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Fathers at Birth by Rose St. John

I love this book for many reasons and recommend it to families all the time.  It is useful not only for partners but for doulas and anyone else attending a woman in labor.  There were many important parts that I thought we should discuss but I tried to limit the discussion because I know we are all pressed for time.  If I missed anything you would like to bring up please feel free to do so…again-let’s have fun!

In the book Rose St. John talks about the father or support person needing to “Be the Mountain.” What has been your experience? Most of the time I have dads who are very involved and other times I have experienced something quite different.  One father we caught drinking in the hospital, another father was getting lightheaded and faint. Just recently I had a mother express concern for her upcoming birth-she was concerned that her husband would be on the phone the entire time and wanted to talk with me about how we would handle that.  What do you think and how do you encourage dads/partners to “Be the Mountain?” and what do you do when they are not?

What about “Be the Warrior.”  How do you discuss or do you discuss at all the role of partners or do you let them figure it out on their own? Do you encourage them to protect moms, be her warrior or to stick to their comfort zone?

Have you ever had a mom anxious prenatally about how her partner will handle labor? From seeing mother uncomfortable to dealing with blood and possibly poop. Do you discuss this with them in your classes or as their doula?  Have you been surprised or enlightened? How important is it that mom and partner are on the same page, whether its for a homebirth, choice of care-provider, doula? What if they disagree?

One of my favorite parts in the book is the chapter about communicating with a woman in labor.  I ask partners if they can’t commit to reading the whole book to at least take a peek at this chapter. What do you tell your clients/students about how to communicate in labor? About using touch and intuition and holding space? How much emphasis do you place on communication in labor?  Do you discuss the idea that mom may dislike something they try but that its important to go back in later and not recoil from her?

In the media we often see moms screaming at her partner-blaming him for the turmoil she is experiencing.  Do moms bring that up in your classes and how do you encourage that discussion?

We all know dad/partner’s energy can also have an effect on mom and the progress of labor to a certain extent.  When discussing breathing techniques that are suggested in the book do you encourage partners to practice prenatally as well? How much time to you spend (if any) on partners fears and concerns about pregnancy, labor, birth, parenting?

Another one of my favorite chapters introduces readers to terminology and jargon medical professionals may use.  As a doula at a birth I often find myself having to remind parents what asynclitic and occiput posterior mean.  I think this chapter is important because it empowers partners to know what is being discussed and to not feel like they are being talked down to or thought of as unintelligent and it's another way for them to protect mom. What do you think?

In chapter ten St. John offers many excellent “tools” to use in labor.  Have you used any of these and if so what are your favorites? If you haven’t used any what would you like to try?  Some examples include; nostril breathing, soft gazing, hand on upper abdomen technique.

In chapter thirteen St. John discusses pain medication.  I think the most common question I get from partners is “how will I know when she really wants pain medication or when she is just asking for more help.” What do you suggest to partners and how can you tell the difference as a support person at a birth?

Another empowering chapter for partners deals with deciding when to leave for the hospital or birth center.  I think this is a high anxiety point for partners as well.  The checklist provides information about when is a good time to leave.  Is there anything you would add or anything you disagree with?

Another important and somewhat stress relieving chapter for partner’s covers the unexpected.  Do you cover this in class? In how much detail? Do you think it’s important for couples to know what to do in an “emergency” or do you think it frightens them unnecessarily?

There are three main goals for partners in the book.  1. Be the Mountain 2. Be the Warrior 3. Be Centered Anything you would add? If you only had a few minutes to talk to a partner what would be the most important information/advice you would give?

Do you have experience (outside of this book) with the St. John Birthing Method? If so, please share. 

I was so excited to receive this response from a man who came upon my last blog entry, "What do men think?" The insight Tom Lampman provides in the following paragraphs gives us a great view of the way a man's mind functions and how that function relates to birth. Enjoy! 

What do men think? The answer is simple. They don’t think. Men react! To assume that men dwell on the subject of reproduction (other than the obvious), labour, birth, lactation or any other feminine concerns is to be naïve to the extreme. I do not want to appear hard in my evaluation of their level of interest or concern, but we have to face facts. Men are completely different creatures than women’s stereotypical dream of the sensitive new-age guy that dotes on her every whim. Guys have been created to specialize in behaviours that are intrinsically male and, justifiably, linked to sex, food and beer, if you choose to believe the ads at half-time. To think otherwise, is to delude yourselves that somewhere, down deep, there is a caring, compassionate, sensitive, man waiting to be liberated from the rigors of their testosterone burdened physiognomy. The good ole days of Lamaze classes and attentive fathers were a brief glimmer of hope that appeared in the sky only to pale, quickly, in this fast paced, insensitive world.

​Now, if you haven’t already written me off as one of these androgenic cretins that surfaces on a regular basis on CNN or FOX news, let me explain. My wife and I have participated in six pregnancies and deliveries, two of them home births. We taught Lamaze and prenatal education as a team for almost a decade at two well respected and established hospitals in Winnipeg in the 70’s. We served as the Manitoba coordinators of the ICEA for part of that time and were active in the La Leche League for quite a while. We have five children aged from 38 to 19. During that time, we were very successful in bringing young couples to a new awareness of the experience of childbirth and the potential it has in bonding a couple. We were not the “whole-earth, Gaskin-esque, communal eccentrics” of this era, but taught in an environment of over medical specialization and the political intrigue of large hospitals and medical staffs. As fraught as this environment was in difficulties, we enjoyed the experience and learned a great deal about people and relationships and, hopefully, aided the cause.

​Unfortunately, in my opinion, that appears to be more the exception than the rule today, as I feel that trend may be slipping away. To that end, my previous comments were designed to elucidate a seldom discussed reality. That is that there has always been a real potential to bring men and women to a closer understanding of the process and an appreciation of each other as a couple and family that childbirth education offers. However, that can only happen when it is viewed from opposite sides of the equation. That’s where understanding begins.  A disequilibrium is formed and the tension must be resolved if it is to have purpose. It is from these polar opposites that a true physical and emotional bond can be formed.

​As for the team issue, you are probably asking how in the world did someone “sucker” this guy into this singular female endeavor. At the time, there was a decided concern that female instructors were not connecting with the husbands. Husbands were fast becoming the visage of a pair of brown shoes with a tuxedo. Something needed to be done. As luck would have it, when asked for volunteers to step forward, everyone else took one step backward and there I was. My course had been set and my male pride (or female fear) wouldn’t have allowed it to develop otherwise.

​It was felt that husbands were becoming an addendum rather than a lynchpin in the journey. They sat back and tolerated the proceedings. Occasionally, a bold husband might ask the expected question of how soon after the baby is born can they resume sex. Although rather one-track, these types of questions came from an unsophisticated honesty of the classic male mindset. Female instructors would usually opt for an answer that gauged the needs of the wife and asked husbands to practice patience in any extracurricular activities. Meanwhile, husbands were thinking in seconds, minutes, or hours; certainly not days or weeks. Being precocious by nature, I would usually respond by saying that it depended on whether they had a private or semi-private room and shying from the classic “a gentleman waits for the placenta”. Fortunately, these apparent uncouth responses had an endearing quality about them that men responded to and opened up an opportunity for discussion that would otherwise not have happened. It was at this point that I sensed that an opportunity was being presented that we couldn’t ignore.  

​Over the years of teaching, it became very apparent that men like to take things apart and put them back together. They like to fix things whether it be an electrical appliance or their wife’s current emotional conundrum. They’re the ones that run into burning buildings, enjoy boxing, rescue damsels and repair occluded coronary arteries. Approaching birth with a male perspective of how things work, only begets more curiosity which draws them in. The trick is to engage them in what’s happening. It’s to pique their sense of wonder and how the pieces fit together. If they know how things work, they have the potential for control. What are men all about if not, “control”? This call to make a difference lays the groundwork for developing a good coach and husband. It is this solid male state of being that becomes the raw ingredient in a persevering, supportive man. My wife and I were privileged to train a lot of good coaches, thanks to this realization, to the benefit of soon-to-be moms.

​As unfortunate as it may have been at the time, no sooner than we got rolling, we found ourselves moving off to Alberta to take up work in, of all things, the dairy business. You can only imagine what a benefit our prenatal education was in this occupation. We lost our connection to our avocation in childbirth education as family life and a new location captured our time and energies. In retrospect, it was a passage into a new phase of our lives that was bittersweet, as we never really got back into it. Life can do that to you.

​The real beauty of our association with childbirth education over the years has been that it has taught us that each and every birth is a unique experience. As much as we want to induce a medical and pedagogical approach to this miraculous event, the failure to allow nature to take its course and allow us to deal with the incremental anomalies of life, only regiments us into a stifling array of what should and what shouldn’t happen. Pathology can rob us of the joy of surprise, of the expectation of the unexpected and the realization of what is new. Isn’t that what life is really about? Our educating efforts should be towards understanding the process and the appreciation of life. The complexities of life on this planet is what we all long to savour; not the sameness. I’m sure that is why the death of a child is so devastating to new parents, because it steals that potential for diversity. We don’t throw caution to the wind, mind you, but adjust to the dictates of nature, which win in the vast majority of cases.

​A large part of why I’m writing you now is due to an experience that helped to culminate part of my original premise. We as humans really don’t think. Usually the situation forces us to do what comes naturally, to react, to do. It’s through that “doing” that we become. I guess that’s why we refer to ourselves as human “beings” not “human doings”. The particular event of which I speak was the birth of our grandson on New Year’s Day 2012. I’m sure it was divinely ordained that both my wife and I were able to be in attendance at this miraculous event. It is extremely rare that grandparents would be in attendance at the birth of their grandchild. However, things just worked out that way much to the benefit of our families.

​ My daughter is not an avid” home-birther” or  a medical professional, just an expectant mom mildly equipped with a sound understanding of what to expect and the techniques to apply. Soon-to-be Grandpa and Grandma fell into full stride as things progressed. Right off the mark, Grandpa was telling son-in-law to time the contractions and to encourage his wife to ride them to her advantage. He was strategically placing the hot water bottle where his wife directed him and there for her to hold on to in the tough spots. Grandma was breathing along with her daughter and keeping her focused. Our daughter stood through much of her labour leaning over the labour bed and on her husband with the accompanying grimaces and winces of labour. Delivery was arduous and seemed longer than I remembered my wife’s labours, but as normal as the law of averages dictate. My wife and I backed off as things became more intense and were not front row center when not-so-little Jacob came into the world (9lbs. 5 oz.). Yes, there were a couple of lacerations and a bit more blood was lost than is normal, but the uterus clamped down nicely with a little nudge of oxytocin. Jacob let out his first cries to the excitement of his father and pinked up beautifully. The labour and birth room filled up quickly with the attending professionals as they did the prescribed duties as my daughter resigned herself that it was over. Before we knew it, mom and dad and Gramps and Grandma were alone sharing a very unique experience; the celebration of a new life.

​There were several times that the attending nurse complimented us on how controlled the situation was. As much as I know it tempted some of the nurses to comment on deviations from the norm while monitoring the process, most sat back and watched things progress. Many were impressed that no analgesics were used. Little Jacob came into the world, bright eyed and looking around trying to figure out what was going on. Eventually, the family settled down into their newborn room as night drew nigh. The evening ended with mom, dad and baby settling down as Gramps and Grandma sailed home in a state of astonished contentment.

​So, what’s my point? Dads need to be part of the birth experience despite their ignorance! To see a number of expectant fathers in the neighbouring waiting room, took me back to the post-war years of proud men and surprised wives. It may seem harsh to say, but men will never be able to understand the event or even have a vague concept of the effort required, tolerance of pain or the myriad of sensations that a female must contend with during the birth of a child. They must be trained, not to react, but to respond in a metered and pragmatic way. They must there in the “clutch” moments when she feels she can’t go on and be the support that she longs for. And, if they pay attention, remain curious and strive to understand what their wives are doing for the benefit of their family (including grandpas and grandmas), they can become the lynchpin that holds them together. Men, truly, have a place in this predominantly female endeavor, but apart from it. The contrast is essential if it is to have meaning.

​As childbirth educators, and especially as men, if we don’t continually reclaim this, we stand to lose much more than we’ve gained.​Tom Lampman, Calmar, Alberta, Canada

Do you ever wonder what men really think about pregnancy, labor, birth, and breastfeeding? Is there a moment when they are jealous that the cannot experience it all first hand? Or do they secretly think "Oh wow, that was gross!" even as they are smiling and nodding while they watch us have a bowel movement in the middle of pushing our children out? 

I have caught my own husband inadvertently let his true feelings peek through his facial expressions, especially when I am excitedly sharing what I've just learned from reading my latest book on placental preservation. While he truly remains supportive, his (sometimes still immature) male mind is full of jokes, related anecdotes, and other inappropriate material forever ready to spill out at the worst moment. Most men only have to dwell on the intricacies of childbirth for nine months at a time, a few times in their lives (unless they are employed in the field)--as birth professionals,  our men have to live childbirth morning, noon, and night! 

And let's talk about men employed in the birth field for just a moment. What about the women in their lives? Do they ever feel threatened, or that their man is becoming less of a man because he sees vaginas all day long? Now I know that's a touchy subject, but as the old adage goes, it's always the plumber who has the leaky faucet. He's so busy fixing other people's faucets he's too tired/bored/sick of looking at faucets to fix his own when he gets home. Something to think about. On the flip side, I suppose a man working with pregnant women, babies, and new mothers on a daily basis might also become more tender, more loving, more compassionate  and more understanding when their wife has PMS or PPD. 

As we continue discussing men and childbirth this month, let's try and look at the subject from both sides. Since men and women can be so different, yetit requires both to make a baby, I think it is important to bridge the gap between mindsets whenever possible.

...to talk to a room of expectant parents about how to optimize their birth-what would you be sure to include?  What would be the most important information-the few things you would want them to take with them when they left.  Would the information you relay differ if you were wearing your doula hat or your childbirth educator hat? What resources would you suggest for further reading? If there were other care-providers on the panel with you-a midwife, a doctor, a nurse, a yoga teacher...what would you include to either compliment what they are saying in their ten minutes or to highlight your specific role as a doula or educator?

This is my first book club experience.  At first I thought I would write a review of the book and the discussion would grow from there.  Then I realized that is not what a book club is about-we just want a place where we can chat about what we have read.  I have put together a series of questions and topics for discussion referring to either direct passages in the book or issues that were brought up to get our conversation going.  I am hoping these topic points will stimulate and the comments will explode from there. (next time I will go straight to the topics of discussion without an intro)

There is no way we could cover everything, in fact trying to put together this list was no easy task.  I felt like I was leaving out so much or that what I was including might not be as relevant to someone else.  I tried to choose juicy topics that I thought would stimulate some debate or dialogue.  We are all coming from a different place with different experiences accompanying us.  I had a different reaction to certain aspects of the book the first time I read it that may or may not have come up when I opened the book again to read along with the rest of you.  If I missed something that you feel warrants attention please feel free to post away.  There are no rules here other than respecting the opinions and beliefs of others.  Other than that…let’s have fun!

Topics for Discussion

Page 1-“Birth matters…for each mother it is an event that shakes and shapes her to her innermost core.”  Page 2-“Giving birth can be the most empowering experience of a lifetime…or it can be disempowering, by removing from new mothers any sense of inner strength or capacity.”

I know this to be true but is it true for everyone?  I have known women that have been unaffected (or so it would seem) by their births-they neither viewed their experience as a source of strength or in a negative light. Is it possible birth doesn’t matter for every woman or is there another explanation? What do you think?

Page 6-“The way a culture treats women in birth is a good indicator of how well women and their contributions to society are valued and honored.”

What does that mean for us-as women in this country? Is this a far-reaching statement or does it ring true for you?

Page 17-“…anyone who advocated for more natural ways of giving birth than was the norm in the seventies was considered by many to be a traitor to her gender.”  Page 18-“Instead of seeing midwifery as a means of female empowerment, these young feminists were repulsed by the very idea of birth.”

I consider myself a feminist and when I read these statements I find that I would rather not believe them but when I think about it-I can see how this was the case at the time and maybe in some circles still is today.  How does this statement make you feel if anything at all? For those of you that were young women in the seventies what was your experience?  I think of the women’s health movement, I think of the publication of Our Bodies, Ourselves and to me it makes sense to include access to midwifery care in the same fight for the right to birth control, and abortion but it seems that was a missing component.  Do you think that is missing today as well? The right to choose where and with whom we give birth…is it not mainstream enough? Are we fighting hard enough?

Page 27-“Women who think that their minds and bodies are separate from each other have little idea how much their thoughts and feelings affect the course of labor.”

I have seen the effects of fear in labor first hand, I have also seen amazing things happen immediately after a laboring woman lets go or releases that fear.  How about you? How much time do you spend talking to your clients or students about the effects of fear on labor? What do you emphasize?

Page 54-“Women who have been taught to be afraid of their bodies are easy to manipulate into making reproductive choices that they may later regret. The best way to combat fear is to provide accurate information that takes account of the wide range of phenomena that can occur.” 

Do you think fear plays a large part in our birth culture today? Do you think many of the women you work with are coming from and making decisions from a place of fear? Do you think education alone is enough? Does anyone else want to go in to the schools as early as possible and teach young girls to trust their bodies and not be afraid-do you think we can take preventative steps for future generations?  What would you do and where would you begin?

Page 63- midwifery model = a wellness model/medical model = an illness model

Is it that simple, that black and white? I am a bit jaded right now-as I was reading this book I received two calls from two friends living in different states and their childbirth experiences, dealings with doctors and staff were so horrific that for me, right now it is that simple but I have not always felt that way. Do you think doctors are trained to view pregnancy and birth as an illness? What about nurses? Is that what they are taught as well-do they have to unlearn to get to a place where they don’t view pregnancy and birth as an illness?

Page 75-“All of this history was forgotten during the anti-midwife propaganda campaign.”

I am sure you all remember this part of the book without having to go back. What effect did this have on the way birth and midwifery are viewed today-could things have been different if people were not told to fear midwifery? What is the value in re-learning this information?

Pages 94-98 Studies, meta-analysis and the like “descent into the realm of propaganda.”

Both times I read this I was frustrated.  How is it possible that information is allowed to be so skewed? Many of us have learned how to be objective when reading these studies, we know there are things to look for and perhaps we have learned not to believe everything we read.  What about those that have not learned this skill? What about those that trust what is written-in some cases they are being flat out lied to.  What did you think about this portion of the book? Were you aware of these studies and their flaws or was this news to you? What do you think could have been the motivation of the researchers? Do you think Ina May’s biases come through?

Page 108- “People who care for pregnant and laboring women-whether they are midwives, nurses or physicians, should not have ignorant hands.”

Ina May begins a discussion on the overuse of technology and they underuse of “manual skills.” Is this something you have noticed where you work or in your training? If you think about it how often is a mother actually touched in labor other than to adjust a monitor or some other procedure? Do you see nurses feeling for contractions or just trusting the machines? Do doctors measure fundal height with their hands or only trust the ultrasound? Do the practitioners where you work even know what pelvimitry is? I am not assuming this is the case I just want to hear what you have witnessed.

Page 126-128 Maternal Mortality and the Safe Motherhood Quilt Project

Did you read the Amnesty International Report? Did you get involved in their campaign earlier this year? Did you contact your representatives? Do you feel like this is being taken seriously? Are you as outraged as I am? Do you talk about this with your students/clients or is this something you keep separate? Ina May offers many excellent ways to raise awareness about the issue, create better systems of reporting etc…Is there anything she is leaving out? Do you know if your state is making any effort to track maternal deaths more effectively? Before I left NM I know the midwife working for the department of health was trying to put a review committee together but I am not sure if she was able to get it off the ground.  What about in your area?

Later in the book Ina May talks about how we can be polarized in our views on things like abortion, birth control, natural birth, breastfeeding etc…but that this is one topic-maternal and I would add infant mortality and morbidity where we can agree.  So what do we do?

Page 145-150 DES, Thalidomide, Gardasil

For those of you that teach history of childbirth classes is this a subject that is included? Gardasil is a modern example that is quite frightening. In fact here in California it is now possible for children to consent to this vaccination without their parents knowledge. What do you think of that and can you think of any other modern examples where the long-term effects of medications have not been studied? What about Cytotec, is that still being used where you work?

Page 149-“When we take a look at the current state of women’s health and maternity care in the US, it is clear that it is even more necessary than ever for a renewed women’s health movement to emerge, and to keep constantly vigilant and skeptical with regard to new drugs that may be prescribed to women or their children.”

A renewed women’s health movement to emerge…what do you think?  I agree and I am ready but do we have what it takes? What would we need, how would we organize and more importantly are you ready? Can we create change on a wide enough scale?

Page 167 What’s a Father-to-Be to do?

I love-love-love this chapter and recommend it to dads whenever I can.  Do you feel the same? What is your favorite part? When you work with a couple where you know the dad is uncomfortable, hesitant, shy, or not sure of his role how do you encourage him? Ina May includes four things that fathers should keep in mind:

1. Know the basics of sphincter law 2. Know how to keep your partner’s oxytocin and beta-endorphin levels as high as possible and her adrenaline levels low 3. She leads you follow 4. Have trust in her monkey self.  Is there anything you would add? Anything you don’t think is necessary?

Chapter 8 Page 191  Ina May’s Vision for the Future

This chapter is by far my favorite. Not only does Ina May share her vision she gives us ideas on how we can get there. This is not just a book of dreams-it is a book with a plan.  I so want to be one of those six doulas on that maternity team which includes two OBs and six midwives.  That would be awesome!

So what does Ina May’s vision include-you read it…woman centered care, MORE MIDWIVES (what? Who is shouting), revise medical education; establish maternity care standards, salaried physicians, BIRTH CENTERS, every maternal death counted and reviewed, and postpartum visits.  Is this attainable? Is there anything you think is way out of reach, anything to add? Suggestions on how to get the ball rolling, steps you have already taken? What is your vision for the future?