Category Archives: 1. Pregnancy & Birth

Fertility and conception, pregnancy, childbirth, and the early postpartum period.

Dawn of Attachment: Why Mom’s Emotions Matter During Pregnancy

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Relax during pregnancyDuring my second pregnancy, I was a ball of nerves. While my baby was born healthily, she was of a lower birth weight than what was expected – only six pounds for a term baby. My doctor had warned me that not finding a way to lessen my anxiety during the pregnancy could cause problems, and one of those was a low birth weight.

That the mother’s emotions can affect the unborn baby’s development is certainly credible, but exactly how does this happen?

We know from neuroscience and psychology that the brain develops according to our experiences, so nurturing forms a child’s brain differently than harsh or ignorant parenting approaches. Because this development and programming of the brain is most extensive when the child is young and his brain is growing the fastest of all his life, it stands to reason that the same is taking place within the unborn baby’s brain as a fetus. The fetal brain is growing at an astounding rate – in only nine months, an unborn baby’s brain goes from nothing to 100 billion brain cells. We have to realize that it’s more than gray matter growing – it’s also the beginning of connections and pathways between the different parts of the brain, which will go on to develop of this new person’s personality, sense of self esteem, and ability to manage emotion and stress through her lifetime.

An article on 4Therapy.com, “Pre-Birth Bonding,” explains the in-utero experience to be the dawn of the attachment process, emphasizing that the emotional attachment between a mother and her child starts long before the day that the baby makes his appearance in the outside world. By the fifth month of pregnancy, the baby recognizes the mother’s voice and shows a preference for different genres of music, marked by a difference of movement type and frequency observed via electronic fetal monitors and ultrasound. The study “Fetal Brain Behavior and Cognitive Development,” published in Developmental Review in 2000, describes that while fetal responses to stimuli are a reflex of the brain stem, this primitive brain structure is capable of learning.

The unborn baby is further affected by an emotional attachment with her mother through what is called the neurohormonal dialogue – for example, when the pregnant woman becomes anxious, her stress hormones course not only through all of her body but that of the unborn baby, too. This is why severe and chronic stress in the woman is related to prematurity, low birth weights, and hyperaroused, colicky babies.

Healthy pregnancies are more than creating a physically healthy environment for your baby, taking such precautions as eating a balanced diet and quitting smoking. It’s also understanding your emotional connection and then creating a healthy psychological environment – relaxed, able to cope with stress, and quick recovery from strong emotions such as anger and sadness. This can be difficult to do, considering the hormones rushing through your body and especially anxiety if this is your first or an unexpected baby.

Ideas for Finding Balance While Pregnant

Staying emotionally balanced when you’re expecting is similar to handling stress at other times in your life. Attachment Parenting International Co-founders Barbara Nicholson and Lysa Parker give a variety of strategies for parents to seek balance in their lives in their book, Attached at the Heart. Some of these include:

  • Work on a hobby or do an activity that you enjoy.
  • Visit with friends or join an API Support Group to seek input on concerns and make like-minded friends.
  • Make sure you’re getting plenty of sleep, eating nutritiously, drinking plenty of water, and doing exercise that your health care provider approves of.
  • Focus on your marriage or partnership.
  • Follow your doctor or midwife’s recommendations in taking care of yourself during these nine months, and prepare yourself mentally for upcoming medical procedures, labor and childbirth, the newborn transition, and parenting.
  • Consider taking of meditation, yoga, or getting a massage specifically for pregnant women.

How did you stay relaxed during your pregnancy?

Name Your Baby the AP Way

By Rita Brhel, managing editor and attachment parenting resource leader (API)

A mix-match of namesPerhaps no activity can consume as much of an expectant couple’s time and energy as choosing a name for their baby. While other aspects of pregnancy and preparing for childbirth and parenting may interest one parent more than the other, both mom and dad are equally invested in the deliberations for just the right name.

And they should be. A name carries so much meaning. It is a person’s identity, the very first introduction any person has to the world. That a name is likely to stay attached to a person throughout his life makes choosing the name to be a huge responsibility. It makes me think of a song my dad listens to, a 1974 song by Johnny Cash, “A Boy Named Sue,” about a father who named his son, Sue, and the resentment the boy felt toward his father because of that.

An Exercise in Sensitivity

Naming a baby can have a lot to do with setting the foundation for attachment between you and your child, in that it may be the first major decision you have to make in that baby’s life. Choosing a name is great practice for making other big decisions in the child’s future that may not be as fun – although baby naming is not without strife. Some parents can get themselves into power struggles over preferred names. Continue reading

The ‘Perfect’ Birth

By Lisa Lord

Lisa Lord and family
Lisa Lord and family

After learning about modern medical birth in a college course, I knew for sure that I would one day attend a birth center for a drug-free, midwife-attended natural birth. Over the years, I held numerous other certainties about my future, only to find repeatedly that the universe had different plans for me. My future perfect birth was no exception.

No Birth Centers in Ireland

For starters, my husband and I live in Ireland, and when I became pregnant and began planning for the birth, I found that there are no birth centers here. Although I wholeheartedly support homebirth, I did not feel ready for it myself, not for my first birth, so far away from home and everything familiar. I settled on a local maternity hospital, certain that I would have to fight “the system” for the birth I desired.

Though I started with a big chip on my shoulder, my opinion slowly began to change over time. My doctor was patient, providing thoughtful rationale when we disagreed and willing to honor my wishes when they were not strictly against policy. I think she recognized my need to feel in control of the unknown. On top of that, the hospital was simply more encouraging of natural birth and breastfeeding than I anticipated.

I soon decided to stop creating problems where they might not exist and focus instead on enjoying the rest of my pregnancy, taking a natural birthing workshop with my husband, listening to Hypnobirthing CDs, reading inspirational birth stories, and visualizing my own peaceful birth experience.

Induction at 17 Days Overdue

I had not factored induced labor into my plan, but I was resigned to the idea by the time I was 17 days overdue and showing no signs of impending delivery. A few hours into the induction process, I was happily wandering the hospital corridors, chatting to my husband and having very mild sensations, which I naively believed to be genuine contractions. When my doctor saw the smile on my face, she immediately administered more medication. Within 30 minutes, I could not talk through contractions; 30 minutes after that, I was nearly out of my mind with excruciating pain.

Nothing could have prepared me for the intensity of induced labor. Everything I had learned about breathing, visualizing, and relaxing was useless as my entire body stiffened like iron with contractions coming less than a minute apart. The longest hours of my life slowly ticked by as I collapsed and sobbed on my husband’s chest between surges, desperate for labor to end.

My doctor broke my water late in the day, which seemed to stimulate my body’s natural labor process. The sensations started changing, becoming more like waves than spasms, and my panic began to dissipate.

An Epidural

When I arrived in the delivery room, I felt slightly more in control but so absolutely exhausted that I asked for an epidural.

It felt like heaven when the epidural took effect. Though my body shook uncontrollably with fatigue, I felt relaxed. Despite the medication, I could sense the urge to push once I reached full dilation. I had once thought a roomful of people shouting at me to push might be intrusive and distracting. In reality, the forced encouragement helped tremendously. After an hour, just as I was reaching my limit, the nurse smiled and told me to reach down and feel the baby’s head. This inspired the final surge of strength I needed to push him free.

A Day to Celebrate, Not to Grieve

My first few moments with Colin must have been like those of so many women throughout time — the surreal feeling of meeting a new and yet very familiar being, a sense of “Oh, it’s you!” As we quietly gazed at each other, none of the events leading up to the birth entered my consciousness; my full awareness was on the tiny miracle I joyfully held in my arms.

Although Colin’s birth was replete with medical interventions and very far from my original vision, I do not feel angry or bitter. Maybe labor would have been tolerable if hospital policy allowed a doula to be present or maybe I could have avoided induced labor if I had taken the route of homebirth with a midwife. Perhaps the upcoming delivery of my second son will be the natural birth I have hoped for.

We deserve something better than our modern medical birth paradigm, and we should continue to work for changes that honor women and babies and reflect trust in the birthing process. However, rather than focusing on what I wish had happened and what went wrong with my own experience, I am grateful for everything that went right on that extraordinary day.

Share your birth story on the API Forum, or send to e-mail to include it on TheAttachedFamily.com.

AP is Good for Mom, Too

By Rita Brhel, managing editor and attachment parenting resource leader (API)

AP is Good for Your Emotional Regulation, TooExperts and parents agree – telling and retelling of a birth story is vital for a woman to overcome an emotionally traumatic birth. But there is certainly something to be said for the power of parenting in an attachment-promoting way in healing a mother’s feelings of disappointment, guilt, anger, and other strong and often confusing emotions that may surround her child’s entry into the world.

Women who are struggling with their emotions are not only grieving their lost dreams of what they had hoped for their labor and birth experience, but may also be battling with feelings of guilt and inadequacy as a mother. While we must take time to fully grieve our birth experiences, we must also find a way to move forward. It can be very fulfilling, and healing, to channel the strong emotions surrounding our child’s birth into caring for her in a loving, positive, attachment-promoting way. Just as a hobby or a phone call to a friend can give a release for our strong emotions in a healthy way, so can we heal through our parenting.

It must be noted, though, that by healing through our parenting, I do not mean that we transfer our strong emotions to our baby or that we attach onto our child in any other way than an appropriate parent-child relationship. What I’m referring to is using parenting as a healthy outlet for women to move forward. Harville Hendrix, PhD, and Helen LaKelly Hunt, PhD, explain this in their book, Giving the Love that Heals.

“In a conscious marriage, partners grow when they stretch to meet the needs of the other, and they heal when their needs are met by their partner,” they write. “The process is mutual. In marriage, it is appropriate for a partner to grow by meeting the needs of the other partner, but it is not appropriate for a parent to try to heal by having the child meet his needs. The process for parents and children is not mutual. The parent must heal his childhood wounds in an adult relationship and not in his relationship with his child.”

However, while healing through the parent-child relationship is not synonymous with the adult-adult relationship, Hendrix and LaKelly Hunt acknowledge that parenting can be a pathway to personal healing.

“The sense in which marriage can be healing is that partners restore their own wholeness when they stretch to meet each other’s needs, giving to the other what is often hardest to give,” they continue. “The sense in which parenting can be healing is that parents restore their own wholeness when they stretch to meet the needs of their children at precisely those stages at which their own development has been incomplete. Through marriage and parenting, partners and parents can recover parts of themselves that have been lost. Both marriage and parenting give people the chance to receive for themselves what they give to their partner or child. They get what they give. In this way, both marriage and parenting can be transformational, because the healing experiences these relationships can provide will change the very character of the people involved.”

Healing from birth trauma is, of course, not the same as healing from childhood wounds, but this excerpt is illustrative of the difference between a parent inappropriately leaning on her baby to provide emotional comfort and a parent appropriately using parenting her baby in an attachment-promoting way as an opportunity to heal through giving to another.

Virtually all Attachment Parenting (AP) practices can help a mother heal from her birth trauma by promoting a close, positive relationship between her and the baby, but there are a few that research has shown to be especially beneficial to the new mother – perhaps not in magically healing emotional trauma but in providing an atmosphere supportive of a mother’s own efforts in healing.

Breastfeeding

Breastfeeding is particularly powerful in jump-starting the mother-baby attachment bond. Attachment Parenting International (API) Co-founders Barbara Nicholson and Lysa Parker describe breastfeeding as the ideal model of attachment in their book, Attached at the Heart, for sale here. There are myriad benefits for the baby and mother, in regards to health and attachment, but what about helping mothers’ emotional well being?

Read API’s review of Attached at the Heart here.

“Breastfeeding triggers the release of the attachment-promoting hormone oxytocin into the mother’s body,” Nicholson and Parker explain. “Often called ‘the mothering hormone,’ oxytocin has a calming effect on both mother and baby. “

Futhermore, “research in depression is showing a correlation between lower levels of certain hormones in mothers who experience depression, so it appears that anything we can do to increase levels of these natural hormones may be a powerful aid in prevention,” Nicholson and Parker write.

Health psychologist and API Resource Advisory Council and API Editorial Review Board member Kathleen Kendall-Tackett echoed this research in her 2007 International Breastfeeding Journal article, “A New Paradigm for Depression in New Mothers: The Central Role of Inflammation and How Breastfeeding and Anti-inflammatory Treatments”: “…although women experience many stressors in the postpartum period, breastfeeding protects them by inducing calm, lessening maternal reactivity to stressors, and increasing nurturing behavior. …breastfeeding can protect mothers’ mental health and is worth preserving whenever possible.”

Responding with Sensitivity & Providing Consistent, Loving Care

Lack of sensitivity toward the baby is a hallmark effect of a mother who is dealing with emotional issues, but a mother who focuses on responding appropriately and quickly to her baby’s cries can improve her mood by reducing how much her baby cries. Nicholson and Parker explain that parents need to respond to their baby’s pre-cry cues; by waiting until the baby is crying, he will be much more difficult to console. Babies are not born with the ability to regulate their strong emotions – they rely on their caregivers to do this for them by responding quickly, appropriately, and consistently.

We don’t need a research study to show us how stressful it can be to listen to our child’s unrelieved cries, but I did want to share one study’s conclusion included in Attached at the Heart. According to a 1995 Pediatrics article, “Developmental Outcome as a Function of the Goodness of Fit Between the Infant’s Cry Characteristics and the Mother’s Perceptions of Her Infant’s Cry,” mothers who responded consistently and appropriately had higher self esteem than did mothers who were inconsistent in the responses to their baby’s cries.

In addition, “mothers who feel low, depressed, anxious, exhausted or angry, who have relationship problems with their partner, or who feel strongly rejected by their baby’s crying are more likely to have a baby who cries excessively,” according to Dr. Gillian Rice in his Netdoctor.co.uk article, “Why Do Babies Cry?” “This isn’t to say that the mother’s feelings caused her baby to become a frequent crier, but they may be a factor in perpetuating the baby’s crying.”

Nurturing Touch

Especially for mothers who are unable to breastfeed, nurturing touch stimulates the mother’s body to also release oxytocin.

“The good  news for a mother or caregiver who is not breastfeeding is that she can still receive oxytocin benefits from holding the baby skin-to-skin, and also by giving and receiving nurturing touch through massage and gentle caress,” explain Nicholson and Parker.

Louis Cozolino suggests through his book, The Healthy Aging Brain, that new mothers add nurturing touch as part of their regular infant care techniques, not just for the baby’s benefit but for their own mental health.

“Studies have found that teaching depressed mothers to massage their infants increased the amount of touching and bonding time between them, and decreased levels of stress hormones in both infants and mothers,” he writes. “The infants showed increased alertness, emotionality, and sociability, and they were easier to soothe. Touching their children not only activated smiles and positive expressions on the part of the infants, but also made the mothers feel happier and more effective.”

Cosleeping

I am amazed of how healing it can be at all stages of parenting to sleep in proximity of my children. For the new mother, cosleeping reduces stress and improves sleep by having the reassurance that the baby is nearby and safe as well as the convenience of caring for the baby in the same room rather than in another part of the house.

A study detailed in Sharon Heller’s book, The Vital Touch, describes how “mothers slept slightly better and slightly longer when their babies stayed with them.” Heller goes on to explain how a mother’s instinct is to protect her baby and separation and crying is contrary to this instinct – arousing a mother’s natural impulse to correct the situation.

“From a purely practical standpoint, parents report that they get more sleep with fewer interruptions when the cosleep,” write Nicholson and Parker. “They don’t need to get up to attend to baby’s needs, which keeps parents from having to wake up fully during feedings.”

Cosleeping enhances early mother-baby bonding, because nighttime parenting allows the mother to continue responding with sensitivity around the clock through breastfeeding, nurturing touch, and consistent and loving care.

“Babies feel warm, secure, and protected; therefore, they fret and cry less,” they continue. “Mothers worry less about their infants at night when they can reach out and touch the baby.”

Balance

Striving for balance between our personal and family lives is a must when seeking ways to decrease stress on new mothers and improve mood. Though it may not seem so, AP practices are in many ways just as helpful to maintaining balance in the mother’s life as they are in being compassionate and nurturing to the baby. AP practices aren’t solely for the child’s comfort – mothers receive hormonal benefits through breastfeeding and nurturing touch, more sleep through cosleeping, and reduced stress from crying through responding with sensitivity and providing consistent, loving care.

Still, especially for the first-time mother or for mothers who are going through a difficult postpartum recovery, balance can be an elusive goal. The key is to rely on others for their help in taking care of you. Postpartum Support International names social support as one of the most effective factors in prevention and treatment of postpartum depression. This social support may come in the form of your spouse, mother, friend, local API leader and API Support Group, or even through the virtual connection through the API Forums.

Nicholson and Parker describe the crucial importance of balance in a new mother’s life in Attached at the Heart, warning that “without support and other resources, we are taking a big risk for our children and ourselves. Margot Sunderland addresses the critical issue of stress and balance from a brain chemistry perspective in her power book, The Science of Parenting. She describes the positive effects of the hormone oxytocin and its role in helping calm all human beings. We are designed to help provide emotional regulation for children and each other. When a parent is alone most of the time without other caring adults to talk to, stress hormones rise, feelings get out of balance, and irritability and anger lash out.”

Sunderland’s advice: Mothers need to seek out nurturing touch from their partners, which triggers the release of oxytocin, which then gives a warm, calm feeling. And a sense of balance.

If you’re partner isn’t available or if you’re a single parent, talking to empathic friends can provide a much-needed outlet for stress. Other activities that can give you that oxytocin release include: meditation, acupuncture, massage, physical affection, yoga, warm bath, spending time in the sun or bright artificial lighting.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

What to Do When a Cesarean Becomes Necessary

By Michelle Smilowitz, CD-DONA, reprinted with permission from International Cesarean Awareness Network, © ICAN-online.org

Baby born by CesareanThe birth of a child is one of the most significant events in the lives of families. It is considered a rite of passage by many women and involves the first interaction between parents and their baby. There is much buzz today about the necessity of making birth a “family-centered” experience, where the focus is often on creating a special environment for bonding between parents and child in the first moments and days of life. But what if you are one of the  women who experiences your baby’s birth as a Cesarean section? Is it possible to make your surgical experience into a family-centered birth?

The answer is a resounding yes. While planning a family-centered Cesarean is easiest for the woman who must, for whatever reason, schedule her baby’s birth, there are a number of ways that a woman who encounters an unplanned or even emergent Cesarean surgery can make her experience into a celebration of her baby’s birth.

Become Familiar with the Procedure

It is first important that every pregnant woman and her partner become aware of the procedures that surround a Cesarean surgery. Many women who experience unplanned Cesarean deliveries lament that, “I skipped the section of the book on Cesareans; I assumed it couldn’t happen to me!” Having some familiarity with the procedure and all that it involves can help reduce much of the surprise and fear that can surround the unknown.

For More Information on Cesarean as a Procedure

If your Cesarean is planned, it is important that you have the opportunity to fully discuss with your care provider the reasons for your surgery. Knowing that this surgery is the best choice for your or your baby can create a less tense environment for the delivery. If you desire a vaginal birth and feel that a Cesarean surgery may be unwarranted for you, consider getting a second medical opinion that all medical consumers are entitled to.

Write a Birth Plan

Next, plan this birth just as you would a vaginal birth. Write up a birth plan including your preferences for the surgery as well as for yours and the baby’s postpartum care. In the case of a pre-planned Cesarean, it is usually possible to schedule an appointment ahead of time with your anesthesiologist. He is the person who actually controls the environment of the operating room. For example, generally, women’s arms are strapped down for their surgeries, so that they do not dislodge IV wires or sully the sterile surgical field. Ask if you can have at least one of your arms free or have your support people hold your arms in place.

Discuss the pros and cons of both epidural and spinal anesthesia as well as the effects of various other medications you may receive both during and after the surgery. Some of the medications that treat specific symptoms such as trembling and nausea may cause extreme drowsiness or amnesia. You may decide that you would rather tolerate these symptoms than be asleep for the first few hours of your baby’s life.

When you write your birth plan and discuss it with your care providers, there are a number of things you may want to consider. Many women negotiate to have two support people with them in the operating room, generally their partner and a doula or friend and family member. Doulas are a great addition to a Cesarean birth team. They are familiar with the process and can reassure you and your partner. Additionally, if you and your baby need to be separated at any point, your partner can accompany the baby while your doula stays with you. Doulas also often have some expertise in post-Cesarean breastfeeding and can help with this.

Many women ask for and are given the right to play music of their choosing for the birth – this can soothe you and serve as a pleasant way to welcome your baby into the world. Feel free to ask those at your birth to refrain from extraneous conversation, and request that if possible someone (generally a member of the medical team) narrate for you exactly what is going on throughout the birth. Ask if you can take photographs or videotape the birth – many women enjoy the opportunity to “see” the birth later on. Sometimes, black-and-white pictures are preferable for this – they preserve the drama of the birth while eliminating a direct view of blood, troublesome to some.

Many women feel a disconnection from their Cesarean baby because they did not actually see or feel the baby born. If you are interested in actually seeing your baby as he emerges from your body, you can ask to view this by having the drape across your abdomen that blocks your view lifted for the actual delivery or by using a mirror.

Before the Cesarean, ask that the medical personnel not announce the sex of your baby — instead allowing you or your partner to discover this. Request that all necessary newborn exams be done in your line of vision or even on your chest, and to make physical or verbal contact with your baby as soon as possible. Your baby has been accustomed to hearing yours and your partner’s voice for the past nine months – even if you cannot touch your baby, you or your partner can soothe your baby with your voice. With the help of an excellent nurse or doula, some women are able to nurse on the operating table, while others wait until the recovery room. Regardless, ask to touch your baby as soon as possible, and to keep the baby with you in recovery if all is well.

Get Help After the Cesarean

During the immediate postpartum period, you are going to need a lot of help! After a Cesarean surgery, women are often confined to bed for as much as a day or two. Once you have been given permission to get up, even such simple movements as rolling over in bed can be quite painful. Clearly, trying to take care of yourself as well as a new baby is generally too much. Having a partner, friend, or relative stay with you in the hospital can help ensure that your baby will room in with you. This person can help with changing diapers, bringing the baby to you to nurse and positioning the baby at the breast, as well as assisting you with your needs.

Once you are home, extra help will enable you to have a more rapid recovery, as well as give you the opportunity to nurture yourself and bond with your new baby. Many women find that they need extra help with breastfeeding after a Cesarean, and there are a number of resources for this.

Not all of these suggestions will work for every situation, and of course, in the case of the emergencies that can occur during surgery, plans may need to be changed or abandoned. Nonetheless, using some or all of these suggestions can help your surgery feel more like your baby’s birth!

Originally published in the Birth Journeys newsletter of ICAN of Seattle, Summer 2004.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

What Goes into a Family-Centered Cesarean Birth Plan

By Connie Banack, CCCE, CPD, CLD, reprinted with permission from International Cesarean Awareness Network, © ICAN-online.org

C-section birth plan basicsFamily-centered birth is used to describe a birth that is more family oriented, allowing the new family to experience their birth more fully. Many believe that this cannot apply to a surgical procedure. This is not true. Even with a Cesarean surgery, you can have a family-centered birth if you know your options and choose to apply them. Some of the options will be the same as for a vaginal birth. You may have to work harder to have a family-centered birth in the event of surgery, but planning ahead — even if you don’t foresee a Cesarean — can go a long way. Make a birth plan! They won’t know what is important to you unless you let them know, and a birth plan is actually a legal contract as it is providing your wishes in a document provided to your birth team.

Very few women would choose a Cesarean for their birth experience. However, it is important that every pregnant woman is aware of the procedures that surround a Cesarean section. This will give those who do birth by this process more choices and hopefully less fear.

A Word about Doulas

The continuous support of a doula has been found in numerous scientific trials to positively affect obstetric outcomes and the women’s satisfaction with their birth experiences. Many women and couples choose to have a doula because they want and need this extra assistance. During labor, an intense bond develops between the doula and the couple, and if a Cesarean becomes necessary, it is very distressing for the woman to have to choose only one person to be with her. Mothers will hire doulas even during a scheduled Cesarean birth to provide the consistent professional support a doula provides.

A 2001 article by Penny Simkin, “Doulas at Cesarean Birth,” details the benefits of a doula during a Cesarean, which include:

  • Doulas are familiar with Cesareans and do not find them upsetting.
  • The doula’s familiar presence can calm and reassure the mother who is likely to be very frightened and worried.
  • The doula can reassure the partner, who is also likely to be worried and frightened.
  • The doula can explain what is happening.
  • Once the baby is born, the partner usually goes to see the baby, leaving the mother’s side. The doula remains with the mother, tells her what the baby is doing, and helps the mother feel less alone.
  • The doula goes to recovery with the mother. If the partner has gone to the nursery with the baby, the mother still has a support person with her.
  • The doula does not get in the way or behave inappropriately.

Check with your doctor to see if your doula is allowed into the operating room and recovery to support you.

Birth Plan Preparation

In preparing a birth plan, each point needs to be discussed with your caregiver, even if he may not be at your birth. He will be able to tell you if what you would like is an option with him or at the hospital you have chosen. Start early and discuss a few points each prenatal visit rather than trying to cover every point in one or two visits. This will help you in providing more time for questions about each point and reduce confusion for both you and your caregiver.

Communication is vital in learning about philosophy, options, and rapport. A good way to communicate with your caregiver in putting together a birth plan that will be read and followed is through the “Who’s the Boss?” Method:

  1. Acknowledge provider’s expertise
  2. Add personal information
  3. Listen and consider
  4. Summarize
  5. Respond in appreciative and authoritative mode.

Example:

  • You: One of my friends was telling me about avoiding post-operative pain medications just after her baby was born, which made her fall asleep, and I wanted to get your professional opinion on the subject.
  • Doctor: Routinely, a pain medication is given to you after the baby is born to help you relax during the long suturing process, which can take up to an hour. It can make you sleepy or even relax you enough to put you to sleep. You can then wake up refreshed when you meet your new baby.
  • You: Is it possible to ask not to have this given?
  • Doctor: Absolutely.
  • You: OK. Thank you for discussing that with me. Now I understand, and I’ll think about what you said before I decide.

When writing your plan, start by introducing yourself through a prologue. This provides a familiar base on which to build a rapport with your nurses and attending caregiver. This is followed by your wishes, which have been discussed with your doctor prior to your birth. Point form is the most efficient way to list these, as you don’t want your birth team to become mired in your plan looking for a lost point. Wording is crucial in a birth plan. It can make all the difference between a supportive or hostile atmosphere during your birth. Yet it is also a legal document.

“The language ‘I do not consent’ may sound harsh but, in fact, is the only statement that has clear legal power so I encourage you to use it for things that you feel strongly about,” emphasizes Gretchen Humphries, editor of BirthTruth.org. “If someone does something to you after you state that you do not consent to it, legally they have committed assault and battery on you. Hospitals are well aware of this, but they assume you are not.”

Make your birth plan short, preferably one page long. Include only those points most important to you. Providing two plans, one for birth and one for your new baby, is an excellent way to ensure that both you and your baby are cared for as you wish. The birth plan stays with you, and the newborn plan goes with your baby if he not able to stay with you. Have several copies with you and give it to everyone involved in your Cesarean. And finally, after you have finished discussing the points with your caregiver, consider having him sign it. This helps ensure that it will be read and followed during your birth.

Basics of a Family-Centered Cesarean Birth Plan

  1. Prologue — Most nurses and doctors appreciate a prologue to a birth plan. A prologue introduces you to your birth team and can give insight into the choices you have made in the plan itself. For instance, parents who have had a former general anesthesia Cesarean experience could include this in the birth plan as an explanation as to why they are choosing an epidural for this birth.

Example:
We understand that there are times when a Cesarean delivery is in the best interests of the mother and infant. We also understand that Cesarean delivery, as a surgical procedure, is common and even routine in most maternity centers. However, we would ask that the staff respect that this individual surgery is a unique and never-to-be-repeated event in the life of our family. For us, it is neither common nor routine, but rather is an event that will have effects lasting a lifetime. We have already experienced the Cesarean delivery of our sons and, because of that, have certain requests and requirements to be taken into account.

  • Pre-operative Preparation — If an elective Cesarean is necessary, then you should request that you be able to begin labor naturally before the Cesarean is done. That is, you do not want a date and time preset; you wish for your baby to decide the day on which it is ready to be born to avoid any problems with prematurity and for both of you to reap the benefits of your hormones. It is also important for your benefit in both recovery and in establishing your breast milk. Labor signals your body to start producing breast milk about two to three days after your baby is born and this is thwarted when baby is removed surgically without labor, often prolonging the production of milk by several days. If a scheduled Cesarean must be performed, then you should request preoperative blood work and tests to be done on an outpatient basis, and hospital admission on the day of the birth not the night before. There are several preparation procedures that are done before you enter the operating room such as establishing an I.V. and giving a bolus of I.V. fluid, placing the epidural catheter and ensuring adequate anesthesia, inserting a urinary catheter, checking of vitals (blood pressure, heart rate, temperature), and checking fetal heart tones. There is no reason why you cannot have your partner and others there to comfort and support you during any of them. One procedure specifically, inserting the urinary catheter, can be quite uncomfortable and many mothers recommend delaying the insertion until after the epidural or intrathecal is in place.

Example:
I do not consent to placement of a urinary catheter until after regional anesthesia is in place, unless it has been discussed with me in advance.

  • Anesthesia — Women have three options for anesthetic during a Cesarean section: general anesthesia (mom is unconscious), epidural anesthesia, and intrathecal anesthesia (with both of the latter, mom is awake for the delivery). Please research each option, both for availability and benefits and risks of each to find which is right for you. What many women do not realize if they are awake is that medications are often given before, during, or just after the baby is born to relax the mother, but the postoperative medication especially often puts the mother to sleep. You will need to decide if you want this or not and include it in your birth plan if you want to avoid further pain medications during or after the surgery.

Example:
I do not consent to any pre-, peri-, or postoperative medication without prior verbal consent from myself, or my spouse if I am incapacitated. I wish to discuss the complete anesthesia protocol with the anesthesiologist prior to any medication administration. I desire postoperative analgesia to be administered via epidural before any use of systemic analgesics, sedatives, or tranquilizers. I have used this protocol in the past and was pleased with the results.

  • During Surgery — It is the anesthesiologist who makes the decisions in the operating room. It is important that he reviews a copy of your birth plan and discusses it with you prior to your birth. Ensure you include in your birth plan who you would like to attend during and after your birth in the operating room. Some anesthesiologists allow only one person with you in the operating room; others allow two or more. Find out what your options are and prepare accordingly. If only one is allowed, one alternative may be having your partner be with you until the baby checks are completed and then have your doula or another support person come in when your partner leaves with baby, assuming baby is moving to the nursery. Routinely, your hands are strapped down to prevent tangling of the various cords to the medical equipment that is monitoring you and to prevent your arms from falling off the narrow boards they are placed on. You can ask to not have your hands strapped down, so as to better receive your baby when he is brought to you. Would you, and your partner, like to view the actual birth? Then make sure your obstetrician realizes this. Explain you would like the option of viewing the birth, either by lowering the screen or by positioning a mirror. Maybe your previous Cesarean is still a bit unreal, as you never have actually seen a baby leave your body — they tend to just appear from behind the green screen and be held up for a quick look before they disappear to be wrapped up and tested. Make sure that the operating room staff realizes that you would appreciate a verbal description of the birth as it occurs. You may have previously felt left out of your past Cesarean as your body and labor might have been discussed as though you weren’t there. Would you love to meet your new baby in his unclothed, naked newborn state — a wet, slippery baby? Request that the baby be placed on your chest with a warm blanket over you both. It would do a lot to make this surgical delivery a bit more natural for mother, father, and baby. And it may even resolve a few inner conflicts that are faced after the birth. In addition, ask that no screen be placed in the way as you will be able to see the baby as he emerges from your body immediately and even be placed on your chest for the baby checks and to cut the cord. Other options include taking pictures or videotaping the birth, having or even choosing background music to be played during the surgery, and your partner cutting the cord. What about that placenta? Most women who birth vaginally get to see it. If you would like to, too, make sure operating room staff knows you want to view the placenta. Make sure they realize the importance of this, and let them know not to just discard a part of you that you have carried for nine months as insignificant. You may like to take the placenta home, to plant under a tree, or even to eat (it reduces the incidence of postpartum depression), so please tell them to be sure to make suitable arrangements with you to see that this happens. If an emergency Cesarean is necessary, under general anesthetic, then you can have your baby given to your partner as soon as possible after birth and held by him (hopefully next to his naked chest – skin-to-skin contact) until you are awake and can be told of the baby’s sex and well-being by your partner. As with any surgery, there are risks and sometimes those risks can have drastic consequences. Some obstetricians remove the uterus to solve a problem like hemorrhage. Is this a concern for you? Many times, a hysterectomy can be avoided using other treatments. Have you considered the option of tubal ligation during the surgery? Many women have been asked on the operating table this question and have answered hastily only to regret it later. Make the decision before your surgery. Also, with any surgery, administration of blood products may be an option when there is excessive bleeding. Many have fears or religious considerations surrounding the dispensation of blood and blood products. Options may include banking your own blood or refusing blood products and building your own supply back to normal in the days following your birth. Finally, there are two methods to closing the uterus. Highly recommended is the double suturing method (suturing of both the inner wall and outer layer of the uterus) to further ensure scar integrity for subsequent pregnancies and labors. Closure of the skin layer can be done either with staples or with sutures. If either of these is preferable, note it on your birth plan as well.

Example:
I do not consent to having my arms strapped down unless I am physically unable to control them. I am familiar with surgical fields and understand the necessity of maintaining a sterile surgical field.

  • Infant Care — How about breastfeeding your baby straight away, rather than hours later? Let them know that you would like to feed your baby while you are being sutured, if you feel up to it, and you would like your baby to stay with you throughout the surgery and even during the recovery. Your baby should remain with you at all times, no disappearing off to the nursery with your partner. This simple routine can seriously affect your bonding with your child. If your baby must go to the nursery, then do send your partner and encourage skin-to-skin contact. Your baby will be much less stressed when with someone he recognizes, as baby will respond to your partner’s voice. Let them know that your partner would be delighted to hold his child within your view throughout these procedures, if you feel unable to participate in the bonding. Newborns are also subjected to various interventions, too — routine health checks using the APGAR assessment, vitamin K injection, eye ointment application, PKU test, weight and height measurements, a bath, and possibly Hepatitis B or other vaccinations. It is highly recommended you research each of these and make an informed decision on allowing, delaying, or not allowing these procedures. You can also ask that the procedures that are done right after baby’s birth be done while in your presence rather than in the nursery. If you are planning to breastfeed your baby, you may want to include in your birth plan that you would like your baby to avoid artificial nipples or supplements including water, sugar water, or formula. If there is a glucose or nutritional concern, ask that it be discussed with you before an action is taken.

Example:
We do not consent to the PKU test until after my milk is in. We believe that this will reduce the likelihood of an inadequate sample, making it less likely a retest will be needed.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

America’s Family Crisis: Parental Depression Putting 15 Million U.S. Children at Risk

By Rita Brhel, managing editor and attachment parenting resource leader (API)

America's Family CrisisDepression is beyond epidemic proportions, not only in the United States but in many societies around the world. People like to blame more recent economic downturns, but these high rates of depression have been an ongoing concern for many years from before the stock markets took a dive.

If depression was the H1N1 Influenza virus (a.k.a. swine flu), no one would venture to the streets or grocery store without a face mask for fear of transmission, schools and businesses would be closed indefinitely, and medical clinics and hospital emergency rooms would be packed with people clamoring for screening and treatment.

But depression isn’t contagious like the flu – although it certainly is more debilitating and has just as much potential to kill. It doesn’t spread by sneezing and coughing, but it is still “contagious” in that people living with a depressed significant attachment figure, whether adult-adult or parent-child, are more likely to develop depression themselves and all that comes with this illness – the hopelessness, the sorrow or anger depending on the person’s response, the suicidal thoughts and possible attempts.

Depression is pervasive in the United States, and it is devastating to families – to marital relationships and to children’s development. We know through attachment research and neuroscience that the way we are parented not only affects the behavior we use in reaction to stressful events but also changes the way our brains work and our genes express brain chemistry reactions to stress. This means that if we are parented in such a way that consistently teaches us to react poorly to stress and conditions our brain to release stress chemicals at high rates, we are literally creating a child who will grow up into an adult who is prone to depression and all that comes with it.

Our families are in crisis.

New Report Brings to Light the Impact of Parental Depression

A new report, Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention, was released by the National Research Council and Institute of Medicine of the National Academies last week at a public briefing in Washington, D.C. Attachment Parenting International attended via webcast.

The National Academies consist of the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council. They are private, nonprofit institutes that provide science, technology, and health policy advice to the United States under a congressional charter.

Depression in Parents, Parenting, and Children explores the interaction of depressed parents and their parenting practices, and the impact on children. It also proposes strategies to promote more effective interventions, as well as recommendations for improving the quality of care for depressed parents and their children. The study was funded by the Annie E. Casey Foundation, The California Endowment, the Robert Wood Johnson Foundation, the U.S. Health Resources and Services Administration, and the U.S. Substance Abuse and Mental Health Services Administration.

Report committee members who attended the briefing included: Chair Mary Jane England, MD, president of Regis College in Weston, Massachusetts; William Beardslee, MD, professor of child psychiatry at Children’s Hospital in Boston, Massachusetts; Mareasa Isaacs, PhD, executive director of the National Alliance of Multi-Ethnic Behavioral Health Associations in Bethesda, Maryland; and Frank Putnam, MD, professor of pediatrics and psychiatry at the Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio.

The Prevalence of Depression

The briefing opened with an overview of depression in the United States, presented by Isaacs. The exact number of people affected with depression is difficult to pinpoint, but it’s estimated that only one-third of adults with the illness actually receive treatment. In some sample communities, as many as 70% of people with depression go without treatment. Although depression treatment is very effective, there are a number of factors preventing people from seeking help: the stigma of mental illness, lack of transportation, inability to afford services and medication, language and cultural barriers, and lack of providers or at least those with training in identifying and treating depression.

Despite not knowing the full extent of depression, there are several tendencies that Isaacs pointed out:

  • Women have double the rate of depression as men.
  • Caregivers are more likely to have depression.
  • Depression typically first shows in adolescence or young adulthood.
  • Those living in poverty are more likely to have depression.
  • Depression is more common among adults who are separated or divorced than those who are married.
  • Depression rarely appears alone – 75% of people who suffer from depression also suffer from traumatic histories such as sexual abuse or exposure to early childhood violence, substance abuse, a medical condition, or another mental health disorder especially anxiety or post-traumatic stress disorder.
  • The development of depression rests in a combination of genetic susceptibility, environmental factors, and individual vulnerability. Depression is as much the result of other issues in a person’s life, as it is the indicator that there are additional problems.
  • The majority of adults suffering from depression are parents.

The Impact of Parental Depression

It is this last point – that the majority of adults suffering from depression are parents – that is the take-home message. It is estimated that in the United States alone, one in five parents are affected by depression each year, or approximately 7.5 million. Here’s the kicker: 15.6 million children under age 18 live in these households where at least one parent is depressed, Isaacs said. Depending on the age of the child, they can be as much as 40% more likely to develop depression themselves with just one depressed parent in the home, said Putnam said – let alone both parents. “Mothers and fathers are often depressed together,” Beardslee added.

Remember what we know about attachment and how this affects the development of our children. For more than 15 million children in the United States, either their primary attachment figure or a strong secondary attachment figure is depressed and modeling all that comes with it.

“Depression is primarily a family issue,” Isaacs said. “It affects not only the individual but also children and other members of the family. It affects parenting.”

While the majority of research in parental depression has included mothers only, the few studies that have been conducted on fathers shows that the impact of children living with a depressed secondary attachment figure is just as devastating as living in a home with only the primary attachment figure suffering from depression, she said.

“Many people don’t get treatment, and those who do, don’t for years,” said Beardslee. “This makes a great impact on the family.”

Depressed parents tend to raise their children in an emotionally detached, withdrawn parenting style that affects the development of attachment, Putnam said. People with depression use fewer positive parenting approaches and more intrusive handling of children, and the end result is a child who is himself withdrawn.

“Depression causes terrible suffering,” in both parents and children, Beardslee said. Depression effectively destroys the attachment between a parent and child. The inconsistencies in parenting by depressed parents leads to a break in trust between the child and his parent. Long-standing depression causes neglect and often abuse. While depression symptoms manifest themselves differently in each person, women tend to be sad and withdrawn while men tend to be irritable and acting out.

Beardslee told of one mother who described what depression does to her parenting: When she isn’t depressed, she has very positive, emotionally close, and healthy interactions with her 12-year-old son, and when he comes home from school, they go through a routine of talking with, playing, and otherwise spending time with one another. But, when she is depressed, all that positive parenting disappears – she puts her son in front of the television and ignores the routine and his emotional and physical needs.

This break in routine, which is so important especially for older children, greatly affects the mental health of the child, Beardslee said. He feels inadequate, as though he is to be blamed for his mother’s withdrawal. Her depression affects his self esteem and models her poor responses to stress – significantly increasing the risk that he will eventually develop depression himself and unhealthy coping mechanisms expressed through social, behavioral, and other mental problems. He will feel the effects of chronic parental depression long after his mother’s depression is treated.

Not every parent with depression will inadvertently or deliberately cause harm to their children, but parental depression increases the risks for spillover consequences during critical periods of child and adolescent development.

“We’re very concerned about the impact on children,” Putnam said. While there is only a 2-4% risk of a small child developing depression when there is a depressed parent in the home, this risk jumps up to 20-40% in adolescents. “What also comes with this is the risk of substance abuse,” which is predominant among depressed individuals, Putnam added.

“To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression,” England said. Beardslee added: “We need to think about people who are depressed as parents first, and individuals with depression second.”

This goes beyond postpartum maternal and infant depression – the screening and treatment of which is becoming increasingly more commonplace in the medical care community: “The first few years of life are crucial, but we need to look more into the long term,” Beardslee said.

The Report Committee’s Recommended Solution

Currently, most screening and treatment of depression happens in primary medical care settings, Beardslee said. However, because depression is more typical in families living in poverty and perhaps without the means to see a doctor, there must be more avenues for depressed parents to find help. Because depressed parents are often withdrawn and difficult to engage, more types of service providers outside the mental health system need to be trained to spot the symptoms of depression and to direct those who need help to accessible entries into the health care system.

Once parents seek treatment, the mental health care system must change the way it treats this illness. Because of the impact on children, interventions should adopt a two-generational approach – parent and child – to effectively treat depression in families, Beardslee said.

Putnam listed these critical components to an effective model of family-centered treatment for depression:

  • Integrative – meaning that all factors contributing toward the depression must be identified, whether this includes poverty, marital issues, health problems, etc.
  • Comprehensive – meaning that all co-occurring conditions must be identified and addressed, such as substance abuse and anxiety disorders.
  • Multi-generational – which encompasses screening and treatment for both parents and children by one mental health care provider rather than by separate providers who often don’t know the full extent of depression on the family members.
  • Preventive – which includes teaching parents positive parenting skills and skills to cope better with stress.
  • Developmentally appropriate – any treatment should appropriate to the particular age group of the children involved.
  • Accessible – screening should be available through programs frequently used by at-risk families such as home visitation, Headstart and other school-based programs, federal nutrition programs, etc., and those parents who are identified as depressed should then be assisted in navigating the mental health system to receive treatment. In addition, the financial barriers of at-risk families must be addressed – many may not have insurance or income, and those who are able to afford services may have difficulty paying for services for more than one person in the family. Also, the mental health system must look into ways of delivering services in nontraditional settings to be able to reach at-risk families, including schools, prisons, community programs, and even homes.
  • Culturally sensitive – which includes techniques to overcome language barriers, stigmas, etc.

“There are a number of exciting initiatives with parts of these features, but no program yet has all of these features,” Putnam said. As it is now, “parents with depression are like orphans” in the mental health system, he added.

To jump-start this model, Putnam suggested the mental health system focus first on implementing a two-generational, more comprehensive focus. More health care providers need to receive training specifically in multi-generational depression. Practices should look into ways that would reduce the financial impact on at-risk families such as charging on a sliding scale, combining children and parent charges into one office visit instead of two, and negotiating with insurance companies to provide same-day reimbursements on medical care services. Once programs are in place that effectively treat family depression, they should be included in training models for other providers.

In addition, more research dollars need to be allocated toward studies that look at the impact of parental depression on children as well as the differences between the impact of depression in fathers and mothers, Putnam said.

The report committee said this report represents a call for urgency from the U.S. Surgeon General and the various mental health organizations and agencies – a major mental health concern that needs to have a working plan in place in the next six to eight months.

What is API Doing?

API actively helps parents who are prone to depression or are depressed by teaching parenting skills and providing resources to help parents develop better ways of coping with stress and strong emotions. According to researchers at the University of Michigan, who reviewed the numerous studies on the subject, there is a link between social support and wellness. Support networks are vital not only in preventing depression but also in its treatment. Local API Support Groups provide parents with a way to develop a solid support system that can follow them through their child’s many developmental stages and the challenges that come with them.

And if parents do fall into depression, API Leaders can help direct parents to the treatment they need as well as continue providing support through the local group or personal consultations, free of charge.

Discuss this topic with other API members and parents. Get advice for your parenting challenges, and share your tips with others on the API Forum.

What Attachment Parenting Does for Your Child’s Future

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Attachment as adults

Especially if you’re new to Attachment Parenting, you may be wondering what does parenting have to do with your adult relationships. Quite a lot, if you understand the impact of healthy and unhealthy parent-child attachments on the child. In fact, you could say it has to do with everything about our adult relationships.

The attachment bond you had with your primary caregiver – most likely your mother – is your model for how a relationship should work for the rest of your life. For some of us, that attachment bond was loving and nurturing and we find our adult relationships relatively easy. For many of us, we may have some difficulties in our adult relationships, mainly in trust issues, indicating that there were inconsistencies in the response by our primary caregiver when we were younger. And for some of us, our childhood homes were downright neglectful and abusive and our natural tendency in our adult relationships is not to have a relationship at all.

Because humans are social beings, having close relationships is an essence of life. Without working relationships, we are at risk for depression and anxiety, substance abuse, eating disorders, and other unhealthy and risky behaviors that we use to fill a void in our lives left by the needs left unmet in our first loving relationship – that with our parents. The success of this first attachment bond in our lives is what shapes the way our brain works, influencing the way we cope to stress, how we see ourselves, our expectations of others, and our ability to maintain healthy relationships all through our lives. Continue reading

Heal Thyself through Birth Storytelling

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Healing through our birth storiesIn preparing the Spring 2009 issue of The Attached Family, I asked a number of women to tell their birth stories who were too uncomfortable in doing so. They were still working through emotions of disappointment, fear, and sometimes guilt surrounding their baby’s birth – even years afterward.

It is obvious that emotional healing is a process, similar in many ways to grieving over the death of a loved one. In fact, the emotional healing process after a traumatic birth is a type of grief: You are grieving over a loss – having to settle for a labor and/or childbirth that may be very different than you imagined it, the loss of your expected recovery or early attachment period with your baby, even the loss of a healthy baby. For some women, the loss may not be so obvious – perhaps you didn’t get to hold your baby after your birth, or you had an I.V. or catheter or couldn’t walk around during your labor as much as you wanted to. Not all losses have to be catastrophic or major to cause a feeling of grief.

“Shock is a normal psychological and physiological response to an unknown, intense or perceived biologically-threatening situation,” according to Pam England, author of Birthing from Within, in her article, “Birth Shock,” on BirthingFromWithin.com. “Labor, even normal labor, qualifies for all of those categories. So birth shock is a completely normal response to either normal or complicated births and postpartum; it occurs in home births and hospitals births.”

Dr. Elizabeth Kübler-Ross was a doctor who spent time studying the emotions patients in Swiss hospitals go through when they learn they have a terminal illness. She wrote On Death and Dying in 1969, where she identified seven stages of grief people typically go through as they work through the emotional impact of the loss of their dreams for their life. Commonly referred to as the Grief Cycle, these stages are common with all forms of loss – such as the loss of a job or pet, and theoretically could be applied to the emotions surrounding a disappointing birth experience.

“Grief is a process of physical, emotional, social, and cognitive reactions to loss,” according to Lori Godin, a licensed marriage and family therapist in San Jose, California (ModernLife.org). “The grieving process is often a hard one to work through. It requires patience with ourselves and with other. Although responses to loss are as diverse as the people experiencing it, patterns or stages that are commonly experienced have emerged.”

The Grief Cycle

The Grief Cycle is often condensed to five stages: denial, anger, bargaining, depression, and acceptance. The original Grief Cycle created by Kübler-Ross includes actually seven stages, which are outlined on ChangingMinds.org:

  1. ShockSymptoms: At first, the person may appear to have no reaction at all, or may nod and appear to accept the news without being troubled by it. The person may need to be told several times before they understand it, which is indicative by a physical reaction such as paling of the skin, shortness of breath, and physical freezing. Treatment: The person should be sat down and given something to hold onto. Show them sympathy and acceptance. Prevention: While there is no prevention of the Grief Cycle, the reactions of the Shock Stage may be lessened some by telling the person the news in a private, safe place with the company of trusted friends or family.
  2. DenialSymptoms: The person pretends that nothing has happened, including denying any evidence that would prove the news to be real. Treatment: Show sympathy by letting the person know that you, too, find it unfair. This will help the person feel safe to become angry about the situation, which opens up their ability to deal with their emotions.
  3. AngerSymptoms: The person may swing suddenly and explosively into anger, as she asks “why me?” She may freely blame people, places, and events – anything that may have been involved in the situation. Treatment: Allow them to feel angry and don’t deny their feelings, much as attachment parents do with their toddlers’ tantrums. However, should the anger become destructive, remind the person of appropriate and inappropriate behavior and help her to reframe her anger into useful channels such as problem areas, tasks, hobbies, and other ways to move forward. Prevention: Again, while the Anger Stage cannot be prevented and is essential to move through the Grief Cycle, you should be aware of your reactions when faced with another person’s anger. Do not turn it into an argument, as this could push the person back into denial or cause future problems. Support and accept their anger, and let them be angry at you, especially if the person’s “why me?” turns into “why not you?”
  4. Bargaining Symptoms: The person feels hopeful that the situation is reversible. She seeks in vain for ways to avoid the situation. Treatment: While you can help the person seek out practical alternatives, do not offer the person any false hope. Offer new opportunities for personal growth.
  5. DepressionSymptoms: The person finally feels the inevitability of the situation and reluctantly accepts it. This can be a deep depression full of despair and hopelessness. Depression can present in many ways, from tearfulness to sleeping all the time to loss of joy in hobbies. As they turn into themselves, they turn away from any possible solution or person who can help them. Treatment: Show sympathy and acceptance. Your presence, while it may not be acknowledged, can be comforting to the person. Professional counseling may be needed to help the person recognize their depression and then find a way out of depression.
  6. TestingSymptoms: The person begins to experiment with activities to find ways out of the depression. Treatment: The support of friends, family, and sometimes professional counselors can help tremendously during this stage. Give the person as much control over the situation as possible, as you help them try different solutions.
  7. AcceptanceSymptoms: The person feels ready and actively involved in moving on with her life. The person takes ownership for their actions and emotions. They start doing things and taking note of the results, and then changing their actions in response. They appear increasingly happier and more content. Treatment: Help the person to establish themselves in their new position on life. Congratulate them on getting through the emotional healing process, and celebrate the transition of their transition.

“Knowing these stages can sometimes help in coping with the process of grief and recognizing that there is a light at the end of the tunnel,” Godlin continues. “It should be noted that although most people experience all of the following stages, they do not experience them with the same duration or in the same order or with the same intensity. It is a very unique process.”

The Grief Cycle in a Birth Story

For this exercise, I am referring to my daughter’s birth story, “The Story of Rachel,” in the Birth Stories section. Try dissecting this story and see if you can identify any of the stages of the Grief Cycle.

Here’s what I came up with:

  1. Shock – “My first thought was that I had lost the baby, but as soon as I stood up, I felt a kick. I couldn’t grasp that she was still alive when it was clear from the blood that things were not at all OK.”
  2. Denial – “I had no idea was he was trying to tell me — I thought the drugs would work, the pregnancy would last until my baby was term, my baby wouldn’t need any sort of NICU care.”
  3. Bargaining – “I braved each contraction, with the help of my dad and a nurse as my coaches since I had never been through childbirth classes, with the expectation that the drugs would work.”
  4. Depression – “It was devastating to hear the doctors say there was nothing more they could do to stop labor and that my baby’s well-being was left to fate.”

Note that I did not appear to go through all the stages. As Godlin mentioned, not everyone goes through every stage of the Grief Cycle, or through in the same order. In addition, some women may grieve their births immediately, while others may wait. Some may think they have accepted the circumstances surrounding their child’s birth but then find a trigger in another’s birth story or when a close friend or sister becomes pregnant for the first time. Many women don’t grieve until they’re pregnant again, or even just considering whether or not they want more children.

What my birth story doesn’t tell you is, I didn’t feel angry until I was pregnant with my second daughter, Emily, and then especially after her Cesarean.  As far as the testing and acceptance stages go, while I believe I’ve accepted the way my birth progressed with Rachel, I’m still bouncing in and out of acceptance and anger with Emily’s birth. Because the two births were only a year apart, it’s difficult to sort out exactly which emotions go with which birth and it’s very possible the two’s Grief Cycles have enmeshed with one another.

Why Birth Storytelling is Needed

Everyone’s birth story is unique unto itself, and every person sees disappointments, fear, and guilt in their own way. This is why it is sometimes difficult to find empathy or sympathy from others, and why it can be useful to use the telling and retelling of our birth story as therapy in working through the Grief Cycle. In the article, “Emotional Recovery from a Cesarean,” on Plus-Size-Pregnancy.org, we learn that many women who suffer from emotional trauma following a Cesarean birth often then feel additional isolation and hurt by friends and family who have difficulty understanding the need to mourn a birth when the baby and mother are ultimately healthy.

According to the article, some people don’t understand the scope of a Cesarean, thinking it’s more or less interchangeable with vaginal birth; others come from an age where interventions during birth, such as putting women out of consciousness or giving them massive episiotomies, were the norm. Some people may disregard a woman’s grief because they don’t want anything to overshadow their own joy of the new baby. Some people may be unable to feel empathy because they have unresolved issues from their own birth experiences, even seemingly normal ones, or because they happy with their interventions, even a Cesarean, and don’t understand why you wouldn’t feel the same way.

The article goes on to acknowledge the power of birth storytelling in emotional healing. In fact, the author, who is identified only as KMom, stresses that telling the birth story is crucial in starting the healing process: “This is one of the most difficult steps for some women, but it really is very important in getting the healing started.  If you can’t name what happened to you, then you can’t fully understand it or begin to make it different next time.  Name the problem, talk about what happened, then retell your story over and over and over. “

Healing Through Our Birth Stories

With the internet, it’s easier now to find ways of telling your birth story. You can share it on the API Forum, where parents are always ready to give support. You can submit your story to be included on The Attached Family online. API Leaders through your local support group, or a resource leader contact, would be happy to listen to your birth story. Some API Support Groups host special meetings specifically for women to share their birth stories. If you’d like to be more personal, write your story in a journal or on your computer where no one else can see it but yourself. Tell your story to a trusted, impartial friend or family member.

Only share what you feel like sharing, and don’t feel pressure to share all of it at once. Many women develop their stories, or parts of their stories, over time. They may remember points of their births that they hadn’t before, or are able to see it in a different perspective. You can start by writing about your pregnancy and work slowly forward in your story, or you can start at your recovery and work slowly backward. For some women, the story just falls together on its own from start to finish. For others, the story comes in little bits and may jump around.

KMom shares that it’s not enough to tell a birth story only once, that retelling it many times with different focuses is needed to be able to start processing the emotions that come with it. Lynn Madsen, author of Rebounding from Childbirth, suggests writing the birth story in two layers, resting between the layers to give time to reflect:

  1. Write down the concrete details you can remember: who, what, where, when, the sensory details, etc.
  2. Write down what was going on inside of you: where was your mind, were you aware of the baby, what did you say to yourself, how were you feeling, etc.

It is in this second layer of your birth story that you will begin facing and processing the disappointment, fear, guilt, and other emotions surrounding your birth experience. This is daunting work for most people, as KMom explains: “Some of the hardest work you will do is accessing your deepest feelings about your child’s birth.  Often, it is very difficult to do this.  People don’t like to go through pain, and facing unpleasant or difficult feelings is painful.  Feelings about birth tend to be very intense, especially the deeper you go.  Often they bring up life issues which can be even more intense.”

“It is completely normal to wish to avoid pain, but if you suppress your feelings and don’t really feel them fully, they become stronger.  Often they will present in your life again and again, each time stronger and more insistent, and sometimes in more destructive ways.  Although facing the feelings may be very difficult or feel very threatening, in the long run it is what frees you,” she continues.

Some women feel they don’t need to deal with their emotions because the experience is behind them, or because their experiences may not be as traumatic as someone else’s. But Madsen explains: “Every feeling about birth matters, no matter how long that feelings lasts, no matter how unreasonable, irrational, or out of proportion it seems.  Any feeling, no matter how strong, is easier to live with once it is named. …A woman may believe she is going to die as the feeling rolls through her, but she won’t.  The trick is to sit with the feeling until this intensity, this sensation of death passes, and light is perceived at the end of the tunnel.”

Telling the birth story, and working through the emotions surrounding a disappointing birth, is essential before a woman decides to have another baby. It is also important for women who are certain they are done having children, because their emotions may be clouding their judgment. Even if a woman is past her childbearing years, naming these emotions and working through them is needed for closure, or else, these emotions will return over and over again throughout their lives at different points and in different situations, until they are finally resolved in some way.

Get the Most Benefit Out of Your Birth Story

In developing your birth story, KMom gives several helpful tips to more fully understand the emotions you may be feeling:

  • Learn exactly what happens during the procedure you went through, whether it was a Cesarean, episiotomy, or another intervention. Search for an article on the Internet, or watch a video. Realize that you’ll likely find this distressing at first, but it really does help you to understand your emotions if you know what physically happened to you.
  • Request a copy of your medical records. Find out what really happened during your birth experience and the reasons for the interventions.  You need to understand the complexities of what happened and if there was anything you could’ve done to prevent what happened. You may feel anger and sadness as you read through your records, especially if you find unkind remarks or misinterpretations by your provider, but you can discover a lot of the behind-the-scenes reasons for why your labor and childbirth went the direction that it did.
  • Listen to your partner’s view of the birth and discuss it. Your partner’s version may be different than yours, and he may be able to offer insight. Realize that he may be working through his own emotional healing process, so understand if he is reluctant or if he tells his story in a brief way that lacks a lot of emotion and details, and ask probing questions gently.
  • Activate your anger. Unexpressed anger can destroy a person, but expressed anger opens up the healing process. It doesn’t matter whether you feel its reasonable anger or not. Women often feel angry at their health care providers or their spouses, but they can be angry toward anyone. But many women also don’t want to acknowledge that they’re angry. A good way to vent your anger is to write a letter addressed to the person with whom you’re angry – although you won’t send it – and let your anger erupt or pour out over the page.
  • Express emotions through the arts. Draw, paint, sing, write a poem, create a sculpture, even out of play dough, or write a children’s story from your baby’s point of view – do whatever your creative tendency is.
  • Acknowledge the emotional power of anniversaries. Your baby’s conception, expected due date, birthday, and other anniversaries can be both joyful times for you as well as times that bring about hard feelings toward your birth experience. Allow yourself to grieve during these anniversaries, which paradoxically, will allow you to work through the feelings and then enjoy the celebration. Otherwise, you’ll spend the day concentrating on your grief instead.
  • Share your experience with others who understand. Join a support group or seek out a mentor, such as through the International Cesarean Awareness Network, ICAN-Online.org; Sidelines National High Risk Pregnancy Support Network, Sidelines.org; Birth Trauma Association, BirthTraumaAssociation.org.uk; SOLACE, SolaceForMothers.org; and Birthrites: Healing After Cesarean, Birthrites.org. Find support through the API Forum or at a local API Support Group. Talk with a trusted friend, listen to or read other women’s birth stories, or especially if your birth was traumatic, seek out professional counseling with a therapist who specializes in birth issues.
  • Reframe the experience to focus on the positive — and on your baby. Give yourself credit for your courage and emotional strength. Think about the positive reinforcement you would give to another woman in your situation. Focus on the aspects of your birth where you did well, and give yourself credit for being mature enough to work through your emotions and to use the experience as a time for personal growth. Remember that you made the choices you made at the time because you believed them to be the best for your baby.
  • Practice self forgiveness. Forgive yourself for your choices, whether it was going along with whatever the doctor said or whatever it is that is making you angry. Tell yourself that you did the best with the knowledge that you had at the time, because that is truly the best that anyone can do.
  • Rewrite your birth in the way you wanted it to go. This is a very effective way to heal, but should be done only after you have written the birth story as it has gone and you have learned as much as you can about how the birth really went, which means looking at your medical records. Recreate your birth story with as much or as little detail as you want. Also, some women may need to rewrite their birth story over and over in order to feel a complete emotional release.
  • Tell your birth story to your child. When you’re ready, hold your child while he is asleep and whisper to him first your birth story and then your recreated birth story, what you wished had been different. Some women feel more comfortable practicing this exercise first without their child present, or by holding their child’s favorite toy, to first release strong emotions like sorrow and rage. This is especially true if there is any anger felt toward the child.
  • Create ceremonies. Some women gather friends together for a birth storytelling circle. Others write their birth stories or letters to those they are angry with and then burn the paper. Some have placental burials, affirmation declarations, or other rituals where they can either give themselves positive reinforcement or express anger in a healthy way toward others.
  • Find activities that help release your emotions, tension, and stress. Exercise, good nutrition, mediation, and massage are especially helpful, as are your hobbies or even chores if you are able to channel your strong emotions into them.

Healing is Possible

When a woman is in the midst of feeling the emotional trauma from a disappointing birth experience, it can seem like her former, happy self has gone away forever and a depressed, angry person has taken place. Healing takes time and effort, but it is well worth it in the end. Unhealed emotions from a traumatic birth experience can take their toll not only on the relationships within a family, but also on the future children (or decision whether to have more children) and on the woman.

Sharing your story through an API Support Group, the API Forum, or by submission to The Attached Family online “Birth Stories” section can be a great start to healing through your birth story – as well as helping others heal from their traumatic births.

In her Plus-Size-Pregnancy.org article, KMom explains: “Reading other women’s stories of recovery after a [traumatic birth] can be very healing.  Sometimes, confronting women’s pain or our own can be distressing, but it is running away from or avoiding the pain that prolongs it. Dealing with the pain when you are ready can be very revealing about general life issues, can help you heal many ways emotionally, and can help you face your fears and prepare for future pregnancies and births.  Remember, ‘The other side of fear is freedom.’”

For More Information

  • Birthing as a Healing Experience by Lois Halzel Freedman
  • Ended Beginnings by Claudia Panuthos & Catherine Romeo
  • Rebounding from Childbirth by Lynn Madsen
  • Silent Knife by Nancy Cohen Wainer & Lois Estner
  • Transformation Through Childbirth by Claudia Panuthos
  • Trust Your Body! Trust Your Baby! by Andrea Frank Henkart

Be Prepared for These Common Childbirth Interventions

By Amber Lewis, staff writer for The Attached Family publications

Common Childbirth Interventions“Childbirth is more admirable than conquest, more amazing than self-defense, and as courageous as either one.”
~ Gloria Steinem, Ms. Magazine, April 1981

Most pregnant women will tell you they have a plan for their labor, but just as parents cannot imagine how their children will turn out as they grow and mature, soon-to-be mothers cannot be guaranteed a perfect birth. Labor experiences are as varied and vast as the types of people who go through them and the children those experiences bring into the world. There are just as many emotions involved in this miraculous experience, and while many births are happy and uncomplicated, others can be deeply disappointing for the parents.

This leads to the question: What to do when childbirth does not go as it was planned to? Continue reading