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Frequently Asked Questions
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What is an "Empowered Birth"?
When we speak of a woman being empowered during birth we're talking about her feeling like she is in control of her environment and the decisions being made about her body and her birth. Providing solid information about the course of a normal pregnancy and the effects of common interventions on a normal birth is the foundation of Empowered Childbirth.
Feeling helpless or powerless during birth is a common theme for many women who value the "experience" of doctors and midwives over their own inner cues. By changing the way we see ourselves, professionals and childbirth we can regain our lost power. Empowering ourselves is a process that takes a lifetime and childbirth is merely a small part of it.
"What 'Empowered Childbirth' means to me", essays from women going through the process themselves. To contribute your voice to this collection,
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Do I have to birth at home to be "Empowered"?
Hospital policies are not designed to empower individuals, they're designed to enhance workplace productivity and manage costs. Hospital administrators have to juggle budgets, labor disputes, legal headaches, equipment upgrades, changing AMA guidelines and more along with the rights of the patient. Labor and Delivery wards are now being marketed as "cozy", "family-friendly" and "private" but there's no real push from the provider side of this arrangement to establish hospital rooms as havens of individual empowerment.
The pervasive cultural image of childbirth is a woman laying flat on her back and taking orders from a team of doctors and nurses along with her "coach" while drugs are being injected into her spinal cord making her physically unable to walk away from the scene. Women who would never tolerate another human treating them in such a manner when they are not pregnant can feel like they give up their privacy and their rights when there's a baby involved. Surely there's a better way to insure the safe passage of our children in to this world than by entering an institution that wants your birth to follow their protocols.
That said, women DO report feeling empowered during their hospital births. Often, women who plan to birth at home but transport themselves to a local hospital during labor find they feel "in charge" of their hospital births. When we see doctors as resources we can use if we need to, rather than as experts we must follow blindly, we can maintain our power and ensure the safest, most rewarding birth possible for ourselves and our families.
A fully empowered woman plans to birth in the place she feels safest and only invites supporters who agree to honor her freedom to birth as SHE chooses. My local hospital doesn't offer this type of respectful environment to me, but perhaps yours will to you.
See our Empowered Hospital Birth Stories section.
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Is it legal to birth without a professional attendant?
In every corner of the globe it is perfectly legal to give birth alone, even if only accidentally. However, there are a few places where laws "protect" women from unlicensed attendants, including their husbands. Nebraska and Colorado supposedly have laws against "catching" babies. The UK has outlawed laypersons "attending" laboring women, except in emergencies. Countries where prenatal care and delivery are paid for by the State seem to be a little less tolerant of families who avoid medical supervision than countries where individuals are privately insured.
There have been a few persecutions of families following a family-only birth, most notably the Cole tragedy in France (In 1999, Wayne Cole was arrested for "delivering" his own child). Most families that fear the disapproval of their government (any government) choose the, "Whoops. Gee, that happened fast" excuse. No sense in alerting the powers-that-be that you refused medical care if you don't have to.
By far the biggest legal fear among families who choose to birth outside of the system is being reported for "child endangerment". We are compiling a listing of families who have faced this situation and their experiences with the local Child Protective Services Agency. If you have a story to share,
Also see, What if I have to transfer and I've had no prenatal care?
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Pain during childbirth is a common experience. Most people believe that it is inevitable but painless childbirth has been reported by many women. Our Painless/Enjoyable Childbirth page is here.
Many women do experience pain during childbirth, however, the modern idea that numbing women from all sensations below the waist is a good way to deal with childbirth pain is not terribly empowering. Epidurals make you dependant on the hospital staff, drugs and monitors to manage your birth. The lure of "pain-free birth" might make epidurals look like a wonderful choice but they often come with a high emotional price tag.
Women who have chosen to empower themselves during childbirth have come up with many ways to comfort themselves through the intense physical sensations of labor. We're collecting some of their combined wisdom here.
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My births are always difficult, how can I trust my body to birth without help?
Women who have experienced traumatic births in the past can find it difficult to trust their body's ability to labor and birth without supervision. There are a small number of women out there who truly, honestly can't give birth without assistance. Even these women can benefit from empowering themselves to take charge of whatever elements they can manage. Empowered birthing is for every pregnant woman regardless of her physical ability to deliver a healthy child.
Learning to trust our bodies is vital to empowered birthing. Many women find great benefit in "de-briefing" their past births with people supportive of their empowerment. Often, the things we were told about our births are not true or accurate from a more holistic viewpoint. Many times birth complications begin as small issues that we ignore until they become big issues. When we empower ourselves we take those little issues very seriously and resolve them (if possible) before they erupt into major problems.
We have collected some comments on learning to trust our bodies here, but to get de-briefed on your birth and your issues you might want to check out our email list.
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What if something goes wrong?
This question is so pervasive and comes in so many different forms (i.e. What if the cord is wrapped around hir neck? What if there's meconium in the waters? What if my baby dies? etc.) that we're slowly creating our own knowledge base on the negative "what ifs in birthing".
But first, try countering some of your most frightening "What if" birth questions with a few of these:
What if I have a wonderful birth? What if I fall even more deeply in love with my partner because we went through birth alone together? What if nobody touches my precious baby but my closest family and friends? What if my private parts remain my private parts during my birth? What if taking responsibility for my own birth really does reduce my risk of suffering serious birth complications? What if my births really can be healing and holy?
What if... ?
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I'm nearly due already. How do I empower myself now?
If not now, when? Making empowered choices is a lifelong process, it doesn't come to us all at once.
If the empowered path calls to you (and it may not...) you start right where you are today, wherever that is. Some women will fire their doctor and birth at home by themselves. Some will find the courage to refuse a procedure they don't want but their care provider is insistent on.
We're not here to tell you how you should birth, we're here to tell you how you CAN birth. No one ought to have the right to tell you how you *should* give birth. Women are perfectly capable of making those choices for themselves and their families, they just need sound, reliable information and faith in themselves.
You get to choose how much of your power you are comfortable giving away to others for this birth. Just remember, you can give all of your power away but the responsibility of bringing this child into the world safely is still yours to keep. If your doctor or midwife makes a mistake they will regret it and move on, you will be the one living with those choices for life.
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How do I convince my partner?
Let's look at this question for a minute, I hear this one a lot. A pregnant woman wants to empower herself and make her own birth choices but her husband/partner/mother/sister/friend wants her to trust in a doctor/midwife "just in case something goes wrong". It looks pretty straight forward on the surface but if we look closer we often see far more complicated issues surrounding this situation.
It's a trust issue, s/he doesn't trust you to do this "right". It's a fear issue, they don't want to lose you or the baby. It's a communication issue, you need to express your needs and concerns without telling your partner they're "wrong". It's a "what do we tell my mother?" issue, etc. Taking the empowered path is rarely simple, hundreds of little problems are going to crop up. You need to handle each one of them with patience, love and trust.
Realize that most of the fear a partner has about birth is fear of losing you. Isn't that sweet? He LOVES you and doesn't want you to die. Partners deserve a lot of credit for caring that much, even if it rubs you raw. Cook his favorite dinner, massage his feet, hand him the remote. Express your love for them in return.
Then, when things are cozy between you and all is right with the world, share your appreciation for the fact that he fears this birth. Share your most romantic birth fantasies together as an exercise. What do you need most from this birth? What does he need most?
If either of you have experienced birth before, you'll need to debrief it together. What were the best parts? What were the worst? Imagine how your baby was feeling at each stage of the birth.
When birth is assessed through the eyes of the newborn people often notice more problems with technological birthing that they would otherwise. Newborns are fresh from the realm of the angels. They deserve no less than the softest, gentlest, most loving caresses after the stress of birth. They ought to be sung to and cooed over, smiled at and adored. You may experience several births in your life but each child gets only one emergence, they deserve the best one you can offer them at this time in your life.
Those couples who do choose to birth in private soon come to realize that birth is a highly sexual experience. We, as a society, like to pretend that birth can be an asexual act done in the presence of strangers. Rubber gloves and sterile drapes help us to detach the act of birth from the realm of the sexual and turn it into a medical procedure, done for our own good (or the good of our children). The fact is, it is part of the same cycle that was begun between two people in the privacy of their home several moons before. Reframing birth in this way often makes couples see the presence of a birth attendant as intrusive. Many women find they are repelled by the idea of a person other than their partner between their legs, especially while birthing.
Imagine how difficult it would be to thoroughly enjoy a sexual encounter and orgasm in a hospital room while strangers monitored your progress. It could turn a loving, bonding, enjoyable act into a terrifying nightmare, couldn't it? The pressure to perform is furthered in the birth arena by the ever-present threat of major surgery should you take too long, get too tired or develop a problem. The last thing a woman needs in the birth suite is fear. If a husband can protect his woman from feeling fearful while birthing, he will be serving her well. In return, he will receive a blessing most men never know.
There's really no way to tell how much damage is being caused to sexual relationships after traumatic birth experiences. Men and women have been known to become fearful of birth and, consequently, sex and who can blame them? The bonding process that begins in the marriage bed can be greatly enhanced in the birthing bed, but only if you both can let it happen. Privacy and faith in birth are in short supply in the childbirth industry. If you want it, you've got to create it together. Couples who experience birth alone together frequently report an enhanced sexual and marital life as well as being ready to enjoy sex again sooner than expected. Birth has the power to draw a family together and the power to rip it apart. Eliminating as much fear as possible from the birth experience will result in a safer, saner birth for everyone concerned.
Trusting in one's own power to give birth can transform a woman and her family with her. Looking at health care professionals as resources rather than as "the final word on wellness" changes the way we view the world around us. We cannot expect that our partners will make this shift in thinking on our schedule, they need to adjust in their own time but when you're counting down to 40 weeks, time is in short supply.
Trust yourself, then ask your partner to trust you. Face your fears together. Share your strength. Talk to your baby together. Encourage him to give a few birthing "pep talks" to your expanding belly. Pray for faith in birth together. Create your birth together, the three of you, don't just let it "happen" to you.
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Shouldn't I hire a midwife just in case something goes wrong?
You can, but you might want to consider putting your energy into creating a solid trusting relationship with your partner and/or family members before deciding to create a new relationship with a "birth-friendly" stranger.
The only midwives we can recommend you work with are the ones who want to see you empowered enough to birth without them. Midwives who insist that you can't possibly learn how to assess your own comfort and/or safety level should be avoided at all cost. We've posted ten reasons not to hire a midwife for your planned home birth here. It's completely up to you to decide if the drawbacks are worth the benefits for your family.
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How do I get my baby's legal papers after an unattended birth?
This question depends a great deal on where you reside on the planet in some ways but not in others.
No matter where you live, there's bound to be an office that records births in your county, province or local area. The biggest hurdle is usually just getting one person in that office to believe that you are recording a legitimate birth, not stealing babies and lying about it. Being confident about your right to file your own child's birth record is important.
I keep saying I'll compile state by state birth data but I haven't yet. There is a partial list of state statutes here though.
If your community is actively anti-homebirth/ anti-unabirth you might have a more difficult time with the legal issues. I know of no place that prosecutes women who birth their babies before they can reach the hospital but there may be communities that frown upon families not packing up and heading there soon after the birth. Some districts require an official document from a health care provider stating that the child has been examined. If I had to get one of these I'd try to get it as late as I could manage. It's usually preferable to keep healthy newborns away from doctors because they seem so fragile and delicate. A robust 3 month old is less likely to suffer from any stigma attached to their birth, in the eyes of most doctors.
You'll want to fill out a form (or have a form filled out for you) that states that you gave birth to this child on their birth date. Often having a photograph taken shortly after birth with mama, baby, an umbilical cord and/or placenta and a "date stamp" of some sort (the current newspaper or a TV broadcast can be used) can clear up any problems "proving" the baby is yours. In a perfect world that would be all you'd require, proof that the birth is yours to register. If your local government requires more than this, you have a larger problem to solve than I can address here.
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Can twins be born unassisted?
They can and they have. There are a number of tales of twin homebirths around and a few unassisted twin birth stories too. While I can see how a woman expecting twins might prefer to have an extra set of hands around during her birth, if help was not available, I'm certain most women would be more than able to catch one baby, wrap it, put it down and catch the next one. It's simpler than you think. : )
When we start taking birth out of hospitals we see all kinds of interesting things. Not long ago, a few of the new birth lists hosted the (indirect) tale of a mother who gave birth unassisted but continued to feel another little one, kicking around inside of her. Labor stopped and she stayed home tending her new baby for two weeks before labor began again and she delivered the twin. All three were healthy and fine.
In birth, as in many other life arenas, we tend to be able to handle much more than we think we can, when we have to. Still, there is no shame in asking for as much help as you want, during the birth and long after it too.
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What if I've had a previous birth by Cesarean section?
Personally, I have zero fear of VBACs/HBACs or even UBACs as long at the mother feels empowered and healthy. Problems, should they come up, can be dealt with as needed. Unfortunately, these days, I appear to be in the minority.
To be fair, there are several different concerns for women who have previously delivered their babies surgically. Some of them are addressed under the heading "What if I just never go into labor?", especially if your labors have always been augmented in the past.
The most common concern for women with a history of surgical deliveries is always the integrity of the uterine muscle itself. The fear of uterine rupture has created a culture where "Once a Cesarean, always a Cesarean" is becoming the norm once again. However, the risk of uterine rupture is actually quite small (typically cited as less than 1%, though certain studies that did not exclude labors augmented with induction drugs show higher risks) and it is reduced even further when drugs like Pitocin are avoided. Not to mention that the risk of rupture exists even for women who have never had a Cesarean at all. The riskiest period for uterine rupture is actually during the tail end of the pregnancy, when the uterus is being stretched out, and, unless drugs are involved or the waters are broken, it becomes less likely once labor has actually begun and the muscle contracts instead of expanding further.
The integrity of the uterine muscle is also related to a woman's diet (a muscle-healthy diet builds muscle faster than an unhealthy diet), the length of time between pregnancies (most sources will suggest a woman wait at least one year before conceiving again following a Cesarean birth, I'd suggest waiting two years) and, possibly, the skill of the surgeon who stitched the muscle together after your surgical birth.
Previously, it was believed that a second layer of stitches in the uterus or a certain type of incision were required in order to prevent a rupture during a VBAC, however, it doesn't appear to matter nearly as much as doctors once thought, especially if the mother eats well and has waited before conceiving again. It is still possible that your birth attendant believes that your type of scar puts you at higher risk of rupture, but that's far from being the only factor involved in the intergity of your uterine muscle and should not be used as a scare tactic or reason to prevent you from laboring wherever you feel safest.
While not all women have the exact same risks going into each VBAC attempt, every pregnant woman is at some degree of risk for rupture. Avoiding the most common causes of uterine ruptures is a wise choice for every woman.
To prevent uterine ruptures:
Eat as healthy a diet as possible, including healthy fats that build muscle (avocados, eggs, red meat, flax oil, fatty fish, etc.). Breathe clean air deeply into the lungs as often as possible. Focus on healing and restoring the muscle tissue of the uterus.
Birth in a VBAC supportive atmosphere. If you're hiring a birth attendant, choose one that has a high VBAC success rate and is proud of it! Home is the safest place to birth for VBAC mamas too, especially if you are empowered enough to direct your own transfer, if you should require one.
Avoid any and all induction drugs, most especially those that have been proven to increase the risk of uterine ruptures; Pitocin, prostaglandins and Cytotec.
Maintain the amniotic membrane intact as long as possible during labor to cushion the stress of contractions around the baby. Do not allow membranes to be "stripped" or "swept" as this can cause a premature rupture.
Avoid epidurals or other numbing drugs that might mask the sensations of a rupture while it's still early enough to prevent serious problems.
Meditate on Wholeness, Repair, Strength and Keeping it/things together.
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The other concern with VBACs (that you may not have even known about) is the slight possibility that cells of the placenta have grown into the scar tissue and right into the uterine wall. This complication (placenta accreta/increta/percreta) is rare but noteworthy. The risk increases with each Cesarean birth and can be a deadly situation, so even though it's rare, it's worth considering. Cesareans can also increase the risk of placenta previa (placentas growing over the cervix) as well, but placenta previa is a condition with obvious symptoms (bleeding) while placenta accreta is frequently symptom-free, until after birth when it can be life-threatening.
An ultrasound is not required to rule out placental accreta. Any midwife or doctor worth their salt can tell if the placenta is growing in the area of the scar or not. If it is and you have a long history of surgical births, ill health or a persistent sense of dis-ease, a quick ultrasound can confirm healthy placental growth patterns and a homebirth can still be planned.
Support is available for families recovering from Cesarean births and planning more empowered future births at the following links:
ICAN ~ International Cesarean Awareness Network. The finest resource on VBAC around.
VBAC ~ A woman-centered, evidence-based resource.
The VBAC Pages ~ Explains that not all uterine muscle separations are "ruptures" and they might not be as rare as we think.
Email Groups:
ICAN ~ The mother of all VBAC websites runs the mother of all VBAC support groups.
UBAC ~ Unassisted birth after a Cesarean. A group for families considering/planning/desiring UBAC.
A Uterine Rupture Support Group ~ For the survivors of uterine ruptures.
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Enjoy your births!
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