I’ve heard through a few different sources that a local hospital specializing in woman care currently has an epidural rate of 97%. That means that 97% of laboring pregnant women admitted into the hospital are administered an epidural. Such a high, almost unbelieveable rate makes me question how many of these women actually need it? How many are convinced that there is no other alternative to experiencing labor and coping with the discomfort that ensues?

This brings up the issue of how women experience childbirth pain. Or, more importantly, how women are taught to fear the experience of childbirth pain—through the media and other social avenues—and how that fear effects the experience of labor and delivery—both emotionally and physically. Dr. Grantly Dick-Read studied the phenomenon of the Fear-Tension-Pain cycle. He observed the ways in which the experience of fear lead to whole body tension which caused an increase in the experience of pain which leads to an increase of fear and so on. Seem simple? Well, it is, unless you’re the person trapped in this cycle feeling as if there is no way out. Thanks to Dr. Dick-Read, there are many, many ways in which women can become aware of the inaccurate, often negative social attitude and perception of labor, overcome these cultural misconceptions and have a positive healthy childbirth experience.

Want to learn more about Dr. Dick Read and his groundbreaking approach? Check back to earthmother.org as we explore the fear-tension-pain cycle and how understanding it can be used toward a positively fearless birth.

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Check out the trailer to this must-see movie for all women—pregnant women, mothers with children young and old, and especially young women learning about the realities of women’s health care. There are some shocking moments in the trailer alone: the panel of doctors who reluctantly admit that they almost never see a natural birth. But, with proactive women such as those that made this film, the word continues to spread that there are many options for pregnant American women—including the right to be informed, be prepared and be positive! For more info about the movie: thebusinessofbeingborn.com

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A pregnant woman recently asked me an excellent question: what was my greatest strength during natural childbirth?

Truthfully, I was very fortunate to have many strengths from which I drew. My husband was an ideally supportive birthing partner. My Midwives were well-seasoned and compassionate. The greatest source of strength, however, came from a motivational tactic presented by the childbirth educator in birthing class. She introduced a simple philosophy that changed the scope of what I thought was possible, and she summed it up in one short declaration: Yes I can!

I admit I’ve always had a rebellious “don’t tell me I can’t” attitude. The idea of yes I can was at once a challenge and an affirmation. Can you? Yes, of course I can! Still, her three-word-creed was less rebellion and more inner empowerment; it was both mighty and quietly wise. The kind of yes I can that inspired my desire to experience the raw beauty of natural childbirth. It would give me the opportunity to reach within myself and put some of my stubbornness to good, productive use. Because, I honestly wondered, Could I?

I discovered I could. Twice…partly due to a newfound fascination with the art of childbirth. I began to enjoy reading books and talking with other women about the subject. The accounts of women who’ve been able to do it without medical intervention are particularly intriguing—especially those who somehow make it seem effortless, or simply, just—well—natural. I’ve learned alot from these women.

There are myriad techniques to maintaining a yes I can mindset while in the throws of labor. These helpful tools not only keep a laboring woman focused and positive but they are also proven to quell pain and speed progress. The trick is to find those that suit you. And, when utilized, the tools do direct a woman’s thoughts toward the end goal: a healthy new baby.

Some of my favorite yes I can tools are:
Deep cleansing breaths. Quiet. Dim lighting. Listening to favorite music. Walking outside. Feeling the warmth of the sun. Gently stretching arms or legs. Squatting. Finding a comfortable sitting/resting position. Bouncing/Sitting on an exercise/birthing ball. Taking a warm bath/shower. Receiving a gentle back rub. Receiving a firm back rub. Visualization of favorite things/places/people. Humming. Singing. Laughing. Enjoying the comfort of a favorite blanket/pillow/pair of fluffy slippers. Drinking a cool glass of water/juice. Feeling the presence of and embracing a spouse/partner/trusted friend. Remembering each contraction brings you one step closer to birth. Mentally acknowledging and being empowered by your progress so far. Relishing that conceiving, nurturing and birthing is part of the magic of a woman’s body. Anticipating holding your new baby. Smiling.

*Thanks to all the women who have shared their stories with me. You are all inspiring sources of strength. Special thanks to Deanna for challenging me with the crazy idea that I could. And, to my mom who has always believed I could even when I didn’t.

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1. It’s the healthiest choice for baby.
   Babies born during unmedicated births are more alert, breastfeed more successfully and have lower incidence of asthma and other illnesses than those born by cesarean. Likewise, many researchers are now questioning the connection between the use of medications and unnecessary cesarean sections with the steep rise in autism diagnosis among young children.
2. It’s the healthiest choice for mom.
   Moms who give birth vaginally without medication or episiotomy heal quicker and resume normal activities sooner and, as a result, also experience much less difficulty breastfeeding. Women who have undergone cesarean sections may be predisposed to future pregnancy risks.
3. It’s the ultimate act of feminist empowerment.
   It keeps the control where it belongs: in the woman giving birth. Natural childbirth encourages women to embrace their strengths and to approach birth as a beautiful positive feminine act. The current trends of coercing women into medications complicate the process of birth, put women in a state of vulnerability and fear, and ultimately place the health of women and their babies at risk. Natural birth encourages women to take back their reproductive rights in the labor and delivery room.
4. It challenges the miserable downward spiral of birthing meds.
   Survey a handful of women who were given Cervidil, Pitocin, Demerol, Epidurals or other common birth medication, and ask them if these methods actually worked to progress labor or assuage pain. Despite popular myth, birth medications oftentimes do not work and actually cause more harm to mom and baby. Many lead to further measures ending in an unplanned cesarean section. The phenomenon is so common that it is frequently referred to as “the downward spiral of labor meds.”
5. It calls for more midwives (and less doctors) to attend more births.
   It may seem like stereotyping, but the statistics consistently ring loud and clear. With drastically fewer complications, midwife-attended births garner much healthier outcomes for mothers and babies than doctor-attended births. Interestingly, midwives are able to achieve more consistently positive results with little use of medications or interventions and less stress to mothers and babies. By contrast, the growing trend of doctor-attended births to routinely use medications, induction and various interventions show increasing incidence of complications—30% of which now end in unplanned c-sections. Disturbingly, doctors make an average of $8,000 on a vaginal birth while the figure doubles for a c-section. Worse yet, some statistics suggest morbidity rates are actually increasing among doctor-attended births. Not so with midwives.Are women being coerced by doctors to be medicated during childbirth simply to speed the process, be hospitalized longer and pay more in fees with no real benefit to themselves or their babies? We’ll never know, and quite frankly no one should live in fear or mistrust when lives are at stake. Do yourself a favor: if you don’t personally know and implicitly trust your doctor, heed the statistics and hire a midwife…preferably one you know and trust.

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1. Select your family doctor, Ob/Gyn or midwife wisely.
   Choosing a person or team that you trust will make all the difference in the world. Find someone that you know will respect your wishes. Base your choice of health care practitioner on a few key factors: What is their rate of episiotomy use? Yes, you can ask this question and expect a truthful answer. It is public record, so it is your right to know. Choose a practitioner that has a low rate (you want less than 10%) and doesn’t practice routine use (emergency use only). Make it clear that you do not consent to an episiotomy.
   Other questions to ask: Does she promote childbirth as a natural process that a woman’s body is capable and built to do? Will she suggest techniques to prepare you for the physical event in the months and weeks before birth? During how much of the labor will she be present? Will she be a positive supportive influence during birth and advise you when pushing the baby to allow your skin to adjust and stretch?
   Knowing the answers to these questions, you will be more confident in your practitioner’s decision-making process. The comfort of trust will help to buoy your confidence and stave off tension.
2. Kegels and Perineal massage are invaluable.
   These two exercises can make a huge difference in how your perineum prepares for birth. And, both are really easy to incorporate into your daily routine. Many women do kegels while performing everyday tasks like driving, sitting at a desk or cooking.

   To do Kegels:

   • Remember to breathe normally.
   • To find the correct muscles, practice stopping the flow of urine when urinating. This is called contracting the pelvic floor muscles.
   • Hold for 10 seconds, then relax. Try not to contract legs, buttocks, or abdominal muscles.
   • You can do a series of “short holds” (5-10 seconds) then a series of “long holds” (10-20 seconds),repeating 10-20 times for a full session of Kegels.
   • It’s recommended to do a session two-to-three times a day.

   Perineal massage can be added to your bedtime ritual and is a wonderful way to get your partner involved. Go to childbirth.org’s step-by-step guide to get started.

3. Remain active during your pregnancy and labor.
   Your perineum is a collection of intricately woven muscles. So, according to what your doctor, midwife or practitioner recommends, be active and exercise. It will strengthen the perineal area just as it would any other muscle group. Walking and squatting do well to keep the area flexible. As squatting is an ideal position for birth, practicing the position will help you to find a comfort zone and be ready for when you want to use it during labor. When in labor, stay as active as possible. This help to keep labor progressing and the laws of gravity will help baby descend.
4. Use visualization. Stay calm. Be relaxed.
   It sounds new-agey, yes, but many women have utilized this technique while in labor. The idea of imagining or visualizing yourself opening up for baby can actually cause your body to physically do it. Some women imagine a melon, basketball or even a hula hoop while focusing on their round, open qualities. Try this as you exhale through a contraction; imagine the sphere widening. You’ll be amazed at the results and distraction from contractions is a bonus.
5. Breathe slowly and deeply.
   Many childbirth preparation classes teach us how to breathe effectively during labor. The key here is to continue through the birth. It’s especially important to breathe during the crowning, stop pushing and let your skin adjust to the stretching. Try to stay calm and wait until your doctor/midwife says it’s OK to breathe and push. By allowing for adjustment, you prevent a tear or drastically reduce the severity of a natural tear. Natural tears heal quicker, easier and with much less pain than episiotomies.

All of the above steps can help to avoid having an episiotomy during birth. More importantly, they can make an impact on your overall experience by keeping you confident, positive and calm. As always, we recommend that you never start a new activity without consulting with your doctor. Discuss the suggestions listed above with your practitioner, and follow her direction as per your individual medical health and history.

See Episiotomy Part One: The real story your doctor isn’t telling you

See Episiotomy Part Two: A Call for Awareness and Change

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The American College of Obstetricians and Gynecologists (ACOG) considers an episiotomy to be minor surgery. Despite this designation, many obstetricians routinely use this medical intervention in healthy, normal births. In April of 2006, the ACOG published a statement acknowledging that “women who have an episiotomy do not have significantly improved labor, delivery, and recovery compared with those who do not have one. The best available data does not support the liberal or routine use of episiotomy.” So why the discrepancy between real life use and researched need?

Not surprisingly, there is no set criteria which a doctor must follow when making the decision to perform an episiotomy. As such, a doctor has full license to perform the surgery without consent whether or not it’s needed. Further, there is no current disciplinary action or accountability to penalize doctors who grossly overuse it or cause permanent damage. And, as a result, at least half of women who have given birth in the U.S. live with the consequences.

In comparison, there is a drastic difference in episiotomy use among MD’s than that of Certified Nurse Midwives. Across the board, midwives report radically lower percentages of use with some rates in the 1 or 2% range. Some midwife practices report well below one or even zero percent—a stark contrast to those condoned by the ACOG. This irrefutable evidence proves that episiotomies in as much as 75% of laboring women is unnecessary and, as some have suggested, obvious abuse.

Yet, the ACOG shows no signs of discouraging rampant cutting of a woman’s perineum during labor. On the contrary, the organization just released a new 2007 teaching aid for new doctors confirming that indeed “episiotomy is the most common operative procedure that most obstetricians will perform in their lifetime. Because it is so common, teaching students or interns the principles and techniques usually is left to the most junior of residents.” With the procedure being taught during childbirth in the delivery room by junior level doctors, it begs the questions: who is monitoring how it’s really being taught and when is it advisable? Issuing a pocket-sized booklet is a far cry from implementing rules of conduct and liability.

Still, it’s pure speculation as to why doctors choose the procedure so often. Perhaps, it is lack of accountability. Perhaps, it’s impatience. Perhaps, it’s because antiquated practices die hard. Instead of making any rush judgments, it is my hope to work toward educating mothers and doctors. Public awareness and activism can force the ACOG to set the standards and accountability that are far overdue. Until then, the only recourse is to spread the word; to educate women about how to choose a responsible practitioner and what questions to ask her maternity team. It’s a mother’s choice to make informed decisions about healthcare, the people who attend births and labor preparation techniques. Mothers do have the option to take a proactive stance, to embrace our ability to birth naturally, and to change the common misconception that a healthy normal labor would need to be medicalized in any way.
See Episiotomy Part One: What your doctor isn’t telling you

See Five things you can do to prevent an episiotomy
Resources:
americanpregnancy.org
acog.org
childbirthconnection.org
bmj.com
jwatch.org
midwiferytoday.com
A Wise Birth: Bringing Together the Best of Natural Birth with Modern Medicine by Penny Armstrong and Sheryl Feldman
Ina May’s Guide to Childbirth by Ina May Gaskin

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