Cultural Perspectives on Childbirth

co sleeping

Every aspect of who we are from our behaviors to our learning processes is framed by our culture. The whole idea of a “melting pot” in America where many cultures blend to become one culture, is a fallacy.  People of like cultural and ethnic background tend to gravitate towards what is similar and familiar.  It shapes their identity.

This is particularly true of treaty nations (indigenous peoples) who struggle to keep their own tribal identity. Even in the cities, away from reservations, native people gravitate toward what is familiar and comfortable (besides where else would they get some Indian Tacos?).

Every indigenous group has their own cultural beliefs, rituals and traditions. Even for pregnancy and childbirth.  How childbirth took place was shaped by cultural values, ways of knowing, and framed within ritual and belief.

Unfortunately the cultural aspects were not all preserved and kept in all tribal groups, due encroachment from white society.  This encroachment has created a rift in fabric of cultural life. “The culture in which people grow up is one of the key influences on the way they see and react to the world and the way they behave (Nichols & Humenick, 139).”

For many cultures, including the Lakota, pregnancy and childbirth is much more than just a physical act.  It is believed that a spiritual force is at work.  Concepts, customs, and traditions develop around these spiritual beliefs.

Here are some of the sites I found, for other cultures:

http://www.midwiferytoday.com/articles/immexico_healing.asp

http://www.louisianafolklife.org/LT/Articles_Essays/main_misc_wait_babies.html

http://ihst.midwife.org/ihst/files/ccLibraryFiles/Filename/000000000004/IHS%20Midwives.pdf

Multi-cultural Beliefs

Within each indigenous culture are the ideas and concepts that surround the actions of the pregnant woman, her diet, how others should act when around her.  Some ideas and traditions actually carry across into multiple cultures around the world.

One concept has to do with knots and ties. That if these were within view of a pregnant woman, or she stepped across them, it would cause the umbilical cord to be tangled at birth. Another has to do with actions of others. If you fight around a pregnant woman or with one, it causes problems with her pregnancy.

For most indigenous cultures there are concepts taught regarding the spiritual aspects of birth and early childhood. There is a belief that a female spirit that assists in childbirth, for the Lakota people, and also assists the soul of the child in “picking” the family in which they will be born.  In western society, what they call the “Mongolian Marks” is what this female makes when a spirit is born in our world.

Infants and young children (until age 5) are considered “sacred beings” and our actions with them must be tempered by this belief.  They are closer to the spirit world, in Lakota belief.

Because of the spiritual forces in play, many indigenous cultures had and still practice rituals at the birth of a child.  This is due to the understanding that childbearing and childbirth are a sacred act.

This may not necessarily be understood by present-day women within the culture, but in their soul and spirit the women do recognize that modern medicine’s “managed care” works against the traditions and ageless wisdom of their tribe.  This is true whether they have a traditional spiritual base and upbringing in their lives or they have adopted non-traditional religious practice. Their sense of “knowing” from their soul, speaks out against what is not natural and a part of the spiritual birthing process.

Next: the Western Culture & De-Colonization of Birthing

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FYI for native women

Just an FYI for all of you…

 

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When: October 14-15, 8:00-5:00PM

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Birth Trauma Part 3

According to Cheryl Tatano Beck, traumatic birth is defined as “an event occurring during the labor and delivery process that involves actual or threatened serious injury or death to the mother  or her infant. The birthing woman experiences intense fear, helplessness, loss of control, and horror” she had later revised that statement to include the woman feeling stripped of her dignity.

What is the cause of women perceiving their birth experience as traumatic? It is the systemic elimination of protective care during the birthing process.

In Beck’s study of 40 women she says that there were four themes that emerged. Theme #1 was to care for the women and treating them as human beings. Theme #2: Lack of Communication.  Theme #3 was safety. Theme #4: The ends will justify the means.

With theme One: #1 women feeling they were objectified, and treated arrogantly and with a lack of empathy. The women were #2 left alone, and abandoned. The #3 birthing mother’s needs were not met by the hospital staff. An example given was of a woman from Puerto Rico who was on all fours, when a nurse brought in 20 students to observe…without her consent.

In theme Two: #1 no one communicated with the woman in labor. They were described as having conversations with one another within earshot but not directly talking with or to the laboring mother. As if she were non-existent.

In the third theme:  the #1 laboring mothers felt that the staff (nurses and doctors) did not adequately deliver safe care. #2 The mothers were not being allowed input into the care being given for their own selves and actually fearing for their own and / or the infant’s life!

In theme Four:  entailed #1 the sense that what was endured and experienced by the mothers was the sense of being “pushed to the background” as everyone around them were celebrating the baby’s healthy birth. These women #2 felt invisible, only the infant mattered.

The experiences mothers have had led to severe post-partum trauma and depression.  Beck, Driscoll, and Watson’s book Traumatic Birth goes into detail about feedback loops [pp. 10-12] that describe the interaction of the mother and child after a traumatic birth, with a listing of the causes and consequences of the cause. Sometimes even breastfeeding is difficult, creating “…intruding flashbacks, disturbing detachments with their infants, feeling violated, enduring physical pain, and insufficient milk supply…” Often the anniversary of a traumatic birth amplifies the feedback loop.

 …

My own reaction to the shared experiences the women in this book had illustrated the barbarism of western medical professionals, a barbarism that is completely contrary to those principles I listed from the ACOG website in part #2.

The women who tell their story of childbirth weave an astounding sense of personal alienation.  It is no wonder that there is PTSD, depression, self-destructive behaviors, socially isolationistic behaviors and pelvic floor injuries as a result of the improper calloused form of care received. Many of the women feel as though they were raped, yet most had no “history of physical, emotional, and/or sexual abuse” so birth precipitated  a sense of having “the loss of the soul”.

I only touched on a small portion of the book in these three posts. In the next few blogs, I would like to address how we can alter the outcome for women in these circumstances and possibly change childbirth for women.

Birth Trauma – Part 1

Many things come up during the labor and birthing of a baby. These may or may not be emergency-level events. A woman in labor is focused on the process they are involved in: birth. The woman may not be aware of what is being discussed around them, nor the things happening that may alter their ideals of the “perfect”  birth.

Here are some things that may occur:

  • Slow dilation of the cervix
  • Labor stalling
  • Movement of the baby stops
  • Blood pressure of the mother rises

Often doctors in the hospital will want to intervene. The remedies may be interventions that you really do not need.

These interventions could possibly be:

  • Monitors
  • IV insertion
  • Inducing labor (Pitocin)
  • Or even the decision to have a c-Section (read my blog post on this here: )

The first two  can be alleviated by using gravity (walking, dancing, leaning forward onto the labor bed with feet on the floor and doing squats). Usually stressors or nervousness are the cause.

With Labor stalling, if already dilated 6-7cm, it could very well be a natural stall while going into the next stage of labor or “Transition” (Balaskas 127-131). Body tension can also effect how labor progression.

Low moaning sounds are effective here, in that the vocal cords being activated relaxes the sphincter muscle group of the pelvic floor, as Ina May states ” The state of relaxation of the mouth and jaw is directly correlated with the ability of the cervix, the vagina, and the anus to open to full capacity (Ina Mays Guide, 170). The sphincter muscles will close due to stress or fear. Goer suggests that “obstetric management can obstruct progress (The Thinking Woman’s, 108)”

Remember: Babies are birthed when they are READY. Not on some sort of perceived time schedule.  This is a process that cannot be forced.

If the baby stops movement, inform your doctor. You can use “kick counts” as a method to monitor movements if you are concerned. In active labor, the baby tends to move in a spiral as baby moves into birthing position . Sometimes stopping movement for a short period of time can be an indicator of  the baby 1) shifting position 2) resting before birthing.

Blood pressure issues could be gestational diabetes, or just stress. The cause for the blood pressure rising needs to be found. High blood pressure is also a symptom of pre-eclampsia. But if you were not having signs of this condition and diagnosed in pregnancy (which is why prenatal visits are essential) then it may be something else.

Of course, water by mouth could assist in lowering the blood pressure level. Here is suggested reading for you to understand the seriousness of this condition: https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy

So now we move onto the second part of this discussion, published one week from this page.

Baby Wearing – Part 2

Why would it be of benefit to you as a mother to carry your baby, using any method?

It would assure you that continuity is available for your baby.  After nine months of carrying the fetus, where gentle rocking motions were constant, it would make sense to allow for this continuity to continue outside the womb.

You and your baby are bonding in the first few months after birth. Babies need to feel, smell, and touch you for assurance.  It stresses baby to have separation from you.  Yet, you need to get things done, right? Baby-wearing allows for both!

It assists in cognitive development (Gross-Loh, 46) when you carry your baby. The baby is in a calm state, content, and observing all the time while learning about their world.

You learn about your baby as well. The attachment of mother and baby is strengthened; mother is able to understand baby’s cues easier which develop a mutual trust.
Let’s take a look at some of the various methods used (by country):

Mexican women use the Reboso, a traditional shawl wrap that usually would be given to girls at Menarche and worn as a shawl or neck wrap until needed for carrying a baby. The Lakota use a cradleboard, the Japanese and Malasian women carried babies on their backs…

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Things to Consider:

In the first six months after having a baby the hormone relaxin may be in your system. It is important to be aware of “postural adaptations that may adversely affect your spinal joints (Ohm, 18)”.  If feeling Fatigued or feeling muscles tightened (such as tightened muscles of the neck or shoulders).  Jeanne Ohm recommends a chiropractic visit.

When you are using your baby wrap, sling, or carrier consider your back.  The higher up and closer your baby is, the more comfort you will feel.

Consider the type of carrier you will use. Of great concern are the types of slings that are like a pouch and hand low, with lots of material.  It is potentially dangerous for the baby as the baby may lie in a “C” position with his/her chin tucked towards the chest.  This position can potentially cause breathing issues, or asphyxia (suffocation).

Anovulation and Irregular Cycles

No two females are the same.  Women have cycles that vary.  It is dependent on if she is an adolescent girl, just coming off the pill, breastfeeding, or is approaching menopause.

Women who live in close proximity do tend to cycle together.  You will notice this as you become more aware of your cycle, and your body.


A Typical Cycle

In what is considered a “normal” cycle, the release of the egg occurs in a predictable pattern.  After your menses, “under the influence of rising estrogen, you’ll usually have several days of no cervical fluid, building up to progressively wetter fertile-quality cervical fluid (103)”.  After the egg is released the cervical fluid will dry quickly. Then the pattern starts again.

Different Phases of Anovulation

Adolescence

The average age of American girls to begin menstruation is 12 to 14 years old. At this age, the onset of menses may not be due to the release of an egg.

One of the characteristics of cycles in teenage girls is the fluctuation of the estrogen cycles.  Therefore the cycle of a teenager is not predictable. The distance between menses and duration may vary, with some anovulatory cycles in between.

Breastfeeding

When breastfeeding “on demand” a woman may not have menses for months.  Every time the baby is breastfed the hormones that trigger ovulation are triggered. But, in order for it to work, the baby must feed regularly when baby indicates hunger (no supplementation).

A woman could go a year or more without a change in temperature, experiencing the same cervical fluid.  The reason that she would not see the good kind of cervical fluid, at first, is that prolactin will lower the estrogen levels and keep the fertile quality cervical fluid from being produced. The trick here is, to be able to notice if there is any change in the cervical fluid, which will indicate that ovulation is soon to resume.

Premenopause

Premenopause occurs prior to Menopause, when all ovulation and menses cease. It often will last for years. During this time, her cycles may start to be very different than usual. At first, the cycles may shorten because of more frequent ovulations and shorter luteal phases. As time goes on, the length of the cycles increases as the number of ovulations become more infrequent.  Finally the cycles end altogether.  If the woman is 40 or older and she has had no menses for a year or more, she is said to be in Menopause.

Other Major Causes of Anovulation

Illness

Normally, illnesses do not affect your cycle.  When illness affects your cycle depends upon the phase of your cycle you are in when you become ill, if before ovulation it may delay or cause no ovulation to occur… If after ovulation, it will rarely cause any problems.

A fever will not affect your ability to chart or interpret it.  There are other fertility signs. Not only that, you can still tell whether the temperature affected your cycle in either delaying or preventing the cycle.

Travel 

Travel is notorious for causing an effect on the cycle.  Some women do manage to be regular like clock-work despite traveling.

Your body may interpret traveling as a stressor.  Some women may find that they have an extended cycle while others do not ovulate at all…in fact stop menstruating altogether.  Despite all this, and the fun of travel, you will find charting using all three signs is beneficial to notate the ambiguities.

 Exercise

Heads up!  Strenuous exercise is a well-known cycle buster!  It can delay or stop ovulation.  Exercise mostly affects competitive athletes with low body fat ratios.  For women, it is mostly those who are runners swimmers, gymnasts, and ballet dancers that have issues.  But metabolism, thyroid, and diet must be ruled out first.

Weight Loss or Gain

To maintain normal ovulatory cycles, a woman’s body weight should be a minimum of 20% body fat.  This is in order to have the body store estrogen and to allow for androgen conversion into to the kind of estrogen necessary for ovulation.

Women who are extremely thin, especially those with anorexia, tend to have their menses stop.  This is due to not having enough estrogen to cause ovulation.

Stress

Long cycles are often caused by stress. Stresses can be either psychological or physical. Stress tends to delay ovulation rather than cause an earlier ovulation cycle. Therefore, the later the ovulation occurs the cycle becomes longer. If stress is severe it can cause ovulation to stop altogether.

Medical Conditions

A variety of medical conditions can cause menses to cease.  These are:

  • Elevated prolactin
  • Pituitary gland problems
  • Polycystic ovarian syndrome

A common and useful way to determine the cause of anovulation is with a Progesterone Withdrawal Test.
NOTE:

For both breastfeeding and Premenopause, the use of FAM as your contraception method can be tricky at best.

Natural Contraception – Part 3

chart


The Four Rules

  1.  First Five Days Rule

You are safe during the first five days of the menstrual cycle if you have had an obvious temperature shift about 12 to 16 days prior.

This applies to the first five days of the cycle. Any bleeding after should be considered fertile whether you bleed or not. Bleeding in that 5 day period is true menstruation, not spotting or abnormal bleeding.

This rule can only work if you have been charting your cervical fluid and temperature for awhile. You cannot rely on this rule if you are approaching menopausal age and if any of the signs of menopause are present[i].  This is due to the hormonal fluctuations that occur in Premenopause.

If your last 12 cycles were 25 days or shorter, you should then assume only 3 days are safe.  This precaution is due to the fact that you could ovulate earlier.  You would not be able to detect cervical fluid change due to bleeding.

  1. Dry day Rule

    Before ovulation you are safe any evening of every dry day[ii].

    Dryness[iii] is determined by periodic checks of cervical fluid throughout the day. There should be no wet or any kind of fluid.

It must not be “sticky” either.  Although sticky fluids may not be conducive to fertility, err on the safe side. Many women cannot distinguish between the sticky fluid and the wet fertile cervical fluids.  But if you have a couple “sticky” days and then return to dry, you are then considered safe on the dry days.

on the day after intercourse you chart that day with a question mark if semen or spermicide is present, these tend to mask cervical fluid. Because the fluids are masked that evening is considered fertile, since you cannot determine “wet” or “dry” cervical fluid.  But if by the end of the day after intercourse you are dry and have been all day, you are safe.

Remember: sperm cannot survive with a dry cervix.  The longest that the sperm stays alive is just a few hours. The sticky fluid of the cervix is just about as inhospitable as a dry cervix, so the risk is low.

  1. Temperature Shift Rule

    You are safe the evening of the 3rd consecutive day your temperature is above the cover-line.

You are infertile starting at 6 p.m. the third consecutive night that your temperature is above the cover-line.   If the temperature falls on or below the cover-line during that three day time frame, you must start your counting over until  it is above the line again.

If you develop a fever due to illness, you cannot consider yourself safe until you have had and recorded three days consecutively of normal temperatures above the cover-line.  If you have had no obvious thermal shift use a more conservative rule.  This would mean you would consider yourself safe only until the evening of the third day you are above the line.

  1. Peak Day Rule
    You are safe the evening of the 4th consecutive day after your peak day

Your peak day is the last day of “wetness”.  On the chart mark “PK” in the peak day column.  Subsequent days should be marked as “1”, “2”, “3”, etc., in that same row.  You should record them only in the evening after having observed your cervical fluid.

You are considered safe on the 4th consecutive day following a “peak day”after 6 p.m. Draw a vertical line on the 3rd and 4th day to indicate your being safe from day four.


Putting it all together

  • The peak day of cervical fluids typically occurs a couple of days before the temperature rises.
  • Before ovulation, the cervical fluid is the critical fertility sign to observe
  • But after ovulation , it is the temperature that is a critical sign.
  • The rules that apply to ovulation will often work in harmony with each other, so the the 3rd evening of high temperatures will coincide with the 4th evening after the peak day.
  • However:
    • If there is a discrepancy between the two post-ovulatory rules, always wait until both signs indicate infertility.
    • If it is critical that you avoid pregnancy, do not take the chance of unprotected sex!

 

[i] Hot flashes, vaginal dryness, etc.

[ii] After 6 p.m.

[iii] No fluids present, the slight moisture at the vaginal opening is not “wet” per se.

Natural Contraception – Part 2

The Fertility Awareness Method [FAM] works as a contraceptive only if you choose to either postpone intercourse or use a barrier method when you are fertile. You should be aware the method is most effective when you abstain.

chart

Here are the reasons why:

  1. If the barrier method is going to fail, it will fail when you are in the fertile phase. ALL contraceptives have a failure rate.
  2. Using barriers with spermicides during the fertile phase can mask your cervical fluid.


Drawing the “Cover Line” For Charting

The purpose for charting your temperature is determine when ovulation occurs.  Your temperature rises on the days after.  But to accurately do this, you need to draw a cover line.

The instructions are as follows:

  • After your menstruation ends and when charting your temperatures, always notice the highest temperature of the previous 6 days.
  • Identify the first day your temperature rises at least 2/10ths of a degree above the highest temperature
  • Now, go back and highlight the last 6 temperatures before the rise
  • Draw the coverline 1/10th of a degree above the highest of that cluster of 6 highlighted days


Charting Cervical Fluids

 Day 1 of the cycle is the first day menstrual bleeding. Brown or light spotting prior is considered a part of the last cycle.

  • The graph below shows how the various types of cervical fluids are recorded in your chart.
    Note: Menses are marked with
    * while spotting is marked (*)


Menses:  Red Blood Flow

Eggwhite          
Creamy          
Sticky          
Dry, Spotting or Menses *        


Spotting: Brown, pink, discolored

Eggwhite          
Creamy          
Sticky          
Dry, Spotting or Menses *  (*)      

Nothing:

Eggwhite          
Creamy          
Sticky          
Dry, Spotting or Menses *  (*)  —    

Sticky:

It is opaque, white, or yellow, and occasionally clear.  Can be thick.  The main quality is stickiness or lacking true moisture.  It can be crumbly or flaky like a paste, of gummy and rubbery (similar to rubber cement). When separating fingers it forms peaks.

Eggwhite          
Creamy          
Sticky        fill in box
 
Dry, Spotting or Menses  *  (*)  —    


Creamy:

Milky, cloudy, white or yellow in color.  Is “creamy” like lotion.  Can be wet, watery or thin in nature.  Does not form peaks when separating fingers.

Eggwhite          
Creamy      
 fill in
Sticky        fill in
 fill in
Dry, Spotting or Menses *  (*)  —    

Eggwhite:

Usually it is clear, but can have opaque streaks in it.  Very slippery and wet like an eggwhite. Feels like extreme lubrication in the vaginal opening.

Eggwhite        
Creamy      
 fill in
Sticky        fill in
 fill in
Dry, Spotting or Menses *  (*)  —    

NOTE: There would be an additional column on the right side, but due to constraints in page size, is omitted. The last column not shown has “eggwhite, “creamy”, and “sticky” boxes filled in.

 

Natural Contraception – Part 1

chart

Many women have said to me “Oh, charting is just too much bother”.  Well, is it too much bother to pencil in your eyebrows and put on lipstick before you leave the front door? This is YOUR body, it is your health we are talking about.  Once you get the blank charts, it probably will take you five minutes. Easy peezy… like tying your shoe laces!

Waking Temperature

Why do it?

  • you can see when you are ovulating
  • tell when you can have safe sex without unwanted pregnancy
  • see when you are no longer fertile (Great for when you want a “green light” for safe sex” or when you are trying to get pregnant, it is not gonna happen…
  • indicates when you will get your menses
  • potential issues with period

How to do it
glass thermometer
When you first wake up, before you drink water or anything else.  Everyday, including during your menses. If possible, take your temperature at the same time each day. Note the time on your chart. The later in the day, the higher the temperature…so if you forget to do the temperature upon waking, you need to note the time.

If your thermometer is digital, make sure to wait until it beeps.  The reading would then be more accurate. A glass thermometer, should be left in the mouth a full five minutes.  Shake it down the night before or at least remember to do so before you take the temperature for that day.

Take your temperature ORALLY.

Also note on your chart if you have had unusual events in your life, such as: stress, illness, are traveling, or you are moving. These events can affect your temperature.

 

Our Gynecological Health – Part 2

Normal VS Abnormal Bleeding

Normal menstruation lasts about five days and usually will follow a pattern, here are two variations:

Light –> heavy –> medium –> light –> very light
Heavy –> heavy –> medium –> medium –> light

Also, some women may spot (ordinarily brownish) or bleed at other times in their cycle besides actual menstruation. Spotting is one of the most misunderstood aspects of a woman’s cycle. A common mistake is to assume any type of bleeding episode is menstruation. True menstruation occurs after ovulation, about 12 to 16 days after. Any other type of bleeding is either anovulatory bleeding, what is considered normal spotting, or is symptomatic of a problem.
Ovulatory Spotting

Light bleeding may occur right around ovulation in some women. It is not only normal, but an indicator for fertility, a sign that tells where the woman is in her cycle. It results from a sudden drop in estrogen, just before ovulation. It occurs more in long-cycles.

Anovulary Bleeding and Spotting

Once in a while an egg is not released. It could be due to the estrogen not reaching the level for the egg to release. When this happens the drop in estrogen will cause light bleeding.

For women over 40, the cause is a decreased sensitivity to FSH and LH hormones. This would result in these women not ovulating. The progesterone level is not able to sustain the lining and some spotting or bleeding may occur.

The way to know if actual ovulation did occur, is to chart the temperature. As a reminder: the temperature pattern is: low before ovulation, followed by the high temperature after.

Implantation Spotting

So when a woman notices spotting rather than bleeding a week after her temperature shifts she might want to consider a pregnancy test. This may be an indication of “implantation spotting”, because as the egg burrows into the lining of the uterus, a bit of spotting may occur. If temperatures remain high for another 18 days or more, this is an indication that the corpus luteum is viable.

Breastfeeding Spotting

After the initial flow of birth has stopped, some women may have some bleeding about six weeks postpartum. This is due to the withdrawal of hormones that were high during pregnancy.

Also there may be a fluctuation of hormones while breastfeeding because of the needs of the baby. The temporary imbalance of hormones may cause women who breastfeed a few anovulatory spotting.

Other times

• After office procedures
• While on the pill
• Or during postmenopausal hormone replacement therapy