the finished products (film plus website, maybe a book) will be extremely useful.

Please feel free to send interesting mamas (including yourself!) to my online/mail-in survey.  Go to www.birth-media.com, and click on “Be part of the next film.”  Thanks!

Vicki Elson, MA, CCE

www.birth-media.com