Thursday, October 30, 2014

Has the Focus of Birth Professionals Changed?

In my humble opinion: 

Many people wonder why birth professionals (childbirth educators, doulas, midwives, nurses, lactation consultants) are so passionate about their profession.  Unlike other professions, childbirth (and breastfeeding) evoke great emotion and energy in many workers.  What is the underlying cause of this emotional energy and has it changed over the years?

I think it is safe to say that in the 1970s when I began teaching became a nurse and subsequently also became involved in childbirth education, the push of childbirth education was
to come along side women who desired less interventions and a more natural (or physiologic/non-interventive) childbirth.  Educators taught women that their gut feelings about physiologic birth were not wrong, what the evidence said, and gave them the tools to achieve that goal.  The empowerment of women in the 70s enabled educators to thrive and achieve those goals.

Somewhere in the mid-1980s, childbirth education relaxed the emotional energy expended and reaped the benefits of the past.  But in sitting back, this allowed a more interventive style of childbirth to emerge and then we were looking at the 1990s with an increase in epidurals, assistive deliveries (forceps and the miti-vacuum extractor), and an increase in cesarean rates.  By the 2000s, we tried to catch up and began movements such as “evidence based information” in childbirth education and later, in social media, but it was too late.  The perception that “drive thru” deliveries that were scheduled, induced, medicated and sometime surgical became the optimum.  Few were mindful of what all of this was doing to moms, babies and future generations.  Women just wanted the uncomfortable last 3 weeks of pregnancy to end, to hold their babies after little/no pain, and to get back to work.

Questions began to arise in 2010.  Why is the cesarean rate so high?  If women are designed physically to give birth, what is the reason for the 32.8%+ cesarean rate?  Why are only 33% of women attending childbirth education class?  What is the medication given during labor/birth doing to our mothers and babies?  Can we curb elective early birth – why don’t we wait the full 40 weeks?  Are future generations going to be affected by birth practices now?  Will women lose their gut instincts about labor and birth? Will women lose their physical ability to give birth (epigenetics)?

Many birth organizations such as AWHONN, ACNM, MANA, APPPAH, Lamaze and ICEA began asking these questions.  Forward thinkers such as Marsden Wagner and Michel Odent wrote landmark books explaining the research and forecasting the future.  Videos and movies such as “The Business of Being Born”, “Pregnant in America”, “Laboring Under An Illusion” and “Birth by the Numbers” allowed the public to be exposed to the questions we birth professionals were also asking.  And this year, “Microbirth”, put it all in perspective: if how we are born affects how our health manifests itself, we must take that as a mandate to let birth alone and allow humans to reach the potential for which they are destined.

The answer then, is yes – the focus of birth professional has changed.  We have gone from “freedom fighter” to someone “sounding the alarm”.  Birth is much more than having a mother choose her position during labor.  How we treat mothers and babies during pregnancy, labor, birth and the postpartum will forever change us as human beings.  It can be a change for the positive or the negative.  Right now, we are on a slippery slope to the negative. 

It is time for a change.

It is time for those of us who know the research, the facts, the truth – whatever you want to call it – to come together in one strong voice.  Does that mean we become the protectors of future generations?


Become informed.  You be the judge.

Friday, October 24, 2014

Breastfeeding in the First Hour After Birth

Friday, October 10, 2014

Conquering Tocophobia with Haptotherapy

Tocophobia or severe fear of childbirth is rising in frequency.  More than 6% of women, and some men, experience tocophobia during pregnancy.  This leads to an increase in obstetric interventions including preterm birth, emergency cesarean section, or cesarean section at maternal request.  Severe postpartum fear of childbirth and trauma anxiety has also been reported.

Studies, primarily in Europe, over the past decade demonstrate an increase in evidence that Haptotherapy might be effective in reducing fear of childbirth in pregnancy women.  What is Haptotherapy and is there a way childbirth educators can incorporate aspects into their classes?

Haptonomy is a typical Dutch form of therapeutic assistance therapy discovered by Dutch physiotherapist Frans Veldman, and first used in oncology.  Haptotherapy is the field of application of Haptonomy.  Haptonomy is being in connection with someone in a non-judgmental way.  Practitioners work to establish an environment of acceptance and calm, peace and tranquility so that the client can let go and begin trusting their own inner wisdom.  It involves listening, accepting, sharing.  In some instances, touch relaxation or simply holding hands leads to the calming of the client and activating their inner resources. The goal is for the client to develop inner security, self-awareness and self-confidence.

The most recent Dutch study is examining a standard haptotherapeutical treatment for pregnant women (and their partners)  with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology.


Included are singleton pregnant women with severe fear of childbirth, age >= 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20-24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction.

Sessions include a getting to know each other opportunity, awareness and presence in pregnancy, identification of cause of fear of childbirth,  desensitization of body anatomy as well as hospital procedures through education, practicing correct pushing techniques, working with contractions and dealing with labor pain, labor rehearsals, and finally introduction to birth of the placenta and first days postpartum.

Haptotherapy has dynamic similarities to childbirth education classes.  One might even call them “old school” childbirth education where educators had the time to take the time to listen to the clients and their partners and confront fears one by one.


They say you cannot go home again, but it looks like we are….with a different name.