Annette's last Pink Kit correspondence

25 March 2007

We've come to the last of the correspondence with Annette. We'll begin on a discussion that occured over several months with a woman who works as a doula and wanted to organize a Pink Kit Presenter training. Many issues are addressed. The great thing about blogs is the ability to correspond with one person about large issues (applicable to many others) and have a place to post the dialogues.

Common Knowledge does have a political view point about birth. It comes from the thousands of us who are Pink Kit families.

1. Birth is birth. We wanted all our births whether medical, natural, hospital, home, midwife or doctor births to be positive births whereever and with whom we gave birth.
2. Birth is birth. We wanted to actively participate in the birth of our children whereever or with whom we birthed.
3. Birth is birth. We wanted something to do during our births even if there was need for medical care or whether medical care was imposed on us through 'standard of care.'

So we'll continue on a new correspondence over the next few weeks.

Annette continued:

You also asked how would I have birthed if I have been alone and had NO CHOICE...good question. Probably squatting and wanting to hold onto something, like a rope hanging from the ceiling and from my husband's neck/shoulders. But I would have had to regain my calm and the breathing and just let go.'

Wintergreen's comments:

'If you were on your own you won't have your husband so no neck in this image. It's very difficult to squat on one's own and traditional women don't squat the same way modern women do. Holding onto to something dangling is very good but what?. Do you know why dangling is good? This is part of discovering positions. A large part of why you were not calm is NOT about you. You were being giving a message from your baby that he needed something. When women are restless in labour it's because the baby is giving a message. For example, in second stage when a woman is naturally making deep, low sounds or the pushing effort is almost soundless then the baby is moving down and this is apparent. The sounds tell us that the baby can find a way forward. If a woman is making high sounds that rise up out of her chest, she is reflecting the baby's inability to come down. These are some of the things we learned together. This meant we recognized this early and adjusted right away to find a position which was more open.'

Annette continues:

'I'm so glad you think I will probably have a quick 2nd stage next time (not that I'm planning anything like that at the moment!).'

Wintergreen's response:

'Yup you will but you'll still have to find open posiitons and do the internal work again'.

Annette goes one:

'I'm sorry if some of these sentences don't make much sense or are jumbled. It's getting late now and my head is going a bit. Just want to thank you again for your insight and your great advice. I'm going to carry on rethinking my birth and trying to figure out anything else that might help next time. The birth story you attached was interesting with some parallels.'

Best wishes, Annette

Wintergreen wraps it up:

'Our dialogues are very important. Every woman who learns about her own body and the process of birth is important. Your photos are great and we will use them. Hope you enjoy the pictures and please feel free to use them on the website'.

Visit: http://www.birthingbetter.com

And here are some photos of Annette and family

19 March 2007

Annette continues her self discovery as so many of us have.

Aren't they beautiful?

'You asked about my pelvis - I consider it to be a gynecoid pelvis, with a "normal" sacrum. Looking back I think the birth didn't happen due to muscular tension in the soft pelvis, rather than the structure of my bony pelvis. It would have been useful for me to really find positions that kept me open, but I never really found one doing the PK (prenatally) that I thought made me feel that way. What I had been taught about positions (during my training, yoga, childbirth prep classes) was mainly to stay upright and mobile and change positions frequently.' Wintergreen continues sharing the importance of our self-discovery:

'Why do you consider your pelvis to be this name? 'Consider' and self knowledge are not necessarily the same thing. When we feel our own shape, we don't have a name for it. It just is. Inside us is both the inside of the boney hole and the tissue holding things together. There are many women with lots of space in the boney hole who do have very tight soft tissue and if that is your case then did you work on it enough with the internal work? And now you know (if this comes up next time) that you absolutely must find a way to override your tension by turning your mind into your pelvis and working inside yourself by intent. Curious that you never found positions that kept you open from The PK. Why? But don't despair you're certainly not alone. This is common when women who don't get into their bodies but rather take information from elsewhere and interpret this knowledge as though it has meaning without really experiencing it. Over the years I've heard a zillion women say exactly what you have said: 'I was told to stay upright, mobile and change positions'. I met with Andrea (one of the midwives today) and she says she hears that a great deal from women who do pregnancy yoga. It was from these general remarks like 'just relax' that we became curious so solve the reality that so many of us had challenging births doing all those things. Women standing up hung up in 2nd stage, so did women who squatted, hands and knees, semi recumbant, leaning forward. Too many of us didn't progress in labour with these formulas and we wanted to know why. The 'why' we didn't progress directly had to do with our own unique body and that's why we spend time to have people work through what positions keep them open and how positions impact our baby. What you and I can do together is figure out how you think we can introduce this to people better. Down the line we will redo all the resources into some simpler form, but that will be years. There are many women who do get this part of the DVD and actually know exactly not only what position but how to subtly get even more open by small body adjustments. What would be a good idea at some point is for you to go back, map your pelvis again and go through the positions once more. Remember ... at every single moment of time our body is in some position or posture. At every moment we can find ways to stay open, or become closed or else we go blank and ignore ourselves. It's a learning process. Because you didn't discover how to stay open when you were sitting, standing, walking, lying, kneeling, then you didn't make choices on how your baby responded to these positions. Instead you relied on these very broad concepts: stay upright, mobile and change positions'. These concepts have led to more medical interventions than people can understand and this is something for another discussion'.

There's always a lot to talk about

17 March 2007

Annette continues:

'You're right Wintergreen, that not being able to use
the pool for the birth "threw me" and that along with
transition, I just gave up!! I didn't realize all this
until you wrote me, that this really was the turning
point when everthing became unbearable. Next time ...I
also agree with you, that not allowing a woman to push
when she wants to could interfere with her labour. In
any case, for me it made me clench all my muscles in
that area, I'm sure of it. I must say, that I'm
wondering with all the sensations in that area, is is
possible to localize the minnie mouse muscles during
this part of labour?? I'm not sure I could have.'

Wintergreen responds:

'Of course, being told 'don't push' requires a woman to tense up. this isn't rocket science. I certainly understand the frustration from women who pushed for hours without progression but these women rarely (when they talked more) actually felt like pushing all the time. Once the birth provider decides they should push then they are eagerly encouraged to. What it seems to me from listening to stories and watching is that if a woman feels like pushing then she should explore that sensation in a conscious manner ... one contraction at a time. Very shortly she becomes aware if the baby is moving down or not. This early 'pushing' is opening the soft tissue at the very top of her vagina. If a baby moves quickly down then she has a massive urge to push that she can't control.

If she feels the baby is not moving down then she gets restless and dissatisfied and it's important to work through each contraction opening her and getting the residual tension released. The concept of 'let's change position' is usually encouraged BUT without knowing exactly what positions actually open that woman rather positions are chosen because they are the trendy ones of the day. This does nothing but confuse the baby.

The purpose of having skills is to work with our baby and pay attention through our contractions what message our baby is giving us. This is discovered by asking questions: 'Is this the best position for your baby?' or 'Do you feel as open as you need to be?' PK women can answer these questions often. Sometimes they can't and then we slowly work with learning to recognize change. This sometimes take time if the woman still has lots of internal tension, hasn't really discovered what positions keep her open and havent really done enough of the internal work. But being a practitioner who is able to work with someone like this requires that the woman knows her body and so do the people helping her. Practitioners must learn over years from many, many women to be able to read subtle signs.

It's not too difficult to know your own body but much more difficult to know lots of bodies. This is another reason women who work as midwives should not bother to get involved too much with the PK as their skills. Rather they should explore how the PK feels in their own body and have the women and men teach them what they have discovered about their bodies. Then women can help guide everyone to help them etc.'

Annette continues her reflections

13 March 2007

Annette continues her reflections:

'You're probably right in that Christian's head must
have been a bit asynclitic, although this was not
mentioned and apparently he was direct occiput
anterior. He did have the cord around his shoulder. I
think that the bradycardia just after the
spinal/epidural was due to the anaesthetic rather than
the cord being compressed. Again difficult to say.
Perhaps the meconium which was present when my waters
were broken at 9 cms might was due to cord compression
or malpositioning. In any case, his head was never
very low, at 0 /+1 station, and unfortunately I sadly
never got to push once I was more comfortable as the
bradycardia occured about 5 minutes after the
anaesthetic was administered.

Wintergreen comments from a Pink Kit perspective:

Given that Christian was not a weighty baby, did he have a big head?

This is also what we've learned about some babies who could be compromised by the cord. First, we don't know until after the birth and then we put 2 + 2 and realize that what was happening had to do with that. But we had to think this out. In the simplest form we realize that if we dont feel we control labour, who does? It's the baby. The baby stimulates our body to open that's why it's so imporant we learn to listen to the messages and work with our baby's efforts.

Often baby's with a compromising cord stay high until full dilation and tend to barrel out. Was the meconium fresh or old? And you know meconium is fairly common and means very little usually. His heart reaction was mostly due to the epidural for certain and perhaps compounded by a compromising cord (so much for 'safety' but then you know that and probably have some guilt about that as well). Most cords aren't a problem as you know but when they are, they are.

In fact this sequence ... 'I couldn't cope, they helped, something happened and then something else happened that required them to do something else and thank god the baby is safe ... but I'm angry'. Usually the anger is directed at 'them' or at ourself. The first thing we had to do is to get past that. Whatever happened, happened. We all did the best we could at the time. So we explored and explored and healed.

Have you gone back to the doctor and asked why you had a failed ventoose? Also asking how tight they found your vagina and if there was anything about your pelvis you should know about. In fact, a baby that is not well down into the pelvis should not have an occiput directly anterior but to one side. These are things we can feel (touch) when we are pregnant by touching our baby a lot and getting to know where are baby is (touching inside and out).

Also, did you do any particular type of sports? Do you store tension in your lower belly? You also need to keep in mind that when someone has sciatica their pelvis is effected. As you know all the nerves come down the spine and into the sacrum. Some of those impact the uterus, but what we noticed over the years is that the pelvis isn't aligned because of sciatica, it makes the internal soft tissue inside the lower belly become more tense on one side. Often baby's don't come into the pelvis. Also the pain caused by sciatica causes the person to become more tense and unable to release tension on the top of the top of the vagina'.

Visit: http://www.birthingbetter.com

So much more to talk about

8 March 2007

Annette continues:

'I'm still trying to figure out why the 2nd stage was
so intensely painful for me... I guess it's my unique
body, what I keep wondering, what could I do next
time? Most women I have seen labour found 1st stage
challenging but generally did so well with the
pushing. And even if they didn't always manage to push
the baby out themselves, at least they didn't appear
to have the intense pain or could "push through it."
That still confuses me. Plus he was quite tiny at 6
lbs 2 oz'.

Wintergreen continues:

'Curious that you believe women do better in 2nd stage. If that were true why are there so many ventoose, forceps and episiotomies? In fact the only difference between 1st and 2nd stage is that women feel more pain in 1st stage and behave tense in reaction to pain. In 2nd stage there is less pain but a huge amount of failure to progress due to soft tissue tension.'

Our Pink Kit dialogue continued

8 March 2007

Every conversation we have about birth and The Pink Kit Method For Birthing Better® is vitally important in the world of childbirth. Common Knowledge Trust absolutely believes we can grow a skilled birthing population. What other choice do we have? If we can breathe then we can learn how best to use breath in labour. Because our body is always in some posture or position then we can learn to relax inside. There are so many wonderful skills for childbirth.

'Annette's comments:

Of course things didn't exactly work out how I had
hoped (natural, beautiful birth), but like I already
mentioned, I'm/we're so thrilled about having a
healthy, happy baby (Christian is 13 weeks old now)
and that what is most important. However, the journey
does count as well, and how we feel about ourselves
and the experience afterwards(i.e. are we empowered?).
As you can tell from all my soul-searching, I'm still
hung up on my birth!!'

My comments:

You've made a comment here that ties 'natural to beautiful'. A natural birth can result in a relatively painless birth that's easy to cope with and a stillborn. There is absolutely no relationship between 'natural' and 'beautiful' except in the ideology of the natural birth/midwifery movement. Couples who have used The PK and still had medical care have all believed they had a 'natural' birth because they were so aware rather than out of control or not knowing what to do.

Of course you're hung up because you've moved back into your head and we'll try to sort this out together. Birth happens in our body. Our perception of what is happening in our body is registering at every nano second in our mind. At every single moment we have a choice to make... tension/relaxation ... more tension/more relaxation .... more tension/more specific relaxation... no matter how painful. Very anti-intuitive!

The only thing that has ever caused any woman to be tense in labour is PAIN. We can call it: rectal spasm, back labour, hip pain, belly pain etc. If we didn't feel pain, we won't get tense. Relaxing in extreme pain requires an extreme, willful, determined mind that couples itself to the body and requires the body to do what the mind instructs. This is ultimately what the PK helps us to achieve. In your next birth (I know not yet), you will know how to do this.

And we can discover what you might have done in this birth so you settle down without shame, blame and guilt. That's what's important ... learning without hinderance. This is the gift women and men gave me and how we learned and developed these resources and the gift I try to return to other women.'

Still continuing with Pink Kit thoughts

4 March 2007

ANNETTE CONTINUED:

Naturally going into childbirth as a midwife is a
different experience. You have seen the spectrum, from
the lovely natural births where the baby flies out and
the satisfaction and exhilaration that comes with it
to the complicated, medicalized ones, that "go all
wrong." So you bring your own baggage with you, your
fears, but also your hopes of how it will be. I
definitely wanted to do everything possible to prepare
myself for the best possible outcome for a hospital
birth (although deep down inside I wanted a home
birth, just didn't trust myself or the process
enough). So that is where the PK came in...'

WINTERGREEN'S RESPONSE:

This is where women who work as midwives have that schizophrenic mind set. First they really don't know how women achieve one birth from those who achieve another type. Because they don't know why one woman's baby flies out and another doesn't, then they assume several things. 1) That women who have cruisey births do it intuitively and just 'know how to' birth while other women are more challenged are afraid and don't trust birth. This just isn't accurate. 2) Also women who work as midwives actually believe that a birth goes 'wrong' when more medical care is required. This is also inaccurate.

I'm not certain how to explain this. I can first say that everything I know about births comes directly from women and men having babies and never from the perspective of a birth professional. When we tell our stories, we don't just tell about 'outcomes' rather about our process. This means that women who have fast births can feel as overwhelmed and out of control as women who have longer births. They often think they've had a good birth because it's over quickly. Also many women who have lots of medical care are perfectly comfortable with the process but a midwife would consider the birth to not be natural. This means women who have medical care are being told they have failed. This is shocking. Up to now, families have just not had enough skills which they can use for both that quick birth and those longer ones that require (or chosen) more medical care. People still use their skills and come away from birth feeling totally empowered. They don't give in and give up because they have more medical assessment, monitoring and procedures. They just use those things because they feel it's safer and has nothing to do with how they breath or relax.

Over the years, what I've distilled from all these stories is rather simple. Very few women actually know how to birth but 100% 'get through' labour. If the labour pains are manageable and the labour doesn't last too long then after its over women feel very good. We always have to keep in mind that 100% of women will give birth if they are pregnant. Therefore, it's very easy to form a conceptual belief that if 100% of women will give birth then there is nothing we can do one way or the other and 'it will hurt but we'll get through it'. What we forget in our beliefs is the individual and how this overlaps the physiological reality.

Individually we can feel empowered just because birth is completed. What has always distinguished a first time mother from a woman who has given birth before is that the latter KNOWS she'll get through birth no matter what. The former can feel as though she will die from the pain or the pain will last forever. Some women who reassess their first birth will learn to relax better or use breath as a focus. The operative word in that sentence is 'some' because there are many other women who never feel in control of any birth. We just received an email from a UK woman who works as a 'radical midwife' and promotes natural birth and alternative lifestyle who used The Pk for her 6th birth after having 5 terrible ones.

Which brings us to why women who work as midwives promote a type of birth which they themselves haven't had? Women who work as midwives are not trained to know how-to birth. Natural birth is the acceptance of birth as it happens with all the good,bad, beautiful and ugly. There is no goal within traditional community that women feel 'empowered'. They just want the baby to come out and the woman recover. That's why they like skills. Modern midwives could stop tearing things apart and just make a statement like this: 'all expectant families should have midwifery care'. Then something like this: 'Expectant parents need to learn how to birth and birth coach'. Then 'we'll all work together to make certain there's no suffering and everything is safe'.

Over the past 30 years, the 'buzz' in birth has been Birth Plans, choice, empowerment, antimedical, home birth, midwives, intuition and trust .. along with water birth. Now we want the BUZZ to be childbirth skills for both mothers and fathers.

For too long, people have looked at photos of birth to determine what is 'beautiful' about birth. A home birth looks beautiful. A hospital birth looks unbeautiful. However, what we discovered is that it's our internal experience that makes our birth beautiful. When we have followed the internal process, worked with it and not gotten lost then we know we've had a beautiful birth. If we have a birth that just carries us along but we feel out of control, lost then we don't feel we've had a beautiful birth although we usually feel better about births that don't take too long to complete (unless it's too fast) even if we feel out of control.

What you and I can do is help you find your language for your 'internal' experience of birth. Whether you know it or not yet, you had a very personally 'internalized' and empowered experience and now you're figuring out what happened when you lost control of your internal experience. That's why you used an epidural ... to get back your control by decreasing the pain or intense sensations.

You're still learning (within your body and not your mind). This is a huge gift, what is the backbone of The PK and what I do with women and men. What a woman who works as a midwife does is to determine the birth from her mind and not from the body of the woman. Because midwives absolutely know that 100% of pregnant women will give birth, they place much more value on the outcome rather than the experience. Too many women who work as midwives have made ordinary women feel total disempowered because those who give birth within lots of medical care are considered to be less, a failure and incomplete relative to women who birthed at home and just got through birth. I've never actually met a woman who works as a midwife who actually thinks about how a woman perceives of her internal experience.

Given that you work as a midwife, may explain why your husband wasn't as involved with learning skills. I will bet that he believes that you would know how to birth because you're a midwife and that is what midwives learn to do. I'd also bet that he felt he could never know what you know so he didn't feel it was essential to learn anything. Rather he saw his job as supporting you because he could never achieve competency in a field where you are a professional. I'd also bet that he confused your feelings of 'safety' with your awareness that you didn't have a clue how to birth.

In fact, women most often use the word 'safety' as an indication that they don't have a clue how to get their baby out of their body and put the ability to do that on someone else. This can change and birth can be actualized within a modern maternity system as well as in one's home with The PInk Kit Package.'

Surprise, Annette is a midwife!

28 February 2007

'I realize that I never told you that I'm a midwife.
Hope that is OK. I suppose I didn't mention it as I
think people often make lots of assumptions about you
as a person (not to mean that you would have), or in
this case, your own feedback might have been
different, not as forthcoming or specific?! And I
wanted to hear what you had to say! You seem to me
more knowledgeable in the physiology of childbirth and
women's bodies than most midwives or obstetricians I
know. They don't teach you this stuff in midwifery
school, but it should be mandatory!! I'm sure you've
been told many times before that midwives even, myself
included, have much to learn from the PK. Still trying
to figure out how exactly to incorporate it into
clinical practice, as so much of it includes prior
knowledge, practice and preparation...but that is
another topic'.

MY RESPONSE:

'It won't have mattered if you had. I know I was talking to two people .. you and your occupation. There are a great deal of assumptions about midwifery care. In NZ where midwives are the lead maternity carers, there is a belief by pregnant women and their partners that midwives will teach them how to birth and be their primary birth coach. In traditional communities, teaching a woman to birth and being her coach is left exclusively to her family members. Usually the midwife will see a woman one or two times in pregnancy, perhaps do a massage and may have some suggestions about herbs or diet etc then arrive well into labour, do the delivery, clean up, do a massage and leave the woman to her family.

Where the idea came from that modern women who have been trained to be midwives should be teaching women to birth and be their coach directly comes from the exclusion of families from the modern maternity system. The UK will be different from the US where midwives and home births were prohibited until recently. My mother was typical of the 1st or 2nd generation of women to birth in modern hospitals. Like so many children of immigrants modern hospitals were seen of as clean and modern maternity care as safe. Women were more than willing to be left alone, knocked out during painful labour and delivered of their babies because they believed this stopped 'suffering' and was 'safer'. They might not have liked it but they accepted it in exchange for the benefits. That's still happening.

Certainly there eventually became a movement of women and men who questioned whether this was necessary about childbirth and since the 1970s hospital and doctor policies have changed favorably. At the same time the 'assessing, monitoring and procedures' have remained as a way to prevent suffering and problems .. good, bad, right or wrong. With our skills, we work with what we have.

My feedback is always the same to pregnant women whatever their occupation. My experience with women who work as midwives (particularly those who work independently) has been more than interesting.

I've never taken anatomy or physiology and everything I know about bodies comes from working with women and men like yourself and your husband. We explored and explored. Which you and I can do together. The gift women gave me is their ability to replay the birth in their body and not their mind. As a woman who works as a midwife this separation between body and mind is vast because your training focuses on the external (assessments, definitions and concepts) rather than the internal (what we experience in our body).

So as a woman who works as a midwife, had you been present at a birth (yours) you would have assessed ('you're not fully dilated so don't push') and then offered pain relief so there wasn't suffering. Then you would have had more medical care available when the baby reacted to the pain relief. You would have managed your own birth from the outside (as a midwife) as happened to you. Yet, somewhere you are inside your body and that's what we can discover so if you were in a rice paddy with no one but you or your village then you would have sorted it out.

Within a traditional culture where there is no system outside what people have available, everyone would have tried to sort out what was happening. What women and men gave me is discussing what was happening in their body. Certainly I was at heaps of births and we could discuss it right then. In fact, these births (whether in hospital, home or birth center) were full of body conversations. The care providers thought we were nuts and most felt women couldn't pay attention, but that's nonsense. That's what we're doing in labour... we're paying attention to what is happening inside our body and we're amazed. So if I had been at your birth, perhaps early labour would have been slightly self managed differently which may have prevented the spasms, but if the spasms occurred, we would have known right away and right away started to work with them and through them. Then it would have been your choice whether you could keep going or needed 'them' (medical care) to offer you something else.

In response to your belief that you should somehow incorporate the PK into your practice. The Pk should NOT be taught to midwives at all nor done on women who have not done the work themselves. This is where you and i could speak as two women. A woman who works as a midwife and been formally trained is like an auto mechanic (making assessments to catch if something is wrong and do somethings to handle problems) but not the driving instructor (because as a profession they believe women dont need to learn to birth). Women expect midwives to be the driving instructor (tell them how-to birth) and the map reader (what to do now) but they aren't. This is also unrealistic. The only person doing the driving is the woman and the best person to help her is a person with whom she is intimate and has skills. So CKT produced a driver's manual and a map readers manual. We just have to realize that midwives have not taken on the job of teaching women how-to or fathers how-to, accept that and now spend time growing a skilled birthing population. This hugely supports a midwifery profession who is the least technical of the auto mechanics in the maternity system. If we want a low tech mechanic then we have to be the best drivers.

Take yourself who self learned rather than taught by your midwife or had her do the pk on you. You are investigating your birth, your experience, what you did that hindered the process AND you are willing to reexperience your body's sensations (we'll get to that) to understand what happened and what you might have done instead of choosing medical pain relief. If a midwife had taught you, you would probably not have used the skills as much, would feel they failed and not grown more skilled for your next birth. If a midwife had come in and done hip lifts on you and been successful, you would believe that you could never birth your baby without a professional! If she had failed then you would believe you couldn't birth without medical care. Is that what we want for each other? Midwives wanted women to free themselves from the belief that doctors in the modern medical system were the saviors and that's right. We shouldn't change that belief over to midwives. We have to realize it's the next breath we take in and what we are doing inside our body .. tension or relaxation that gets us through labour.

We shouldn't give that empowerment to others. This is what thousands of families taught me. If we do that there is absolutely nothing left for us to do for ourselves. If we give these skills to women who work as midwives or doulas then we place too much expectation on them to solve birth issues 'alternatively' rather than through medical care. Childbirth skills do not fit into the 'alternative vs medical model.'

Let me give you an example. I spent this weekend doing a PK presentation for farming couples who are choosing to birth in a rural maternity unit, 1 1/2 hours from a high tech hospital. Mostly they 'get through' labour (because 100% of women will give birth one way or another). Like everywhere in NZ (under midwifery care) there is a 30+% c/s rate in the hospital. More local women are choosing to birth in hospital so they can have an epidural. NZ midwives set up 'choice' in their partnership assuming more women would 'choose' natural birth but they are choosing more pain relief and elective c/s. From the PK point of view this is caused by the midwifery model which focuses on natural birth (undefined) rather than just on any birth and what skills women and men need to bring to their birth. Most women believe 'natural birth' means home birth (which many women don't want for many reasons ... 'I want a rest from the other kids', 'my home's a mess', 'My mother birthed in hospital', 'my mother had problems' etc) and they aren't certain if there is a problem they'll get to hospital fast enough and they believe if they might go to hospital then why not start there. The natural birth movement and 'alternative' midwives did not bother to listen to the masses of women. I listened to everyone and we've been able to produce a resource suited to everyone.

Anyway, this past weekend, there was a woman who has recently become a midwife. She told me that she had attended two births where couples had taught themselves PK skills and they had great births. Then during her training she also worked with Suzie, one of the midwives who has collected the statistics. At that time Suzie hoped to just 'do' some of the PK techniques on pregnant women. They were at a birth with a woman who knew nothing about the PK and was having a slow, tense birth and had been pushing for a long time with little progress. This young woman (recent midwife) saw Suzie do the hip lift on this woman and then the baby's heart beat dropped severely and they did a rapid ventoose.

This frightened this young midwife and she told me she would never do the PK on anyone. She's right. If a woman is tense in labour and you suddenly create openness, she'll just go back and be tight again which can cause a change in the heart tones. The PK must be learned during pregnancy, worked with through labour. It is not an alternative to medical interventions and certainly not an alternative to women who don't know how to cope with labour.

The best way to integrate it into your practice is to tell your clients how important it is for them to do it and you expect them to bring a whole set of birthing and birth coaching skills to the birth. In order for this to happen, women who work as midwives must explain to pregnant families that the role of a midwife is not to teach the woman how to birth nor be her primary birth coach. Then explai what your role is: safeguard birth, support birth plans. This does not undermine the role of the midwife, instead it separates the roles more clearly. If these roles aren't separated then women are turning to you to solve their problems. Fathers tend to be excluded even though WE wanted our husbands with us. And believing women who work as midwives know how we can get through labour, we basically do very little for ourselves with the expectation the midwife will do it for us. No wonder women who work as midwives are exhausted. In the UK they think they aren't supported by the Government but really they aren't supported by the women and men'.

Sometimes I'm aware that people within a particular field tend to think only within that field. A pregnant woman will only really think about pregnancy and childbirth during a specific period of time and then life moves on. But women who work as midwives are always thinking about the issues surrounding childbirth.

For us at Common Knowledge Trust when we promote The Pink Kit Method For Birthing Better® we only think about one thing ... how to grow a skilled birthing population. Once we focused on gaining and using skills, so much just fell away.

Continuing Our Pink Kit Dialogue.

26 February 2007

So, here is our continuing dialogue about The Pink Kit skills from Annette in the UK. She's goig to mention Kate who is a UK Pink Kit Presenter.

'It would be neat to meet you and Kate. I live in Reading, which is not far from High Wycombe.

MY CONTINUED COMMENTS:

'How nice that you live so close. We'll definitely get together. that would be terrific.

There is absolutely no doubt that PK skills can change birth. The more skills we have as birthing women and our birth partner has as a birth coach, the more we'll cope with the naturally occurring pain of contractions. That's the first level of success .. just get women to cope and men to help them. Second level is preventing some common problems: back labours, long ones, delayed 2nd stage. Third level is along side many medical conditions yet make labour better. Example, heart problems/easier 2nd stage because of internal work. Example, induction/coping skills. Example, twins/internal work and open body. And many more.

Medicalization of birth does not have to mean a terrible birth and when medical care is important then a positive birth is still important and achievable. This is the first part of the schizophrenic persona of women who work as midwives who so strongly promote a concept of 'natural' birth that they shut out 99% of the population. Not only that but only a small % of women who work as midwives have had the birth they want for other women. In fact, I'd place a bet on the fact that women who work as midwives have about the same amount of medical care as do women who don't work as midwives. I'll try to help you understand how the PK fits into modern maternity care and why women who work as midwives should not become the PK teacher or practitioner. Go back to the bottom line and see where this all developed. There was absolutely no element of these skills that had one bit of relationship to our birth professionals.

This means The PK can be used by anyone regardless of their birth. Most birth professionals have no clue women and men are learning a set of skills. Sadly for pregnant women the trend to separate medical birth and natural birth have implied that only people who resist medical maternity care will have a beautiful birth. And somehow if 'medical care' is required, women still feel they have failed not to have a 'natural birth'.

Actually no one has ever defined 'natural' birth. Everything about birth is natural and normal ... death, injury, long labours, tense women, rectal spasms, back labour, quick/intense ones, good breathing, torn or whole vaginas. Absolutely everything about birth is normal and natural. Yes, medical care adds a dimension to birth but to imply medical care is for abnormal or non-natural births is incorrect. Once we realize that medical care is used in birth to keep birth as 'safe' as possible then people can make choices based on their personal perception of safety. Whether medical care is good,bad, right or wrong has never been any aspect of The PK. What I'm articulating is what thousands have said to me. Most people perceive of medical care as a 'safety' issue rather than a 'medical vs natural' issue. This freed us. If we chose or had (whether we wanted it or not) medical care during pregnancy and birth, we still had our skills!

After listening to the concepts behind the natural birth movement, there are many confusions based on inaccurate assumptions about childbirth prior to medical care.These inaccurate assumptions have torn women apart. They put women in two camps ... those who want to be 'natural' and those who have modern medical care. The first inaccurate assumption is that birth is essentially safe. Traditional people absolutely believe birth to be highly risky. For example, a woman who is exhausted after birth is perceived of as 'at risk'. Birth is essentially and potentially very risky relative to just living. For example if you live a 24 hour day in your life what is the potential for you to have a problem, illness, injury or death? In fact, you're more likely to have any of those than be in labour and more likely to die at any other time in your life than when giving birth or being born. However, when a woman is in labour, she is in a very dynamic situation and so is her baby which means there are more probabilities of something potentially happening that causes injury or death or even illness in that 24-72 hr period. Women who live in traditional communities know this and that's why in traditional communities women are so very protected during pregnancy, labour and afterwards.

A second inaccurate assumption is that traditional living women do nothing to learn to birth. Actually all traditional cultures have very sophisticated health and wellness systems which are particularly used during this transition period of a woman's life because cultures are aware of the potential risks. During pregnancy there are many taboos and prohibitions and must do to safeguard both the mother and baby. For example if you had given birth in any traditional culture and had rectal spasms, the women and men who were attending you would be doing their best (with interventions) to get you past that experience. They may have had herbs or massage but they won't have had an epidural. You would have gotten through it OR your baby would have gotten stuck and eventually you and your baby would have died. Remember 100% of women give birth one way or another. If a baby doesn't come out then they both die. You just had a modern way to get you past that period. The 'natural birth movement' implies we should do things outside medical care (unless there is a medical reason... what does that mean?) but everything about birth is natural so we're just choosing to do something things naturally because we have the system available to make things 'safer'. The medical system is the savior whether we like it or not. If we don't use it then we accept whatever happens because it is natural. Does that make sense?

Certainly there are women who birthed in rice paddies just as there are modern women who birth in taxi cabs but that happens not because it's the norm or is planned. The biggest difference is that the woman in the rice paddy has no one but herself to help if there is a problem Or others in her community whereas the woman in the taxi has the abililty to call 'them' ... the outside system called modern medicine.j

In fact another inaccurate assumption about traditional and natural birth is the belief that women can only birth when they feel safe. Women birth where ever they go into labour, whether in war, drought, floods, violence or not. Safety has absolutely nothing to do with giving birth. It's lovely to believe women should have a safe environment however, that isn't true for millions worldwide even if that means they have no access to clean water or reasonably healthy diet. But women can always have skills no matter what.

Another confusion set up by the natural birth movement is an assumption that medical care is always blocking women's ability to birth. Most modern women want modern medicine. That's one of the attributes of modern living, along with education, indoor plumbing, electricity that separates modern living women from traditional living women. There are very few women who will refuse modern medicine. I worked a great deal with certain religious groups who would not take blood products but certainly would use a great deal of modern health care except that. The natural birth movement, by not defining 'natural' has pulled women into two camps. The smaller camp, led by the Midwifery movement advocates a reduction of medical care and assesments, home births and intuitive response to birth pain. Curiously the women who work as midwives in this group still believe they need 3 years of training to attend 'natural' birth. How weird is that. If something is so natural that we should just assume the rice paddy is a fine place, then why do we need medically trained women. The laugh is that direct entry midwives believe they are not 'medically' trained. How crazy is this? However,the predominate group of pregnant women want to be cared for within the medical system yet still feel in control of birth pain. That's The PK'.

Visit www.birthingbetter.com

Following through with Pink Kit Births

24 February 2007

Hi Wintergreen,

I've just reread your email - it contains so much
useful information and accurate insight that it blows
me away! Wow! I've just relived my birth a few times
over just reading your feedback...I'm still trying to
figure out what I would have done to have birthed my
baby without any intervention and how to have coped
with the intense rectal spasm/pain that made me refuse
to push...you're so right, the birth goes through your
mind many times and probably for will a long time yet.
More on that in a moment.

Thanks for saying you liked the insights I shared with you, particularly with what you then revealed about your being a midwife. All my insights come from the thousands and thousands of birth stories. We always asked the same question (what would we do if there was no medical care?). That's not to say that most of us want to live in traditional communities where there is no medical care, however, we have to look at birth in a 'relative' manner. If we are the very few unfortunate few women and baby who would have died without medical care than we pretty much know that. And even with medical care some unfortunately did.

Most of us realize that we and our baby probably would have lived without the medical care but that type of care came into play because of some concern at the time. We learned two primary things; 1) Medical birth professionals were trying to make birth safe for us and our children. 2) We also recognized that sometimes the medical care we received caused problems that then had to be dealt with by further medical care.

We first committed to have no shame, blame or guilt so that we could explore, explore and explore ways to birth more effectively. We developed a bottom line (which I'd like you very much to hear) ...

1) We wanted medical care available when something really went wrong.
2) In order for us to have access to emergency medical care, we had to accept birthing in an environment with the assessments, monitoring and procedures used to determine whether emergency care was neccessary.
3) We knew there would be A,M and P so we wanted to work with it rather than feeling passive or constantly fighting the care. We didn't want to feel we were sitting in a dentist's chair.
4) Aside from all the medical care, we wanted to handle the next contraction, the pain and not freak out (because of increased pain) when we had to lie on our back to have someone listen to our baby's heart tone.

(That's a long bottom line). Shorter. We wanted the modern maternity care and still wanted to have a good experience. These were separate things and could be achieved. Also the Medical system did change very positively.

Your comments about why you chose a hospital birth although you obviously have a strong belief about childbirth are typical for most women and definitely most fathers I've ever spoken with. What about 'alternative, home birth women and midwives?' They are few and far between but have a very loud voice. There has also been a huge push toward some undefined word called 'natural birth' (loading the term with broad assumptions that 'natural' means 'easy' or with good outcome or even with women having the highlight experience of their life). Rather we need to stick to the reality of ALL birth. For example, a quick birth without any A,M.P can totally blow a woman away with the intensity. It might be natural but she felt totally out of control. There are so many other examples where the term doesn't fit the perceived experience.

Shouldn't all mothers and fathers-to-be deserve and be entitled to a positive birth? Of course, so we have to stop trying to rip us apart by ideology and go for positive birth in all birth situations. The best way. That's why The PK can become the new buzz in childbirth and what I have tried to uphold for 35 years of our collective stories. We were tired of the shame, blame and guilt years ago. We knew there was an image of birth that was being promoted. With PK skills we achieved the personal 'beautiful' experience because of what we did for ourselves rather than have the 'external' beautiful birth that seemed to be held up as the ideal.

Most of us realized that an incredible amount of medical care was being used in childbirth relative to any other time in our lives (we always looked 'relative to'). For example, every sore throat did not immediately mean we had our tonsils out right then and there. Every belly ache didn't require an emergency run to hospital to get our appendix out. Every heart problem didn't mean open heart surgery nor were we likely to have a heart attack in hospital, nor were people with heart problems constantly monitored. In fact, many of us lived with very serious medical conditions every day, all the time, for years with relatively infrequent actions taken to the extent we experienced during pregnancy and in childbirth.

Yet, at the first blip during pregnancy and childbirth everything was treated as though death and injury were about to arrive instantaneously. Please keep in mind, what is known as The Pink Kit started in the US in the early 1970s,100% obstetrical care, no midwives, no home births, shaved, enemas, flat on back, 100% episiotomy, strapped down, left alone in labour and on and on. However, when my daughter was born in 1970 things were vastly changing. I experienced some of those changes and not others .... relative to ... when I gave birth to my son in 1982 when I birthed him myself in hospital even though he was 8 weeks premature.

The evolution of the PK was and is entirely about what we can do in whatever birth situation we found ourselves and with all the issues that we were presented with. The skills developed after a 10 year period when couples attended LaMaze classes to learn breathing and relaxation skills so we could still do something for ourselves within this medical system. Women wanted their husbands to come along with us in labour compared to our mother's generation where husbands hung out in the waiting rooms and pubs. During this short period of time, there was a very high socially accepted expectation that couples go into their birth working well together .. each with their own job. The Pink Kit did not at all come from 'alternative people' or an anti-medical viewpoint. It developed from very conservative families.

This all changed in the 1980s with the beginning of the Natural Birth Movement and Midwifery Movement in the US. As people promoted the natural birth movement they also devalued birth skills as being artificial and not essential to this naturally occurring physiological process. This was a huge mistake. Consider what birth would be like today if people said: 'let's have less medical care because we have such good skills that we don't choose pain relief as much and we get our babies out of our bodies relatively easily.'

Instead this was the message: 'The less you know the better, just trust birth, allow your instincts to take shape and whatever you do say no to medical care'. First of all, thank you for the opportunity of getting further involved with the PK. Perhaps at some point that would be very interesting. I do find the PK so revolutionary in that I think the body awareness and
knowledge it imparts would change much of childbirth (and its medicalization) as we know it!

VISIT www.birthingbetter.com