MIDWIFERY CARE FOR THE VBAC WOMAN

Posted on May 6, 2015 by Gloria

Midwifery Care for the VBAC Woman
by Gloria Lemay
© 2001 Midwifery Today, Inc. All rights reserved.
[This article first appeared in Midwifery Today Issue 57, Spring 2001.]

Someone asked me recently what things are done differently with vaginal births after cesarean (VBAC) as opposed to a first baby. Midwives usually reply to this question with a reassuring, “Oh, we treat you normally,” but there are differences in the two situations that can be distinguished in midwifery practice.

Prenatal Preparation

The full history of the events leading to the cesarean is very important. With a VBAC client, ask her to get her operative record, nurse’s notes, anesthetist’s report, pediatric report—get all the records and go over them thoroughly. Often the couple did not get full or accurate information about what was going on. Sometimes there’s a little “clue” as to what went wrong that could help to prevent a cesarean from recurring. Sometimes there is a big chunk of information that didn’t get communicated. I saw one set of records where the only indication for the cesarean was the note from the obstetrician that “this woman is a natural childbirth fanatic.” Another set of cesarean records had no indicator whatsoever of why the woman received abdominal surgery when she had given birth at l9 years old. When she told her parents that the midwife was perplexed and could see no reason for the surgery, her father admitted to her that he had stayed in the visitor’s lounge all day and had been verbally threatening to the doctor: “If anything happens to my daughter, I’ll sue you!” This helped the daughter to understand what had happened to her and also helped her to be firm with her father that he was to be nowhere near her VBAC birth.

With VBAC births it is important for the midwife to work with the dad prenatally. A VBAC father is in a horrible position because, despite the fact that his wife had an operation and a long recovery, he still got a live wife and baby at the end of it all. VBAC dads are often “fantasy bonded” to the medical system and terrified of childbirth in general.

The good thing is that they listen very carefully and really know when the care is better and more thorough and when the practitioner is authentically on their team. I find that if the midwife talks to them very honestly, they can trust and be fully supportive when the birth time arrives.

If the woman has dilated past five centimeters in the first birth, I plan for it to be fairly fast—like any second baby. If the woman has not gone into the birth process or not dilated past five the first time, that’s all right, she’ll still give birth vaginally, but we have extra midwives on call to bring fresh energy if the others get discouraged or tired. We plan for it to be like going to two births in a row. The point that the woman reached in her first birth is often a psychological hurdle for her. If she dilated to six centimeters the first time, the news that she is seven or eight will be a relief and a breakthrough. One of our clients, a minister’s wife, said over and over again in her pregnancy: “I just want to feel what pushing is. If I only get to push, I’ll be happy. I just want to know what other women mean when they say they had to push.” She’d had a Bandl’s ring in the first birth process and the cesarean was done at five centimeters. We were praying that the complication wouldn’t repeat. She dilated smoothly and began to push. With each push she would exclaim “Thank you Jesus, thank you Jesus!” What a wonder it was to watch her push out the baby, a girl whom she named Faith.

All humans have a certain propensity to self-sabotage, and the VBAC woman must be on guard against her own defeating patterns. The midwife must be bold in pointing out ways that the woman is repeating dumb moves—there’s no place for us being “nice” if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, she will be cautioned to keep her VBAC private.
Privacy and quiet are a must, and we will be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because this woman’s whole obstetrical future rides on its success.

Keeping a VBAC normal

We show the couple lots of videos of beautiful VBAC births because one video is worth a thousand words. If you don’t have your own, purchase a copy of my dvd “Birth with Gloria Lemay” which shows a beautiful VBAC waterbirth. Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to, “Draw your birth cave” or, “Color your birth.” When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.

I schedule longer appointments with VBAC women because they seem to need to obsess. I don’t have solutions to many of their fears but it seems to help to just be able to talk to someone who cares and understands. I usually also ask them to, “Tell me how you know that this time you’re going to have a vaginal birth?” The answers always amaze me. One woman said, “Because this time I’m not depending on my doctor or my midwives—me and my husband are going to have this baby.” I suggested that she give up depending on her husband, too. She looked terrified at that idea but I could see that she understood; she looked me in the eye and said, “Right!” That was the moment I knew she would do it. She’s had three water homebirth VBACs since then, and after each birth her first words were, “I did it.”

VBAC women are so grateful for the opportunity to birth normally that they are often shy to ask for the extra things that make a birth beautiful, such as a Blessingway ceremony or a waterbirth. The midwife must remember to offer and encourage the mother to think “really beautiful birth” rather than “bare minimum birth.” I find it helpful to ask, “This is the only second baby you will ever have—what would make it really special?”

The Day of the Birth

In my practice, no one gets induced in any way or gets pain medication. This policy is very important for all women but especially for VBAC women. If there is a small chance of uterine rupture, we must have everything on our side to prevent it (the rate of VBAC uterine rupture without induction is 0.4 percent or less than one in 200*). It is beyond my comprehension how anyone could give a VBAC woman misoprostol (Cytotec), oxytocin or castor oil or strip the membranes or use any other form of induction when that would triple her chance of having a uterine rupture.

I believe that VBAC women have longer, gentler births because Nature is compensating for the scar. There is no hurrying. I would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally. We keep it in the back of our heads that the signs of rupture are stabbing pain, unusual bleeding, decels of the baby’s heart, or a peculiar shape of the abdomen but we don’t look for problems if they don’t exist.

We are especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and we do not want to have a uterine prolapse caused by pulling.

Postpartum Differences

After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe it when we ask them to do sit-ups and leg raises on day one. Usually by day three when we go to visit, their husbands say, “Oh, she’s gone to the gym.” With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing.

In the years following the birth, these women and men send us more clients than anyone else, and if we’re in legal trouble, they’ll be at all the rallies, raise money, stamp the envelopes, write letters to legislators, and be our true friends for life. A VBAC is an amazing experience for the birth attendants as well as the family. Very Beautiful And Courageous (VBAC).

Q & A: VBAC

Two Types of Pelvises
by Gloria Lemay

Q: From a midwife: A great many Asian women are very small and small-footed, yet I hear that many of them birth vaginally. Would you comment on pelvic size?

A: When I get a VBAC client and she is endlessly self-psychoanalyzing and beating herself up for having a c-section, I usually say, “Look you made two big mistakes! First you were born in the wrong country, and second you were born in the wrong century—if you’d been born and raised l00 years ago in France, for instance, you would have given birth vaginally.” When I teach my workshops, I tell the students there are two types of pelvises in allopathic medicine: l) contracted, and 2) adequate. In midwifery, there are two types of pelvises as well: l) roomy, ample, and 2) you could get a pony through there!

Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada and a frequent contributor to Midwifery Today and The Birthkit.

Checking Your Own Cervix

Posted on September 23, 2014 by Gloria

How to Check Your Own Cervix- “it’s not rocket science”

“I think it’s a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm. Clean your hands well and make sure your fingernails are trimmed and rounded.

“The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet (or if that yoga is too difficult, put one foot up on the bathtub or a stool with your knee bent).

Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 fingerwidths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.

“What’s in the centre of that opening space is the membranes (bag of waters) that are covering the baby’s head and feel like a latex balloon filled with water. If you push on them a bit you’ll feel the baby’s head like a hard ball (as in baseball). If the waters have released you’ll feel the babe’s head directly.

“It is time for women to take back ownership of their bodies.”
-Gloria Lemay, Vancouver, BC

http://www.gentlebirth.org/archives/birth.html#Self-Checking

Update

One birthing woman who checked her own cervix described it like this: “I could feel my bag of water bulging down and then later the baby’s head once the waters broke- so cool.”
“How did I do it? I just reached up in all the way to the back and felt. It’s sort of awkward/difficult to reach but if you are familiar with what your cervix normally feels like, sort of like the tip of your nose, it gets shorter and stretchy. I felt it at like maybe 2 cm, about 6, which is when I could feel the bag, and then when it was time for baby to come. When the contractions were getting super intense I pushed a bit and that was enough to break my waters. Babe came shortly after.”
(shared with permission) 2014

New Thinking in OBGYN

Posted on August 6, 2014 by Gloria

Want to see the future in OBGYN? Just keep reading my blog. This morning’s email (2014) contained a newsletter that updates obstetricians on the latest trends. Some of which I wrote about in 2009 and 2011. Now, if we could just get these ideas into practice.

OBGYN Clinical Updates/ July 23, 2014 Analysis Questions Use of Antibiotics for Group B Strep During Labor
Do prophylactic antibiotics for group B strep do more harm than good? The practice of giving prophylactic antibiotics to women in labor who are positive for group B Streptococcus was based on studies with poor methodology, an analysis finds.
Gloria’s blog Sept 2011: https://wisewomanwayofbirth.com/group-b-strep-what-you-need-to-know/

OBGYN Clinical Updates/ July 23, 2014: Medicare Costs for Screening Mammos Have Soared: New Strategies Needed
Spending on screening mammography has increased 44% ($296 million) in 8 years, without a corresponding increased benefit of earlier detection of breast cancer. Analysts suggest this spending increase is unsustainable, and new screening strategies are needed.
Gloria’s blog 2009: https://wisewomanwayofbirth.com/seven-ways-to-reduce-unnecessary-medical-costs-right-now/

OBGYN Clinical updates/ July 23, 2014 POLL
Is the Pelvic Exam Important?
New recommendations against routine pelvic exams in adult women with no symptoms have been issued by the American College of Physicians. Many women will be happy to hear this. As a provider, are you?
Gloria’s blog 2009: https://wisewomanwayofbirth.com/7-tips-for-creating-a-calm-joyous-homebirth/

Just say “no” to stripping membranes.

Added to post April 10, 2015
AROM (Artificial Rupture of the Membranes) October 30, 2007
Vital Signs
Childbirth: Purposely Breaking Water Does Not Speed Delivery By NICHOLAS BAKALAR

http://www.nytimes.com/2007/10/30/health/research/30chil.html?_r=1&ref=health&pagewanted=print&oref=slogin

A large review of studies suggests that a common procedure in labor, intentionally breaking the water, has no effect in reducing the labor time or assuring the baby’s health.

The procedure, sometimes called amniotomy, involves rupturing the amniotic membranes to speed contractions. The procedure has been in use for at least
250 years, although its popularity has varied.

The researchers reviewed 14 randomized controlled trials involving almost
5,000 women and found little evidence for any benefits. Amniotomy did not shorten the length of labor, decrease the need for the labor-stimulating drug oxytocin, decrease pain, reduce the number of instrument-aided births or lead to serious maternal injury or death.

The report, published Oct. 17 in The Cochrane Reviews, did find that the procedure might be associated with an increase in Caesarean sections and a reduced risk of a lower reading on the Apgar scale, which rates the baby’s condition at birth. But neither finding was statistically significant.

“We advise women whose labors are progressing normally to request their waters be left intact,” said the lead author, Dr. Rebecca Smyth, a research associate at the University of Liverpool. “There is no evidence that leaving the waters intact causes any problems, and there is not sufficient evidence to suggest any benefit to either themselves or their baby.”

Polycythemia and the natural emergence of the placenta

Posted on May 27, 2014 by Gloria

I have only encountered it once in my career (over 1300 births plus lots of prenatal class parents, 35 years in the birth biz). The baby with polycythemia I worked with was very ill with it, she was hospitalized on Day 2 of life and had some blood removed which improved her condition right away. She remained in hospital for about 7 days. She had Down syndrome and polycythemia can be part of the presentation with Down. A very good friend who is also a doula has a daughter with Down Syndrome and her story is almost exactly the same as the baby girl in my practice i.e. polycythemia after a gentle homebirth which was treated well in hospital. Both these baby girls were discharged from hospital much faster than the medical professionals involved expected.

I am a believer in leaving the birth of the placenta for a full 30 minutes (or longer). If the placenta births before 30 minutes, it is rare, and it means that the mother pushed it out without any advice from me. In my work, the cord is clamped and cut only after the placenta is out. With the one exception of the girl with Down Syndrome, I do not see cases of polycythemia, jaundice or any of the other dire predictions that the medical profession warns about with leaving the cord to pulse until it stops naturally. Fear of polycythemia is no justification for continuing on with amputating the placenta prematurely. Waiting only two or three minutes to clamp the cord is still an assault on the baby.

Couple cutting cord after birth of placenta

Remember, scissors, hemostats and cord clamps have only been invented for a short time in human history. Before that, people waited till the placenta came out naturally before doing anything about the umbilical cord. When the baby is adjusting to life with the cord intact, the blood goes back and forth through the two arteries and one vein in the cord. . . it isn’t just going in to the baby from the placenta, it’s coming out, too, in correct balance for that baby’s anatomy. The placenta was trusted to sustain the well being of the baby in every way for nine months, I am certain that it’s okay to let it keep performing that function for another 30 minutes.

(This is a comment from Facebook that I made in response to a query about cord clamping. The women who birth at home are not induced, not medicated and receive no routine injection of pitocin after the birth. They are healthy women with full term babies, for the most part.) Gloria Lemay

Behold the Lilies of the Field

Posted on April 16, 2014 by Gloria

This is something that I posted to Facebook for a 9 day period while I enjoyed this bouquet and thought about how birthing women bloom when the time is right. I promised a long time ago to make the photos into a blog post, so here it is. Gloria

A bouquet of tightly closed lilies was purchased in the morning. The birth attendant left them alone for the day. No checks, no blood pressures, no heart tones were taken. One over-achiever dilated to fully with no coaching or support. A few of the others are dilated a fingertip (failure to progress after 12 hours), some are “unfavorable” and may never dilate. They certainly aren’t following the normal curve. We’ll wring our hands and wait to see how things look in the morning. 🙂

First day, one fully dilated

DAY 2 Two more have gone into the blooming process and have now dilated to 5 cms. Some signs of early ripening and an improved Bishop’s score for some of the others.

Day 2, slight progress

DAY 3 Stragglers and over achievers, all hanging out together.

Each in her own time

DAY 4 I noticed on this day that the water level in the vase had gone down. . these flowers know how to self-hydrate

Day 4 of the blooming process

DAY 5 There are 5 closed buds amongst all the exuberant fully opened flowers. They stand straight and unconcerned, knowing the Universe will open them when the time is right.

There are 5 closed buds

DAY 6
Only two remain undilated. The other ones that were closed yesterday are 5 cms, 3 cms, and fully dilated.

Only two remain undilated.

DAY 7 Another one opened overnight, only one left to dilate. The very first one that opened immediately on Day 1 is at the bottom of the bouquet and she’s looking a bit depressed now.
It was all I could do to hold myself back from interfering. . . I wanted to trim the stems, add clear cold water, fluff them up, trim off the stamens. Every time I went to do it, I could hear the women on Facebook, who were following the daily progress reports, shouting “Hands off!”

DAY 8 One lily remains closed but there is an almost imperceptible change going on if you compare to yesterday’s photo.

One lily remains closed

DAY 9 WooHoooo! The very last one is dilated to 7 cms! Can you see the last one at the very top of the bouquet?

They’ve all dilated!

She’s opening up in her own way and her own time. Every one of them knew when, how and with whom to do it.
Yes, they had an unassisted birth . . .even though they were cut off from their roots and photographed with a flash camera every day. . . . despite that, they dilated without fuss, muss or shenanigans.

The Herbal Bath

Posted on April 10, 2014 by Gloria

This is something I have had in my files for many years. I’m posting it for those who are interested. The only time I have prepared all these herbs, we had them “cooking” while the woman was in the birth process. She didn’t like the smell so we had to interrupt the process, take the big pot outside and get the house cleared of the smell. So, lesson learned, don’t do this during the birth. I’m not in agreement about the idea of getting a woman into a bath to stop excessive bleeding or the idea of opening the labia and swooshing bath water into a post partum vulva. Actually, there are lots of ideas in here that I don’t go along with but I thought you might like to read this handout from around 1985.

I’m sorry I don’t know the source of this to credit the author. Gloria Lemay

Beginning of the quote:

THE HERBAL BATH
This bath mixture should be prepared, strained and put together in a large container ready for the bath. Remember, this bath is also used as treatment for heavy bleeding, and must be ready for immediate use if necessary. A quart or two of strong shepherd’s purse and extra comfrey (fresh if possible) should be set aside for internal use and for adding to the bath if needed.

¼ C sea salt
1 ounce Uva Ursi
1-2 ounces Comfrey
½ – 1 ounce Shepherd’s Purse
1 large bulb fresh garlic

Have ready for emergency use:
2 quarts strong shepherd’s purse tea
2 quarts strong comfrey (fresh if possible)
1 qt. alum root tea, or alum crystals

Simmer the tea and let set for some time before straining. Simmer the tea leaves again to get their full benefit. If you have garden fresh comfrey, do not simmer—use raw. Whiz it in the blender, strain and add to the tea mixture in a large container. Whiz the fresh garlic, add this and the sea salt to the mixture. Cover, label and set aside. Add to the warm bath water when needed.

This herbal bath is highly recommended for every woman following childbirth. There is absolutely no danger of introducing an infection, if the baths are done correctly. The garlic and sea salt make the bath solution aseptic. Uva Ursi is a specific for healing a woman’s reproductive organs. Comfrey contains alantoin, a cell proliferant, which causes the edges of wounds to grow together. It is very healing and soothing. Shepherd’s purse is excellent for preventing and controlling excessive bleeding.

The bath should be taken shortly after the birth. If the placenta has not been expelled, and you would like to get in the bath, you may do so. When you feel a contraction coming on –squat over a bowl and push it out.

A warm bath to soothe after the birth.

The water should be comfortably warm, but not hot. The water should be about hip level. Lie back, spread your legs and swoosh the healing waters up inside the birth canal. Thirty minutes should be the minimum time in the bath. You will find the bath very soothing, relaxing and rejuvenating.
The baby should be put in this bath with you. The herb bath will start the healing process of the cord stump, and it may drop off as early as 3 days. In this bath, your baby will become mellow, and may even smile. He will unfold, stretch and float in the lovely weightless, warmness of the water. It’s wonderful to watch his pure joy at finding something so familiar and enjoyable in this new world. Caress and speak softly to him. He will love this communication, and will respond by total eye contact and facial expressions. When the infant is taken out of the bath, he should be patted dry, not rubbed. Dress him in soft, warm things. Put him to bed with you and let him cuddle up next to your warm body.

End of quoted material.

Low tech, non invasive ultrasound alternative

Posted on March 19, 2014 by Gloria

The original Baby Egg Pregnancy Countdown Calendar

This is a photo of my friend, Kelly, at a prenatal clinic visit. We took her picture so she could show her friends “See, even though I’m really big, I only have one baby in here!”

I bought this Baby Egg at a Midwifery Today Conference that I attended in Eugene, Oregon. I had to own it when I saw it. I discourage routine ultrasound and recommend that dopplers and imaging devices be kept well away from the developing fetus. I like to kid around with my clients and say “Okay, today we’re going to take a picture of the baby.” They look shocked because they’ve already heard me go on and on about NOT using ultrasound. Then, I bring out the Baby Egg and they get to see their baby actual size and there’s a cute caption on the back that describes what the baby is doing at that week of gestation. I take a photo of them with the egg, like this one, so they can send it to the grandparents or post to Facebook.

The Baby Egg retails for about $16 (U.S.) through Amazon. You can see some sample illustrations on their website at http://babyeggcalendar.com/

Courage

Posted on October 30, 2013 by Gloria

According to the Merriam-Webster dictionary, courage is a noun meaning ‘ability to overcome fear or despair” The fear has to be present in order for courage to exist. The English word “courage” is derived from the French word for the heart, “cour”. When someone finds the heart to continue on doing the right thing in the face of great fear, everyone around her is inspired to become a nobler human being. This is the source of courage for many midwives. In ourwork, we see women and men facing their fears in birth, we ask them to have faith in the face of no evidence, we demand that they be bigger than the circumstances and, when they conquer, we get a renewed vision of how life can look when our fears don’t stop us.

The paths of parenting and midwifery push me up against my fears and despairing attitude on a daily basis. Luckily, I have found teachers and teachings that have inspired me to keep going despite a rapidly beating hummingbird heart. When my daughters were very young and I was juggling my heart’s desire to be a good parent and make a difference in childbirth, one of my friends told me to use the affirmation “My vulnerability is my strength.” I thought she was insane and argued that if I lived by that slogan my children would surely perish. I was pretty sure that my strength was my strength—and by strength I meant my ability to force and push life to suit my will. I now know that true strength is an elusive quality of being able to strengthen others. At that time, I trusted my friend and, on faith in her alone, began toying with sharing my vulnerability. I tiptoed into revealing my fears and apprehensions to a few “safe” people and slowly began to realize that what my friend had given me as an affirmation worked a lot better than my stoic, stubborn, brave warrior act.

After a few harsh lessons, I began to realize that it wasn’t up to me to conceal information that was worrying me at a birth from the parents. In fact, if I am afraid at a birth, the best thing I can do is name the fear boldly and even ask everyone else present to say what his or her fears are. One of my dear clients released her membranes at 36 weeks in her second pregnancy. Her first birth had been a beautiful, straightforward home birth and I was deeply invested in her second birth being just as great. After four days of leaking, she began having regular, intense birthing sensations and we drove to the hospital for the birth. I drove and the parents were in the back seat of my car. As we approached the hospital, my hands on the wheel were clutched into white knuckles and a ball of fear formed in my gut. I started picturing the cord being whacked off immediately and the baby being taken away from Mom. I looked in the rear view mirror and saw the father with his eyes looking terrified. I said to him “What’s your biggest fear right now, Brian?” He replied, “I am afraid we’re going to have a Cesarean.” I never imagined this would be his fear. A cesarean was not even a possibility, I explained, “Your wife is in strong birthing, she has already had one vaginal birth, the baby is small—for sure it will be born vaginally”. He asked me, then, “What are you afraid of?” I told him honestly “ I’m afraid that the baby’s cord will be cut too quickly and the baby will be taken away from Karen.” This had not occurred to him but he knew that my experience was a better barometer of things to come. He asked me what we could do to prevent this. I was able to tell him that it was very important to take the doctor aside out in the hall and tell him “It means everything to my wife and I that the cord be left to pulse and that the baby be placed on her skin until the placenta comes out.” We did a couple of “dress rehearsals” of what had to be said and then went in. The staff at the hospital respected the parents’ wishes to have the cord left intact. The birth went beautifully. I would have wished that the baby didn’t have as heavy doses of antibiotics as he was given (with resulting colic for months) but having a birth that involved no induction or anesthetics was a big accomplishment in these circumstances.

Nancy Wainer, author, midwife

There was a period in my career when I was unable to divest myself of fear and dread. I wanted to have a breakthrough and so I decided to “import” some courage into my city. I thought about my heroes in the midwifery movement and asked myself “Whose the bravest person I know?” The answer was, of course, Nancy Wainer Cohen. Her book “Silent Knife” had kept my feet in the room at VBAC births where every cell in my body had been screaming “What the h— are you doing here?!!” I was pretty sure that if Nancy came and lived at my house for a few days, I could get some courage. My husband picked Nancy up at the airport and she came into my house and hugged me wracking with sobs. She cried her way through several boxes of Kleenex at the workshop she taught for my students. Her visit was four days of snot, tears and intense passion for healing birth. I learned so much about the vulnerability and strength connection. Nancy is still my hero in the courage department and she continues to live her life with her heart pinned right on her sleeve.

The sharing other midwives have done about their fears has strengthened me to face my fears of birth One midwife wrote in Midwifery Today that “the drive to the birth with all the “what ifs” running through my head is the hard part, when I walk through the door and see the woman, all that disappears”. Another midwife told me “The scariest thing for me is the first prenatal class of a series. Meeting new people who have so much riding on my teaching is enough to give me an ulcer.” An acronym for fear is:

F= false
E= evidence
A= appearing
R= real

When I am most afraid, it is because I have forgotten the truth about how loved and blessed I am. The fear can dominate and stop me or it can be used to alert me to something to which I am deeply committed. Using a journal to write out fears in the morning helps to clear the mind. Once the fears are on paper, somehow they seem less foreboding. Being in action is another antidote to the paralysis that accompanies fear. Any action—cleaning your desk, organizing a drawer, making a phone call—will bring a new perspective and lessen the dread.

My favorite philosopher about fear and courage is the Wizard of Oz speaking to the cowardly lion “Courage is doing what’s right even though you’re afraid.” I have learned courage from birthing women and other midwives. We are there to inspire and raise the bar for each other on what’s possible in the domain of courageous action.
This article by Gloria Lemay was written in 2003 and first published in Midwifery Today, Issue 67, Autumn 2003

New live, online classes on April 11, 2013

Posted on March 19, 2013 by Gloria

Questionnaire for Birth Professionals

Posted on February 15, 2013 by Gloria

Questionnaire for birth professionals (self awareness)

Ask yourself the question and then write down the answer(s) that pop into your head. Don’t figure it out. There are no right or wrong answers. What pops into your head may open up some awareness of your subconscious fear of birth.

1. With regard to having babies, what my mother said is_______________________________
2. With regard to having babies, what my father said is_________________________________
3. With regard to having babies, what I learned in school is _____________________________
4. With regard to my clients, what I have done that doesn’t meet my standards is ____________________________________________________________________
5. With regard to my birth practice, what I would be willing to forgive myself for is _____________________________________________________________________
6. With regard to pregnancy/birth, my biggest fear is________________________________________________________
7. How I feel when I’m standing in the lobby of a hospital is ______________________________
8. What I know about my own birth is_______________________________________________
9. If I could go back to the womb and re-create my own birth experience, I would: (write out all the elements of your fantasy ideal birth)
10. If I had beautiful, ecstatic births happening in my practice, who might be wrong? Who might be upset?
11. Some ways that I could be nicer to myself are _________________________________________

Wise Woman Way of Birth

Gloria Lemay on natural birth, breastfeeding, and other womanly matters

Category Archives: Holistic midwifery & doula education