Ruth Ehrhardt's Blog, page 7

A Story of Surrogacy

I met her when she was pregnant with her fourth child and was planning her first home birth. I got to attend that birth as her doula – after three hospital births, this was a very different and empowering experience for her.

She loved being pregnant and she loved giving birth but four children were enough for her and her family.

She decided to take on being a surrogate mother – A woman who agrees to give birth to a child resulting from artificial insemination or the implantation of an already fertilised egg and who surrenders any parental rights to a third party. A big thing to decide to do but she felt very strongly that she wanted to do this for someone else.

She met and carried the child for a single man. They became good friends and as she had trained as a doula as well, she was able to educate him on the options available in bringing his baby into the world. He went from wanting an elective caesarean for his child to attending hypnobirthing classes with her and planning a water birth in a hospital with midwives! I attended as her doula.

She laboured well, but sadly, due to various circumstances, a cesarean became necessary. This mother who had birthed her babies (one of them breech) with no issues was suddenly wheeled to the theatre where for the first time, she underwent this operation.

There was obviously a lot of emotional (and physical) recovery after this but she did say at one point that she felt that she felt that in order to be able to give the baby away, to not bond or attach herself to the baby, him being born via caesarean was necessary.

A few years later, she chose to walk this road again with another couple, a couple who had lost their son in an accident. They were quite clear that they were taking no risks  that their baby was to be born via elective caesarean.

Again, I walked this path with her as her doula, and there was much processing about the previous birth and preparation for the imminent caesarean birth. One of the things she was able to request and implement was a ‘natural caesarean’. 

On the day of the caesarean, I fetched her from home. It was strange to be attending a birth that was scheduled – for both of us I think.

We had planned to go for a walk together first.

I took her to The Company’s Gardens and we walked and talked until we reached St.George’s Cathedral where we sat quietly for a while. Then we lit a candle each.

Then we went to the hospital.

I have to admit to it being one of the most beautiful, and dare I say, ‘holy’ caesarean births I have ever experienced. There was no idle chatter, everyone felt fully focused on this event – there was a real reverence for this gift that was being given.

She even admitted that although she had been terrified of this second caesarean, it was actually a healing experience for her.

She is now pregnant again for another couple. This time, it is twins! Again I will be attending as her doula and an obstetrician has agreed to assisting at a VBA2C (Vaginal Birth After 2 Caesareans) for twins. The parents are in agreement.

We wait and see…

Shared with permission.

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A Little Drop in the Ocean

This last Saturday, after weeks and months of discussion and deliberation, the board members of The Compassionate Birth Project, were finally able to meet and discuss their ideas and to receive valuable feedback from the midwives working at some of Cape Town’s busiest and highly stressed MOUs (Midwife Obstetric Units) – Mitchells Plain and Hanover Park.

It was a very informal meeting and we all sat in a circle and introduced ourselves. We spoke about our passions and why we were there. We spoke about our children.

Robyn introduced the project and the proposed modules for The Compassionate Care Training Course for Midwives and MOU staff.

We wondered about how these would be received. What would the feedback be? And for us, more than anything, it was of utmost importance that we were not telling these midwives, who work so hard and who have done so for so many years, relentlessly, under conditions, which are far from ideal, what it was that they needed.

We wanted to hear from them what their needs were.

The feedback was amazing. I don’t think anyone of us ever thought it would be received with such open arms.

And such a sense of relief.

Finally!

Finally something for the midwives! Something to take care of and nurture and support the midwives!

These bastions of strength who, day in and day out, make sure, that mothers and babies are alive and safe.

It was a small meeting. A small circle of women in a room in Rondebosch.

But I think to everyone present, the power held in that little drop in the ocean, was tangible.

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and remember what peace there may be in silence…

“Go placidly amid the noise and the haste, and remember what peace there may be in silence. As far as possible, without surrender, be on good terms with all persons.

Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant; they too have their story.

Avoid loud and aggressive persons; they are vexations to the spirit. If you compare yourself with others, you may become vain or bitter, for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals, and everywhere life is full of heroism.

Be yourself. Especially, do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment, it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here.

And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be.

And whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.”

– Max Ehrmann, “Desiderata“

With every birth I walk away with something new.

or what I know to be true is reiterated or reconfirmed.

What peace there is in silence…

How those words resonate as I sit behind the young mother gently pressing on the part of her back that she has indicated is needing a gentle touch as she lies on her side labouring.

Her friend…who has been with her all night sleeps behind me.

We don’t speak.  We convey everything purely through our bodies and through touch.

Our communication is through the silence and respect and reverence we have for this process.

The wind howls and the windows rattle.

And whether or not it is clear to you, no doubt the universe is unfolding as it should.

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Embracing Traditional Midwifery

Here is the video from my talk at the 2015 Cape Town Midwifery and Birth Conference where I shared my journey and path to midwifery.

 

 

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The Media and Childbirth

Last week I was hired to play a midwife in a commercial. I also had to help dress the set, which obviously was a hospital room. I tried to de-medicalise the set it as much as possible, getting rid of unnecessary machinery and having the mother as upright as possible. But it was interesting to see how we still fall back on the old stereotypes of childbirth, dramatic, stressful, painful…

In her documentary film, Laboring Under an Illusion: Mass Media Childbirth vs. The Real Thing, childbirth anthropologist Vicki Elson explores how birth is portrayed through the media. She juxtaposes this with footage of ‘real’ birth – without the dramatic voice overs and music and tension. It is a hilarious take on how we have allowed ourselves to be influenced through television shows, films, comedies, reality shows, etc.

What has the media taught us about birth?

That pregnancy is awful. That you will feel ill throughout, have insufferable cravings and make your partner’s life miserable. In a nutshell – your life is over.

Oh…and antenatal classes consist of mothers sitting in circles hyperventilating.

And the birth?

Well, birth inevitably is triggered by the mother’s waters breaking, and flooding the supermarket.

In reality, only 15% of women’s waters break at the onset of labour, and sometimes it is more of a leak than a gush. Also, it will usually happen at night, when she is in bed, at rest, when it is dark.

In films, once waters break, the mother is then suddenly in full blown labour and pain, she screams and flails, sometimes falling backwards, conveniently knocking over a pile of tomatoes, peaches, apricots (insert colourful soft fruit). She grips at her partner desperately, whilst her partner, in a sweating panic, tries to help her.

In reality, labour starts slowly and gently. Often a mother will keep the little twinges that are niggling to herself, enjoying them whilst she gets on with her day. There can be many, many hours of  these little twinges and niggles before things shift gear and move into the next phase of stronger labour.

Cut to the car ride. Which feels more like a cops and robbers car chase. They are breaking all speed and safety records, putting their lives and others at risk to get to the hospital in time. Mother is screaming. Father is panicking. Birth seems imminent.

In the real world, moves to the hospital are usually slow and mothers are encouraged to stay at home until ‘active’ labour kicks in. They are sometimes sent home if they arrive at the hospital too early.

Now we are pushing. She has been stripped of her clothes and her persona and is on her back in a hospital gown, in a hospital bed, surrounded by people shouting “Push! Push!Push!” Perhaps, leading up to this moment, she had been planning a natural birth but now she is screaming for an epidural/caesarean and a great joke is made out of the fact that there is not need to be brave. She is also surrounded by lots of hospital equipment. It all feels very dramatic.

Finally, the baby is born, or rather, it feels as though it has been rescued.

And all is well.

Or is it?

Phew…tough one.

This last bit is quite true actually and is often how birth can play out in a hospital setting. But which came first? Have we allowed ourselves to think that this is what birth is like? Or that this is how it has to be?

How many women think, that they have to give birth on their backs because that is how they have seen it being done through the media? How many of us think we have to ‘coach’ a woman in labour to “Push! Push! Push!” because that is how we have seen it being done? And how many of us are painfully afraid of birth because we have been shown what agony women are in during the throes of childbirth?

I also have a bone to pick with ‘natural birthing’ films who often portray childbirth to be the polar opposite of what I have described above. Calm. Blissful. Centred. Supported. Even Orgasmic. And yes! Absolutely, births like this are possible BUT they do put a lot of pressure on new mothers to behave or perform in a certain way during their labours and births. And if they do not, then they are disappointed because their birth was not gentle, or calm, or orgasmic.

So how do we portray birth?

Do we portray it?

Last week I attended the birth of a young 23-year-old woman who lived very simply in a shack built of wood and metal. She had never attended an antenatal class, nor watched any birth films.

And yet, in the quiet of the candle light, she found her own birth dance and song – something no one taught her but which was embedded deep within her and was unique to only her.

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The Good ol’ Thinking Brain

One of the most essential things in meeting the basic needs of a woman in labour is to ensure that her thinking brain or her neocortex is well and truly switched off and understimulated.

What is the neocortex?

Simply put, it is our ‘thinking brain’ and is the most newly developed part of the brain. In humans, it is very developed and makes it possible for us to do all the wonderful things that make us human. Unfortunately, it also makes it much harder for us (as opposed to other mammals) to allow labour to just happen…our thinking brain tends to stand in the way of oxytocin (the love hormone and the hormone that makes that uterus contract) flowing freely.

The thinking brain needs to switch off

One of the prime ingredients for shy oxytocin to take effect is that the thinking brain needs to switch off. We need to make sure that the labouring woman’s thinking brain is not stimulated.

We stimulate the neocortex during labour by talking to the labouring woman about logical things, such as telling her how many centimetres dilated she is, or asking her to remember when her waters broke. We stimulate her neocortex with these observations and questions, and as a result, we slow down her release of oxytocin.

A woman needs to be able to slowly fall into her labour (like falling asleep) and not be ‘woken up’ by the outside world. If she can be given the space to switch off her neocortex, oxytocin will be able to do its job.

No observers

Feeling observed also stimulates the neocortex, so it is important that the mother does not feel watched. Observers and unnecessary people make the mother feel observed. Cameras can also slow labour down because they can make a mother feel observed which will “wake her up.”

Darkness

It is important that there are no bright lights around a labouring woman. Drawn curtains, candles and other forms of dim lighting, will help to suppress the thinking brain and aid in the stimulation of oxytocin.

Warmth

The labouring woman needs to be warm. A fire or a heater or warm water is helpful in relaxing her body and her neocortex. In fact, immersing herself in warm water at the right time (when she is in established active labour) can relax the mother so much that her cervix will dilate completely.

The ideal birth attendant

The ideal birth attendant understands that talking and asking questions will stimulate the labouring mother’s neocortex. Therefore, she keeps talking to a minimum and will try to answer as many questions as possible on behalf of the labouring mother. This way the mother doesn’t need to be ‘woken up’ from her labour.

The ideal birth attendant knows that bright lights stimulate the neocortex and so she makes sure that the lights are dimmed or off or that the curtains are drawn during the day.

The ideal birth attendant knows that the labouring mother needs to be warm in order to relax and for her oxytocin to release and flow. She makes sure that the room is sufficiently heated and knows that a warm shower or bath can work very well as a form of pain relief.

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Every Mother Matters

About a year ago a young mother, pregnant and living under a bridge, went into labour. She was a sex worker and we can only assume she stayed under the bridge to birth her baby because she was afraid to go to the hospital to birth her baby. I don’t know. Sadly, the baby got stuck and both the mother and her baby died.

Dudu from SWEAT (Sex Workers Education and Advocacy Taskforce) phoned me when she and a group of other mothers were returning from their friend and colleague’s funeral.

“We must do this training Ruth!” she said.

I had some time ago been invited to help facilitate some of the SWEAT Mothers of the Future meetings and there we had shared our birth stories and chatted about pregnancy and other reproductive issues. Mothers shared how they were slapped and hit and shouted at by nurses and midwives for being uncooperative. They felt they were stigmatised for the work they do whilst giving birth. They often felt unsupported.

Three or four mothers shared their stories of birthing at home with no assistance when labour had gone more quickly than expected and how different and empowering and different those experiences were.

We talked about how the mothers in this group could be of better support for one another and we eventually decided that perhaps a doula training would be a good idea.

As part the Compassionate Birth Project, we envision the option of a doula for every labouring mother and initially we thought that our job was to train doulas who could be employed by facilities so that any mother arriving in labour could gain access to a doula. But the SWEAT Mothers of the Future have decided for themselves that what they want to do is ensure that there are doulas within their own networks and communities. Fellow mothers who understand each other and who have walked similar paths.

Makes total sense.

Dudu is a real visionary and she has plans to roll out this doula training to sex worker mothers countrywide.

I like how she thinks.

Yesterday, Robyn Sheldon and I started our training with five beautiful souls who made the journey from their various dwellings, catching buses and taxis to get there. They have made the commitment to be part of this training for the next week.

Yesterday one of the mothers said:

“ If I understand it correctly, to be a doula I need to be able to let go of everything and to just be there for the mother. To be able to fill her with positive energy.”

Couldn’t have said it better myself…the perfect definition of the doula.

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Hello Darkness my old friend

So the uterus, amongst all the other marvellous things it does (“There is no other organ quite like the uterus. If men had such an organ they would brag about it. So should we.” – Ina May Gaskin), apparently ALSO has melatonin receptors attached to it.

These receptors work in conjunction with good ol’ oxytocin, aiding the contractions of the uterus, which dilate the cervix and, if undisturbed, will elicit a foetus ejection reflex .

Melatonin is the hormone that anticipates the daily onset of darkness and cannot be secreted when it is light. Which is why we need to switch off lights and screens, to fall asleep.

Seems we need darkness to go into labour too…which is probably why most labours begin at night and why most call outs for midwives are during the witching hour.

It is important that there are no bright lights around a labouring woman. Drawn curtains, candles and other dim lighting will help aid in the stimulation of oxytocin.

How do other mammals prepare for birth? They will find a quiet, dark place, far away from anyone, somewhere where they will feel safe and secure and know that they will be undisturbed.

We often forget that we humans are mammals too. We are above all of that by now aren’t we? What with all our technology and higher thinking and sophistication? But when a woman goes into labour, her body responds like every other mammal who seeks safety, comfort, protection, warmth and darkness to give birth.

A birth I attended recently, saw me arriving to a woman in labour in her bedroom. Her two year old son slept on her bed while her husband sat and watched television in the next room. The bedroom light was on, a stark, white light from a naked bulb. There was no bedside light or a dimmer light available.

I asked the father if he had any candles in the house and we made some makeshift candle holders using stainless steel cups and sand and set those up in the bedroom.

And then we turned off the lights.

It was as though the room breathed out all its tension as the room warmed with the golden glow of the flickering candle light and the mother was able to go into that mammal state that she needed to be in to birth her baby.

She had a mattress on the floor and now lay down there and began to moan softly.

Labour sped up.Ten minutes later her waters broke and five minutes after that I was handing her her daughter.

So simple…and yet so overlooked.

Isn’t it interesting the way most labour wards are still so brightly lit, and all for the convenience of the caregiver?

For what other purpose does it serve?

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Where you are, you Shine from Your Corner…

Where you are, you shine from your corner…

Those were the words that Karen and Nomvula sang to us at the beginning and at the closing of The Cape Town Midwifery and Birth Conference.

And so true.

As we work away, feeling often so alone, in our little corners. Working with mothers and babies and tears and loss and birth and life and everything. It is so good to be reminded that actually we are not alone. That there are many of us who feel the same way who are doing the same work, believing the same things, in our little corner.

Wow…

Like an amazing birth, I think I still need to process everything that took place this last weekend.

Powerful.

I look forward to seeing the photos and reliving the talks through the footage we filmed.

By Saturday night my face felt quite parched from all the tears I had shed. Each story shared so beautiful and courages and vulnerable and real.

Thank you to everyone who came and shared and was there and held space.

The people who came in buses and planes and cars from all over the country to be at this gathering of tribes.

Thank you.

And don’t forget:

Where you are, you shine from your corner…

 

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This Above All:

to thine own self be true,

And it must follow, as the night the day,

Thou canst not then be false to any man (or woman).

 

From Shakespeare – my words of wisdom for today.

 

In the thick of preparing for the Cape Town Midwifery and Birth Conference so not getting much chance to write this week. If you are in Cape Town you should come – it is an awesome conference. Hope to see you there.

 

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