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When it comes to birth, there are so many options we are asked to consider…

For every birther and every child, each birth is an invitation to dig deep and source our wisdom, to know ourselves, find our voice, and reclaim our power through the choices we make.

Questions we are asked to consider…

  • Where? Hospital, Birth Center, Home, Somewhere Else
  • With Whom? OBGYN, Certified Midwife Midwife (CNM), Certified Professional Midwife (CPM),  Independent Midwife, Doula, Partner, Friend, Family, Support Person
  • How? Unmedicated, with medication, vaginal, cesarean, VBAC, water birth, and more!
  • Pain Relief Preferences? Epidural, Narcotics, Nitrous Oxide, Water, Movement, Hypnosis, Touch, Breath, Sounding, and more!

Every birth is truly unique, and rarely does it go “according to plan”.

For many, birth is a wild ride of initiation and an invitation to meet yourself in new ways each time.

Being informed about your options, preferences, and choices can help you feel prepared, informed, and empowered to make the best choices for you and your family.

Like where to give birth...

Hospital

  • Typically occurs in an area of the hospital designated for labor & delivery
  • May be attended by an OBGYN or a Certified Nurse Midwife (CNM)
  • Offers immediate, or near immediate, access to emergency medicine
  • Offers access to pharmaceutical pain relief options
  • Standardized protocols for treatment and care
  • Prenatal appointments are generally short in duration. Birthers will often meet with a variety of care providers and will often be attended by whoever is “on call” when they are in labor

Birth Center

  • Usually a free-standing center with an active working relationship with a hospital
  • May be attended by a Certified Nurse Midwife (CNM), a Certified Professional Midwife (CPM), or an independent midwife
  • May offer access to some pharmaceutical pain relief options
  • May offer a seamless and integrated transport option in the event of an emergency
  • Offers a more home-like environment with access to conventional medical care
  • Usually offers more individualized, birther centered care

Home

  • Home birth can happen in many types of homes – a single family home, apartment, or communal living space for example. It may be the birther’s home, or the home of a family member or friend
  • May be attended by a Certified Nurse Midwife (CNM), a Certified Professional Midwife (CPM), or an independent midwife.
  • A birther or family may also choose an unattended, or unassisted, birth in which they receive no formal medical care during their pregnancy or birth
  • Midwives receive varying levels of training and offer a different range of treatment and care options, including when appropriate, medications, herbs, or transportation to the hospital.
  • Generally only available to low risk birthers. Each midwife will have their own criteria for safely birthing at home.
  • Care is highly individualized, based on the unique needs of each birther or family
  • Prenatal appointments often last an hour or more. Midwives often work with a partner, or as part of a small team. Usually you will have a well developed relationship with the provider who will attend your birth.

And from whom you will receive support...

OBGYN

  • Typically works in a hospital based practice. May work with a team of other OBGYN’s and/or Certified Nurse Midwives (CNM). May also work with residents and student doctors.
  • Has completed extensive training in high risk birth, surgical deliveries, and life saving interventions
  • Overseen by the American College of Obstetricians and Gynecologists (ACOG)
  • Office visits are generally short and are often more focused on physical assessment and reducing risk factors.
  • May be more conservative in their policies and protocols, or assessment of risk.

Certified Nurse Midwife (CNM)

  • May work in a hospital, birth center, or homebirth setting depending on the regulations of the state
  • May work in a private practice, with a partner, or as part of a midwifery team. May have a formal or informal relationship with an OBGYN or MD
  • Has extensive training in normal, physiological birth, as well as the complications that can occur during pregnancy and birth.
  • Overseen by the American College of Nurse Midwives (ACNM)
  • Often has access to medications and emergency medicine. May have prescription writing privileges depending on the state.
  • Prenatal visits are often more “birther centered” and may be longer in length

Certified Professional Midwife (CPM)

  • Generally attends births in an out of hospital setting such as a birth center or at home.
  • Has extensive training in normal, physiological birth, as well as the complications that can occur during pregnancy and birth.
  • Overseen by the North American Registry of Midwives (NARM)
  • May utilize herbs in addition to medication. May or may not have access to pharmaceuticals, depending on the regulations of the state.
  • May or may not be legal authorized to attend births depending on the regulations of the state. Each state has different policies regarding out of hospital birth and who can support a birthing family in that decision.
  • Prenatal visits are generally tailored to the unique needs of each birthing family. Time is spent assessing the health of the pregnancy but also may include discussions around nutrition, self care, emotional health, spiritual growth, and childbirth education. Visits are often an hour or more in length.

Independent Midwive

  • Only attends births in an out of hospital setting
  • Has received training in normal physiological birth and common complications. May have varying experiences and depth of training.
  • Generally does not have access to pharmaceutical medications
  • Generally attends low-risk births
  • May work independently, with a partner, or as part of a team.
  • May or may not be legal authorized to attend births depending on the regulations of the state. Each state has different policies regarding out of hospital birth and who can support a birthing family in that decision.
  • Prenatal visits are generally tailored to the unique needs of each birthing family. Time is spent assessing the health of the pregnancy but also may include discussions around nutrition, self care, emotional health, spiritual growth, and childbirth education. Visits are often an hour or more in length.

Doula

  • May support a birther wherever their birth occurs
  • Provides non-medical support through pregnancy, birth, and postpartum. Most birthing families will be supported by a Doula AND an OB or Midwife if they are choosing Doula support.
  • Provides one on one companionship, support, education, and advocacy
  • May work independently or as part of a team
  • Has received training in normal birth, possible complications, comfort measures, and support techniques
  • May or may not be certified by an organization
  • Studies have shown that having the support of a doula at your birth reduces the likelihood of cesarean delivery, NICU admissions, and use of epidural while improving overall satisfaction with the birth.

Unasssisted

  • Some families choose an unassisted, unattended, or free-birth.
  • They may or may not receive formal prenatal care from a care provider. They may provide their own prenatal care.
  • When the birth comes, they give birth by themselves, with a partner, or with a close circle of family or friends.
  • This is a highly individualized decision, and one that isn’t right for everyone
  • For some birthers, this is how they feel safest giving birth
  • Some birthers choose this option when policies surrounding their birth prevent them from making the autonomous choices they desire, or they face barriers to accessing care.
  • Others choose this option because it is how they feel most well supported in their process of giving birth.

Join Our Next Live Class!

Anatomy & Physiology of Birth ~ 5/24

Join us LIVE on May 24th for a discussion of our sacred anatomy and the physiology of birth.

This space is both educational and support oriented. Bring your questions, curiosities, and fears.

PRE-REGISTRATION IS REQUIRED TO RECEIVE ZOOM LINK

Registration closes at 5:00 pm on the day of class

Getting acquainted with what makes you feel safe...

Finding Your Felt Sense of Safety

Our choices in how we give birth are as varied as the personalities of the individuals who are doing the work of birthing, and those who are being born. They are as unique as each parent – child relationship. Birth occurs on a spectrum.

In a time of life where so much lies beyond our control, we are invited to remember that in our birth, we have an element of choice, power, and autonomy. We may choose an unmedicated birth if the circumstances allow. We may choose, due to personal preferences or pregnancy circumstances, to have a more medicalized birth. We may birth vaginally or by cesarean. We may have our baby at home, or at the hospital, or at a birth center. We may receive support from an OB, a midwife, a doula, our partner, or only ourselves.

When it comes to the birth of your child, there is no one option that is better than any other - truly - it is about what will make you feel most safe and most well supported.

How we navigate that decision making is going to be based on our personal preferences, our personal risk factors, our personal relationship to physical sensation or pain, our personal histories of trauma or prior birth experiences, our cultural background, and the preferences and practices of our care provider.

Personal Tolerance of Risk

When it comes to birth, it feels near impossible to not feel the catastrophic fears of “What if?”.

What if, I make this choice, and harm comes? How will I live with myself?

Birth, like much of life, is inherently risky. And the grief of perinatal loss, is like no other. So we err on the side of caution. No one wants to take an unreasonable risk of harm.

But safety and risk of harm are tricky…

We need to consider what the data tells us about best practices and the risk~benefit balance of the choices we make. Anytime we intervene, we introduce new risks into the journey. And the data isn’t always we clear. We must determine for ourselves, or our family, what our personal level of risk tolerance is.

But we also need to contend with the physiological impact of our felt sense of fear and safety. As primal beings, our internal systems are hardwired to respond to the effects of fear, panic, and the felt sense of safety. We are adaptively designed to prioritize self protection and survival.

And so we need to contend with both what the science tells us about potential risks and benefits and what our felt sense and lived experience is. We need to listen both to what our mind knows and what the wisdom in our body tells us about our own unique experience. Birth offers an opportunity like no other, to dig deep and source our wisdom, to know ourselves, find our voice, and reclaim our power through the choices we make.

Fear & the Hormones of Birth

If you’ve ever watched a non-human animal give birth, what do you remember about the way they behaved, or how you knew they were in labor?

Often, the pitch of their voice changes, they slow down and get quiet. Often, we will find that they intentionally seek out a space that is warm, dark, quiet, and undisturbed; a space that feel safe.

As humans, we aren’t all that different. We draw closest the people we trust. Perhaps a care provider, a partner, the father of our baby, or a close friend. The way we move, and sound changes. And we too, if left to our own devices, will seek spaces that are warm, dark, and quiet.

And yet, if you’ve ever witnessed an animal labor in the presence of danger, you may notice that their labor stalls. The process slows down, attention is diverted to the present fear or threat, and the work of labor only resumes when the birthing environment becomes safe again.

What I’ve seen in my experience of birth, is that as humans, we aren’t all that different. Many of those primal response patterns remain. We are biologically designed to give birth when we feel safe.

Oxytocin – the hormone of love and bonding – requires a felt sense of safety and trust in order to be released. We are inherently vulnerable in the moments where we release oxytocin….during love making, while birthing and breastfeeding, while cuddling, hugging or embracing a loved one, or while being intimate with our body or our heart.

We are inherently adaptive beings.

While our mind may get raptured in fear and vulnerability, our bodies are adapted to self protect. Our brain chemistry changes when we feel fear. We loose touch with our “thinking brain” and become embedded in our primal “survival brain”. From that place of primal panic, the surrender of an orgasm, the bonding of a heart, or the birth of a baby are experiences that require a different kind of resiliency.

Our body responds to the chemical release of adrenaline and cortisol by turning off the production and release of oxytocin. And oxytocin is the queen bee of hormonally inducing contractions and co-regulating the dance of labor and birth. What we know about birth is that it is less impeded when the birthing person has a felt sense of safety and trust with their care team. This is, in part, due to the hormonal cascade of labor and birth, and the impact of our chemical signals of fear on that dance.

For some birthers, that felt sense of safety comes from the autonomy and freedom to be in their home space, encouraged to labor in their own way, without a lot of intervention or hands on assessment and support.

For some birthers, that felt sense of safety comes from being in a hospital, where they have access to pain medications, emergency medicine, and the best of technology and medical support.

For some birthers, their felt sense of safety comes from finding a birth setting that uniquely suits their needs, such as a birth center or other location. 

Ultimately, the best choice is the one that leaves the birther feeling safest, and recognizes that sometimes circumstances change.

Sometimes, we believe we will feel safest at home, but circumstances during pregnancy or birth arise that inform our decision making and we decide that for this baby and this birth, our safest or preferred choice is to birth in the hospital.

Sometimes, we believe we would normally feel safest in the hospital, but circumstances arise (such as our unique time of COVID-19) and we decide that for this baby, and this birth, we feel safest birthing outside of the hospital system.

What we know, is that having a sense of autonomy, choice, and involvement in the decision making is the strongest predictive factor for whether a birther will experience their birth as a positive or empowering experience, or one that is heavy with feelings of trauma, grief, or dissatisfaction.

Ultimately, it seems that sometimes HOW you experience your birth matters more than WHAT happened during the experience.

The Conversation is Changing…

Since the days when birth moved out of the home and into the hospitals, out of the hands of midwives and into the patriarchal hands of obstetrics, the way that we as culture hold fear around birth has changed. Even a cursory look at the evolution of birth in this country will show how fear and mistrust, of women’s hands and women’s bodies, has led to a sea change in how homebirth is held and supported.

The current conditions of COVID-19 are catalyzing a new conversation about birthing at home. Since the move towards obstetrics, home birth has been viewed with an air of distrust and a focus on the potential risks. It has sat at the edges of our society and has been held as something that only the most radical of birthing mamas do.

What we’ve seen in recent months is a change in perspective. Families who once would never have considered homebirth are now exploring their options. Midwives who once struggled to fill their calendars have been inundated with new requests and last minute transfers of care. More people are choosing to birth at home than we’ve seen in a very long time.

For some of us, our trust in the safety of the hospital setting has changed, not through the fault of any care provider, but due to the changing dynamics of infection control. There is a new appeal to the safety of our homes.

For others, our risks of birthing at home have changed, as we navigate delays in emergency services, the complexity of a hospital transport, or our concerns over the risk of infection wherever we birth.

As we navigate birth in the age of COVID-19, the conversation is changing and we are invited to get really clear about our birth preferences and choices. Because something deeper is happening…

As we all sit with the potential of risk embedded in every outing out of the house, we are all being asked to re-negotiate how we navigate life.

We are all, collectively, re-learning informed consent and how to navigate my comfort with risk alongside yours.

 

 

Maybe, in the slow down necessitated by the pandemic, we are all re-learning to source our power and find our voice. As birthing families everywhere sit with new questions around where they feel the safest giving birth, there is an invitation to broaden the conversation. We are being asked to become self-determined in our tolerance of risks, and our boundaries around where we feel the safest. What the ripple effects of this will be, remains to be seen.

But I do believe that the conversation is changing…

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Join Our Next Class Live!

Anatomy & Physiology of Birth ~ May 24th

Join us LIVE on May 24th for a discussion of our sacred anatomy and the physiology of birth.

This space is both educational and support oriented. Bring your questions, curiosities, and fears.

Pre-registration is required to receive zoom link

Registration closes at 5:00 pm on the day of class

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