According to doula and DONA founder, Penny Simkin, "A birth is said to be traumatic when the individual ([birthing person, partner], or other witness (8)) believes the [birthing person's] or [their] baby’s life was in danger, or that a serious threat to the [birthing person's or their] baby’s physical or emotional integrity existed." Between 25 and 34% of people describe their births as being traumatic (Simkin). Risk factors associated with the perception of birth as traumatic include unexpected complications, unwanted routine interventions, lack of understanding or agreement over reasons for intervention, loss of control over sensations, perceived poor treatment, lack of respect, and lack of communication from staff, poor family support, personal defeat, and profound opposite of expectations. There are some factors that one can only, at best, hope to mitigate with support. Yet there are other factors over which providers have a profound impact - such as reducing the perception of poor treatment, thoroughly communicating with the laboring person and support people, and ensuring complete respect for the person and their legal right to informed consent and/or informed refusal. The intersectionality of racism, classism, sexism, and paternalism that occurs in childbirth is the perfect storm for a traumatic experience.
From April Dawn Reigart, Integrative Nutrition Health Coach:
"I still live with the trauma of my birth/almost dying. I still have night terrors. And I still struggle."
When someone is opening themselves up to a partner for the first time, what would they need to do feel most comfortable, confident, and in control throughout the experience? The list could be quite long but guaranteed it would include a partner that is patient, understanding of the wide variation of normal in the body's appearance and in the primal responses that are results of physical sensation, and respectful of the importance of ongoing consent and the boundaries set along the way. Respect may come in the form of communication, intuition, and a willingness to be flexible and adjust as necessary. These same things that someone needs to feel empowered and excited and positive about their first sexual experience are the things someone needs to feel empowered and excited and positive about their first (or second or third or fourth...) birth experience.
People of color birthing in the United States have a three to four times higher perinatal mortality rate than non-Hispanic white women (and 12 times higher in New York City). Neel T. Shah, assistant professor of obstetrics and gynecology at Harvard Medical School, obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston, and Director of the Delivery Decisions Initiative at Ariadne Labs, has pointed out that the maternal mortality rate for women of color is not only due to a lack of resources but is also due to the lived experience of being a person of color. He has cited the perpetuation of myths in obstetrics surrounding the perception of pain among women of color as being largely responsible for the mistreatment and subsequent greater morbidity and mortality among black women in the United States (Deborah Kuhn McGregor's book "From Midwives to Medicine: The Birth of American Gynecology" details the early days of obstetrics and its origins in brutality towards women of color and immigrants.) It is well understood that black women die at a higher rate in childbirth regardless of education, income, social standing, profession, or prenatal education (Lost Mothers). The racism, however subtle or pronounced, that people of color experience on a daily basis increases the likelihood of pregnancy-related complications. According to an article by Theresa Chalhoub, senior policy analyst for the Women's Health and Rights Program, and Kelly Rimar, women's health and rights intern, both at the Center for American Progress, "Racial disparities in risk factors related to pregnancy—such as hypertension, anemia, and gestational diabetes—exist and are exacerbated by stress related to racial inequality and often inadequate health care, which is not in tune with African American women’s needs." The increased nervous system response to moments of stress, fear, or discrimination, a biologically intended protective mechanism similar to "fight or flight", can prove debilitating when this increased response is happening on a frequent basis and the effects accumulate over many years. According to the documentary, "Expecting Possibility, "Stress is linked to one of the most common and consequential pregnancy complications, preterm birth." Black infants are twice as likely to die as white infants, a greater racial disparity in infant mortality than in the year 1850 (Villarosa). In addition, a 2016 study done by the University of Virginia found that "White medical students and residents often believed biological myths about racial differences in patients, including that Black patients have less-sensitive nerve endings and thicker skin than their White counterparts.” Reading this, especially as a black person preparing to give birth, may feel especially discouraging and frightening. However, there are ways to help mitigate the consequences of this reality and alter the course of a pregnancy, birth, and parenting experience.
How does someone - anyone - up against such hard truths as these create an environment in which they maximize their health and minimize the effects of daily stress? Focusing on the aspects of care that one can control is a crucial part of mitigating the effects of stress. According to Miriam Zoila Perez, doula turned journalist, some ways to reduce the effects of stress in pregnancy include having a strong social network, prioritizing health and nourishment, asking for help when it is needed, talking through events that increase stress response, and daily meditation. Family, friends, and community can provide an outlet to discuss daily occurrences, surrounding oneself with love and fellowship, and decreasing the release of stress hormones in favor of increasing feel good hormones. Utilizing resources such as childbirth education classes, community doula programs, and infant care and postpartum preparation classes can decrease anxiety specifically surrounding pregnancy and parenting and help build networks of support throughout the childbearing year.
It is important to recognize, however, that the root of racial bias and its effects on reproductive care are systemic and responsibility must be taken by the greater culture of white privilege and by those within the system that are perpetuating myth and providing unequal care - whether knowingly or inadvertently. According to Shah, "The common thread is that when black women expressed concern about their symptoms, clinicians were more delayed and seemed to believe them less." To truly reverse the trend of abhorrent mortality rates among people of color, the implicit bias, the racial stereotyping, and the paternalism that infiltrates daily life and reproductive care must be addressed. As Natalie Krichten, Pittsburgh based doula and owner of Growing Love Birth Services, suggests in her essay "Self Care and White Privilege," looking to leaders in communities of color whom are already doing the work of combating unjust care and empowering individuals may help a Eurocentric birth world to become a safe place for all whom are birthing in the U.S. Supporting businesses owned by people of color, spreading awareness about events such as the Black and Brown Maternal Health Fair being held June 8th 2019 at the Kingsessing Recreation Center, and connecting birthing people of color to health and wellness resources run by people of color can help to increase access to care, mitigate stress, and decrease morbidity rates. In an article written for Patient Safety and Quality Healthcare, author Megan Headley discusses the Maternal CARE Act proposed by senator Kamala Harris which provides grant money to the development of evidence based implicit bias training for health care workers, with a priority on OB/GYNs. The bill proposed by Harris also requests that the "National Academy of Medicine complete a study in bias recognition, with the goal of developing recommendations within three years for rolling out bias training to all medical schools and health programs" (Headley).
From Pittsburgh birth worker Natalia Krichten, owner of Growing Love Birth Services:
"...in July of this year I started to work through Layla F. Saad’s “Me & White Supremacy challenge” (workbook currently available on her website & I cannot recommend it enough!) & I realized my work had been largely based on white exceptionalism & savorism, that I often responded with white fragility when called out, that I had done harm when I hadn’t meant to, & that the way I viewed my life & business needed to dramatically change. So I listened, I followed more BIPOC leaders already doing the work I thought I had the right to do, & I learned to fall into my lane."
From Iris Kimbrough, CLC, Doula, and founder of Phoenix Rising Birth Works:
During my postpartum checkup after the birth of my middle child, the doctor asked my plans for contraception. I stated that I don’t use conventional contraception. I have chosen to chart my cycle and abstain when ovulating unless I’m trying to conceive. He sneered and said “Well, how well is that working for you?” “I assume very well as my children are 7 years apart”, was my response. He didn’t have much to say about anything after that! It never ceases to amaze me how so many medical professionals refuse to acknowledge our ability to learn, listen to and work with our bodies. Shouldn’t a big piece of their job be helping and encouraging us to do so?
From clan homemaker, idea cultivator, and tea drinker, based in Northeast Philadelphia, frequenting cafes and kitchen tables, beaches, and distant shores:
I have a history of pelvic issues. In between and around my pregnancies I tried to sort out and isolate symptoms and causes. One doctor suggested an exploratory procedure, which would require being under anesthesia, but which would allow them to gain a more thorough sense of my reproductive system, without extreme physical discomfort. Considering a basic pelvic exam is not tolerable, this seemed like a sensible option to gain answers and to be able to move forward with treatment options. After the procedure, at the follow-up session, the doctor casually mentioned that they had also performed a D&C. I thought I had misheard the doctor; it certainly wasn't mentioned in advance or planned and certainly wasn't the reason for my visit. When I questioned the doctor, I was told that it was something that was done while I was under, 'as a bonus, just to reset my system and clean things out a bit'. I remember going numb, and feeling like the walls were closing in, and wondering how it was possible that that was allowed, let alone presented like a reward and mentioned so flippantly.
Childbirth educators offer a unique opportunity to provide support and information to pregnant adolescents in a non-clinical environment. However, the role of a childbirth educator working with teens is much different - due to the unique needs of the adolescent group - than when working with adult pregnancy. Training in challenges unique to adolescent pregnancy as well as training in the developmental needs of teens can help educators provide appropriate and useful services. Utilizing community spaces such as churches within communities (as opposed to classes held in a hospital or clinic setting) or schools can alleviate the burden of transportation that often prevents young people from accessing resources. Due to financial constraints, municipal budgeting that includes childbirth education for teens could help offset the costs of the educator and allow the pregnant people to access care more easily. Community programs such as Maternity Care Coalition offer free resources including classes and doula support to low income families and teens across the Southeastern Pennsylvania area. Knowledge of health risks unique to youth (such as greater effects of peer pressure and social status) and the physical effects of metabolic changes in the adolescent body on pregnancy (such as increased likelihood of toxemia) need to be addressed by educators. Simply creating a safe space for adolescents to talk about their experiences and have a facilitator listen can make a world of difference for everyone involved. Educators are able to gain insight into the unique challenges teens face and the participants are able to find autonomy in expressing themselves and using their voice (which is great practice for utilizing their voice in their labor process and onward in parenting and life).
From Ashley, mother:
...my birth experience would not have been the same without the things [birth class] taught us...I was able to manage my pain in a way I didn’t know possible. I almost managed a little too well, when I was admitted I was already 8 to 9cm dilated and was being applauded by the nurses, midwives, and doctors around me. I also was lucky enough to have a husband who stood up for me and the things that were important to us - he insisted I be put on my hands and knees for delivery. In the end, I spent just seven hours in labor at the hospital and a mere one hour pushing, on all fours, my sweet baby out.
Sometimes the pressure to make certain choices is overt yet more often it is subtle. Horizontal violence is a term used to describe the abuse or violence that workers on the same level of hierarchy inflict upon each other. This reality among nurses is explored in depth in the Evidence Based Birth podcast "Why It's So Hard to Get Evidence Based Care." This term, however, is just as applicable to the way that women interact with other women. The patriarchal system in which we have all evolved from the time of the agricultural revolution 10,000 years ago, sets women against other women. Before a level of trust or intimacy is reached (if it is at all), a subconscious need to create feelings of inadequacy or "less than" in other women often prevails. (I also want to point out here that this is a learned behavior and completely open to adjustment. This is an opportunity to take a moment to reflect, to not act on impulse, and to address one's own insecurities before projecting them on someone else.) In "Women Who Hate Other Women: The Psychological Root of Snarky," Doctor of Psychology, Seth Myers, explores the idea of female criticism stemming from feelings of inadequacy in an area of life they highly value. Traumatic birth has been defined by people birthing not feeling listened to or supported in their choices by their providers and sometimes this is as simple as a nurse doubting, questioning, or negating the laboring person's choices because it differs from the standard of care they are used to providing within the setting.
From Tonya, mother:
Initially when I said I wanted no drugs/interventions, our nurse said 95% of women that say that end up getting the epidural. There was another point when I thought my contractions were getting closer together. She said it looked like they jumped from 4 minutes apart to 2 minutes apart but that they were sporadic so nothing was actually happening or going to happen until they were consistent. In reality, I jumped from 4cm to 7cm within the next hour. I understand she was probably only speaking from experience.
When birthing in the United States health system, the policies set by the hospital (lawyers and insurance companies) do not always match up with the recommendations of research. Research has found that a lag of ten to 20 years exists in hospital policy meeting research-based recommendations. This translates into commonplace or routine interventions that serve the majority of people in a certain setting but may not serve those whom are birthing differently. For example, intravenous (IV) fluids are routinely administered in most hospitals in the United States. IV fluids have some benefits including preventing a steep drop in blood pressure that can arise when an epidural is administered and raising amniotic fluid levels. There are also drawbacks to routine fluids including dilution of oxytocin in the blood stream (potentially slowing down labor and leading to augmentation) and fluid accumulation causing babies to be born at a higher birth weight (due to excess fluid) than they would be otherwise which can lead to what appears to be an excessive weight loss in the newborn after birth (which can then wind up affecting the support someone has in breastfeeding). In hospitals with a 90% epidural rate, the vast majority of clients will benefit from the administration of the fluids. However, for someone whom is choosing to birth without an epidural, the risks may outweigh the benefits. This sets a person up to either have to begin advocating for what they want from the time they arrive at the hospital (which engages the neocortex and can slow the labor process) or to succumb to routine procedures that have the potential to affect their labor and they way they perceive their participation in the decision making process.
From Tammy Bradshaw, mother, professional photographer, owner of Tammy Bradshaw Photography:
We preserve so many of our most treasured memories with photos and the births of our children should be no different. The minutes and hours before, during, and after birth are filled with emotions and details that are often difficult to put into words. Photographs serve to document those moments and make sure that our stories live on.
"Photography and filming during delivery is permitted only with the authorization of the mother and staff members involved in the delivery."
After a few more lines of additional reminders as to who can and cannot give authorization, another line reads:
"If there is concern that photos or videos have been taken without permission, security will be contacted. Security has the right to confiscate the recording device and erase any unauthorized photo or film."
Photography of labor and birth can be an amazing reminder of the power of the body and the intensity of the birthing process (a recording that, of course, some people want to treasure and of which others do not want a reminder). Support people - family, friends, and doulas - may be the ones snapping pictures (with consent of the laboring person) while some people hire a professional photographer to document the experience. Because hospital policy leaves the authorization of photography up to the staff at the birth and with most birthing people utilizing a large practice of providers, it is unknown whom will be there during labor, it's common to not know how documentation will be received until someone actually comes in to the birth place ready to have their baby. Some providers are comfortable with still photography but draw the line at recording the moment of birth (or video recordings, period, in some cases). Recording on phones often leaves one unaware as to whether the documentation is still or video so many providers flat out refuse to allow pictures at the moments just before, during, and after birth. The concern here, for providers, is liability. Yet the concern for parents is that they are being forced to relinquish visual mementos from their child's entrance into the world (and the incredible expressions captured on the faces of loved ones as the baby emerges).
From Rachel Utain-Evans, mother, birth photographer and videographer, owner of Rachel Utain-Evans Photography:
I'm never sure how I'm going to be received at any particular moment during a hospital birth. Getting permission at a hospital birth is a moving target and hard to get in advance; it can depend on whomever is in charge for that shift or in the room at the time, policies on what may and may not be photographed and how strictly they're enforced, the number of support people allowed in the room, and how hard the parents want or can advocate for in the moment having their birth documented. The obvious difference documenting at a hospital birth [than a homebirth] is that the permission is coming from the hospital and they can dictate moments or body parts that are off limits, even if the birthing person has clearly expressed how they wish to have their delivery documented.
I had the epidural and I was pushing on my back. I knew it wasn't the best position so I told my midwife I wanted to change. She said "Well you could get on your side." After I did that and found it uncomfortable and more challenging to push in, she helped me get back into a lying down position. That was the end of the discussion about other birthing positions. Maybe I should have suggested other things but I got the feeling nothing else would be considered.
From Philadelphia birth worker Jenna Brown, owner of Love Over Fear Wellness and Birth:
Even in 2018, the majority of medical professionals in perinatal spaces expect to be met with a cisheteronormative parenting dyad - “mom” and “dad.” Which not only erases queer identities and families but steals the freedom to self-identify of all people navigating these spaces.
We are in an interesting space in time right now as there is a greater awareness of the ways that people identify and general encouragement to respect people's gender and relationship identity. However, there is a pushback against this inclusion that is furthered by some facets of the midwifery, childbirth education, and doula community. Organizations that certify birth workers yet refuse to change their language - or even simply add language - to their training sessions and manuals enforce a profound disrespect for those whom are birthing that don't identify as women and/or mothers and also risk alienating those whom do identify as women and/or mothers yet embrace the need to include all birthing people. The language used in trainings offers an opportunity to educate new birth workers in an inclusive approach to working with clients that can then be tailored to the needs of the individual with whom they are supporting. When organizations refuse to use inclusive language, it is a direct refusal to stand by all those whom are birthing and a dissonance is formed that only serves to propel fair, just, and informed care for some but not all.
The refusal of many organizations to include language and appropriate care for those whom do not identify as women and/or mothers has been a catalyst for those whom are embracing reproductive justice for all. "Birth for Every Body" is an online resource for gender and birth and is geared for both patients and providers and includes some trainings that can be used for CEUs. This website was created by midwives in response to midwifery organizations refusal to acknowledge trans inclusive language and training. The online presence of such an easy to access and easy to navigate resource that presents information to both expectant people and professionals offers an opportunity to both find inclusive care providers and find resources in inclusive care training. There are also many birth workers whom are offering trainings to clinical and non-clinical birth professionals (and other businesses as well!) on gender inclusive practices in the workplace, in client/provider relationships, and in registration and intake forms. A few people local to Philadelphia that are offering LGBTQIA community education include Ray Rachlin, LM, CPM, CLC and Jenna Brown, birth doula. The argument for resistance to use birthing terms appropriate for all (or even incorporating those words into the common birthing language) is often that it feels like an attempt to erase "woman" from birth. It is understandable to the extent that "women" have, and continue to be, viewed as a second class group of people in the social structure (one only needs to look at pay disparity, balance of work inside and outside the home, and the horizontal violence between one another to begin to see the social impact of this) and to own and claim the world of birthing as that of the woman allows ownership of something that no one can "take away." However, the reality is that people who do not identify as woman do also give birth so to deny that is just simply unrealistic (and far more complex as well). If someone lives their life as a man or as a non-binary person, refers to themself as a man or non-binary person, and chooses to use their internal organs to carry and birth a child, why should that person be referred to as anyone other than whom they identify? If someone is concerned about the "womanly" world of birth being taken away from them, one need look no further than the fall of midwifery and rise of obstetrics in American history (in which a long cultural history of midwifery - both within communities of color relying on "granny midwives" and communities relying on European midwives was annihilated by an overwhelmingly patriarchal system of medicalization of childbirth). Those running group trainings or sessions can ask for the pronouns of those attending, can use language to reflect and include all birthing people yet can also, when appropriate in situations where the gender identification of people is known, be more specific. The eradication of "woman" and "mother" from pregnancy and birth is not at stake here; it is simply being expanded so that all birthing people get the respect all people deserve.
From Jodi Silberstein, Doula:
The organization I trained with made it clear that if I wanted to use inclusive language in my own doula practice, I could, but they had no intention of including it in any formal training setting. They argued that as an international organization, they were working within other countries who were nowhere near ready to use inclusive language, and they feared the neutrality of it would weaken the women’s movement.
Whether adequate prenatal care specifically improves outcomes depends on the factors being assessed under the heading of "outcomes." Outcome could be assessed as physical health of the birthing person, physical health of the baby, emotional well-being in the postpartum, satisfaction with birth outcome, feelings of support during the perinatal period, access to additional community resources, and more. The review mentioned above cites the limitations in assessing only the most basic definition of "outcome" - maternal and infant morbidity and mortality. In the documentary "Why Not Home?," it is suggested that free access to prenatal care - such as the care provided at The Easy Access Clinic, founded by CPM Jennie Joseph - may improve birth outcomes because it may increase interest in midwifery care and out of hospital birth. The Easy Access Clinic, located in Central Florida, is based on the belief that everyone deserves access to quality medical care. They accept insurance (including Medicaid), they offer sliding scale payment, and they don't turn anyone away for lack of ability to pay. The clinic has had amazing statistics for demographics commonly marginalized in the larger reproductive health system. The adherence to principles including but not limited to freedom of choice, easy access, self reliance, and education, part of an approach Joseph has created called "The JJ Way", have improved birth outcomes, while the personalized social support that can come from care without any fear attached helps to create positive pregnancy and birth experiences. The outcome of providers and organizations coming together in hopes of addressing and remedying this disparity in access to prenatal care has the ability to address the continuum of support for families that is a break in the full spectrum of adequate health care.
Less than 10% of births in the United States are attended by midwives and just slightly more than 1% take place outside of a hospital (according to statistics from 2013, 64.4% of the 1.4% of out of hospital births took place at home and 30.2% of the 1.4% took place in a freestanding birth center) (CDC). There are only about 350 freestanding birth centers nation wide (with two available right here in the greater Philadelphia area!). Greater government support of midwifery care could increase the availability of birth centers and therefore increase access to midwifery based care. Despite a study of over 16,000 people that showed planned homebirth to be as safe as planned hospital birth (Cheyney), the lack of financial coverage by insurance makes homebirth out of reach for many people. It is easier for someone to pay a $1000 deductible for a $13,000 uncomplicated vaginal birth in a hospital than it is for someone to pay $4000 to $7000 out of pocket for an uncomplicated homebirth. Although midwives are covered by Medicaid under the Affordable Care Act, private insurers may not cover midwifery care. Greater insurance coverage may lead to greater access to midwifery care, which is an important component of reducing morbidity and mortality, reducing health care costs, and providing more supportive care for normal birth.
The disjointed care system - the lack of collaboration between obstetricans and midwives - leave many birthing people having to choose between one or the other. Birth centers have the support of a back-up hospital but often give up a significant amount of autonomy when the transfer of care to a hospital takes place. Clients become subject to the policies of this new birthing place and the birth center provider has very little leeway when it comes to individualized care in that setting. If a low risk pregnant person chooses to birth at home under the care of a skilled midwife and it is decided in labor that a transfer to the hospital is safest, many people transfer to the closest hospital. When the midwife has not been integrated into the larger system of care, the transfer can be quite stressful. "If midwives were allowed to work alongside other providers, patients would get the care advantages, and if difficulties arose, a woman whose home birth suddenly became complicated could be seamlessly transferred to a hospital" (Editors) A study that looked at the integration of midwifery care from state to state in the U.S. found that states that ranked best (defined by having fewer preterm births, underweight newborns, and cesarean birth) had licensing requirements for different types of midwives, gave midwives the ability to care for people in different settings, write prescriptions, and receive payments from Medicaid (Vedam). In an article published by Reuters, lead study author Saraswathi Vedam stated, "The question is not whether it is better to have a midwife or a doctor, but the degree to which midwives and doctors are able to work together to provide the best care utilizing all of their expertise and abilities." This perspective reflects one of the Common Ground Statements from the The Home Birth Summit Collaboration Task Force, a group of national reproductive care leaders including physicians, midwives, researchers, health administrators, payors, policymakers, and consumers that have come together to improve maternity care in the U.S. in all settings. The Common Ground Statement reads:
"We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits."
I chose the larger birth center practice... because of the number of midwives and availability to deliver at the birth center. Well things did not go as planned and during my last checkup there were some hiccups so I was told to go over to the hospital. Right away there was miscommunication between the birth center staff and hospital staff. You could sense that the relationship between the two were not solidified... Within one hour I was told I would have to have a c section, transferred to the hospital, only to get there and have the doc on call clear me... I was left with many questions and a disconnect between myself and the practice.
From homebirth midwife Christy Santoro, CPM:
As a homebirth midwife, I've learned how to best to prepare my clients for the potential of a transfer and what to expect while still keeping the overall focus and energy on the most likely outcome of a healthy birth and baby at home. We discuss that while they certainly retain their rights at a patient, if we are going to the hospital from a planned homebirth, then we clearly need some of the tools and expertise that setting has to offer. We prioritize which birthing preferences and hopes I should focus on to advocate for and support if we had to shift to Plan B and head to the hospital.
Because community midwifery care is based in relationship and trust, when a family knows their midwife can remain a part of the care team (albeit in a different role) when they go to the hospital, it really helps them feel safe and comfortable and that in turn benefits everyone--the family, the hospital staff and the community midwife too!
From mother, Alison:
I think there’s very little postpartum support for women who have had c sections and inadequate screening for PPD/PPA. I also think there is probably over prescribing of opioids for women who have c sections, which as a health professional I also find to be really concerning.
Prenatal infant care and postpartum wellness classes offer parents an opportunity to explore the realities of life with a newborn and prepare in advance for the support they may need. Classes often cover the myths and realities of expectations of newborn behavior, feeding patterns, and sleep in the first six weeks or so after birth and go over the basics of caring for a baby. Postpartum wellness classes include information about the hormonal ups and downs of the postpartum period, the physical and emotional needs of both new parents, and tips for easing the transition into a new family dynamic. These classes are often offered by childbirth educators and/or doulas and may be part of a childbirth class series or an additional class option.
The importance of birth is not only in the birth itself but is truly in the understanding that labor is the starting point for a much larger transformational journey. When that journey begins and proceeds in a positive and supported and informed way, it's like beginning a long trek through uncharted territory with an up to date map and a lot of knowledge of the flora and fauna, and echo of the words of wisdom from those whom have successfully made their own treks before. In contrast, when that journey begins in fear and anxiety and with little information, it's the equivalent of beginning a trek after a night without sleep, when your map has spilled coffee on it, and you don't know a single person whom has ever journeyed in this way before, all the while you have a nagging feeling that some sort of animal is tracking you but you can't quite place it's location. When the supporters of birth and the transformation of parenting have the opportunity to provide solace, to build confidence, to encourage someone to claim their autonomy in their journey, it is that support person's innate responsibility to embrace that opportunity. The need to constantly reevaluate oneself and one's practice for the greater good can only arise when we break free of the conventions that hold us down and face the uncertainty of giving ourselves to one another without greater agenda. In offering that, we rise up together and make change.
*Thank you to Jenna Brown, doula and founder of Love Over Fear Wellness and Birth, for their guidance and editing assistance.*
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