Women's Bodies, Women's Wisdom (108 page)

Once settled in, women in labor then must
allow
the pain. Thrashing about doesn’t help. Going deep within yourself does. Dr. Hays and I were talking recently about the pain of labor and how to help women work with it, and we exchanged a few stories about women who appeared to “go to another place” when they were in labor.

She told me about the wife of a medical student she once worked with who sat quietly in bed with the lights dimmed during her labor and was so focused that her mother and husband figured that she probably wasn’t in labor. Not only was she in labor, however, but when she finally opened her eyes and spoke, she said, “I think it’s time to push.”

“After the birth,” Dr. Hays told me, “my curiosity prompted me to ask her where she had gone when I instructed her to go ‘somewhere else.’ [Early in labor, she had seemed to be very disconnected from her body, and Dr. Hays had told her to get comfortable, relax, and just “go somewhere else.”] Her answer was totally unexpected. She said, ‘Oh, I was concentrating on the pain.’ Her answer intrigued me. Could a woman really deal with the pain of labor not, as I had been taught, by distracting herself and concentrating on something else—her ‘breath ing’ or her ‘focal point’ or her fantasy trip to the Caribbean? Could she, rather, focus on her body—on the work it was doing, on the
pain itself
?”

So Dr. Hays began questioning those women who labored without noise or a lot of activity each time she worked with one. One said, “Well, I was just concentrating on my cervix. You know, letting it open up for my baby’s head.” The common thread running through all these labors was that the women were
with
the pain. They were going down inside themselves to the place where the pain was and allowing it.

One of Dr. Hays’s patients gave her the following beautiful piece of birth imagery in answer to the question “Where do you go during your contractions?” She said, “Well, you know when you are in the ocean, in a heavy surf, if you stay on the surface you will get thrown about against the reefs and the rocks, and you get a lot of water in your nose and mouth and feel like you’re drowning. But if you dive down and hold on to something and let the wave pass over you, you can come up in between and feel just fine. Well, that’s what I did during labor. When the contractions came, I dived down and let them pass over me.” Water imagery is very common when women describe normal birth.

During my own second labor, I realized that I had
allowed
the process quite differently than I had with my first. Labor is a true
process
—with its own rhythm and timing—and it is a process that is bigger than we are. For that reason, learning to go with it—to let it sweep us along—is something that we never forget. And it is great training for the give-and-take of parenting.

Women’s Stories

Rebecca’s Story: Reclaiming Birth Power

The following story is related in the words of Bethany Hays, Rebecca’s obstetrician.

“Rebecca was a second-time mother whose first labor had been long, but she did well with the help of her labor support person and a gentle, loving husband. Rebecca arrived at the hospital for her second birth already seven centimeters dilated and feeling great. She walked and talked with her team of supportive people, and she sipped fluids. She tolerated our medical intrusions into her birth with monitor, blood pressure cuff, and thermometer.

“After several hours, Rebecca was still only seven to eight centimeters dilated. She was puzzled and frustrated, wanting to ‘get on with it.’ We discussed her options, including rupture of the membranes, which might bring the baby’s head down against the cervix. The cervix felt ready and soft enough to allow the passage of the head, waiting for some unknown work yet to be done.

“After considering the possible negative effects of it, she chose to rupture the membranes. This was done. Now the contractions got harder, but after some time, the exam showed that she was not quite fully dilated. The head was still high up in the pelvis. She showed some urge to push when squatting, but she was not pushing effectively. Her monitrice [professional labor support person] reminded me that during the first labor, she had also had difficulty pushing—requiring three hours in the second stage and pressure applied to the posterior vaginal wall to encourage her to push.

“Maybe that would help again, someone suggested. So as Rebecca squatted, I knelt on the floor, placed two fingers in her vagina, and pushed firmly on the posterior wall. Her response was an immediate and reflexive withdrawal. I realized that not only was I causing her pain, but I was triggering some much more serious emotional response. My own reaction was equally strong. ‘No,’ I thought, ‘I will not partic ipate in this abuse. This is sexual abuse of another woman’s body, and I will not do it.’

“ ‘Rebecca,’ I said, ‘let’s try something else.’ Now, I have always been touched at the faith (often undeserved) that patients place in me, and I knew that she trusted me. Whatever the new plan was, she would try it. The joke was that I had no plan. I was flying totally by the seat of my pants. I asked her to get comfortable, and she arranged herself semireclining on the bed, with her husband behind her and wrapped around her. ‘Now,’ I said, ‘I just want you to relax and listen to my voice. First, go down inside yourself and find your baby where he is in your body. When you are with him, tell him he is okay, in case he is scared.’

“As we waited, a slow smile came over her face, and I knew that she was with her baby. The fetal monitor no longer disturbed her. It now showed sudden resolution of the small to moderate variable decelerations she’d been having with contractions. [Variable decelerations are heart rate patterns associated with compression of the umbilical cord, which can sometimes produce stress in the baby.]

“ ‘Now,’ I said, ‘I want you just to listen. Many of us women have not owned all the parts of our bodies. We have not allowed ourselves to feel our vaginas and our perineums. They have seemed separate and are not within our control. They have negative connotations: porno graphic or dirty. In many ways these parts of our bodies are problematic for us. But the truth is that they are ours. They belong to us like our hands and our lips and our minds. This part of your body is yours, and you can reclaim it. Right now. Take it back as the sensual, enjoy able part of you that it really is. Since it is yours, you are totally in con trol. You can allow your baby to move through this part of you as fast or as slowly as you like. It does not have to hurt you, but you will feel very strong signals from this part of your body that you are not used to feeling. Allow those feelings and celebrate them as the return of a long-lost friend.’

“Now we were all watching. Rebecca was totally relaxed, lying in her husband’s arms. The room was quiet except for the fetal monitor, which was quietly attesting to the continued well-being of the baby. I was wondering if I was deluding myself—pretty sure that everyone in the room must think I was nuts.

“Suddenly I realized that with each contraction, Rebecca’s perineum was bulging—the head was coming down. It was working. Occasionally, Rebecca lost contact with her body, became frightened, and clutched her husband. Immediately when this happened, the baby’s heart rate pattern showed prolonged variable decelerations with slow recovery. At these points, I would say, ‘Talk to your baby again, Rebecca. He’s scared. Remember, don’t go faster than you want to. This is your body. All of it belongs to you.’

“Once again, Rebecca was quiet, and we saw the baby’s head begin to crown [to appear, just before delivery]. Soon, with little or no pushing effort, the baby was born into his mother’s loving arms.”

After hearing this story, I realized that the second stage of my own second labor might have been different if I’d had a doctor like Bethany Hays. I also realized that I have been involved in the unwitting physical abuse of many laboring women by pushing down on their vagina to try to help them push, and by encouraging them, like a football coach, to “push him out.” I wouldn’t have done that if I had known what I now know.

Amanda’s Story: A Home Birth

Bethany also attended a birth in which one of her patients went further into herself than either of us had known it was possible to go. Amanda’s first baby had been delivered by Bethany by cesarean section. “I thought we had done everything right,” Bethany says. “She had been healthy, confident, and wanted a normal birth, including labor without anesthesia. She had labor support, family, and friends. Though it seemed perfect, the baby simply wouldn’t come. We did everything I knew to do, which at that time was not a lot. I finally did a cesarean.”

With her second pregnancy Amanda returned to Bethany’s care and said, “I want to have a normal birth this time.” Bethany agreed and told her that she thought that was entirely possible. The women who are most motivated to give birth normally are those who did not succeed in doing so with their first child but haven’t lost the desire to try. Amanda also did not want to have her second baby in the hospital, because she felt that the hospital environment had been part of the problem the first time. Instead, she would have it at home.

For years I’ve had a special place in my heart for those women who choose home birth. The reason for this is that these women trust themselves more than doctors and hospitals. Though they sometimes make mistakes, they have something to teach us. My sister had a home birth, and I wish I had had at least one child at home. Though I left the hospital right after both my children were born and neither one of them went to the nursery, I still would have liked the experience of waking up in labor and not having to get into the car and go someplace. Both times it felt like a very unnatural interruption of my process.

Though Amanda wanted Bethany there, Bethany does not do home births. Finally they reached a compromise. Bethany would be there only as a labor support person, and Amanda herself would hire the best midwife she could find. For an ob-gyn to do a home birth has been politically very unsafe. Many hospitals will not allow physicians who do home births to have hospital privileges, and most malpractice insurance companies won’t insure these physicians despite statistics on the safety of such births. But Amanda was determined to have Bethany present, and Bethany was interested in supporting her, as long as she wasn’t responsible for being the caregiver.

Long discussions ensued, regarding risks, uterine rupture, fetal compromise, their likelihood, and what Bethany could and could not do if these problems happened at home. Ultimately, Amanda convinced Bethany that she herself was in charge of the safety of her baby and the integrity of her uterus, and that if she felt she could not do this job, she would let Bethany know and they would all go to the hospital.

The day of Amanda’s delivery came. Her early labor was long and painful, but she didn’t call anyone. When she finally invited her care givers to join her, they found Amanda in the rocker. “I feel so great,” she said in one breath. And with the next she said, “The pain was so bad this afternoon, I thought I would die.” Bethany later told me, “I didn’t know how to put those two statements together.” As the birth neared, Amanda lay in her king-size bed on her side. “As we tried to keep up with her,” Bethany told me, “she circled the bed. Her head remained in the center, and her feet made a full circuit around the bed twice, a maneuver that I had not seen before in the hospital. It was very primitive. Though it was not clear to me what it represented, I trusted her need to move in this way as part of her unique birth process.

“There was little talk. Amanda said nothing and made little noise. She pushed her baby out on hands and knees and then kneeled over her. She was somewhere else. We were all commenting on the baby, but she was not looking at her infant. Her body was in a pose of ecstasy. When spoken to, she did not respond. For a moment I was frightened that she might not come back from wherever she was. Then she looked down at her infant and slowly came back into her body—or was it back out of her body?”

Bethany took a picture of Amanda in that ecstatic state, and she showed it at a recent medical meeting in which we both lectured on women’s health. From this and reading Vicki Noble’s
Shakti Woman
and
Ina May’s Guide to
Childbirth
(Bantam Books, 2003), I learned that Amanda’s experience of ecstasy is potentially available to all women at birth.
⁸⁸
Since then, I have talked at length with some of my patients who have had home births. One recently told me that during her home birth she “left her body” and became an eagle flying high overhead. She experienced no pain. She had never told anyone about this. From that moment on, however, she trusted her body completely.

Women have learned collectively, though not necessarily con sciously, to fear the birth experience, and every obstacle has been put in our collective paths to keep us from experiencing this power. But as Bethany says, “This kind of birth is possible in many environments. It requires a mother who trusts her body and is connected to all of its parts. She must love and want her baby. She must understand that birth is a sexual event and be comfortable with her sexuality. She must feel safe. She needs to know that the people around her accept her body and the sexual nature of what she is doing and are not embarrassed by it and will not interfere with the process. She needs to know that she can go down inside and come back safely. If she has never been there before, she needs the grounding love of family and friends who will, if needed, call her back.”

Those women who have already had babies in standard ways should understand that they are not responsible for what they didn’t know at the time. I was born drugged, as were all my brothers and sisters. Though we were breast-fed, we were still left in the hospital’s nurs ery for hours while my mother woke up. This isn’t the way she had wanted it, but she didn’t know she had a choice.

Remember that
being responsible
simply means “being able to respond.” No one is guaranteed a perfect birth. In fact, the concept of “a perfect birth” is part of the perfectionism of the addictive system. Sometimes a baby needs to be observed in the nursery right after birth. Sometimes an emergency cesarean is necessary. When this happens, it is not a failure on the woman’s part. She is only one part of a complex and mysterious process. The baby herself (or himself) is also an active participant in the labor process. Each baby makes a unique contribution to her mother’s pregnancy, labor, and delivery. We can always learn something from it and use the experience for personal growth. But whatever happens, parents should be involved as much as possible, at all stages of pregnancy, labor, and delivery. They need to understand that their input is very important to their baby’s health.