Monday, February 28, 2011

Change #20 An Opportunity to Learn Our Pain Coping Approach LD

Dear Peeps,

We patiently teach children to cross the street, step-by-step (even though most could probably learn on their own if we let them take their chances--teaching them how to do it--and making them practice with us increases their chances of success).

Birth stories are the most powerful teacher we have, and every birth story is teaching our young and pregnant woman how to cope, or not cope, with the intensity and unknown of labor.

Building a pain-coping mindset is not a "belief." It is learned through repetition, practice, and small successes. It is embodied knowing, embodied in the nervous system.

So learning how to help parents realize what they have already learned, unlearn it, and learn a new mindset is critical to changing birth in our culture.

Virginia is figuring out the technology so we can offer YOU, our Birth Peeps, a pod cast or a Conference Call to share more of the BFW practical approach to building a pain-coping mindset--so you can begin sharing this with parents.

Stay Tuned,


Wednesday, February 23, 2011

Good Morning Birth Peeps,
Kimberly responded to Change #20 telling us about her childbirth classes, and how about five minutes is spent during each class mentioning pain-coping. This is not unique. Many parents over the years have told me that with all the other information and videos that were given, teachers simply "ran out of time" for pain-coping and either "squeezed in a bit of relaxation" at the end, or promised to do more the following week. More time is dedicated to epidural information.

Over the years, postpartum, enlightened (if not burned) parents have taught me that most of the information they learned in classes (including my classes at the time) was not useful in labor, nor could it be remembered in the haze of labor's trance and exhaustion.

The one thing parents have consistently told me--and sadly still are telling me--was that they wished they had learned more about how to embrace and cope with pain, intensity, the unknown, and surprises.

From the wisdom and pleas of unprepared parents, and from knowing (both as a midwife and a mother) what they were saying was absolutely true, I changed my classes decades ago. The Birthing From Within model is based on the wisdom of parents.

There are four beliefs that motivate me to dedicate so much time to building a pain-coping mindset in classes:
1. I believe that the one thing for certain almost every mother will face and embody throughout labor, beginning with early contractions, is an unfamiliar, growing ever stronger, physical experience of dilation (call it pain, rushes, waves or whatever you like), exhaustion, and feeling "lost" or "uncertain" from time to time. Almost every mother will tell you it was more than she expected. She deserves to mentored to meet and move with the power of labor.

2. I also begin with the knowledge that as labor progresses, women shift from rational or thinking, rapid beta brainwaves toward their maternally intuitive, imaginal, slower alpha/theta brain waves. Women labor in their body. Labor is not a concept or a plan to be followed in their mind. So, I want my classes to engage and train the part of their brain in which they will spend most of their time in labor. I want the parents to cultivate emotional and physical skills and mental concentration: things they will need in their labyrinth of birth. At most we have twelve short hours to do this!

("Side Bar:" That said, most of the Fascinating Facts parents learn in their beta-note taking-class brain will fall away in the passion of labor. This is why so many women complain or shrug their shoulders when asked about their childbirth class. They say, "It all seemed interesting at the time, but it wasn't really useful in labor. Don't think I'll do that again." Or worse, as one father told Virginia recently, their previous classes were "boring," "a waste of time," and "irrelevant." And this rap is the recommendation given to peers... which may account for the fall in childbirth class attendance.)

3. Fathers, other mothers, and birth support people also need to learn mindfullness practices--to center themselves in labor; they also need to learn mental concentration in order to support and entrain the mother's efforts in labor. They need step-by-step experience (not cliches) to build genuine confidence in pain-coping and solution-focused thinking. When a mother's support people are afraid of, or uncomfortable with, her pain, intensity, or exhaustion in labor, the mother sees this and may want to take care of them by controlling or stopping her expression of pain in any number of ways. It is imperative for the support people to be prepared--so they will not feel powerless.

Perhaps it is natural for women in labor to find their way through the pain and intensity. I believe this is often true. But, it is new for fathers/other mothers to stand by and witness someone they love "in pain," and perhaps it is natural for them to want it to stop. For this reason, 60% of my attention during pain-coping practice goes to the father/other mother/birth companion. Their confidence and personal mindfulness practice during labor may entrain the mother during labor.

4. If labor progresses quickly, normally, and the mother is well-supported with no additional surprises, she and her partner could probably get on without all this fuss and training. Lots of women/couples do--and many can not. Since we don't have a crystal ball to know what she will need, we cannot rest on the theory that labor is natural and that all (modern) women know what to do.

What Change Can We Bring To Birth in our Culture!
1. Every childbirth class begins with a pain-coping practice. At least a half hour of every two-hour class is dedicated to building a pain-coping mindset. Building a pain-coping, solution-focused mindset is not the same as learning to relax or some stylized breathing pattern or technique.

2. Parents don't just hold ice for one minute "to see how long a minute long contraction is"!! I am hearing this nonsense from many parents. They tell me that their teacher made them hold ice for a minute -- how could this gimmick possibly be helpful? Is it a bad misunderstanding or poor imitation of BFW classes?

What parents in BFW classes do is learn a pain-coping practice, then... ice is held for a one-minute "ice contraction"--for several "contractions" in a row--to experience, embody, and really learn and refine the practice. Without ice, the practices would be sweet little meditations that didn't really require concentration or focus.

3. There is so much more to building a pain-coping mindset in classes... which can't be explained in this blog. It is a major section of our Level One Introductory Trainings and it required three CDs in a set for teachers called How to Teach Pain-Coping Practices.

* * *

So Kimberly, you still have time. Since your classes don't have enough time to prepare you in pain-coping, please write the office and ask Raquel to send you a Pain Coping Cd for Parents as a gift from me for inspiring this blog.



Sunday, February 20, 2011

Change #20 A Teaspoon of MIndful Pain Coping During Every Prenatal & Class

Dear Birth Peeps,

There is a common belief that if a woman believes birth is "normal," if she has a positive, confident attitude, and is committed to birthing without drugs, that her belief and attitude alone will carry her through labor. And sometimes it does!

I so want to believe that if she just believes in herself and the process it will be enough, but experience and birth stories inform me that women (and their partners) are too often surprised by the intensity of labor that is progressing normally (not to mention protracted labor), and find themselves completely unprepared to meet it. It is this shock, shame, and/or feeling of helplessness that is emotionally traumatizing to women, perhaps more so than the physical experience of it.

Today's Change is something so basic, so ordinary, so unglamorous, it is often overlooked by the most caring of birth peeps. A mother can have a dozen prenatals, meetings with her doula, even take classes, and nary a word is said about how to cope with the physical and emotional intensity of labor--except of course to reassure her that having an epidural is her choice.

It is my conviction that every mother and her partner (regardless of whether or not a an epidural is planned or will be part of her birth) need to be prepared and shown various ways to cope with emotional and physical intensity and uncertainty of being in the labyrinth of labor. (A woman/couple needs these skills because they may birth too fast to have an epidural, or the epidural might not take, and, in addition to pain-coping, a woman/couple will benefit from mindfulness skills during/after an epidural, during birth, postpartum, and parenting.)

When we learn any new skill, embodied practice makes the master! Not beliefs. Since pain, exhaustion, shaking and other sensations of labor are felt in the body, then pain-coping mindset and skills are best developed gradually, with small successes, in the body.

Beginning in the third trimester, if not sooner, I propose every prenatal visit include a five to fifteen minute pain-coping practice. This practice is absolutely done "without attachment to outcome," meaning without coercion to birth without drugs or any implication that doing so is better. Simply teach the mindful pain-coping, mind-centering practice. Then send the mother/couple home with homework: she/they must practice every day during the week or two weeks. Practice can be done during "meditation" or during periods of stress (traffic, work, etc) in her ordinary life. Each time she practices, her nervous system is learning how to respond to breath, she is learning how to quiet her mind and focus. This is nearly impossible to learn in labor.

I think it is safe to say that the majority of birth peep training, from medical or midwifery school, nursing, or childbirth education, the focus is more on epidurals (for or against) and informing mothers about tests and technology, and very little time is spent training the birth peep how to motivate parents to learn mindful coping practices. If this changed, if just four to six prenatals included mindfulness practice, the conversations between birth peeps and parents would change. And the conversations parents have in their own minds, before and during labor, will change.

We cannot leave this task to parents. How can a parent (even a mother who is a doula, nurse, or midwife herself) teach themselves to cope and be mindful in labor when they have never been in labor before? We can no longer leave this task to the majority of hospital taught childbirth classes if we know they will not learn this skill there... Maybe someday the tide will turn again and these skill will be taught as they once were!

I don't want to make this blog an info-mercial. However, if you are interested in doing this but don't know where to start, there are two Pain-Coping Practice CDs in the BFW Store: one on pain coping for parents, and the other is pain-coping for teachers. Either one would give you some ideas of how to begin.

Thank you for listening,


P.S. This posting is not meant to stir up the arguments about a woman's right to choose drugs/epidurals in labor, or what "normal" birth means, or that some women need epidurals. All of those considerations are valid, and not in contradiction to t

Monday, February 14, 2011

Change #19 Republicans Propose Cutting WIC’s Budget: Write Your Congress Representative Today!

Dear Birth Peeps,
Since the beginning of time there have always been the Haves and the HaveNots. Not only is the discrepancy between the Haves and HaveNots widening, but, it infuriates me when certain wealthy people in power show so little compassion and concern for the HaveNots. Sometimes changing birth in our culture involves writing a letter to our (well fed) state representatives.

Lots of parents worry about feeding their kids, especially parents who are living at or below poverty. When pregnant women and young parents have to choose between healthy food, and enough of it, and paying rent... they often opt for cheap food: high carbohydrate, processed food. Milk, fresh fruits and vegetables and healthy meats and fish are luxuries.

The recession, unemployment, and foreclosures have hit low-income families the hardest. One of the fastest growing segments of the homeless population is families with children. Single mothers working at minimum wage who can’t pay rent, mortgage, and all the bills—especially if they lose their job—are finding themselves living in stressful, over-crowded living situations, on the streets, or in shelters. Research indicates that the increase among poverty and homelessness is disproportionately attributed to mothers and children. The Brookings Institute found a 34% increase in homelessness in 2009, with a 24% increase in children who are homeless.

In New Mexico, about a fourth of our kids and families go to bed hungry every night. These parents have to choose daily between eating (or eating better foods) or paying rent.

Recently President Obama announced a noble goal to end childhood hunger by 2015. Then, last week Republicans proposed budget cuts. Birth Peeps need to speak out on behalf of one in particular, cutting nutrition supplements (WIC) to low-income mothers and children by 10 percent. If this passes, millions of low-income families will be affected.

Republican Harold Rogers from Kentucky said: “We have taken a wire brush to the budget and scoured every program to find real savings that are responsible and justifiable to the American people. Make no mistake, these cuts are not low hanging fruit.”

Once again, they have taken the wire brush to underserved mothers and children who can’t even afford to pick or buy fresh fruit! How is taking food supplements from the tables of low-income mothers and children responsible and justifiable, especially during a recession, with unemployment and foreclosures? I’m sure the world would benefit from taking that wire brush to other “programs” that cost billions.

W.I.C. (a Nutrition Program for Women, Infants and Children) started as a pilot project in 1972 (and was established in 1974) in response to concern about under-nutrition of mothers during critical stages of fetal and infant growth and development.

WIC provides specific nutritious foods, nutrition education, and health care referrals at no cost to its low-income participants. Mothers who are pregnant or nursing, and their child up to five years old, who meet certain income requirements and are thus “at nutritional risk” are eligible for WIC. In 2010, over 9 million women and children were enrolled in WIC (9, 175, 429 to be exact). The states with the highest enrollment were New York, Texas, Pennsylvania, and Michigan, but the number of people living marginally at poverty level or in dire poverty are rising in every state.

The Republicans want to cut WIC’s funding by 10%, which is about 758 million.

This proposal will be voted on this week. Don’t Delay!! Today, write or call your Representative and let them know that we, a wealthy country Must Feed all of our Mothers and Children. The unborn and the infants of low-income women are our future; if our children’s brains, bodies, and psyches are starved during this crucial formative phase of life, no amount of nutrition can make up for it later.


Thursday, February 10, 2011

Practice presenting "intact facts" from the center, without attachment to outcome

Hi Birth Peeps,
I'm a bit late, have lots of projects on the burners these days. This may be preachin' to the choir, but I said I'd send a few more comments on circumcision.

Just yesterday a friend told me about someone she knew was circumcising their baby for the same reason that has been used for a century, cleanliness and to prevent sexually transmitted disease. My friend knew it wasn't accurate, but didn't know what other facts to offer up. She was quite surprised to learn the following!

Remember, we are changing birth in our culture with kindness, patience, and understanding. If this subject riles you up, return to as centered a place as possible before you teach. If you tend to avoid conflict, and turn to "whatever the parents choose" as a way to reinforce your old agreement, see if you can stretch a bit and find a way to simply talk about the facts--without being attached to outcome (that outcome being to avoid conflict or to prevent the circumcision).

A Few Intact Facts:
• The foreskin is a retractable, double-layer fold of nerve-rich skin—it is the only such tissue on the human body uniquely designed to protect and lubricate the glans (head of the penis) and to provide sexual pleasure.

• When the foreskin is amputated 20,000 nerves are cut, as well as damaging other nerves in the penis.9 In addition, blood vessels are severed, forever disrupting the normal blood flow to the penis.10

• The foreskin on an adult penis is 12 square inches.

• Because the foreskin is the most sensitive part (and the glans the least sensitive), an intact penis has four times the sensitivity of the circumcised penis.11

• When the foreskin is amputated, 75 percent of the total source of pleasure is lost—before the boy will ever experience that pleasure.

The glans and foreskin at birth, and before circumcision
• In the womb, from about 16 weeks gestation, the glans is covered by the foreskin.
• At birth, the foreskin is almost never retractable; it is naturally fused to the glans.
• The fusion naturally dissolves in childhood, the average time is about ten years, but it may take longer (or never retract, and that is normal, too).

Circumcision Complications
The incidence of medical complications, 2 – 10%, ranges from mild to severe. There are twenty different potential circumcision complications, including hemorrhage, infection, permanently altering the length and shape of the penis, and in rare and tragic cases, amputating the penis.
However, keep in mind two complications that affect 100% of circumcised males: severe pain during the procedure and permanently desensitizing and eliminating 75% of sensitivity.14

Monday, February 7, 2011

Change # 18 Let's Catch Up ... and Eliminate Newborn Circumcision

Change # 18 Eliminating Circumcision
There is still a taboo about talking openly about the “circumcision decision.” Some parents avoid talking about it with one another. Awkward silence is kept again when Birth Peeps consider it a “personal” decision—and shy away from providing the current evidence-based information parents need to overcome the cultural myths they grew up with, and in order to give true informed consent on behalf of their infant sons.
Or, at the other extreme, Birth Peeps make it “their personal cause” to protect the baby, present information in a charged manner, for example, calling it “genital mutilation.” This language, intended to motivate, sometime causes additional resistance and confusion.

If parents are to give truly informed consent, and if we are to reduce or eliminate the practice of newborn circumcision, the subject can no longer be taboo or avoided because it is “personal.” Babies depend on their parents to be informed, to choose for them. In America, one of the first and most important decisions parents will ever make for their son is whether to decline or provide consent to have his healthy foreskin amputated (circumcision) in the first weeks of his life.

It is an important decision because foreskin amputation is irreversible, painful, and it carries certain risks. Not only does current evidence-based research need to be considered, but also the wishes of the other parent, and others (relatives and religious affiliation) who may take an opposing position. The topic can be so charged for couples that they come to a standstill, while resentment grows and isolation divides their marriage. Not talking about it insures one parent will defer to the other, and this is not something either one can “forget about.”

In addition to evidence-based information, parents attitudes are changing. In one survey parents who chose not to circumcise their sons said “that their decision wasn’t based on whether or not circumcision was beneficial or harmful, but that it is not their place to decide on elective surgery for their child . . . Since it is his body, not theirs . . . he can make the decision when he is older. By leaving him intact, they are leaving him with a choice [and not making him live] with an irreversible [foreskin amputation].”6

In the world, 80% of men are not circumcised. In 2000 a survey of declining circumcision in Great Britain predicted that only 1.5 percent of boys would be circumcised by their 15th birthday.(3) Canada’s circumcision rate cascaded from 44% in 1975 to only 4% in 1995.(5)

However, about a third to a half of America is still clutching to its long, unique, and bizarre love affair with male circumcision for “medical and moral” reasons. In 1893, a doctor called for the immediate and mass circumcision of all American boys, and by 1900, 25% of boys were circumcised to “desensitize” their penis.(1) The upward trend continued until 1971 when 80- 90% of newborns in the United States were routinely circumcised. Nowadays, as more and more parents learn that circumcision is very painful, medically unnecessary, and that they can decline this procedure for their baby boy—they do.

This is evident in the decline of newborn male circumcision in the United States – from 56 percent in 2006, to (possibly) 32.5 percent in 2009 (stats are not confirmed yet).(2 ) A recent Medicaire study found their population still choosing circumcision 55% of the time.

I think it's time to catch up with the rest of the world and stop doing routine foreskin amputations on newborns.

How will you go about opening this dialogue with parents, and between the parents? If you have been reluctant until now, what has kept you from talking about it? How much do you know about circumcision?

In a day or so, I’ll drop by with a few circumcision history and medical facts.
‘til then,


Friday, February 4, 2011

Change #17 Motivating Mothers to Be Hydrated Before/During Labor

Dear Birth Peeps,
Welcome new Peeps! Glad you have joined us.

Tonight we will move to a new Change, although we have not yet exhausted our consideration of changing our collective attitude toward prenatal ultrasound. When something becomes "routine," when it is referred to as "routine," it seems like we begin to equate it with "benign" and "proven safe." No urgency to question the status quo. And this is when it is imperative for us to stay awake and to continue to thoughtfully question whatever has become "routine."

Let's Drink to Change # 17
Today's change may not seem particularly exciting, and yet it could change birth for many women, reducing the length of time they are in labor, the "need" for augmentation, or cesarean. So it fits the criteria for our group commitment to change birth in our culture, "drop by drop," paying attention to small things we might otherwise take for granted.

In BFW I recommended mothers drink 4 ounces an hour in labor. That seemed do-able! Last week while doing a little review-research, I found a study, published in 2006 (so some of you may already be aware of this), of 300 first time mothers who received either four or eight ounces of intravenous fluids in labor. Mothers who were better-hydrated with eight ounces per hour actually had significantly shorter labors, and a tendency toward fewer cesareans.

Of course, I am not suggesting that every healthy woman should have an IV to achieve better hydration. But why not let moms know about this study, and let it motivate them to really pay attention to their hydration as their due date approaches; to stay well-hydrated before labor starts, and to drink more in early labor.

Finally, someone reading this blog might be looking for a research project. I'd like to see this study done with women who drank fluids in labor, showing which drinks and how much influence labor outcomes and lengths of labor.


Eslamain, L, Marsoosi, V., and Pakneeyat, Y. (2006, May). Increased intravenous fluid intake and the course of labor in nulliparous women. International Journal of Obstetrics and Gynecology. 93(2). 102-206.