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.
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.
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.
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.
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.
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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