Tree Life Birth Care in White River Junction, VT, is our newest location for Total Pregnancy Fitness. The center is dedicated to providing balanced, evidence-based support to women and their families during pregnancy, labor and postpartum. They offer doula care, childbirth education, prenatal dance classes, and lactation consulting in the Upper Valley region of Vermont and New Hampshire. For more information, visit http://LifeTreeBirth.com or email Mary Etna Haac at DoulaMaryEtna@gmail.com.
Mary Etna R Haac, MPH, PhD, DONA-trained Birth Doula. Bilingual: English-Spanish. 703–447-98–94.
Women’s Health & Fitness Programs
Many important health issues for girls and women involve matters of reproductive
health, childbearing, fertility and aging. Research informs us that an active, healthy
lifestyle provides a number of benefits throughout a woman’s life span:
reduced discomforts from pregnancy, labor, birth, recovery & menopause
reduced risk of hypertensive disorders of pregnancy and premature birth
potentially shorter active labor and reduced risk of cesarean delivery
more rapid return to joyful activities, less excess weight following birth
mother-infant interaction, leading to infant psychomotor enhancement
reduced rates of obesity, cardiovascular disease, and type 2 diabetes
reduction of some cancers, osteoporosis, falls and loss of muscle mass
improved social support, networking and stress management skills
greater belief in one’s ability to be strong and capable (self-efficacy)
In the generations since birth moved from the home to the hospital setting, it has become less and less frequent that women in developed nations see birth first hand and accept it as a natural part of life prior to their own first birth experience. The “epidemic” of fear surrounding birth may well be partly a result of this phenomenon. In a recent post published in Midwives magazine, a publication of the UK’s Royal College of Midwives, DTP director Ann Cowlin wrote a blog entitled ‘Exercise and Body Trust in Birth.’ The post addresses the confidence in one’s body that accompanies training specific exercise and how this applies to pregnant women and their preparation for birth. Here is the link to the blog post: http://community.rcm.org.uk/blogs/exercise-and-body-trust-birth
As I became involved in the birthing field, one of the nurse-midwives with whom I was acquainted introduced me to Jung’s quotation: “There is no birth of consciousness without pain.” (Alternately, “There is no coming to consciousness without pain.”) It struck a deep chord in me.
When I first saw the saying, “There is no birth of consciousness without pain,” intertwined with a drawing of a woman literally giving birth, the truth of the image seemed obvious to me. It become hard-wired into my underlying assumptions about giving birth. The process itself combines intense noxious sensations with mid brain emotional input into what neural science calls pain. For years, this realization has driven what and how I teach: Being fit and educated in body/mind are the tools of enlightenment and self-empowerment.
…And This Is Now
A little while ago I came across a NY Times article “Profiting From Pain.” While the article concerns the huge increase in the legitimate opioid business – products, sales, hospitalizations, legal expenses and workplace cost – it restarted my thinking about a topic fermenting in my brain between That Was Then And This Is Now: The sense of entitlement to a pain-free existence. The idea that pain free is better than painful. And the selling of this idea for profit.
Could it be that human fear of pain is being used to generate financial profit? (the opium-is-the-opiate-of-the-masses model). Perhaps once the notion of palliative care reached a certain level of acceptance for the dying within the medical community, it began to spill over into other human conditions (the slippery-slope model). Or, perhaps we don’t want transparency at all (the denial model).
In the last few days, NPR has raised the question of whether the high cesarean birth rate is tied to the payment for procedure rather than outcome model? The recovery from cesarean is more painful than the recovery from vaginal birth, has adverse side-effects for mother and baby, and was originally designed for use only for the 15% +/- of real complications that arise in normal birth. So, how is it being sold to 35% of women in the U.S,? At one point, there was a serious discussion within the medical community that if women were afraid of the pain of birth and wanted a cesarean, a care provider should do one. No discussion of why it seems painful or how to deal with pain.
The Affordable Care Act aims to improve some of the cost issues in medical care by shifting the payment incentive away from procedures and on to outcome assessment. As a result, the cesarean rate and even such seemingly innocuous procedures as fetal monitoring are coming under scrutiny. If we truly want to do a service to the mothers-to-be in the ACA transition period and beyond, I think we must discuss the question of birth and pain.
I can think of many questions that fall under this topic…Why do we call the intense phenomenon of birth “painful”? How do our genetics, behavior, training and thought-processes affect our experience of pain? What about the health care culture – has it focused on relieving pain at the expense of what we gain from working with pain short of trauma or imminent death? How do we prepare women for working with sensation without automatically labeling it pain? Is the “empowerment” often attributed to giving birth what is learned by going through the center of the “there is no birth of consciousness without pain” experience? These questions are just a start.
Let me address the childbirth educators and pregnancy exercise instructors. This is our present challenge. In my work, I feel the necessity to make all pain management strategies understandable to my clients. I find that most of the women I see in classes must deal first with self-discovery before they can assess their commitment to the view of birth they carry in their minds. The images of birth we lay out for them to consider need to include an understanding that you cannot escape the work of birth. Being present – mindfulness – can be scary and intense but it is the medium by which our consciousness expands. Cardiovascular fitness and strength are the source of our endurance and power.
Periodically, arguments arise in the birthing field over who controls the way we give birth. Often this happens at times when birthing women change their behavior trends, putting financial pressure on professionals working in this field. The major players in this argument are medical doctors (obstetricians), certified nurse midwives and professional home birth midwives.
Currently we are seeing women leave the traditional hospital setting for birth in larger and larger numbers…and taking their dollars with them in the process. While the question of home birth safety arises every time this control argument comes around, the question of whether it is safe to intervene in a labor that is progressing normally is a new component of the discussion. This time the argument is: The safety of home birth vs. the safety of using hospital technology to intervene in normal birth.
How Money Affects this Issue
As with all commercial ventures, controlling access to safe birth requires controlling the information in the market place. This information needs to address the perceived wants of the target audience. For a long time the main message has been: Safe birth is only available in a hospital.
The financial pressure of giving women (consumers) what they want — a normal experience of birth in a safe setting where medical help can be quickly available — has powered the birth-center industry. Free-standing and in-hospital birth centers have grown in numbers, and are largely enabled by certified nurse-midwives. Meanwhile, professional home birth midwives have increased both their credentials and practice standards, as well as their visibility.
Both of these options, birth centers and home birth, threaten the livelihood of traditional obstetrical practices. Low risk births (about 70% of births) have the potential to be normal births, requiring little or no intervention. But, giving birth in the hospital means participating in measurement procedures that intervene in the labor process.
So, to convince women they need to be in a hospital to be safe, medicine has maintained the argument that home birth or out of hospital birth is not safe. However, research does not indicate this is true. The nature of this ongoing argument is discussed in a 2002 article from Midwifery Today.
What’s New? The Counter Argument.
The physiology of normal labor is dominated by parasympathetic, meditative, gonadal energy systems. Measurement is a sympathetic, rational, adrenal energy dynamic. Only when it is time to expel the baby does the underlying energy system make a transition (transition, get it?) to an adrenal impetus for the strength activity of pushing. Immediately following normal birth, maternal physiology is again dominated by gonad-driven energy along with a rush of endorphins.
“Intervene enough and things will go awry. You can easily end up being cut and/or separated from your baby at birth.” These ideas have gone viral. With the arrival of the internet, women have found a very quick way to do what we have always done: Share information.
Thus, in my exercise program and in my childbirth preparation classes, I have more and more frequently been fielding the following question from women who want a normal birth and want to be safe: “How can I avoid interventions while I am in the hospital?”
So, I ask them what leads them to ask this question. And, they say: “I read on the internet and/or heard from my friends that interventions make birth less normal and less safe. I want to protect myself.”
Women themselves are entering the argument in a much more conscious way than in the past. Some professionals would like to keep women out of the argument. But, like with many things in our 21st century world, we have already past the point of no return. As they say, the horse has already left the barn!
Word has gotten around. More and more, as a prenatal fitness expert who strives to listen to my clients, my job has become educating and physically training women to cope with a strenuous and primitive process in a technological world.
Hopefully, we can all keep our eye on the ball here. Preventing trauma should be one key goal. Just as we have learned to hold our newborns skin to skin so they can smell and taste us, listen to our heart beat and voice, and maintain their core temperature, let us learn to comfort and nurture our new mothers, while we steel them for the rigors of birth.
I love Yoga. But…Power Yoga, Hot Yoga, Fast Yoga, Pilates-Yoga, Fresh Yoga, Baby Yoga and even Prenatal Yoga…not so much. I find these phenomena strange.
Why? Well, 40 years ago – when I first learned Yoga – it was a privilege. A person came to Yoga in the search for a meaningful life path. It was a blend of the spiritual and the physical, and it required a commitment to what was revealed within the practice. Before being allowed to take my first class, I had to demonstrate that I already practiced meditation. It was not exercise per se.
It was not adaptable like it is today. Depending on the teacher, you learned an ancient system – Hatha, Vinyasa, Ashtanga, Iyengar, or Kundalini. Those were the major methods that have Hindu roots, and those who practiced these art forms knew what they were doing. The teachers themselves had worked on their craft for decades. Today, I know only a few teachers who have a profound grasp of each of these methods.
Why is Yoga so popular?
Is there something within the work itself – even in the diluted forms, hybrid versions and the celebrity/competitive studios – that allows it to thrive in the self-centered, free-wheeling, branding-crazy marketplace of the early 21st century developed world?
I find the answer to this in a strange place: Zen practice, Bhuddism. One of my favorite notions is from Suzuki’s text Zen Mind, Beginner’s Mind. “When you feel disagreeable, it is best to sit.” This is an element of nin – constancy – or being present in the moment. Not patience, which requires a rejection of impatience and therefore cannot accept the present as it is. When you sit – just sit period, that’s it – all that is real is the moment. This is at the heart of all spiritual experience.
I’m not an expert in Yoga. I don’t teach Yoga, although I have integrated Yoga-based skills into my work. I have practiced Hatha and Vinyasa over the years enough to learn how certain skills are treated…belly breathing, slow deep breathing, maintaining position and listening to the wisdom of the body, and isometric strengthening in preparation for more expansive shapes or motions. Long ago, I integrated these skills from my Yoga experience into my teaching style because these skills are effective for the populations with which I work. But, I do not teach Yoga.
Can Research Help Us?
Researchers find Yoga a nightmare. There is so much variance now in the practice that findings from any one study cannot be transferred to the general population. One of the most revealing experimental-design studies found that none of the claims of Yoga improving metabolism could be demonstrated. When asked why they thought this outcome had occurred, the teachers who were used in the study said they thought the participants in the study were not fit enough to do Yoga!
One of the most successful Yoga teachers in my area, and one of my favorites, has for decades used a bicycle for her primary mode of transportation. She credits her longevity and success to Yoga. I attribute it to bicycling. Dr. Cooper is right…fitness (which means aerobic fitness) is the biggest bang for the buck. Unless you are fit, it is hard to execute some of the more subtle demands of many exercise regimens.
Some Yoga teachers will say that you can make Yoga aerobic or that some forms are aerobic. OK, then it’s aerobics, not Yoga. Whenever I see “aerobic Yoga” it reminds me of aerobic dancing. It’s helpful to remember that Yoga developed in a time and place where survival was dependent upon fitness. People didn’t need to do more aerobics to find enlightenment. They needed reflection and to be present in the moment.
So, I insist on aerobic fitness as the first goal of a fitness regimen. In the pre/postnatal field, this is the only consistently demonstrated factor in improved outcomes. As a birth preparation there are Yoga-based factors that will help in labor and birth IF THE WOMAN IS FIT ENOUGH. It is the fact that some Yoga-based skills help fit people find nin that is my justification for continuing to use them in conjunction with aerobics and special pre/postnatal preparation and recovery exercises.
But, there are cautions. Not all Yoga assanas (positions) are safe for pregnancy. Down-dog, in particular, scares me because of incidents reported in obstetrical literature in the 1980s and 1990s that indicate such a position is implicated in fatal embolisms. Some shapes are just not doable and others become less comfortable over time. The ones that work have been identified since the 1940s and 1950s and integrated into birth preparation courses.
All exercise components -
Aerobic or Cardiovascular Fitness
- are necessary for a balanced fitness routine. Too much emphasis on any one factor often results in injury. Aerobics is where the greatest health benefits reside. Recent research has demonstrated that it is physical “fitness” (which we can measure) as opposed to just spending time in physical activity (which can be a wide range of intensities) that is responsible for improved health outcomes. Strength and flexibility training need to be purposive. There are things we don’t need to do unless we are going to play pro football or dance Swan Lake! Mind/Body skills help us recover and prepare.
I for one will be glad when we get beyond yoga and back to cross training!
The First Stage of Childbirth is the long, hard labor. It is the slow process that produces dilation, or opening, of the cervix — the “neck” or outlet at the bottom of the uterus. Once the baby’s head can fit through the open cervix, it is time for the Second Stage, but that is another topic for another post.
Labor is generally a long, slow process…there is no “enter” button for dilation!
Before the baby can leave the mother’s body, s/he must leave the uterus. The opening of the cervix to let the baby out of the uterus generally takes up the most time. For a first time mom it can be 10 or 12 hours…or, yes, a couple of days. Of course, for some moms, this time is difficult and for others it only becomes difficult in the last few hours.
But, you know all this, right? What you want to know is: Why do I have to go through this? And, if I must, how can I make it the least painful?
Why labor is important. Let’s go to another question: How important would your offspring be if it was no big deal to drop one out? If you were walking along the sidewalk and you could simply drop a newborn on the pavement, would you even stop to pick it up if you could do it again in a few days, when, of course, it will be much more convenient?
Frankly, pregnancy and labor remind us to pay attention. A newborn cannot survive on its own for at least two years. If we don’t pay attention, it will die.
Okay, now that labor has your attention, what else does it do that is beneficial? It stimulates the baby’s stress response and teaches the newborn to be alert during situations of duress. Each contraction is pulling the cervix, helping it slowly open. If you are upright, each contraction is also alerting the baby to the influence of gravity.
Why is labor painful? So, you need to go through this because it is the bridge from pregnancy to parenthood. Why does it have to be painful?
The first thing to keep in mind about pain is that pain is a combination of sensations and emotion, mainly fear. Fear makes you tense; tension reduces blood flow. Reduced blood flow to the uterus makes the contractions less effective. In addition, cortisol is released, making sensations stronger and evoking greater fear.
Fear is the emotion of fight or flight. Interestingly, the opposite response, the relaxation response, is very effective in promoting labor. So, relax. Breathe deeply and slowly, focus, move through the center of your experience. You don’t have to be in fear if you know what is happening and if you are physically fit and prepared. Both childbirth education and physical fitness teach your body to work with discomfort. By including them in your preparation, you give yourself a tremendous advantage.
Does this mean you will never feel like you want to stop in the middle of labor? No, but it does mean you can do it. It is finite. The notion that the baby will not do well is also tied to your physical fitness…babies of fit mothers less often experience fetal distress. Your care providers will let you know if there is some factor beyond your control that requires medical intervention.
Birth is an empowering event. But, before the baby can be born, it must escape the uterus. It is a classic conflict and the mother’s body is the venue. Give yourself over; go with it. Only women can do this.
There is no birth of consciousness without pain.
Birth is a life process with two major components
Okay, be here now: This is about a really major experience…bringing human consciousness into the world…opening a door to a room of love in your heart that you can only know by giving birth to this person…changing your identity forever.
Getting your mind around the image: If you have not taken the time yet to get your mind around this, take a moment. Breathe in deeply. Gently blow the air out. Repeat. Repeat. Let go of any resistance. Slow your heart. Slow your mind. Consider: Your body has the power to create a person. Your body has the power to expel this person when the rent is up.
Your brain, glands and organs are having a conversation with the baby’s brains, glands and organs. At some point, this discussion reaches a place where it is time to end this arrangement of two people sharing one body. It is true that occasionally the passenger doesn’t want to leave, but that is rare. And, we have a remedy for that. Let’s just focus now on the what happens when it’s time to go.
Labor starts how? Well, it depends. Sometimes contractions start in fits and spurts and take a while to get organized. Sometimes they start strongly from the get go, and for others the process of getting rolling can take a few days. Sometimes it starts early, and sometimes has to be helped to start. Once in a while, the water breaks and labor starts…or not. So, the first lesson of having a child come to live with you is that you need to be flexible in your expectations.
In the next two posts, we’ll cover Labor and then the Birth Mode. Each of these processes is unique. They involve different energy systems. They require different mind-sets from the mother and her support team. The outcomes are different. Going through the center of these processes helps you deal with them, helps you recover from their strenuous nature and helps you move on to being a parent.
Remember: Breathe in deeply. Gently blow the air out. Repeat. Repeat. Let go of any resistance. Slow your heart. Slow your mind. Consider: Your body has the power to create a person. Your body has the power to expel this person when the rent is up.
The following are notes from co-author Robyn Brancato, CNM (certified nurse midwife) who practices in New York City, or, as she is know here: Wonderrobyn! You can read about both authors in the About tab above. Here they are on the beach in San Diego, when they gave a talk at conference there a couple years ago. Robyn on the left, Ann on the right.
Robyn and Ann, Pathway authors
1. Addition to Small Rant: “Resist the temptation to watch A Baby Story on TLC! It does not portray birth accurately, as they condense 15 hours of labor into 30 minutes and play up the drama so that you will be on the edge of your seat! In the majority of women, birth is not that dangerous.”
2. Regarding: When does conception occur? “This is a really interesting post… I love the discussion about at what point conception occurs! Personally, I like the Biblical notion of quickening. Even though this varies from woman to woman and can range anywhere from 16 to 22 weeks gestation, it seems like the most natural theory.”
Dear Reader: What do YOU think? Did you read the conception post on March 23, ’09?
3. About sperm & preeclampsia. “Is the connection between barrier methods and preeclampsia actually established? I have read studies stating the contrary — that barrier methods have no effect on preeclampsia rates.”
HURRAY! THIS REQUIRES FURTHER CONSIDERATION.
More information: The immune maladaptation theory suggests that tolerance to paternal antigens, resulting from prolonged exposure to sperm, protects against the development of preeclampsia. Thus, barrier methods and being young may predispose women to this major disorder of pregnancy.
Evidence exists on both sides of this theory. Here are two recent studies (one of each) that readers may find helpful in understanding this idea. Keep in mind that other factors than just sperm exposure may be affecting research findings. But, it does seem that under some conditions, barrier methods and amount of exposure to sperm can affect the pregnancy itself.
Ness RB, Markovic N, Harger G, Day R. Barrier methods, length of preconception intercourse and preeclampsia, Journal: Hypertension in Pregnancy 23(3):227–235. 2005. Results did not support the immune maladaption theory.
Yousefi Z, Jafarnezhad F, Nasrollai S, Esmaeeli H. Assessment of correlation between unprotected coitus and preeclampsia, Journal of Research in Medical Sciences 11(6):370–374. 2006. In a matched controls study, women with <4 months cohabitation or who used barrier methods had higher risks of developing preeclampsia than those with >4 months cohabitation. Oral contraception users had a lower preeclampsia rate than those who used no oral contraception.
In a commentary article in OB/GYN News ‚ July 1, 2002, the following note was made by Dr. Jon Einarsson: With insufficient exposure, pregnancy may induce an immune response and preeclampsia in some women with predisposing factors such as an endothelium that already is sensitive to injury due to age, insulin resistance, or preexisting hypertension.
Is there a plain and simple truth about sperm exposure and pregnancy risks? Alas, no. But, know your circumstances. If you are young, protect yourself. Wear a condom. When you are ready to be a mom, you will be ready to figure out your risks. So, this, too follows the axiom:
Events in life are rarely plain and never simple.