An Entirely New Childbirth Approach … reducing the shame, blame and guilt

(Modified from the keynote talk given at Australian Midwifery Conference 5-7 November, 2008. The theme of the conference was … Being real in the real world)

Fill in the following question with one of the four words that most identifies you. ‘I am a ...’

Here are your four choices … woman, midwife, mother, human.

(note: at this conference the vast majority of people identified themselves with ‘I am a mother’. Then came ‘woman’, then ‘midwife’ and only a few identified with being a ‘human’. There were no men present at this conference.)

It’s curious how we identify ourselves. Take everything else away and we are human. Some of us are women and some are biological mothers … these are our physiological realities. Being a midwife is your job or occupation … even if you felt ‘called’ to become one … being a midwife is your employment no matter how much you love it and how passionate you feel about childbirth issues.

This talk is about us as human, for both women and men equally although there are no men here today.

So let’s get real.

The Natural Birth Movement and Midwifery Model that rose to prominence in the early 1980s have not been successful. Even in New Zealand where midwives achieved professional autonomy and status as the Lead Maternity Carers in 1990, they have not saved childbirth nor lowered the rates of c/s or interventions.

In fact, I’m talking to you today because the Natural Birth Movement and Midwifery Model has not produced the ‘outcomes’ hoped for. Perhaps my talk will inspire you, women who work as midwives in Australia, to participate in creating an entirely new childbirth approach and a whole other reality.

I have an agenda

I run a New Zealand registered charitable Trust called Common Knowledge. One branch of CKT produces The Pink Kit Method For Birthing Better®. This branch has only one agenda… to grow a skilled birthing population by getting the majority of expectant parents to teach themselves The Pink Kit Package (PKP) skills. Let me give you the bottom line … as humans we need to teach our selves birth/coaching skills when we become expectant parents.

However, this is not a business conference so I’m not going to talk with you about how to sell The PKP. You just need to know I have an agenda.

Inspired by a message

I have the courage today to get real with you as women who work as midwives because I’ve recently seen a documentary called Man on Wire. This is the story of a French wire-walker named Philip Petite who walked between the World Trade Center buildings in 1974. At the end of the film Philip gives his view of how to live life. Although I cannot quote that, just know I was inspired by his comment.

So this is my coming out, the moment in time when a new approach to childbirth is launched.

Brief outline of this talk

•    We’ll investigate what a skilled birthing population looks like
•    The past trends in childbirth approaches
•    Then we’ll look at the present trend … Natural Birth Movement and Midwifery Model
•    We’ll look further at this possible new childbirth approach
•    Hopefully we’ll arrive at a collective understanding and perhaps a decision to work diligently to bring this new childbirth approach into our societal expectations.

This is what a skilled birthing population would look like

***** For there to be a societal expectation and acceptance for having a skilled birthing population will only occur when doing so is perceived to have a significant number of PRIMARY and secondary benefits for both expectant parents and care providers and is achievable by the majority of expectant parents who are quite capable of teaching themselves and using birth/coaching skills. ****

Societal expectations are around us all the time and change. Many of you remember when public service messages began to tell us to buckle up seat belts and later to put children into car seats.

In all modern societies there is a high societal expectation and acceptance that anyone who wants to get a driver’s license must learn the exact same set of complex skills, prove their competency in a practical test and use these skills every time they drive. Childbirth is certainly as significant as driving.

A new societal expectation around pregnancy and childbirth would give this clear yet simple message conveyed in these three achievable goals:

1.    It’s necessary to prepare our pregnant body (a container) to make space for our baby (a very large object) to come out of it.2.    There are appropriate birth and coaching skills for us (mother and father-to-be, friend or relative) to learn in order to do the activity of birthing this big object.
3.    On the Big Day (our test) it’s then expected that we use our birth/coach skills to work with our baby’s efforts to be born in any birth we have … alongside the health care we receive and including elective c/s.

Hopefully in 35 years from now, given that this conference is the official launch of this new childbirth approach, The Pink Kit skills will be such common knowledge and accepted that we’ll actually look forward to the next generation of families giving birth rather than continue to have the despair of the present time.

I’m speaking to you today to open up your minds to the primary and secondary benefits for all of us as we move toward adopting and promoting this new societal expectation …for you, me and all of us as human beings especially those who are becoming parents.

We should want these three practical and common sense goals to be part of our human existence. We should want to have the skills to do one of the most important activities of our lives.

Who do I have to convince to make this happen?

•    One really large group … expectant parents and some might be resistant. We do believe that what we are absorbing through the childbirth classes we take, books we read and birth stories we hear is right information rather than understanding that actually there is a present trend that has followed on from two previous ones. We can also be resistant to any expressed belief that there are a common set of skills suited for all our births because the fundamental principle of this present trend highlights our unique differences based on our choices or lack of and not the commonality of the birth experience.

•    The other group I have to convince is made up of you, the women who work as midwives. You have to be willing to accept a new societal expectation without feeling you are losing your values or your hopes to become the lead maternity providers.

Obstetricians and other doctors do not need to be convinced. Within the modern maternity system, they bring highly sophisticated assessment, monitoring and procedural skills. They have no more interest in whether a woman copes or manages the birth experience than a mechanic cares how you drive your car. They have their job and you have yours both as mother and father-to-be.
Once this new childbirth approach becomes well known, it will make common sense that both mothers and fathers-to-be each have distinct and defined skills in order to do their job and work together with their baby’s efforts to be born.

Hopefully what I say inspires you to become one of the hundred monkeys that will put this new trend over the Tipping Point.

Change only comes from growing awareness

The first step to changing any entrenched belief system comes first from a collective acknowledgment of present gaps. For example, People in cars without seat belts caused problems. This was a gap that needed to be filled and was collectively recognized.

The second step comes from identifying what the new trend will look like. Seat belts were proposed.

Third step is to actively create change. Seat belts were put into cars but each of us has to take the responsibility for using them every time we get into our car.

Let us look together at the past childbirth trends and the gaps that led to the next trend.

The past trends

I was born in 1944. My mother birthed in hospital and was unconscious during the delivery and this was normal for that period of time. Fathers sat in the waiting room. The childbirth trend to that impacted my mother was … follow doctors orders.

Whatever the trend prior to this time was is unknown to me. If we keep going back in time eventually we reside in the multitude of cultural practices prior to modernization and the Industrial Revolution.

Following doctor’s orders didn’t give us much to do nor choices in the care we would like. These were some gaps in this childbirth approach. So change began to occur.

When my daughter was born in 1970 there were heaps of positive things that were changing.

•    Women wanted their husband and then other friends and family members with them during labour and delivery.
•    Rooming-in.
•    Delayed cutting of the cord.
•    Birthing in the same room as labouring.
•    Being awake during surgical births.
•    Low-lying surgical scars.
•    Breast-feeding immediately.
•    No sugar water or formula given if breast feeding.
•    Vacuum extraction as an alternative to forceps.
•    Early discharge.
•    No shaving of pubic area.
•    No mandatory enemas.
•    Being able to move around during labour.
•    Being in a more upright posture for delivery.
•    No mandatory episiotomies.
•    And many more!

Many of these positive changes have become the standard of care in modern hospitals worldwide.

At this time, there developed in the US a high societal expectation that the majority of expectant parents learn Lamaze (a techniques-based childbirth approach). Eventually The Bradley Method also became popular (a father and techniques based childbirth approach). Systems like Active Birth or Hypno-birth came later. They are also ‘techniques’ based systems.

So in 1970s the trend changed from a ‘follow doctors orders’ childbirth approach to a techniques-based childbirth approach that also focused on ‘increasing/achieving natural birth’. I used Lamaze.

Please pay attention the two elements shared by all the above systems:

•    Techniques-based
•    Their goal is to increase natural birth and decrease medical births.

Any ‘techniques-based’ childbirth approach can work in any birth as long as the family chooses to use the techniques. However, because all these systems grew from a basic philosophical goal to achieve a natural birth versus having ha medical birth, when a birth was more medical than a family wanted or hoped for they often gave up using their techniques. They felt the techniques didn’t work, choices had been taken from them or they had failed.

This was the beginning of the shame, blame and guilt that has exploded into childbirth.

A personal experience

My son was born in 1982 I delivered him myself in hospital in an unfamiliar town. He was 8 weeks premature! This certainly showed that childbirth had really changed in US hospitals since I was born!

The biggest personal difference I experienced is that I now had The PK skills that had evolved over the past 12 years. I now had an entirely different capability.

In my daughter’s birth I used the Lamaze ‘techniques’ but I knew they were techniques and not always adaptable. With my now enhanced skills twelve years after my daughter’s birth I knew how to work with my son’s efforts to come down, through and out my body.

There are profound differences between ‘techniques’ and ‘skills’ as applies to pregnancy and childbirth.

Just one tiny example of a childbirth technique would be:

‘Drop your chin to your chest and push down like you’re having a bowel movement’.

Just one small example of a childbirth skill would be:

‘When I felt the pain in my back, I knew I had to make more room for my baby. I had learned Kate’s Cat so I worked with my sacrum to keep it mobile. Eventually the pain shifted down as my baby moved through my pelvis. I felt I worked with my baby’s efforts to open me up at every contraction.’

We have to trust that ‘techniques’ work no matter what is happening. Sometimes this does not happen. This is just one of the gaps in this system.

On the other hand skills permit us to entirely focus on creating our own working relationship to our child’s efforts to come down, through and out our body. Birth no longer happens to us, it’s an activity we do with another person … our child … and in a skills based childbirth approach our loved ones also share these skills and help us stay on task.

The present childbirth approach

These techniques-based childbirth approaches lasted only a very short time in the US from the mid 1960s-early 1980s and were replaced in the early 1980s by the Natural Birth movement that then coupled to the Midwifery Model of care. This is actually a double trend: a natural birth philosophy joined to the professional status of women who work as midwives.

Part of the Natural Birth Movement philosophy rightly recognized that these ‘techniques’ didn’t always work and seemed a bit artificial and said so:  ‘women don’t need to be taught how to birth, cats aren’t. You breathe all the time and will breathe in labour so you don’t need to be taught how to breathe. You shouldn’t be told what to do, you’re the mother and you know best.’ This then became a ‘choice based’ childbirth approach with Birth Plans as the foundation for the birth a family wants.

The previous childbirth approaches …  both to follow doctor’s orders or use techniques to achieve more natural births … were still integrated to the doctor model of maternity care. However, the present childbirth approach … Natural Birth Movement philosophy … is tied to and often led by women who work as midwives.

This double trend has lasted 35 years and is aspired to by many people around the world as the ideal future direction for childbirth.

Here’s pause for thought. Even in New Zealand where midwives have been the Lead Maternity Carers and achieved professional status since 1990 and women have ‘choice’ the Caesarean rate has more than doubled and the intervention rate is as high as in many obstetric run maternity systems.

This double trend is what CKT is trying to change.

Changing the present childbirth approach does not mean the Natural Birth Movement or Midwifery model childbirth approach is wrong or has failed. It merely means there are huge gaps. Choice and Birth Plans have more often led to seeing childbirth birth in opposition … natural versus medical, home versus hospital and midwife versus doctor.

From the early 1970s what is being launched today … a skills based childbirth approach … started to evolve and has become known as the Pink Kit Method For Birthing Better®. As mentioned at the beginning of this talk … this is the formal launch of this new childbirth approach on 5 November 2008.

Notice it’s not The Pink Kit Method For ‘better birth’. That would imply someone can give us a ‘better birth’. No one can give us that but ‘choices’ and Birth Plans as promoted by the Natural Birth Movement have become a ‘wish list’ or ‘items on a menu’ or an expectation of a better or perfect birth given to us.

Birthing better is always something we have to do for ourselves.

Understanding more about the Natural Birth Movement philosophy:

Besides the few aspects I mentioned above … ‘women don’t need to be taught how to birth, cats aren’t. You breathe all the time and will breathe in labour so you don’t need to be taught how to breathe. You shouldn’t be told what to do, you’re the mother and you know best.’

Here are some further elements of this philosophy:

 'Birth is natural. Women have always had babies so trust yourself that you can give birth. You'll know what to do on the day. You should be left alone to discover birth for yourself.  Trust your instincts/intuition. Your home is the best place to give birth with a trained midwife.'

Let us look at one of the goals of this overall philosophy.

To do this we must look at the Conscious – Unconscious – Competency - Incompetency model.

One of the goals of the Natural Birth Movement is for birthing women to reach a state of Unconscious competency. Self-knowledge is meant to rise up within us during the birthing process through our intuition and instincts because we open ourselves to ‘trust’ the experience. This means we don’t actually know or are aware that we are using skills.

Conscious competency is exercised by expectant parents when they gather information to be able to make informed ‘choices’ that lead to their Birth Plan. This means we consciously make choices that are meant to lead us toward an automatic and enriching birthing process.

The presently accepted societal expectation for taking ‘responsibility’ by expectant parents is for us to make informed choices and exercise informed consent. This means that the phrase ‘taking responsibility’ focuses on what we want or choose rather than what we are able to do.

Naming one of the gaps:

So few of us achieve this Natural Birth Movement goal. There are so many elements (and I’ve just mentioned a few) that must all line up in order for a truly ‘natural’ birth to happen. It’s virtually impossible for the majority of us to achieve this. Besides the term ‘natural birth’ has never been clearly defined except to say it occurs without ‘interventions’ which is another word not clearly defined.

It’s not uncommon to hear another woman say ‘I wanted a natural birth BUT I had to be induced.’ This statement implies that she ‘chose’ a ‘natural birth’ yet didn’t achieve it because an ‘intervention’ was used which then left her feeling less complete.

The exponential rise in shame, blame, guilt, disappointment, anger and frustration comes directly from the Natural Birth Movement. This wasn’t intended. It’s one of the unintended negative consequences of this present childbirth approach that focuses on ‘choice’ and builds a ‘us versus them’ model.

Ask yourself if you have achieved this goal?

•    Did you give birth at home?
•    In water?
•    Had both spontaneous 1st, 2nd and 3rd stages without anyone telling ‘what to do’?
•    Were left alone to discover birth your self?
•    Used your intuition or instincts at every single moment of the experience?
•    Had an orgasmic birth?

If you achieved this you are indeed lucky and probably envied by many who know you. How many of your friends or relatives have achieved the same? (At this conference of over 300 people not one had achieved this type of birth). So what about us?

Now ask everyone you know who has given birth these questions:

1.    How many of you had a labour whether you gave birth vaginally or had a surgical delivery, had your baby at home or hospital, had a midwife or doctor, had a natural birth or medical one? Did you breathe? Was your body in some posture/position? Then you could use birth skills and could have prepared your pregnant body for the birthing experience.

2.    How many of you had a c/s whether non-labouring or labour? If you were awake then you also breathed and your body was in some posture/position even if it was flat on your back … use your skills! And you could have enjoyed preparing your body during pregnancy.

A skills based childbirth approach includes every type of birth and can reduce a huge amount of the shame, blame and guilt.

With a skills based childbirth approach, the skills are what we have in order to feel in control of a situation even if we are not in control of anything except our own behavior.

Pink Kit families who have medical care whether they want it, need it or have it forced on them strongly believe they achieve a natural birth because they worked together at every moment in a skillful manner. Wires and tubes attached to every orifice does not stop us from using one or more of our skills. Not only did they use their skills during the birth, they recognized and acknowledged how important it was to take 16 weeks (if possible) during pregnancy to prepare for birth so that the skills became second nature.

Pink Kit families are as committed to the pregnancy part of childbirth preparation as to the birth part. This is something that needs to be stressed. It’s during pregnancy when attention must be paid to the process of getting a big object out of the container where it’s lived for 9 months. Doing so requires work and work is best done with appropriate skills and skills are best learned prior to the efforts that will be required for this task.

Now society can define a natural birth as something we do rather than something that happens to us. We ‘drive our birth’ just like we drive our car … using one or more of our complex skills that we previously learned. We don’t need to be passive to the standards of care or feel raped by them or desire them. These things will happen to us and around us. Just like everything that happens around us when we drive. We always have to use our driving skills to navigate through all the outside experiences. Childbirth is exactly the same except that there are external experiences such as someone talking to us as well as our internal experiences. … often painful.  Skills permit us to work with both.

Gaps that lead to a new childbirth approach

In the present childbirth approach there is a projected belief that a better birth is achieved when there are no ‘interventions’ even if the woman screamed her head off and the father stood around gob smacked. We often hear ‘Well at least you didn’t need any interventions’.

If we’re going to get real, we have to stop the judgments of women to women … such comments as ‘I had a home birth YOU had a hospital birth’. Or ‘I whimped’.

As nice as the present trend sounds, it’s not achievable by the majority of women and men yet 100% of pregnant families will give birth therefore we should all know how to work with our baby’s efforts to be born. A skills based childbirth approach includes everyone and is achievable by all.

Remember this new childbirth approach focuses exclusively on these three elements:

•    Prepare your pregnant body for birth
•    Learn your birth/coaching skills as both mothers/fathers-to-be
•    Use your skills to work with the baby’s efforts to be born in any birth.

The Natural Birth Movement and Midwifery Model:

There has been a desire by women like your selves who work as midwives to have what has been achieved in NZ and other in other countries where midwives work independently within their maternity systems.

•    Direct Entry
•    Lead Maternity Carers
•    Give women continuity of care
•    Support women's choices
•    To have the ability to deliver both at home and hospital
•    Be paid by Government or privately insured.

Women who work as midwives often separate themselves from obstetricians by defining their profession as ‘the Guardians of natural birth’. 

If midwives in Australia want to be the highly skilled yet low-tech primary birth providers as in NZ and others countries as compared to the high tech obstetricians then it would make common sense that their clientele should be deeply and thoroughly encouraged to prepare the pregnant body for birth, learn the appropriate skills and use them at their births.

At this specific conference where the progress being made by the Australian College of Midwives was presented, there was no mention of what women who work as midwives will expect of expecting parents.

In New Zealand, women who work as midwives have developed a Partnership based on developing a Birth Plan. This has not created less ‘medical’ interventions. This does not mean that Birth Plans are wrong or fail. It does mean that they are not sufficient and in fact put more pressure on birth providers to give the families what they want.

True partnership between women who work as midwives and women and their partner must include a separation and clarification of what skills each person is expected to bring and use during the birth.

Giving birth is not like a dental appointment where you can choose what type of treatment you want and then become passive while the treatment is provided.

Childbirth is always an activity that the mother must do.

Pregnancy is the time frame in which to prepare for this activity. Fathers, friends or other relatives are the person designated a support role that should become more pro-active than wiping a brow, holding a hand, giving ice chips or a small back rub.

Growing a skilled birthing population will only become accepted by diverse societies when giving birth is perceived of as an activity worthy of skills. We hope this launch of a skills based childbirth approach will begin to gain momentum.

For this to happen we must stop seeing childbirth in a similar way we go to the dentist and more like when we drive a car.

The good news

When we adopt a skills-based childbirth approach, everyone’s included and this is a Primary benefit. Families giving birth in hospital with either midwives or doctors will have a more positive birth experience because everyone expects them to use skills. Midwives attending home births will thoroughly enjoy working with skilled families.

From eight years of statistics collected skilled families self reduce the use of many of the common interventions through their pregnancy preparation and by using skills to work with their baby’s efforts to move down, through and out the pregnant body.

Working with skilled families reduces the fatigue of continuity of care providers and increases the enjoyment of staff. These are just a few of the secondary benefits for growing a skilled birthing population.

 But more important those skilled families who have medical assessments, monitoring and procedures and use their skills feel much more empowered and less disappointed. (Primary benefit)

Success in our birth experiences leads to better parenting and partnering relationships particularly in the early months. (Secondary benefit to parents/baby).

There is another important fundamental difference between the present childbirth approach and a skills-based childbirth approach.

The Natural Birth Movement and Midwifery Model childbirth approach is heavily based on individual ‘choices’ or lack of. In fact, a big motivation for creating an autonomous midwifery profession is to give women choices. Also, the focus of ‘choice’ is about our individuality and creating our unique birth experience.

A skills-based approach focuses entirely on our commonality … our pregnant birthing body and what we can do in any birth we have whether with a midwife or obstetrician, at home, in hospital, with medical care, natural even whether we labour or have a non-labouring surgical birth. 

We all blink, cough and can tighten our rectum. Therefore, we can all take the same common knowledge skills into whatever birth we have whether we have ‘choices’ or not. And our partner, husband, friend or relative can share exactly the same set of skills based on our shared humanity yet purposeful in their role as birth support or coach.

Our present Natural Birth Movement, choice-based childbirth approach hardly touches on our commonality much less builds on it. This is just one of the gaps.
If everything and all things are different from each other even in birth then there will never be any commonality. In fact this belief in our uniqueness originates from a primary message about childbirth we have all heard for generations extending back in time long before the Natural Birth Movement and continues today … ‘you never know what your birth will be like so there’s really nothing you can do.’

This skills-based childbirth approach uses the word ‘choice’ in a different manner. This is best expressed by a skilled PK woman. ‘At every moment I had a choice to make … how to breathe in and how to breathe out.’

Worldwide ignorance

Basically as human beings we all feel unempowered by childbirth. I have traveled extensively and spoken to people in multiple cultures for the past 35 years. Women are taught to make bread but not how-to birth. Childbirth, worldwide, is assumed to be an unknowable experience both life-giving and threatening.

Ask yourself … both as women and men … what did your mother/father tell you about how-to birth? Did either show you exactly what types of breathing patterns create relaxation and what indicate a reaction to tension? Did either show you how-to make certain that each contraction is effective? Did either show you how-to work create internal relaxation and recognize internal tension? And to do this at every moment of the birthing process even if there is pain or use skills during a surgical birth?

If you do not know how-to birth to the level of driving your car, then you don’t know how-to birth because they are not skills passed down through the generations.

Yes, as women and certainly men, we all feel pretty unempowered about childbirth … everywhere. It’s time for a total change worldwide so that childbirth becomes a skillful activity. This is the goal of Common Knowledge Trust and The Pink Kit Method For Birthing Better®.

What exactly is childbirth?

One things for certain giving birth takes time. It’s an activity and we experience internal sensations. This experience and incredibly important life event requires us to either respond to or react to the internal sensations that reflect our baby’s movement through and out of our body.

Skills will give us something to do to fill the time as we continually work with the sensations while we move from the beginning, through the middle and come out the other side of this process. Birth is not like sitting in a dentist’s chair. It is much more like driving a car.

Skills grow our Conscious competency … we know that we know what to do and what we are doing … we become self reflective and self-aware. This happens to both us as women and men. Fathers know they know how to help. Anyone of you with these skills knows that every one of us who has them knows the exact same thing. The is a small pixel of the collective mind of our humanity

All humans feel better when they feel skilled. This reduces our embarrassment, gives us pride, enhances our ability to refine our actions and we reach toward personal mastery and then, most important we are be able to pass on exactly what skills to use and when to our children.

Good news for women who work as midwives

Working with families who are skilled is a pleasure and gives energy not dependent on the outcome or whether the birth was natural or medical, home or hospital. Working with families who do not have birthing/coaching skills is often exhausting and depressing because you see women struggle with the process of giving birth and fathers who aren’t able to help.

To get a high percent of skilled birthing families we need to purposely give a societal message that states clearly that self-learning and using these birth/coaching skills is our ‘responsibility’. It’s not a choice.

Our societies should expect and accept that expectant parents come into our births knowing how to work with our baby’s efforts to be born … at least to some degree. We should treat this wildly important experience with as much expectation of competency as we do driving a car.

Hopefully from this talk you, women who works as midwives, will realize that you cannot save us, other women just like you, from ourselves. As women you have birthed no better than any of us. Your profession does not teach you how to birth your own children. Your profession teaches you to see birth from the outside.

A skilled birthing population (all of us included) means we have skills that we use from the inside of us. Those outside of us may never know what skills we are consciously choosing to use but we have them and we know.

So this new childbirth approach focuses on:

•    Prepare our body for birth.
•    Learn skills to use in our two roles: birth/coach
•    Use our skills however our birth unfolds and in any birth
•    The skills are based on our human commonality.
•    Achievable for all regardless of the outcome.

Moving past ‘outcomes’ 

We all know there is huge focus on ‘outcomes’ in childbirth. I identified NZ Midwifery model of care in terms of outcomes … doubling of the Caesarean and intervention rate. Birth has become a judgmental experience.

The medical model primarily values only one ‘outcome’ … a healthy mother and baby.

The Natural Birth Movement and Midwifery Model places multiple values on different ‘outcomes’.

On a scale from 1-10 with 10 being the best birth outcome, an orgasmic home birth in water attended by a trained midwife would rank as 10. Having a home birth would rank as a better birth than one in hospital. And a better hospital birth without pain relief would rank higher than one with pain relief. A ‘better birth’ is tied to ‘outcomes’.

Let’s change our focus instead on ‘birthing better.

Over the past 35 years I’ve asked these three questions thousands of time all over the world to other mothers, fathers and maternity birth providers. In other words I have listened to thousands of birth stories that come from families and how birth providers see families during the births.

In other words, how do women perceive of themselves and how to birth providers see them.

How many women?

1) Really, really know how to birth?
2) Really, really be overwhelmed?
3) Just get through it?

From the composite stories told by families and providers, they agree that for women:

1) About 1 out of 10 knows they are really skilled or is seen of as birthing in a skillful manner.
2) 4 out of 10 felt freaked or overwhelmed.
3) 5 out of 10 (especially those who had babies before) … felt they ‘got through’.

Curiously, there is common acceptance that women who have previously given birth are acknowledged to be more confident and capable the next time. Often we hear a woman say:  ‘I really focused on relaxing this time.’ That’s a skilled woman!

This new skills-based childbirth approach focuses on creating a vastly higher percentage of skilled mothers for any birth they might have.

As for fathers:

1) 1 was skilled.
2) 6 freaked or were disengaged.
3) 3 tried their best to do something.

Birth can change:

For women who self-learned the Pink Kit skills during pregnancy and prepared their pregnant body to give birth the birth stories are vastly different. Birth providers only see women in the climate of today’s childbirth approach and not what happens when the majority of women have learned skills. So the below information is expressed from the viewpoint of women and from one New Zealand woman who has persuaded her clientele to self-learn these skills during the past 8 years.

Women:

1) Seven women report they felt very skilled and knew how to work with their baby’s efforts to be born. This was across all types of birth experiences.
2) Two still felt overwhelmed and admitted they had not invested any time to learn these skills.
3) One ‘got through’ and knew they should have done more and would next time. In other words, they pretended to learn but didn’t really own the skills or commit to using them during their birth.
 
Men:

1) Five felt very skilled.
2) Three still felt overwhelmed and had not committed to learning during pregnancy, often because they perceived birth to be ‘woman’s business’ and the role of the birth provider.
3) Two ‘got through’ but realized from the experience that next time they would be more confident to use the skills.

The New Zealand midwife has been able to get 80-85% of her clients to self learn these skills. 5% remain resistant and will not even look through the resource. 10-15% say they have learned but it’s obvious in their birth that they do not exhibit using skills to cope or manage.

Just imagine what childbirth would look like if within our societies 7 out of 10 women really knew how to birth and 5 of the fathers really knew how to help? This would certainly be a primary benefit for families. Let’s put that into more realistic numbers. Instead of 10 out 100 women feeling they coped well with childbirth, we could have 70 out of 100 or 700 out of a 1000 births.

Don’t you think this would create some shift in childbirth? The New Zealand midwife’s statistics clearly show two things:

1) Families who self-learn these skills self reduce the common interventions that are rising worldwide.

2) Families who self-learn these skills and have medical interventions still feel better about their participation and their birth experience.

All we have to do is delegate. Expectant families need take part in the birth process to a far greater level then just make Birth Plans. The roles are clearly defined: the mother, her support and birth provider. The birth provider’s skills are well documented. Now it’s time that the birth and coach role have specific skills to do their jobs.

When this happens, the majority of families will skillfully work with their baby’s efforts to be born alongside the health care they receive. This has to be good for everyone.

Further good news

The last 20% of reluctant people can be reduced once a skills-based childbirth approach becomes a high societal expectation and is accepted. Social trends can change quite quickly once the benefits are known and the achievable steps are also known. We have the achievable steps … the PK Package.

Benefits for staff midwives

•    Experience a huge increase in men and women who behave* well.
•    Staff and doctors are more relaxed when the woman is coping well.
•    Staff and doctors love to see fathers who really know how to help.

When women are tense or not coping everyone gets stressed. No one wants to see women suffer.

* NOTE:

•    What are better terms to use for how people see a woman in labour if we don’t like the words ‘behave or act’?
•    What are the better terms to use for how women speak about them selves in labour if we don’t like the words ‘cope or manage?’

Words in childbirth have become so sensitized and often unclear.

There are current social beliefs that can hamper us from making this change:

•    We’ll never know what our births will be like.
•    Our mothers/fathers didn’t pass specific skills down to us.
•    We’ve come to belief that it’s necessary to set up all the dominos of the Natural Birth Movement in order to achieve the better birth.
•    And we’ve been told that because birth is natural it doesn’t require skills.

And as women, we are being told to believe that you … the women who work as midwives and who see yourselves as the guardian of normal birth … will provide us with the safe, natural home birth because we’re told that once you’re in hospital you don’t stand a chance to have a natural birth. So what about us who do birth in hospital? We’re not really included in this very difficult to achieve iconic birth.

And this highlights another gap in the Natural Birth Movement and Midwifery Model … there is continued judgment and this has to stop.

Frankly if we’re going to get real, we need to focus our attention elsewhere than on better births.  We should want more families to be included in successful birthing better and stop tearing birth apart.

There are deeper societal beliefs that might hamper change:

Often women will say: ‘I had a good birth’ just because it was short. Some times you hear ‘Oh, you were lucky or had an easy birth.’

Because only women of our humanity give birth (and that’s true) there is a firmly entrenched belief that because women have always given birth then they automatically know how. But do we, as women, automatically know how to breastfeed or as men and women know how to parent or have great sex or know what foods are poisonous? All these other natural physiological processes are infused with multiple and complex skills. Why not pregnancy/childbirth?

Also when we, as women, wanted our husband/partner to be with us during birth to help us, we put men into a situation where birth was often considered to be woman’s business and in the sphere of professionals. How were they supposed to know how to help us? Or do they get relegated to being hung on?

Not only that but when many men see their wife/partner in pain it’s easy for them to think several things:

•    Women have always birthed, so she knows what she is doing.
•    And how she’s behaving is how women behave.

When the pain gets really bad he can easily think:

•    Boy, I’m glad I don’t have to do this
•    My god won’t someone come in and give her something.
•    My god, put her out of her misery … women shouldn’t have to suffer like this.

Added to all of this is the woman’s response:

•    Why isn’t he helping me!

Many, many women know they are not coping … in other words, we know we don’t have skills to do this activity and we look for someone to help us.

Many of us experience Conscious incompetence while giving birth.

Besides men AND women rightly believe their birth professional will ‘take care’ of things… because that’s their role based on the skills appropriate to their training. This is coupled with no societal expectation that women learn how-to give birth and men (or other ‘support’ person) know how-to help. These roles are defined but do not yet have recognizable skills.

Therefore, women and men remain relatively passive even if they make Birth Plans. This type of passivity in birth makes the experience much more like a dental appointment rather than like driving on a long journey. This is the perception that needs to change.

And there’s more to add to the above:

The Natural Birth Movement projects the iconic birth as an orgasmic experience led by our intuition/instincts. What about all of us who don’t achieve that orgasm or instinctively/intuitively tense up in reaction to the pain?

In fact, we need to permit our selves to not like the experience one bit. How liberating. We can find labour challenging or hate every second of it yet know we have managed, coped, behaved and acted well by using our skills. How empowering is that?

Do you see what Common Knowledge Trust is up against in launching a new childbirth approach?

It’s so simple to understand why we don’t know anything about how-to birth or coach when our mothers/fathers have not taught us and we’ve been told there is no way to know what our birth will be like (which is accurate). But there is so much we can do to prepare for birth during pregnancy and then know how-to work with our baby’s efforts to be born that goes far beyond either the preparations suggested in the present ‘choice-based’ childbirth approach or even in the earlier techniques-based childbirth approach.

In order to actualize this skills-based childbirth approach:

We have to collectively agree on several things:

1.    That once you become pregnant you will give birth 100% guaranteed. Of course, this includes miscarriages, premature births as well as planned surgical deliveries. Birth follows pregnancy.
2.    That birth is an activity, something we have to do rather than just let happen to us.

Once we’ve agreed to these simple premises then we must want for ourselves:

1.    To know that we (mothers/fathers alike) can learn how to work with our baby’s efforts to be born.
2.    And have a sense of being in charge and in control of something we know we aren’t controlling … our baby efforts to come out of our body or even what is happening to us or around us.

Once we create a skilled birthing population we will no longer experience birth as something that happens to us. We can experience birth as something we do when it unfolds because it will unfold … 100% of the time!

Let’s get real and heal the wound.

Approximately 1/3 of all pregnant women will give birth through a surgical delivery whether they laboured or not or wanted a Caesarean or not.

A skilled birthing population treats all pregnancies and births the same. Because you’re pregnant, prepare for the birth of your child.

•    If we move from labour into a surgical birth, we can continue to use our skills. Why not?

•    If we plan a surgical delivery (whether by choice or pressure), we can thoroughly enjoy preparing our body to give birth … why not?
In fact, the day we (both mothers and fathers-to-be) head to hospital is no different from ‘labour’. Why not use skills thorough out that day as a way to honor the process? While we’re being prepped and during surgery, our skills will help us feel more connected to our baby, our partner and we can experience the same involvement as women and men who do the activity of labour and then give birth. The skills are also great during recovery.

All our births can be engaged, involved, participatory and meaningful.

In order for this to happen we must stop judging our own and each other’s birth. There is no better birth than any other. Why should the birth of any child be better than any other birth? To think so is just mean spirited. We can all birth better and then feel good about ourselves for our efforts.

Why I am not ‘teaching’ you any of the skills?

Let’s stay really real about this topic. Throughout this talk I have repeatedly mentioned that these skills are designed to be self learned that’s because we’ve shown over the past 35 years that we must self learn just like we learn to drive, play the flute or work out.

The Pink Kit Package is the best teacher for all of us to learn from but we must practice these skills in order to learn them so they become our own skills. We must own these skills within our mind/body relationship then choose to use them even when the sensations are unpleasant.  When we really are competent these skills become our default behavior. Then we achieve Unconscious competency …  this time it comes from the marriage of our mastery and intuition.

What you need to know as a pregnant woman and expectant father is that these skills will work for you 100% of the time if you use them. We hear Pink Kit stories every day.

‘The Pink Kit was wonderful. I had an epidural hours after I thought I would’.

‘Our Caesarean birth was so enriched by our having taken time to learn these skills and use them. No one call tell us we didn’t birth our son.’

‘I used The Pink Kit to heal the damage to my birth canal that caused me excruciating pain having sex for 3 years.’

‘I have changed from just being a man to being a father. Thanks to the Pink Kit I’ll never be afraid of my newborns’.

Conclusion:

Childbirth will really only change when more of us are skilled. It’s as simple as that.

Now we just need to get The Pink Kit Package to the 3,800,000 women having babies each year in the US; 800,000 in the UK; 250,000 in Australia and 58,000 in New Zealand.

Then we need to raise the money to make this resource more contemporary and able to be translated into multiple languages.