Cara’s mother had driven 4 hours to arrive at her daughter’s bedside. Her coat was still buttoned when she blew into the room. As the door swung shut behind her, she stopped, squinting at us in the dim light. Her son-in-law gently touched her elbow and gestured past Cara’s bed to me, whispering, “This is our midwife, Susan.” She allowed herself to be directed but her gaze was on the still form of Cara lying under the hospital blanket. Her first words were to me, “Is that normal? I mean, to sleep through labor?” “She’s not sleeping,” I assured her, “She’s just very calm.”
Cara did not have an epidural, and despite appearances she was indeed in real labor. In fact, she was working very hard. Cara had studied mindfulness, using a book by Nancy Bardacke, Mindful Birthing. Her study was paying off. She was in the middle of one of the most peaceful and beautiful births I have ever been privileged to attend in my years of midwifery.
Childbirth usually involves considerable pain, particularly for first-time mothers. For most of human history, it also involved a considerable amount of danger, and thus fear. On the heels of the industrial revolution came the first widely available analgesia, hailed as a miracle. Beginning with ether and chloroform, then later “Twilight Sleep,” and more recently IV narcotics and, used by over 60% of laboring American women, epidural. All of these relief measures have potentially dangerous side effects for both mother and baby. Their use also alters the character of the experience in important ways.
For most first-time mothers the 4-6 hour period prior to birth is when real grit is required to forego or delay the tempting pharmacologic pain relief methods. One of the most effective, non-pharmacologic techniques a woman can learn for coping with the pain and anxiety of labor is training the mind to be purposefully attentive to the present moment without judgment, also known as mindfulness. The quality of attention is one of intense focus on the true experience, brushing aside thoughts of past or future. This attentiveness can open the woman to savoring the minutes between contractions, noticing the absence of pain, and sinking down into the relaxation and pleasure of the endorphins her body is naturally producing. Through training and practice she can learn how to let go of anxiety about the coming contractions and delivery and how to attend fully to the peacefulness of the between-times.
Jon Kabat-Zinn pioneered the use of mindfulness for coping with pain almost 40 years ago, but mindfulness has been associated with various spiritual practices, most notably Buddhism, for centuries. Research of the past 20 years has built a strong argument for the multiple physical, mental, and social benefits of mindfulness. It has only recently begun to move into the labor & delivery suites of America’s hospitals.
In the course of an hour of active labor, with contractions every 4-5 minutes, each lasting roughly 1 minute, with the intense portion only half of that time, a woman experiences only 7-8 minutes of intense pain during the entire hour. In Mindfulness for Childbirth classes, various techniques for coping with those minutes of intensity are introduced and expectant parents begin to select those that work best for them. These techniques included counted breaths, visualizing her baby, being supported or lightly massaged by her labor support, low vocalizations of moans or mantras and more. When labor requires strength for the intense moments, she and her team will have a set of techniques they have practiced in advance.
When I met Cara and her husband the first time, they were transferring to me because they had decided to seek midwifery care to improve their chances of an un-medicated birth. The two of them were so soft-spoken that, after we had been together for half an hour, I realized I was doing all the talking, so I stopped and leaned toward this young woman. I asked her, “What scares you about this birth?” Her face changed in an instant and tears quickly came to her eyes. In the next half hour, I learned that they were not scared of any one thing, but had a lot of worries. He was afraid he wouldn’t be able to support her without being overcome. She was afraid of having a cesarean. These are the fears many expectant parents hold bottled in their hearts, through all the fanfare of baby showers and well-wishes. For Cara, I was able to promise them we would be with them from start to finish, come what may, and no matter what path this took, they would not be alone.
When her hour came, I was with them, and they used their training to gracefully bring their baby into the world. She did much of her labor in the shower, resting in bed for brief periods, and did much of her pushing with her stalwart husband holding a cool cloth to her forehead. He was so proud of her, and never wavered in his attentive support. When their baby emerged, the newborn looked at his parents’ faces intentionally, attentively, and it struck me how learning mindfulness is rather like learning again to be like this little one.
Melissa Marback and I are offering a course for expectant parents on childbirth preparation using mindfulness as the cornerstone. Dr. Marback is an obstetrician, and I am a nurse-midwife. The two of us have enjoyed hosting women’s meditation retreats over the years, and recently traveled to California to learn more about the work of Nancy Bardacke. We have come back inspired and ready to bring our knowledge and experience to expectant parents. The course is designed to introduce the concepts of mindfulness for labor and birth, with exercises to practice at home. This ongoing practice is an essential component of the course. MP3 recordings of guided mindfulness meditations for pregnancy, purchased from Nancy Bardacke, are included in the cost of the course.
Classes are taught at Kerrytown Wellness Center, 220 N. 5th Ave., in Ann Arbor, MI.
The cost is $157.50 per expectant parent. Registration is limited to 14 participants. To learn more, contact me at susangreenleeCNM@gmail.com. For upcoming class dates and more detail, see our website at https://childbirthweb.wordpress.com/