Ruth Ehrhardt's Blog, page 7

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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Bungie Jumping Baby

It was her third baby and first home birth and she had created a beautiful warm cave for herself in her bedroom. Dim lights. Birth pool. Candles. Lovely burning oils. Hypnobirthing cd playing in the background. Safe and warm and cosy.

But labour had slowed down since she had gotten to fully dilated and we waited patiently for labour to pick up again. And it just didn’t.

And so the difficult decision was made to move to the nearby hospital to seek assistance.

I packed the car while Marianne stayed with the labouring mother and once we were ready to go, we made the slow shuffle across the much colder and starker open plan kitchen/dining area/sitting room to the front door. The slow shuffle of a labouring woman. A few slow steps forward and then stop to swing her hips as a contraction surges through her.

After a few steps, the baby’s head was suddenly on her perineum.

BOOM!

Plans changed…baby was going to be born on the kitchen floor.

I ran to get our equipment out of the car again and then knelt down behind the mother who was standing and rocking her hips.

Marianne and I sat, to the back and either side of the mother, averting our eyes so as not to make the mother feel observed, waiting for the head to emerge.

But then out of the corner of my eye I saw the entire baby shoot out of her mother in one big push. Reflexes I didn’t know I had dived to catch the baby, centimetres before she hit the floor.

Old classmates will attest to the fact that I was no good at catching balls at school.

But catching babies…well…I think this particular birth was certainly an initiation of sorts.

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My Mother was the First one to Touch my Baby

Thursday 11 October 2001

I fell pregnant when I was 20 after returning from a hitchhiking session through Europe with my younger sister, Kate. I came back home to pack up and move to Ireland to study drama but when I realised the constant nausea was morning sickness, I made plans to move to a nearby farm community. I wanted  my child to be born into the world in a natural setting.

I had grown up on a farm North West of Ceres and my mother while not trained to, had fallen into the role of being the farm labourers’ midwife.

When I was expecting my first baby, I saw no reason why my mother should not be the person to support and assist me.

I wrote the following two years later when I was expecting my second child.

*

I woke up with a desperate urge to shit at about one in the morning. I went to the toilet, came back to bed again and lay down again.

I tried to sleep.

Again, I wanted to poo, so again I went to the toilet, relieved myself and came back to bed. I tried to snuggle up to Nolan but my boep* was in the way, so I turned around and tried to sleep.

Again, I needed to poo, so off I went, but this time only dribbles of shit came out. My abdomen cramped.

I went back to bed.

The cramps kept on coming. Building up…building up…building up…ebbing away…ebbing away…ebbing away…

I sat up.

I put on the bedside light. I sat and felt the pains come and go…not sure. Scared to wake Nolan up. Eventually I did. He sat up immediately…

I phoned my mother. She was at a friend’s house. She told me to time the contractions. If they were less than a minute apart, she said, I would have to go into hospital because she wouldn’t able to get to me on time. My mother was going to go and fetch my sister Kate and then would be on her way.

I timed the contractions. 1 minute and 35 seconds apart.  1 minute and 20 seconds apart. 1 minute and 40 seconds apart. They felt fast and hard. I panicked. I didn’t want to go into hospital. I was set on a home birth.

The night before I had read (funnily enough) that to relax and slow down labour, a warm bath would help. Nolan ran a bath while I tried desperately to breathe through the rushes of pain. Breathing was impossible and painful, unbearable. Easier to grit my teeth, not breathe and bear it.

Once in the bath, great relief flooded my body. I relaxed in the pink hue of the candlelight. I could begin to breathe with the pain.

I phoned my best friend Nikki (who was studying in Jo´burg) from the bath. Nikki phoned me back from her dad’s cell phone. So good to speak to her, wished she was there, so far away.

Nolan had been instructed by my mother to line the bed with black bags. To get all our towels and sheets together. To put a pot of water, with a pair of scissors and a string in it, on to boil

I ate a paw-paw in the bath.

After an hour in the bath, I got out, wrapped in a white towelling bathrobe. The starkness of the light in the kitchen brought on the pain tenfold. It slammed into me.

At that moment, my mother arrived in a rented car. I hung on her.

Hello Mom.

Back in the candlelit room: it was quite magical and soft. Kate and my mother were there. My mother showed her how to breathe:

“Loosen your lips when you breathe out…”

“Prrrr…”

What a relief it was to breathe out. As though my pains, my worries, my tensions were leaving me. How it eased the burden. I felt the breath go until my lungs were empty. My mother’s gentle palm on my chest, gently pushing that last breath out.

Gone.

In limbo.

Then the first intake of breath. Gasp. Pain. Agony. Unbearable. As though my groin, my womb, were being ripped open. I felt like a shop-grilled chicken, a carcass, ripped open by some gluttonous fuck.

The pains came and they went. Everyone watched me. Kate sat in the corner, sketching the process. I breathed and squirmed and winced.

They built a pyre of cushions and blankets. I knelt before it and leaned into it. Softness enveloped me. A shock of pain grabbed hold of me. I couldn’t bear it. I couldn’t stand it anymore.  Instead of breathing out, I buried my face in the cushions and screamed and screamed and screamed. I then flung myself on to my back.

The pain was gone…

Steve was playing the marimba outside. Ballie was drumming a gentle repetitive rhythm on his seisel drum. Again I felt bathed in bliss. I had a view of the sun rising from her bed and I thought,

Aaah, I’m going to have a sunrise baby.

Then the door opened. Pete walked in.

“How long have you been in labour for? How long’s this been going on for?” He demanded.

The spell was broken.

My mother’s cell phone rang. She answered it.

Chaos took over.

“When did your waters break?”

“They haven’t broken yet. Or I don’t know if they have…I had a bath earlier…”I stammered. I wanted to tell him to leave, to fuck off, that he was invading my sacred space. But no one asked him to leave, protected me, too scared of him, why?

“I told you not to have a bath, you know what happened to Noesj.”

(As though it was my fault).

“ I…” I didn’t know what to say.

He talked at my mother; she smiled weakly.

I screamed, wracked with pain, but also to scatter the energy.

My mother´s cell phone rang again. She answered, talking to some idiot. I screamed to stop her talking. To draw my mother´s attention back to me. Me! This is happening tome!

Put down your stupid fucking cell phone!

I walked around in that tiny space. Like a caged tiger. Pacing. Pacing. I was cold, shivering, even though the heater was on and it was hot that day. Everyone was watching me, sweating. I felt  irritated, I wanted to escape. Anywhere, sleep, death, anywhere.

Vomiting. All kinds of shit coming out of me. Dribbling. Spraying.

I hung on Nolan. The shower rail. Pete. Squatting. Hanging. Screaming. Desperately trying to scream away the pain.

And then bliss, even sleep…

Then I was a lion. Wounded. Full of spears. On a cliff. Hunted. Roaring my last roar of pain.

Noesj came in. Fuck off, I wanted to say, we don’t need more people crowding in here, but I didn’t have the strength or courage. Instead, I beat Nolan’s back. He thought it was Noesj beating him on the back and told her to leave.

I can’t go on. I can’t. 12 hours. Contractions every 1 to 3 minutes. Fuck. Fuck. Fuck. I can’t go on. Just want to escape. Help me. Anything. Sleep. Death. Whatever.

Then,

“You’re fully dilated,” said my mother, “I can see the head.”

I reached down and felt my baby’s head and laughed with relief, wanting to cry, a new surge of strength rushing through me.

Breathe. Push (I thought my eyes were going to pop out) and out slid a perfect little head. Everyone rushed to see, leaving me gasping. Feeling this being hanging from me.

Another push and out he slid. Perfect little boy with all his fingers and toes.

We all cried.

I held my slimy perfect little baby.

My son.

We called him San.

San stayed attached to his umbilical cord for the rest of the day. We cut it that evening as the sun was setting. San’s placenta is planted under a peach tree on that farm.

We weighed San by bundling him in a baby blanket and hanging that from an old fish scale. He weighed 11 lbs ( I only worked out years later using an online converter that 11 lbs translates to 5kg!)

(and no…I didn’t tear)

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The Fetus Ejection Reflex

One cannot help an involuntary process, the point is not to disturb it…

If the labouring mother has had her basic needs met during the first stages of her labour, her body will prepare itself for something called the Fetus Ejection Reflex.

What are the basic needs of a woman in labour?

To feel safe
To leave the thinking brain (the neo-cortex) switched off
Silence
Darkness or low lights
Warmth
Not feeling observed
No adrenaline

It is very important that the labouring mother has utmost privacy during this time, otherwise the fetus ejection reflex will not take place.

How does it occur?

When a fetus ejection reflex is about to take place, the mother will suddenly become fearful and will say things like: “I want to die!” or “Kill me!”

It would be a mistake at this point to try to soothe or placate the mother with reassuring words.

Soon after this there will be some very strong contractions. The labouring mother will suddenly be full of energy and she will want to be upright.

The baby will be expelled in a few strong contractions. The Fetus Ejection Reflex is different from what we know as the second stage of labour, which is when the mother has to actively push the baby out.

When a true fetus ejection reflex takes place, the likelihood of the mother tearing is very low and the placenta should only take a few minutes to separate.

A fetus ejection reflex cannot take place if the basic needs of a woman in labour have not been met.

Read more on the Fetus Ejection Reflex here.

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The Knitting Midwife

A midwife sits in a dark room.

She has a shawl wrapped around her shoulders.

A candle flickers on the table.

She is knitting.

From another room, you hear the soft moan of a woman. The midwife continues knitting. The woman in the other room becomes silent again.

The midwife continues knitting. After a few minutes, you hear the moan from the other room again and the midwife smiles to herself while she continues to knit. 

Some time goes by and the midwife gets up and leaves the room. She goes to the kitchen. You hear her switch on the kettle.

The labouring woman continues to moan and groan – the pains seem to be intensifying.

The midwife comes back with a steaming cup of tea and a plate of biscuits. She dips her biscuits and sips her tea.

The labouring woman continues to moan softly in the next room.

The midwife is sitting on a rocking chair and now she rocks herself quietly while the woman in labour continues with her noises.

The midwife falls asleep.

The midwife sleeps for a while… the mother’s noises intensify.

The mother begins to shriek. She feels that the pain is too much. She is afraid that she is going to die.

The midwife opens her eyes and quietly listens. She slowly gets up (her bones creak a little) and she shuffles out of the room towards the sounds of the labouring woman.

Quietly, like a cat, the midwife slips into the room where the mother is.

The mother is grunting and screaming and the baby is born.

The baby is crying.

The midwife comes out of the room.

The mother is cooing to her baby.

The midwife shuffles back to her chair, sits down, smiles softly to herself and continues to knit.

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