On births in this time of crisis


I just wanted to write a bit on and in reaction to some of the things I am seeing in social media, and counter it with some ways to process all the unknowns.


Anyone who has sat in the office with me has likely heard me ramble on about Birth Culture, a set of words I learned about from my time with Birthing From Within. In their model they talk about many concepts that I have woven deeply into my practice model. The first I want to review is recognizing that we all come to our pregnancies with information that we have collected through out our whole lives, either intentionally or passively. For example, if we were told birth is terrifying and dangerous, we will be scared and worried about our health when pregnant. Alternatively, if we were told that birth could be empowering and beautiful, you may see pregnancy as an opportunity to be strong and lean into the trust of your body and your local care providers and system (as I was by my mother due to the system of support she had in Holland when she gave birth to my older sister compared to the birth she had 16 years earlier in the US as a single teenage mother).


I have taken this concept one step further to look at the births and stories that women carry with them into my office, or more often, the stories they hope to soon have. Birth Culture is a term that I came up with when speaking with women with prior birth experiences in regards to what happened at the time of their care, at the location where they were, with the providers that were there, with the information we had at that time. If we change any of those variables, the culture is totally different. Each birth can only be experienced in the moment where it occurs, it can’t be compared to prior births, or births you saw or hoped to have.


For example, when I was an L&D nurse in 2004, some evidence based and progressive hospitals were re-allowing vaginal births after cesarean (VBACs) after many years of being “disallowed” due to the previously assumed statemen “once a cesarean always a cesarean”. However, it was determined that those babies deserved continuous fetal monitoring to ensure their safety. That meant that women had to sit in bed for their labor and birth, or maybe stand at their bed side, but hooked up to many wires that were only 3-4 feet long. These caring, but restrictive practices may have resulted in a far harder way to give birth, decreasing ones likelihood of a vaginal delivery. In those same facilities in 2010, we had monitors that are were telemetry based, so women could walk the halls, stand in the shower, bounce on yoga balls, you name it. Both situations were using evidence-based care, and the latest technology, but are vastly different. Women were laboring with many similar variables, but very different situations, hence, a totally different birth culture.


In steps another concept that I got from Birthing From Within, which they call “the birth fairy” and I call “the backpack for the hike of birth.” They suggest that she is with us at every birth, whether invited or not, and she can step in and mess with our plan. We can’t control her, we just need to accept her presence and accept the shifts that come with the wave of her wand.


In typical prenatal care I talk often of packing your imaginary bag for the birth you hope for. In that bag we put things like the info we got from reading, classes, supportive words from friends, trust in our bodies, our providers and our baby. We put in vital signs on mom and babe as well as lab results and ultrasound images. We also pack our mother’s worries for us, the opinions of our co-workers and the recent article or study published in a journal we just read. We even pack a bit for the midwife and staff, like memories of their recent births, maps to the closest hospitals, their skills and supplies.

This analogy can be used and manipulated in many ways, just like the fairy. We can pack too much in our bag, making it too heavy to carry. We can pack things we never needed or discovered we didn’t need or like (a music list we never got to, soaking in the tub and finding that you don’t like how it feels.) We can under back it and accidently leave out the cards of affirmation to pull us through some hard contractions. So, like in a time where we packed a backpack to climb our local well known and loved trail, but then got stuck in a rain storm, or some how end up on a path that you totally didn’t plan to visit in the first place, we need to stop, empty our bag and re-pack it with new and more useful gear (obviously, when on the trail, we don’t have new supplies to pick from, but bear with me here).

Do you see where I am going with this?


Right now, in early 2020, we are in a totally different place than we were a week ago, 3 months ago or a year ago. We are in a medical and social crisis like no other in our lifetime. And for this reason, we need to have an open heart to what this may mean for your birth. We need to acknowledge that the culture of birth has made a tremendous shift in the last weeks. We have new limitations to what we can do, and new variables to take into account. I find myself packing and re-packing my backpack many times a day, both as a mom and as a midwife. I can’t fit all the supplies needed in one backpack at all times, sometimes things are spilling over, so I dump it all out, re-evaluate and repack.


My heart goes out to women who can’t bring their doula to their birth, who can’t share their birth with their dear friend who was going to be their labor support. For women who are being limited in care options with their providers, being turned away from prenatal visits, access to education and care, ultrasounds and labs. I hear that some women are even being separated from their babies for extended times at birth, something that hasn’t been part of our birth culture in decades. But here we are, in unprecedented times, and from day to day, the culture and our backpacks are changing, both your birth backpack and the backpack of the health care system in response to this pandemic.



So here is my last piece of advice, again a very visual idea. Take two bowls, or cups or your two hands hands. In one, either actually or visually, place the worries, questions and ideas that you have control over. These may be to remember to use your breath to stay calm, being kind to your body with movement and careful food choices when possible, paying attention to the movement of your baby, rest and so on. And in the other side, put the things you cannot control, and at this time, that list may be long. Things such as the pandemic, the status of your local hospital in regards to staffing and supplies, the worry of your family, your due date, your geographical place in the world, your medical history and so on. Now that all the variables are separated into these two piles, give rest to the things you cannot change, and put your focus and energy into the things you can. It is in the things that you can change where you will find flexibility, grace, forgiveness and empowerment.