Remembering How to Birth

I have been sitting with women in labor for a very long time.

Long enough to know that there is a moment when she leaves us.

Not literally, of course. She is right there. But the woman who was talking between contractions, asking questions, wondering what time it is, wondering how many centimeters she is, wondering how much longer this will take—she begins to disappear.

Her eyes close.

Her words get fewer.

She rocks.

She hums.

She moans.

She finds some strange little position that makes absolutely no sense to anyone else but makes perfect sense to her.

And if we are wise, we don't disturb her.

This is one of my favorite moments in birth.

Because she isn't losing control.

She is finding something much older than control.

We know how to do this

We spend so much time teaching women how to give birth.

Take this class.

Learn this breathing technique.

Practice these positions.

Download this app.

Count this.

Time that.

Make your birth plan.

And yes, prepare. Please prepare. Know your options. Know your body. Know the people who will be in the room with you.

But after all these years of attending births, I am increasingly convinced that much of my work isn't teaching women how to give birth.

It's helping them remember that they already know.

There comes a point in labor when all the information needs to get out of the way.

The thinking brain gets quieter and the ancient brain gets louder.

Michel Odent has spoken about this for decades. The neocortex—the part of us that loves language and questions and being sensible—begins to take a back seat.

And the mammal comes forward.

This is why a woman who was perfectly happy chatting an hour ago may suddenly look at you like she wants to throw something when you ask:

“How are you feeling?”

She's busy.

Leave her alone.

Birth likes the dark

There is a reason so many labors really get going at night.

Birth likes darkness.

It likes warmth.

It likes privacy.

It likes familiarity.

It likes repetition.

It likes quiet.

It likes not being watched.

There is beautiful physiology underneath all of this. Oxytocin, endorphins, adrenaline, melatonin—an entire hormonal orchestra is playing while a woman labors.

But women knew this long before we could measure a hormone.

Watch any mammal prepare to give birth.

She doesn't head for the brightest, busiest place she can find.

She makes a nest.

She goes somewhere protected. One of my favorite OBs Stu Fischbein used to say “You don’t see deer heading towards the freeway in labor.”

And underneath all our intelligence and technology and monitors and birth plans, we are mammals too.

Sometimes I think we forget that.

Stop asking her so many questions

One of the simplest things we can do for a laboring woman is stop requiring her to be social.

Stop making her explain herself.

Stop making her answer questions that don't need answers right now.

Stop asking her to come back into the room when she is trying very hard to leave it.

Dim the lights.

Close the door.

Lower your voices. In fact, what if we just let go of speaking altogether?

Warm the room.

Let her move.

Let her get in the water.

Let her hang over the side of the bed, or the tub, or use a peanut ball…

Let her squat in the corner.

Let her make that low, guttural sound that she didn't know could come out of her body.

Let her swear.

Let her cry.

Let her laugh.

Let her be naked.

Let her cover herself completely.

Let her say don't touch me.

Let her say don't leave me.

Listen.

Women tell us what they need in labor all the time.

The trouble is, sometimes we're too busy helping to hear them.

Birth isn't particularly polite

Ina May Gaskin understood this beautifully.

Birth lives in the same body as sex and orgasm and bowel movements and breastfeeding.

It's intimate body work.

Ina May talked about something she called the sphincter law: that the openings of the body don't particularly enjoy being commanded, frightened, embarrassed or observed.

This makes perfect sense to anyone who has ever tried to pee while someone was waiting outside the bathroom door.

And yet somehow we expect a woman to open her body while strangers walk into the room, lights are blazing, people are talking over her and someone asks her a question every seven minutes.

Sometimes what birth needs isn't another technique.

Sometimes birth needs everyone to get out of the way.

Instinctive birth doesn't always look beautiful

At least not Instagram beautiful.

It is sweaty.

Wet.

Loud.

Quiet.

Bloody.

Funny.

Sexual sometimes.

Animal sometimes.

Tender.

Wild.

A woman may roar.

She may shake.

She may vomit.

She may announce that she is absolutely not doing this anymore—which, after enough years of midwifery, occasionally makes me quietly think, Oh good. We might be getting somewhere.

She may suddenly reach down and touch her baby's head.

She may know exactly which position she needs.

She may tell everyone to stop talking.

Listen to her.

There is intelligence there.

Our job isn't to make birth happen

This may be one of the hardest lessons in birth work.

We want to help.

Midwives want to help.

Doulas want to help.

Partners desperately want to help.

So we rub and coach and count and suggest and reposition and encourage and hydrate and reassure.

Sometimes that is exactly what she needs.

Sometimes she needs someone to look straight into her eyes and remind her that she can do the next minute.

And sometimes the most skilled thing you can do is sit quietly in the corner and knit.

Not because nothing is happening.

Because everything is happening.

The question isn't always:

What can I do?

Sometimes the better question is:

What can I protect?

Her privacy?

Her concentration?

Her sense of safety?

Her connection with her partner?

Her ability to move?

Her confidence?

Her right to say yes?

Her right to say no?

Her labor belongs to her.

And sometimes birth needs help

This is important.

Trusting birth does not mean pretending birth is never dangerous.

I've been a midwife too long to romanticize it that way.

Sometimes physiology needs assistance.

Sometimes a baby needs help.

Sometimes a mother needs help.

Sometimes the beautiful home birth becomes a hospital birth.

Sometimes the vaginal birth becomes a cesarean.

Sometimes the plan we carefully made gets blown completely apart.

That doesn't mean she failed.

And it doesn't mean we stop protecting birth.

We can protect birth in an operating room.

We can ask people to lower their voices.

We can play her music.

We can explain what is happening before touching her.

We can help her feel involved rather than operated upon.

We can protect skin-to-skin when it is possible.

We can keep mother and baby together whenever it is safe to do so.

We can remember that while a cesarean may be an everyday procedure to the people performing it, this woman is meeting her baby.

There is nothing ordinary about that.

A mother is being born too

Jane Hardwicke Collings talks about birth as a rite of passage, and I love that language because that is what I have witnessed again and again.

We focus so much on the baby.

Of course we do.

But someone else is being born in that room.

A mother.

She will remember pieces of this day forever.

Maybe not what time she was six centimeters.

But she will remember who believed her.

She will remember who frightened her.

She will remember the person who looked into her eyes.

She will remember whether she felt heard.

She will remember whether her body felt like it still belonged to her.

She will remember the first time she touched her baby.

These things matter.

Maybe we don't need to learn how to birth

Maybe we need to remember.

Remember that women have been doing this since before anyone knew what a cervix measured.

Remember that darkness has a purpose.

Privacy has a purpose.

Movement has a purpose.

Sound has a purpose.

Safety has a purpose.

Remember that the strange things a woman does in labor may not need correcting.

Her body may know something before her thinking mind does.

So yes.

Read.

Learn.

Ask questions.

Choose your birth team carefully.

Know your options.

Make the birth plan.

Pack the bag.

Do all of it.

And then leave some room for the mystery.

Because when labor really takes you, there may come a moment when you don't need another instruction.

You don't need to perform birth.

You don't need to be good at it.

You don't need to look beautiful doing it.

And you really don’t have to enjoy it.

You just need people around you who understand that something ancient is happening—and who are wise enough to protect it.

Your body carries an old, old memory.

Sometimes our job is simply to make enough quiet for you to hear it.