Ruth Ehrhardt's Blog, page 6

After the Birth…

“Your feet must not touch the ground for 40 days…”

I remember my grandmother’s voice crackling over the phone the day after giving birth to my first baby.

“And no visitors, unless they are coming to help.”

Words of wisdom which carried me through four babies and which I treasure still and pass on to new mothers.

I have Greek and Indian family and both these cultures, amongst others around the world, afford this time of healing, protection and bonding time to new mother and baby.

While my grandmother did not mean that my feet were literally not allowed to touch the floor, she was giving me permission to take my time in finding my way as a new mother. She was reminding me that I was a new mother.

A new mother with a new baby, finding a new way.

And that I was allowed protection.

Because I was wide open. My heart, my body, my mind and my soul had been opened in ways I had not known were possible. And I had been given the honour of cradling a perfect, innocent being in my arms.

Outside influence may or may not be beneficial but in the same way that pregnancy and birth need calm and sense of safety, so do mother and baby need this after birth.

Dr Silvana Montanaro, who wrote Maria Montessori’s conception to age 3 programme and who is the author of Understanding the Human Being, eloquently stated that the first six weeks outside the womb should mimic those within.

The arms of the mother should be as the womb and the breasts like the umbilical cord.

It is a sleepy, dreamy, other-worldly time.

It think it helped that I lived rurally when I first gave birth, this helped to keep visitors at bay.

But more than anything, it gave me the time and space to find my way as a new mother. And despite sore nipples, aching breasts, and bruised body, I found my way…

We found our way.

This confidence carried me into me being able to trust myself as a mother, and to understand the needs of my babies. It also helped me to know, that that time with my babies was too precious to give away to visitors. It is such a special time and gone so quickly.

Watch this video of Jacqui Roche sharing her thoughts on the woman’s needs after the birth. I was honoured to be at her birth for her second baby. I think she summarises those needs very well here.

And then, as I finish writing this, I read this article by midwife Mary Cronk “The First Time the Iron Entered My Soul,” and it resonates so strongly.

Protect mothers so they can be strong mothers.

 

The post After the Birth… appeared first on True Midwifery.

A Story I Wrote as a Young Mother

Today I walked through the entire length of Plumstead subway and didn’t even notice. What I was thinking about when I walked through it, I cannot recall. I arrived at Checkers and realised that I had suddenly arrived. I must have gone through the subway but have absolutely no recollection of having done so.

Last week I walked through the subway, telling myself that this was the reality I had created for myself. I had created the hardness of the cement steps, the starkness of the walls. I began to imagine that they were soft, that their atoms gave way from my foot. I put my right foot down. Whoosh! The step beneath my foot was like water, and pinkish. It made a sound like a water drum. I panicked and reality returned. I tried to play the game again but my mind was either too scared or too convinced of the hard greyness of the steps and walls. I laughed and continued on my way to Checkers.

Sometimes I feel ‘grrrr’ with the world and on those days the subway is the stinkiest and most ugly of places. I’ll be pushing the pram and Sai will be screaming as we roughly go bump bump bump down the stairs. There’s vomit and piss on the steps and green sludgy water has flooded the bottom. The bottoms of my jeans drag through it. Yuk. Broken glass. Bergies (homeless people) are sitting on the steps, suiping (boozing). They say, “hey girl!” but they don’t offer to help with the pram. Bump bump bumping angrily up the other side. 

Sai screams. 

‘Grrrr.’

Sometimes I walk ever so mindfully through the subway, slowly and smiling at the world. Before I enter the subway I smile and look at the world. A cool breeze blows and lifts my spirits higher. I breathe deeply feeling my lungs expand. I push the pram carefully and slowly down the stairs. I notice the starkness of the walls, but I also notice the soft light of the sun on them. I notice the plants growing in the cracks. The small coloured gardener who cuts the grass across the road appears and helps to carry the pram through to the other side. I thank him wholeheartedly before he runs back to work again. Again, I stop and smile at the world. I notice the honeysuckles beginning to bloom. I look up at the block of flats across the road.  I notice an old woman looking at Plumstead from her balcony on the third story. She has long grey hair, clipped back at the sides and is wearing a bright pink jersey. I watch her for a while, smiling at her, hoping she will notice me. She doesn’t, although I stand there watching her for quite some time. 

As I walk away though, I feel connected to her.

The post A Story I Wrote as a Young Mother appeared first on True Midwifery.

Big Baby

I have a tendency towards giving birth to large babies. It seems to run in the family. I was 5 kg (11lbs) at birth and my three younger sisters were between 4-4,5 kg (8,8 – 10 lbs) at birth.

Growing up I was always tall for my age (my nickname was High Tower at school) – I am 1,83 cm (6ft) tall as an adult and I have been this height since I was twelve years old. I inherited long legs from my father who had to duck his head to walk through doorways and my paternal grandfather’s nickname was Giraffe.

So when I gave birth at 38 weeks pregnant to a 5kg (11 lbs) baby boy (over an intact perineum) with my mother in attendance as my midwife, no one in my family blinked an eye at his weight. Life went on. It was only during my second pregnancy when I met with my new midwife and she nearly fell off her chair at the mention of my first baby’s birth weight, that I realised that perhaps my story was slightly unusual.

My second baby, a girl, was born 9 days past her ‘due date’ and was ‘only’ 4kg at birth. Even though she was a whole kg lighter than her brother, she was much harder to birth because she had decided to emerge facing sunny side up.

Ouch!

(But she too was birthed over an intact perineum).

My third baby decided that he quite liked it in there and decided to incubate more than two weeks past his due date. Ten years ago today, I was heavily pregnant with him, waiting for him to trigger his labour. His head sat low and I waddled my way very slowly through my day. There were many false starts  and false labour alarms and by the time the twinges began, I and everyone else in my circle of friends and in family, had decided that I was going to be pregnant forever. Ten years ago today, I would still have to wait another five days before labour began.

It was a sunny Sunday morning, during my morning yoga session, that the sharp twinges in my cervix began. These twinges propelled me into a mad nesting frenzy – I hung curtains (I remember hammering nails furiously into the window frame) and I scrubbed floors on all fours until the wood gleamed. I washed, hung, folded, and packed away laundry. I even cooked a massive pot of vegetable stew – enough to feed roughly 15 people!

And in-between doing all of this, intense surges would slam into my cervix, opening me up to the bliss of heaven and agony of hell simultaneously.

I remember rocking my hips in the sun whilst hanging the fluttering laundry, and as the contractions grew, so did my strength. I had to channel that strength somewhere or else the pain of it would overwhelm me. So I pushed against a wall with all my strength, willing, believing, that I could push it over. That is how strong I felt.

And yet, I was an ant trying with all its might to push over a brick.

At some point, children were fetched.

The midwives arrived.

Counter pressure on my hips eased the intensity for a while.

The birth pool was filled. I remember stepping into it and feeling as though I was stepping into the warmth and privacy and comfort of the womb.

What bliss!

What calm!

What peace!

Then I was overwhelmed again, drowning in surges of unbelievable pain. And with each surge the pain was ten times stronger than the one before. I had never experienced labour so intense before…with seemingly no respite, no chance to get the hang of the next wave…each wave more powerful that the one before. In previous labours, I had learned to navigate, but in this labour, I just had to let go and hope I would not drown.

I can’t do this! I shouted, No! No! No!

Try saying ‘Yes,’ The assistant midwife whispered to me.

What the Fuck?! I thought and flashed her the evil eye.

Just try it, she whispered.

Yes…I said begrudgingly, through clenched teeth.

But as the next surge came, the word Yes transformed my feelings of hopelessness and drowning, to feeling like I was a cowboy astride a bucking bronco. I was no more in control of the labour than before, but instead of feeling like I was being trampled underfoot, I could wave my Stetson triumphantly in the air.

Yeeha!

Then everything shifted and my body began to bear down. That confusing feeling where a coconut seems to try to force itself out of your vagina and anus simultaneously.

Oh my God, I need the toilet!

No…the midwives said, It is the baby coming. There is not need to get out of the pool.

No! I need the toilet!

I clambered out of the bath.

Wet. Heaving. Primal. Powerful. Roaring. Mad.

I lumbered down the corridor to the loo. There, as I sat on my cold porcelain throne, I was stretched and pulled further apart as I opened wider.

I reached down.

A slimy head was beginning to stretch my perineum. Bloody snot covered my hand. I roared as another surge hit me and I threw the blood stained mucous across the room.

Where is it? a midwife asked. I ignored her as I heaved myself off the loo and tried to escape this monumental experience.

(the mucous plug I had thrown across the room was later found on a bar of soap resting on the edge of the basin)

His head emerged as I trundled down the corridor and was crossing the threshold of my bedroom door. blue.

My legs stiffened with the next contraction but the rest of his body did not emerge as his face began to turn blue.

Get on the bed, my midwife commanded firmly.

I can’t! I wailed pathetically, My legs are stuck!

They were stiff and cramping.

But my baby was stuck, one of his shoulders were impacted against my pubic bone. I needed to change position.

Get on the bed, she repeated firmly, looking me in the eyes. I don’t know how it is that I moved. Perhaps it was her voice or the look in her eyes, but something propelled me onto my bed where I found myself on my back with the assistant midwife applying suprapubic pressure and my midwife urging me to pull back my legs as she manoeuvred my son out. He suddenly shot out as his shoulder dislodged and he was immediately placed on my chest, where despite being a little blue in the face, he spluttered and cried.

Later he was weighed and he clocked in at 5, 47 kg (12lbs) the largest of his siblings.

(and yes, even though he needed some assistance with getting his shoulders past my pubic bone, he was still born over an intact perineum).

He also got to be in the newspaper for that one…his little claim to fame.

We named him Ayo, which means ‘happy’ in Ghanian.

Happy birthday Ayo for this coming Saturday.

Love you…

The post Big Baby appeared first on True Midwifery.

When you Strike a Woman, You Strike a Rock!

Sixty years ago, 20 000 brave South African women marched on the Union Buildings in Pretoria to protest the pass laws. The pass laws insisted that all black South African men under the country’s Population Registration Act had to carry these ‘passports’ when outside their designated areas. Up to this point, black women had been excluded from carrying the ‘dompas’ (literally dumb pass), but the change in this law is what triggered this protest march.

Wathint’Abafazi Wathint’imbokodo!

(When you strike a woman, You strike a rock!)

Was the song that the women chanted after standing in silence for thirty minutes and leaving bundles of 100 000 signatures in the doorways for the then Prime Minister.

(He apparently never saw the petition, he was away and the papers were very quickly removed before he could see them).

Wathint’Abafazi Wathint’imbokodo!

(When you strike a woman, You strike a rock!)

These words, first chanted in 1956, have come to symbolise women’s resilience and courage in South Africa.

This march and these words made a big impression on me when I first heard about them as a girl and these words often float through my mind when attending a labour and birth and seeing a woman ‘s strength and resilience surface.

Women will put up with a lot in life. See them go without, for their families, for their children,  for their husbands. But push a woman too far and she will push back with a previously unseen inner strength .

There is that point in labour; when a woman has reached that place where she seems to give in and the act of giving birth seems insurmountable. But then it is as if something inside her pushes her to stare Death defiantly in the face with a strength not even she knew she had.

And that is why women are scary.

Because we all have it.

Wathint’Abafazi Wathint’imbokodo!

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When did Breastfeeding Become Such a big Deal?

I know that I was breastfed until I was almost two and my younger sister Kate was breastfed until she was three. We lived in Switzerland and we went to the creche on the property of the hospital my mother worked at. She would pop down every few hours to breastfeed us. I remember her coming down to do that for my sister. I know that when my sister reached the age of three, my mother had had enough and she left us with our dad while she went with a friend to to France and my sister was left to go cold turkey. I remember her telling us about how when she woke up with rock hard breasts, she squeezed and squirted breastmilk all over the walls.

When I was eight, we moved to South Africa and when I was nine, Gypsy was born. Jasmin’s birth followed 16 months later. Gypsy had to stop feeding while my mother was pregnant because her milk had dried up but as soon as the milk flowed again, both babies were back on the breast suckling away – even whilst driving! That has got to be one of my most prominent breastfeeding memories; my mother driving the bakkie (pick up truck) on the bumpy dirt road in the Bokkeveld near Ceres with a baby straddling each leg and suckling away at a breast each. Unfortunately, I don’t have a photo of this wonderful scene but I do have this one which is the two of them asleep post feed so you can get the idea.

My mother driving with my two younger sisters post a feed

Growing up, breastfeeding was normal. Like giving birth. If you had a baby…that is what you did to feed them until they were old enough to eat other things. The women who lived and worked on the farm also popped out their breasts to feed their children, most of them until their children were two or three, and one woman until her child was seven. When I was eight I saw a white woman cover herself while breastfeeding, she made such a fuss of it and seemed to draw so much attention to herself with this act. I thought it was odd and I wondered if the baby wasn’t hot in there?

I got a fright the first time my baby suckled away at my nipple after giving birth – Ouch! I thought the hard part was over, no had told me that breastfeeding could hurt! It took me about three weeks of engorgement, tears, frustration, mastitis, pain, irritation, beauty, bliss and bonding to get the hang of the whole breastfeeding thing. And one day we got it. But I have to admit, that for me, breastfeeding was like learning to ride a bicycle – I had to fall off a few times before I got it and I got some scrapes and bruises along the way also.

And it wasn’t just the first time I struggled with breastfeeding, it was a struggle every time I gave birth. Four times I struggled. That was my reality. Labour and birth was hard but give me that any time over the first three weeks of breastfeeding. I would feel that little jaw working away at my nipple and I would inwardly grown as I thought, “Oh no…not this again!” I am well aware that there are all sorts of techniques to make all of this much easier. And I tried them. And sometimes they worked. And sometimes they didn’t. There is nothing like exhaustion and engorged breasts in the middle of the night to get the latch all wrong, your nipples become chewed to pieces and before you know it, a fever and a sore breast have erupted.

Such fun.

On day three I would inevitably burst into tears and cry as the milk flowed and the reality of motherhood and the beauty of my baby overwhelmed me. Milk fever and engorgement were a reality I learned to work with with hot water bottles, pumps and homeopathy. My breasts squirted and ached and dripped and leaked and wet more t-shirts than my babies wet nappies. My nippled felt like how chewing gum must feel and I even dreamt one night that my baby had stretched my nipple as though it were a pink piece of chewing gum.

ouch!

 

 

 

 

 

 

Boobs hung free as a I ran out of t-shirts, or a forgotten breast would hang from my top because I forgot to pop it back in after a feed.

And then one day, we’d get it and we could venture forth and feed anywhere and anytime we wanted to…looking as though it had always been easy.

But I was never harassed nor had any issues whilst feeding in public. I popped out my breast whenever my baby was hungry. In restaurants, on the train, when visiting, in parks, in shopping centres.

What’s happened? Why are there so many stories now of women in South Africa being harassed while breastfeeding? I breastfed four children over a period of ten years and was never made to feel like what I was doing was strange, unusual, shameful.

I was once politely offered a Woolworths changing room to feed my baby in but I declined saying I preferred to sit somewhere where I could watch people going by. That was about it.

Happy World Breastfeeding Week everyone!

 

The post When did Breastfeeding Become Such a big Deal? appeared first on True Midwifery.

There is hope…

Two weeks ago I came back home to South Africa after a full and busy tour of teaching and presenting in various countries in Europe.

I don’t think I quite realised what I had signed myself up for when I said yes to all the commitments I had made but for three weeks I ended up either teaching or travelling every single day.

This was my itinerary:

14-15 May, Additional Skills and Information Session Weekend for Doulas at DO-UM in Istanbul, Turkey
17-18 May, Helping Babies Breathe and other obstetric emergencies for home birth at Da a Luz, in the Alpujarras, Spain
20-24 May, An Introductory Course to Midwifery at Vale dos Homens, Portugal
26-31 May, book launch of Italian translation of my book, The Basic Needs of a Woman in Labour, in Rome and various towns on the island of Sardinia.

I flew to Istanbul mid May to teach doulas and student doulas at DO-UM, a space run by Nur (the first ever doula in Turkey) and Sima. These two doulas are pioneering and bearing the torch of birth through education and birth attendance in Turkey. Turkey has a rising caesarian rate which matches our own here in the private sector in South Africa. The majority of births are attended by doctors and most end in caesarans. But DO-UM and other places are trying to shift this by offering doula courses, as well as childbirth classes for expectant couples.

The students of the course in Istanbul

Then I went on to Spain where I spent two days teaching the last workshop of Da a Luz Midwifery School’s second year in operation. The school, is the vision and idea of Vanessa Brooks, a British home birth midwife residing in Spain. It is still a work in progress but what I have seen in visiting the place twice  in the last two years, is that it is coming together very nicely, and growing as a course which supports women in choosing the path to true midwifery. Students sign up for a year’s apprenticeship and have the added challenge of having to provide completely for themselves in terms of accommodation (living in tents, vans, yurts, caravans, and one student even building herself a little cob hut), living off the grid and living communally. The school building, is slowly being built and has gone from being a pile of stones to taking on a majestic presence of its own. I look forward to seeing it when it is done but for now, classes still take place mainly outdoors, on rugs, on the grass, under the olive tree. I am very inspired by what Vanessa is doing at Da a Luz because we all know that there is something lacking in midwifery training nowadays, and that is often a lack of trust of the birthing process. Da a Luz aims to instil a sense of confidence and faith in birth.

The doorway to the school at Da a Luz

Last year I taught the Helping Babies Breathe course to a group of doulas in Portugal. After that course, there were numerous requests to build on that and for me to provide a longer, more detailed course, exploring some of the skills of midwifery.

Hence,An Introductory Course to Midwifery  was born.

At the beautiful venue at Vale dos Homens we spent five days discussing, exploring and mostly laughing our way through basic midwifery skills, sharing birth stories and discussing what birth and midwifery meant to us.

This picture perfectly summarises the essence of the course

You can see more pictures from the course on the True Midwifery FaceBook page.

After the course in Portugal I had to catch a plane to Rome where the Italian translation of my book, The Basic Needs of a Woman in Labour (I Bisogni Di Base Di Una Donna in Travaglio in Italian), was being launched, with special guest Michel Odent in attendance.

Hilda Garst, a Dutch mother and La Leche League leader for twenty years, discovered my book online and after reading and feeling inspired by it, contacted me about translating it into Italian. Not only did she take on this task, but she, along with Rome based mother group Nanay, organised two conferences in Rome and Sardinia with Michel Odent and I as the primary guests and speakers.

Pretty cool hey?

And after two days, Michel left and Hilda and I drove around the Sardinian island, presenting the book, sometimes twice a day, to various mother groups, students at the midwifery school, paediatricians, psychologists, doulas, as well as a gynaecologist who, after hearing that I gave birth to a 5,47 kg baby over in intact perineum, asked me to stand up so that she could check out my hips.

It was rather tiring travelling so much and presenting the book every day and having to do it through a translator as well. Also, sometimes debates would become quite heated and I would lose track of what was being discussed but I got the general idea through the expressive hand gesticulations the Italians are known for. I also understood the passion and anger that issues around birth can bring up, those are universal. Although there was so much repetition on the book tour, I was able to remind myself daily of the essence of the work that I do.

Michel summarised it so well when he said, “the keyword is protection.”

That is my job, my role, to protect the basic needs of a woman in labour. And when you look at it like that, then it is, and should be, so very simple.

I came away from this trip tired but hopeful.

In a world where birth seems to becoming a more and more medicalised event, I was privileged enough to meet and work with people who believe and trust and who, in their own way, are beacons of light and hope for birthing women and their babies in this world.

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My Father Wasn’t at my Birth

My father wasn’t at my birth.

My mother had hoped for and planned a home birth for my entrance into the world, but she was a single mother living in a communal house in Switzerland at the time. She was considered to be an older mother (She was 29 when she fell pregnant with me) and was advised against having a home birth by her doctor. The man of the house she was living in was also dead set against having her birth in his home – there was no way that African girl was going to squat down and birth in his house. My mother then found out about a natural birthing centre in the neighbouring canton of Graubünden, and while she drove to take a look at it and loved the pink rooms and the deep birthing pools and the midwives in attendance, there was no one who was willing and able to drive her there once she was in labour (which I have now worked out via Google maps is only 1 hour and 23 minutes away!). So she settled for the very fancy and exclusive private hospital at Stefanshorn.

My father wasn’t at my birth.

I was a planned pregnancy. Very much so. I was very much hoped for and wanted, but it was an unusual arrangement of sorts.

I’ll let you in on a  little secret.

You see, my father was married to someone else when he met my mother and he stayed married to his first wife (my parents actually never married) while embarking on a relationship with my mother. My mother was a staunch feminist at the time and had all sorts of theories about different ways of having relationships and so they embarked on an ‘open relationship’ – which my father’s wife was actually rather reluctant about. So the plan was for my father to impregnate my mother and that she would be a single mother and that he would be a long distant parent and visit once a month or when time and travel allowed him. My father lived in England and in South Africa at the time.

My father wasn’t at my birth.

He was in England at the time, at home with his wife.

My mother was admitted a week before her due date to be induced for no medical reason other than that her doctor was going to be away on holiday. She was admitted on my father’s wife’s birthday, which his wife always saw as a personal affront to her and made her resent my presence even more.

My father wasn’t at my birth.

A friend drove my mother to the hospital, but my mother was alone when she went into labour with me. I know that she laboured for twelve hours and that she had the latest in foetal heart monitoring technology strapped to her while she laboured. I know she laboured on her back.

I also know that she held on to a little green Verdite statue.

A little bust of an African woman. It had been given to her by a grateful woman my mother had counselled when my mother had volunteered as a rape counsellor in South Africa. I know that this little statue was a lifeline back to South Africa for my mother while she laboured.

My father wasn’t at my birth.

He was in England at the time, at home with his wife and while she hung out a load of wet laundry he snuck a call to my mother and shouted instructions on how to breathe through the heavy black phone. I know he irritated my mother and that she was relieved when he had to go and she could return to her own rhythm. She had found a way to relieve her pain by breathing out for as long as possible and making her lips loose while she did that.

After twelve hours, she gave birth to me. A girl. I weighed five kilogrammes and I took to the breast easily apparently.

My father wasn’t at my birth.

But he arrived the following day and examined me thoroughly. He was concerned that my toes would be bent and gnarled like his and he was comforted to find that this was not the case.

He then announced with relief that I was only slightly pigmented.

(My mother was classified Coloured, my father was classified White – their relationship had begun in South Africa and the fact that they were a mixed race couple now with a child made it difficult, if not impossible, for them to continue their relationship in South Africa and was one of the reasons I was born and raised in Switzerland. We only moved back to South Africa after the Immorality Act was repealed in 1987 ).

My father wasn’t at my birth.

I did not grow up with him in the way most children grow up with their fathers. I never lived with him except for a short stint when I was seven and the Apartheid government had changed its laws and my parents came to South Africa and rented a house  and tried living together – this did not last long. 

He was always a regular part of my life though and he visited and sent gifts and we visited him and he phoned on birthdays and Christmas and I know he prayed for me.

Twenty-six years later my father was dying of cancer. It had spread to his bones and his blood. I found out two weeks before he died and I spoke to him on the phone. He was jolly as ever and told me he loved me. I was pregnant with my third child at the time and I could not fly to be with him. I had not seen him for six years and he had never met any of my children.

My father wasn’t at my birth.

And I wasn’t there when he died.

That was ten years ago today. The day before his 80th birthday.

My father wasn’t at my birth.

But he was very much part of my life

And he always will be.

The post My Father Wasn’t at my Birth appeared first on True Midwifery.

The First Time I Ever Witnessed a Fetus Ejection Reflex

The first time I ever witnessed a fetus ejection reflex was one summer’s night when I was attending a home birth as a doula.

The first time mother was ten days past her estimated due date and there had been some pressure to induce. She had declined this intervention and made it clear that she would wait for her baby to come. She was a very petite woman and had already been warned by both her obstetrician and her midwife that more than likely, she would require a caesarean and that she should prepare herself mentally and emotionally for that eventuality. The baby hadn’t dropped into her pelvis at all, let alone engaged, her hips were tiny she was told, and she was already very much past her due date.

Instead of these remarks squashing her plans and her confidence, they fueled her instinct to birth at home even more and she made it quite clear that she would prefer to be left alone until she went into labour.

So, ten days after her due date, she let me know that her waters had broken but that she wasn’t yet experiencing any labour pains. She would let me know once things were happening but for now, she was just going to stay at home and wait and see. She would be in touch. Even though we only lived ten minutes from one another, we were separated by the Argus Cycle tour taking place that day, so even if I had wanted to get to her, I couldn’t have, and neither could anyone else, so she really could just be left undisturbed at home.

At around 3 pm in the afternoon, once the roads were open and clear again, I made my way to her home at her request. She and her partner were sitting on the sofa when I got there and after greeting them I sat down on the sofa opposite them.

I felt on the spot, they were looking expectantly at me, as if they were waiting for me to do something. She was experiencing the occasional contraction but it was definitely still very early labour and there was certainly not much that I could do!

I excused myself and went to the loo, and once I was done, I ducked into the garden thinking,

What do I do with myself now?

I spotted a cat lying lazily in a spot of afternoon sun on the grass and I remembered Michel Odent saying something along the lines of:

“If you are unsure of what to do with yourself at a birth, find a cat and copy what they do. Cats are the ideal birth attendants.”

So yeah, I went and sat with the cat.

She didn’t seem to mind too much that I was infringing on her bit of sunlight. At first, I sat a little stiffly, I felt awkward. But soon, her laziness rubbed off on me and eventually, I too was stretched out enjoying the last rays of afternoon sun.

The mother came out into the garden and asked my advice on what she should do.

I asked her what it was that she felt like doing. She said that she was tired and felt like resting and sleeping, so I said,

“Well, why don’t you go and try to do that.”

So off she went. And I stayed with the cat until the sun set.

I snuck back inside the house (like a cat) and saw out of the corner of my eye the mother sitting cross-legged on the sofa, propped up by pillows, resting in between surges – which now seemed to be coming at a more regular pace.

I lay down on the bed in the spare room and fell asleep.

The father woke me to let me know that the mother’s waters had properly broken and so I got up and quietly helped her change her panties and leggings and fetched her a pad.

She then silently slipped off to her bedroom where she stayed for the rest of her labour.

It was interesting because, during her pregnancy, she had envisioned herself spiralling in her great white open plan sitting room. The birth pool was set up there and it had been deemed the official birth space.

But intuitively, as a mammalian, labouring woman, she found the smallest, darkest, cosiest room to labour in. The space she had chosen made it quite clear that she needed and wanted to be left alone.

And so we did.

I stayed in touch with her midwife who was very aware of the labouring mother needing as much space as possible during her labour and that the midwife would head through only once labour was well established.

The father and I read books in the sitting room. At one point he got up and made a stir fry.

I peeked at the mother on my way to the loo once or twice and saw that she was well and truly in her zone, kneeling, leaning on a birth ball, a soft blanket over her shoulders, a sleepy look on her face.

A gentle pink glow from the Himalayan salt lamp giving the room a womb-like quality.

She made soft sighing sounds.

And sang quietly.

Then suddenly, the quiet was broken. She came out of the room looking wild-eyed.

She gave a big grunt and it was as though her entire body contracted into one expulsive peristaltic movement.

“I can feel the head,” she said.

And so we helped her to take off her leggings. We had to cut off her panties, she couldn’t lift her legs.

Three more spontaneous pushes and the baby was out.

A first-time mother.

Giving birth.

A GENUINE fetus ejection reflex!

Wow!

It is possible!

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No Matter How Tired You are, Remember to Stay Mindful

Words echoed over and over again by stressed and exhausted 4th-year medical students yesterday during their Obstetric rotation OSCEs.

A good reminder for a midwife who had had 3 hours sleep after a long labour and who had to sit through 4 hours of 50 students being examined on ‘Compassion.’

No Matter How Tired You are, Remember to Stay Mindful…

That was the message that echoed over and over again and what kept me going through yesterday.

 

 

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Sexual Abuse Triggers During Labour and Birth

I have started writing a book on creating a safe space for pregnant, labouring and birthing women who have been sexually abused.

I don’t claim to be an expert on this very sensitive subject matter. Nor do I claim to have covered every aspect of it in this book.

For a very comprehensive and thorough analysis on this subject matter please read When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse in Childbearing Women by Penny Simkin and Phyllis Klaus.

I am putting this book for numerous reasons. I am putting this book together because I live in a country where women are more likely to be raped than literate. A country where, according to the Medical Reasearch Council, one in three girls under the age of 18 has been sexually abused.The MRC’s study also states that by 2009, 40% of all victims who reported rape to the police were under 18 and 15% were under 12 years old.I am putting this book together because of my own personal experience. I am putting this book together because abuse is so prevalent in our birthing facilities. I am putting this book together because I see what a difference knowledge, skills and the correct language can make. I am putting this book together because of my mother. I am putting this book together for all the women out there who have, or will still some day, give birth.

This book springs forth from a series of tutorials called Compassion tutorials started by midwife Robyn Sheldon. They are a series given to the 4th and 5th-year medical students at the University of Cape Town during their Obstetric and Gynaecology rotation. I teach these tutorials along with Robyn, Caitlyn Collins and Alexia van der Velde. We teach at Groote Schuur hospital, Mowbray Maternity hospital and New Somerset hospital. These tutorials were started to address the high incidents of abuse from caregivers towards women birthing in the labour wards.

With the  4th years, we focus primarily on the concept of compassion in the context of the labour ward. Often students are rather traumatised from attending births and how women are treated and this is very much the focus discussion amongst meditation, learning skills when attending women in labour and understanding better the emotional and psychological aspects of labour and birth. These tutorials are usually well received and have been deemed a success.

By the time the 5th years are in their gynaecology rotation, the students have hardened from their experiences, sometimes the Compassion tutorials fell a bit flat because they seemed not to deal with the real issues the students were faced with.

One day, I decided to tackle the subject of compassion from the perspective of working with women who had been sexually abused.

Something shifted.

The feedback was very positive from the students.

I have now been regularly speaking on the subject matter for the nearly two years.

Over and over again I hear the words, “I wish I had had this information sooner – it will certainly change the way I work with women in the future.”

That feedback is enough to make me want to spread this message far and wide.

I will touch on two aspects of what I share with them here today:

I emphasise the prevalence of sexual abuse in South African society. As mentioned previously, 1 in 3 girls will have experienced some form of sexual coercion before the age of 18.

Let that sink in.

These statistics made me think that we needed some sort of sexual abuse universal precautions in place around working with pregnant and labouring women.

As caregivers, we ensure our own safety, by having universal precautions in place. We assume that all bodily fluids we come into contact with, may potentially carry some form of bloodborne pathogen. And therefore, we protect ourselves from them.

These statistics around sexual abuse made me think that we needed to have universal precautions in place for pregnant women also and almost assume that every pregnant woman who comes to see us, or who we care for in labour, may possibly have been sexually abused.

This is not to say that she should be treated as a victim, or assumptions made but that we need to be aware of the care we provide and the language we use, because we as caregivers during this time, could potentially be part of either the healing from or the perpetuating of, the abuse.

This leads me  on to the next thing.

2. Possible triggers in labour and birth

Sometimes sexual abuse memories can be triggered by the uncontrollable sensations of labour and could be linked to previous experiences of sexual abuse in the same parts of the body.
The lack of control over the process could also be a trigger.
The sensation of the baby moving through the birth canal and vagina.
How we touch a woman speaks volumes and we must always ask permission to touch, even touch that is meant to be caring and calming could be a trigger.
The feeling of the baby on her chest. There is such an emphasis on the benefits of skin to skin contact immediately after birth and yet, all too often, I have seen, especially young teenage mothers, put their hands up, or have a very strong negative reaction when the baby is thrust onto their chests without permission. Waiting a few minutes until the mother is ready to receive her baby, will be a more gentle transition and less likely to trigger the mother if she has been previously sexually abused.
Some birthing positions, especially lithotomy, with its accompanying feelings of disempowerment. Also, hands and knees, squatting and pulling a woman’s legs apart.
The environment she is birthing in could also be a trigger.
The lack of privacy.
Lack of respect for her modesty.
Being left alone.
Vaginal exams.
Any medical procedure, like being monitored or having blood taken.
Being watched and questioned by strangers
Language is a big one. Saying things like, ” Open your legs,” “Relax your bottom,” “This will only hurt a little,” and “Relax and it won’t hurt so much,” may make sense in the context of a labour ward but these words could also have been used by her abuser.

Remember, that many women do not remember that they have been abused. They may have been too young when it happened to remember, or they may have blocked out these memories.

Just because she does not remember having been abused, her body may.

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