MAYD to Birth: At Your Doorstep

Promoting gentle, empowering mother journies…

Cora

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Anna, 25


After a few false alarms and one hard pregnancy, finally at 1:00 a.m.- I wake up having contractions that I have trouble breathing through. Poor Devin hadn’t slept much already so I let him sleep.


5:00 a.m.- Devin wakes up and can see that I’m in pain. We time the contractions and they are about 3 minutes apart lasting a minute and a half long.
5:45 a.m.- Off we go to the hospital to be checked for the 6th time. “You’re at a 4 and 90% effaced, and have a bulgy bag. We’ll come back and check you in an hour.”
6:45 a.m.- “Sorry, the bag has receded and you’re at about a 3 and 90% effaced. The cervix can open up more when the bag is bulgy, but since it went back up its not as big. Here is a prescription for some Tylenol 3. Go home take a warm bath, take the drugs and try to relax. “


Seriously?!? Relax, how is that supposed to happen when I’m having constant contractions! Not to mention that pharmacies don’t open for another 2 hours!


Devin takes me to my parents house where I can take a nice warm bath in the extra deep tub that allows water to cover most of me, and has jets. The water is SO soothing!


After my bath Devin is out cold on the couch, so I take up the sofa and try to do the same thing. Sleep isn’t coming and my mom’s phone (that she forgot to take to school with her) continues “alarming” to remind her to send her classroom kids to various places. I decide take the phone over to her at school and help for a couple of hours in her classroom.


By 2:00 p.m. I was back home at my house and had taken the tylenol 3 prescribed this morning, and was trying to relax but being very unsuccessful. We get home from lunch, I notice that I am bleeding. I was told that this could happen and that it was very normal, but if the bleeding got bright red and/or heavier that I should be checked again.
7:00 p.m. hits and I’m quite certain there is something not quite right so we’re off like a herd of turtles for the second time that day. The nurse comes in and checks me: “You’re maybe a 3 but I’d say a 2+ and 85%.”
-Hold it! I thought once you started progressing there were no take backs!-
“We’ll keep you for a while and see what happens. There are some concerns with the bleeding but we’ll let you know.”


9:00 p.m.- “You’ve been checked quite a few times and that can cause the bleeding, so we’re really not concerned about that anymore. You’re also still at a 2+ and 85% so there isn’t a reason we can keep you. Your contractions are about 2.5-3 min apart lasting about 1.3 minutes so take Tylenol 3 every 4 hours so you can get some rest tonight and your Dr. would like to see you first thing in the morning.”
At this point I’m so tired and CRABBY and in the utmost denial. I didn’t know what I was going to do. I had decided this traipsing back and forth to the hospital is for the birds and I’m NOT going back until my water breaks. I kept following their directions and they kept sending me home. I was NOT amused.


10:00 p.m.- The contractions became much stronger. I stopped keep track of how long they were lasting because it didn’t matter. They were already close together and not making me progress, so what was the point of timing them? Devin was playing games on his phone and watching t.v. while I was writhing in pain on my side of the bed. I didn’t want to complain or say anything to him because we were {again} just sent home only a short time ago. I really thought I was a pansy. Why didn’t anyone [Mom, sister, grandmother, friend...?] tell me it would be like this??? Time continued on and I was getting annoyed that I was having to breath myself through the contractions and I was starting to shake. Devin wasn’t paying any attention to me. Woe is me!


11:00 p.m.- I finally gave in and told Devin, “I have to have you put your hand on my back right here!” ( I showed him where the pain was.) The pressure and the heat of his hand made the pain at least somewhat bearable and we continued doing this for a bit longer.


April 22 2011


12:00 a.m.- I ask Devin to give me a blessing. In the blessing, I was told that I would be able to deal with the pain of the labor for however long necessary, and when baby was born, no matter what happened, she would be alright.
1:00 a.m.- I didn’t think I could take anymore of this. Devin’s hand on my back wasn’t helping as it had to begin with and I was shaking so violently I could hardly breath. Devin called the hospital and was told, “She was in only 4 hours ago. She hasn’t slept in 24 hours…. When did she take the Tylenol? … 3 hours ago? … Ok, Give her the Loratab at 2am and go see your doctor first thing in the morning. “
1:30 a.m.- I start to tell Devin that I feel like I need to use the restroom. {However, I feel to lousy to get up and do so!}
2:00 a.m.- Devin gave me the Lortab even though I argued and told him if the Tylenol 3 wasn’t doing anything what would ever make him think the Lortab would help? I still need to use the bathroom.
2:15 a.m.- That’s it! I need to go use the bathroom no matter what. I need to have a bowel movement and Emily (my sister) said that would happen before my labor would really progress anyway.


I strip down to my birthday suit because I’m hot and sticky. Not sweaty, just sticky. I proceed to use the facilities in the comforts of my own home. I take a seat minding my own business waiting for the contraction to stop when I feel this phloosh. No water, but there was definitely a drop. I slowly check my southern regions and feel a squishy bag and a hard spot inside the squishy bag.


“DEVIN! We have a problem!” I yelled from the bathroom. “What’s wrong? Get in the car! We’ll go now!” he tells me. I quickly respond back. “We don’t have time for that. I don’t think I’d make it if you drove. Call 911.”"Call 911, are you sure!?!” ”Devin, I can feel her head and the bag of water! CALL 911!” As Devin is doing as instructed I have this sudden urge to push. I yell to him that I have this urge to push and the Dispatcher, on the other end in her calm voice is yelling “DONT LET HER PUSH! They are on their way and will be there in about three minutes.”
Devin starts to run downstairs to let them in when I scream, “Where do you think you’re going! You can’t leave me! I need to push!”


Devin comes rushing back and tells me not to push then hands me the phone and tells me to talk to the nice lady while he lets the EMTs in. Again, I tell him not to leave me so instead he wakes up Brandy to let them in and comes back to help me breath through my pushing urges. At this point I realize that I am still completely naked and I tell Devin I needed something to wear! Quickly he takes his own shirt off, that says, “Life is Good in Newton!” and throws it to me. I get it on just as the EMTS get there.
The paramedic in charge checks me and says, “Good the water is still intact and we’re going to keep it that way. I don’t want to deliver a baby tonight. We can’t the gurnie up the stairs, do you think you can walk?” I get help up and walk down the stairs with an EMT on either side while another EMT holds the “Life is Good in Newton!” shirt down so I stay somewhat modest. Once in the ambulance they quickly and efficiently hooked me up to all the monitors and started an IV. ”Your contractions are about a minute apart, and lasting about 2 minutes,” said the EMT. I, again, have the urge to push so I start breathing the way I was told in my Lamaze class just the Monday evening before. The EMT looks at me in the eye and says,”Anna, look at me. You can’t breath like that. Breath with me. In through the nose, deep breath, out through the mouth slowly.”


“What do you mean I can’t pant. That is what they taught me in Lamaze!”
“Listen to me, you can do this, breath with me.” He repeats totally ignoring what I just told him.
I decided it was better to listen to him and complain later. Once on the main street I heard the sirens go on. Why sirens are needed at 2:30 in the morning I have no idea, alas they were on anyways.
They got me to hospital bypassing Emergency, and took me straight to Labor & Delivery. The nurse assigned to me quickly checks out the situation and says, “You’re at a 9 1/2. How do you feel about a natural delivery?”This didn’t upset me at all because it is what I wanted from the beginning.
“Well, I better get the delivery stuff out and call the doctor.” she says. The nurse started pulling out everything as the EMT finished up paperwork with Devin, who made it to the hospital before the ambulance did. I was admitted at 2:47 a.m. My parents arrived very shortly after I arrived at the hospital as well. Mom and Devin helped me breathe through the contractions as the nurse continued to get ready for the doctor. After 15 minutes when we hadn’t yet heard from Dr. Firth the nurse, Dee, picked up the phone to call again. Just as she started to dial, s Dr. Firth walked in and said, “I had a feeling it was you.”
He checked me and smiled saying, “Let’s get this baby here!”He quickly donned the Dr. Delivery outfit and broke my water. I felt this immediately relief. “Oh that felt so good,” I sighed. Then the next contraction started. “Can I push!?” I squeaked. ”Not yet.” was my answer. I was allowed to try on the next contraction then told to stop. Just for the record, trying to stop pushing after you start is near impossible. I had to breath through another two contractions. ”Ok start pushing.” ~ I blew out all my air instead of taking a deep breath and had to start all over again.


I pushed for all I was worth for about 20 minutes (mom says only 5 contractions) and at 3:31 a.m. Cora Adeline Reeder was born weighing in @ 5 lbs. 12 oz. and measuring 18 1/2″ long.

1. When did you decide you wanted to deliver your baby naturally?
I was always told growing up I was always told that I would be able to just whip the baby out naturally, without medications, because of all the medical issues I’ve had. I decided to have a natural labor mostly because I don’t do very well with drugs and or anesthetics. That gave me the thought, “If I have a low tolerance for them what about my baby?” How was I to know how she would react to an epidural or any of the other drugs they give you during labor. Sure I’ve heard “Epidurals don’t effect the baby in any way.” I’m still a bit skiddish on that subject. I have personally seen babies born both ways and there is a difference. It may be slight, but a difference nonetheless.

2. What reasons or factors went into your decision?
My mom had all 4 of her children medicine free. One 8 lb 13 oz. baby that was sunny side up, and one that was breach. Still without any type of medications. It may sound silly, but if she can do it, so can I. The biggest factor, other than my ego, was the issue I have with medications. That was really the biggie. I may not have been 100% against medications, but I truly wanted not to have any, just in case she has issues with them like her momma.

3. What did you do to prepare for natural childbirth? (midwife, classes, methods, books, etc.)
Ha! Prepare? Nothing can truly prepare you for this wonderful experience. I did however read, Thank You Dr. Lamaze by Marjorie Karmel. It helped me have the mindset of I can do this. I also took a Lamaze class offered by our hospital but we didn’t make all 6 classes. We only got through the first four.

4. What was the hardest part of your experience – before, during, or after childbirth?
The hardest thing for me was I was in labor for more than 2 weeks and I was told that even though your in labor it’s not active labor so go home. Had I known I was in active labor I would’ve had a much easier time dealing with the contractions.

5. What was most helpful to you during labor to help make pain from contractions manageable?
My husband put his hand on my lower back for me during the contractions. Again had I known I was in real active labor I think there would have been a few other things I could’ve done to help with the pain.

6. What do you wish you would have known going into delivery?
There really isn’t anything about the delivery I wish I would’ve known. I talked to my Dr. quite frequently about how I wanted the delivery to go. I talked to him during delivery as well so I continued to know that we were on the same page.

7. Is there anything you would have done differently?
I would’ve gone to the hospital a little earlier, and not taken the ambulance.

8. What did you feel were the positive benefits to your natural childbirth – were the benefits what you expected?
My daughter suffered something called Persistent Pulmanary Hypertention of the Newborn (PPHN). It was very serious and she had to be Life Flighted to Primary Childrens Medical Center. Since I had her without an epidural I was able to get out of bed and go to the NICU before Life Flight got there and spend time with her. Stand by her and hold her hand. If I had an Epidural that wouldn’t have even been an option.

9. Is natural childbirth something you recommend to other mothers, or something you’d do again?
Natural medicine free, is the way to go! I wouldn’t want to go any other way. It’s a choice and one I’m glad I made.

10. What advice do you have for other mothers interested in natural childbirth?
It’s a choice. My Dr. told me if you want to do it medicine free it’s your choice, but keep your options open. It’s different for everyone. Everybody has different pain tolerances. I decided I wanted to go Med Free since I didn’t know if there would be problems with medications in my child’s system. It was a very fulfilling experience having a baby, especially without the side effects of drugs in my system. I had already been in labor for more than 2 weeks. It just wasn’t considered “Active Labor”. I was getting close to my wits end because the contractions had remained constant and although they kept getting closer together, nothing was happening. 

Anna can be contact with questions at her blog http://24piecesofpie.blogspot.com/

“If Birth Matters, Midwives Matter,” says Ina May Gaskin

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courtesy Guardian UK

From Time.com: “Ina May Gaskin started delivering babies in 1970 while on a hippie cross-country trip known as the caravan. She had no medical training, just a master’s degree in English and a gut feeling that women deserved kinder, gentler births. When the hundreds of caravaners settled in Tennessee on what they called the Farm, Gaskin and several other women began delivering the community’s babies at home and also opened one of the first, nonhospital birthing centers in the country. Word got around when Gaskin wrote about her successes in Spiritual Midwifery, and a movement was born.

“Today, women still travel far and wide to give birth on the Farm, and Gaskin’s methods have the respect of clinicians around the world (there is even an obstetric maneuver named after her). Now 71, she is credited with reviving what was essentially a dead profession in the U.S., inspiring scores of women to enter the field and helping found the Midwives Alliance of North America. But even while midwives attend more births in the U.S. — about 7.5% in 2008 — they’re finding it increasingly hard to get practice agreements with doctors and hospitals. In her latest book, Birth Matters: A Midwife’s Manifesta (Seven Stories, April 2011), Gaskin argues that America needs midwives more than ever.” Read my interview with Gaskin in Time.

  • .
  • Guest post: when birth is trauma

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    This is a guest post by Elizabeth Ford (website) who is based in the UK so is writing from a UK perspective. Elizabeth explored birth trauma for her PhD and generously agreed to write a post for MidwifeThinking. There are lots of references for students and/or those who like to access original sources of information.

    Artwork by Amanda Greavette: http://amandagreavette.com


    For most women, birth is not the blissful event of three easy pushes and welcoming their precious baby into the world. Even for those women who have a short straightforward vaginal birth, it can be a tough slog and a real test of the depth of their resources. However, for some women, birth is much more than that. It is a physical and psychological trauma. The aftermath of a traumatic birth can affect a woman for months or years and impact on her bond with her baby, her relationship with her partner, her decision to have another baby and even her willingness to engage with future health care.

    Birth as a trauma

    Childbirth is a common event in society so is viewed by most people as “normal”.  It may therefore be difficult to understand how it can be traumatic for some women. However, case studies and other research make it clear that women can suffer extreme distress as a consequence of their experiences during childbirth. A small proportion of pregnancies and births involve events that most people would agree are potentially traumatic, such as stillbirth, severe complications, or undergoing invasive medical interventions without effective pain relief.  Other women may have a seemingly normal birth but feel traumatized by aspects such as loss of control, loss of dignity, or the dismissive, hostile or negative attitudes of people around them.

    Post-Traumatic Stress Disorder

    Recently it has become recognised that women who experienced a traumatic birth can develop post-traumatic stress disorder (PTSD). Some women experience childbirth as threatening and frightening and go on to develop PTSD symptoms.

    The American Psychiatric Association defines the symptoms of PTSD as (1):

    1. Persistently reexperiencing the event, by flashbacks, nightmares, intrusive thoughts, and intense distress at reminders of the event.
    2. Persistent avoidance of reminders of the event, and emotional numbing and estrangement from others
    3. Persistent symptoms of increased arousal. This means difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance or an exaggerated startle response

    For a diagnosis, patients must report experiencing all three types of symptoms for longer than one month. Many women (around 30%) experience these symptoms in the days or weeks following birth, and this is a normal way of coming to terms with a stressful or overwhelming event. It is only when symptoms do not get better that PTSD is diagnosed (in 1 to 5% of women).

    What causes trauma & PTSD?

    Research has been carried out into what makes someone more likely to develop PTSD following childbirth. These risk factors fall into three categories: those that exist before the birth; aspects of the birth itself; and the type of support and care women get after birth.

    Some women will be more vulnerable to a traumatic birth because of pre-existing problems. For example women with a history of psychiatric problems and previous trauma are more likely to be traumatised by their experience of birth. In particular, a history of sexual trauma or abuse is associated with PTSD after birth. There is some evidence that women with a history of trauma will be more vulnerable to PTSD following birth if they have inadequate support and care during the birth (2-5).

    During the birth, certain complications and events may be more stressful to women than others. Broadly speaking, women are more likely to get PTSD if they have an emergency caesarean or assisted delivery (forceps or ventouse). However, women who have a vaginal birth are still at risk (4, 6). Other stressful aspects of birth, such as blood loss, a long labour, a high level of pain, or a large number of interventions are not clearly related to getting PTSD. Importantly, women who feel out of control during birth or who have poor care and support from midwives and doctors are more likely to get PTSD (3, 5, 7). Furthermore, if a woman is overwhelmed by the experience and copes by dissociating (feeling like she is mentally “not there any more”, or having an “out of body experience”), she will be at higher risk of PTSD (8, 9).

    Following the birth, support from friends and family, and possibly that from health professionals, may help women resolve their experiences and recover from a traumatic birth (5, 10). Conversely, a lack of support may prevent recovery or possibly cause more stress and thereby increase symptoms.

    Feeling angry when birth is mismanaged

    In some cases births are mismanaged and a woman can feel unable to get past her experience. She may go over and over the events in her head and feel angry that she was denied the experience she could potentially have had (11). This can form part of the symptoms of PTSD (intrusive thoughts, irritability & anger). However, PTSD is considered to be an anxiety disorder, and so for this anger and preoccupation to be diagnosed as PTSD, the other symptoms listed above must also be experienced. A woman who feels very angry is struggling with a valid emotional response to being discounted or not listened to during the birth, or even being mistreated or assaulted. Even when women don’t fit into the “PTSD box” (fulfilling all the symptom criteria), they may have a spectrum of subclinical trauma reactions which would benefit from support, counselling, or psychotherapy.

    Is PTSD the same as postnatal depression?

    PTSD has different symptoms to depression. Depression symptoms encompass a depressed mood i.e. feeling sad, empty, tearful or irritable, in addition to diminished interest or pleasure in activities; significant weight loss or weight gain or decrease or increase in appetite; insomnia or hypersomnia; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; and a diminished ability to think or concentrate, or indecisiveness.

    In contrast, trauma symptoms are focussed on the traumatic event (re-experiencing it, avoiding reminders of it) and a diagnosis of PTSD is not possible without having experienced a traumatic event.  This is not the case with depression. However, in practice symptoms overlap and a majority of women who have PTSD will also have depression (3, 4).  Effective treatments for PTSD and depression differ. Recommended treatment for PTSD is psychotherapy, and only long-lasting or complex cases of PTSD benefit from anti-depressants.

    Do women expect too much from childbirth?

    A question that is often asked by health professionals is whether women have too high expectations of achieving a natural or drug-free birth, contributing to them being traumatised when birth does not go as expected. The answer to this is rather complicated but research studies point towards it not being the case. Firstly women’s expectations are found, on average, to be similar to their experiences (12, 13). That is, if a woman has broadly positive expectations she is more likely to have a positive experience. Secondly, if unrealistic expectations were linked to PTSD we might expect to find more trauma responses in first time mothers. This has been found, but subsequent analysis suggests it is due to the higher rate of intervention in these women (14). Finally, one study looked at this question directly and found that a difference between expectations and experience in the level of pain, length of labour, medical interventions and level of control was not associated with PTSD symptoms. However, a difference between expected support from health professionals and the level of care experienced was predictive of PTSD symptoms (13). Women don’t seem necessarily to be traumatised by the events of birth not happening as they expected, but may be affected when they do not receive the care they expect.

    Implications for maternity care

    Research in this field is at an early stage and more needs to be done before making policy recommendations. However, the body of evidence points towards several considerations. Firstly, some women enter pregnancy and birth with existing risk factors for PTSD, and these women may need particular care. Health professionals should be aware that women with a history of trauma, abuse (particularly sexual abuse) and psychiatric problems are at higher risk of PTSD following birth. There is some evidence that a lack of support during the birth may put these women at particular risk (5).

    Secondly, interactions with other people have a strong effect on trauma reactions. For example, PTSD is more likely following events which are perceived to have been intentionally perpetrated rather than following accidents (15). This effect of personal relationships and care is particularly relevant to childbirth (16). There is substantial research showing support during labour and birth improves both physical and psychological outcomes (17), and that perceptions of inadequate support and care are predictive of traumatic stress responses. Women who are traumatised often describe negative interactions with staff such as feeling rushed, bullied, judged, ignored or put off when asking for pain relief.

    Understanding the importance of support helps explain why, for example, level of pain is not consistently associated with PTSD symptoms. It may not be the level of pain per se which is traumatising for women, but the experience of unbearable pain in combination with the perception of being denied pain-relief by an uncooperative caregiver. Women also report caregivers proceeding with interventions, such as forceps deliveries or episiotomies, without consent, and sometimes even when the woman has clearly expressed her wish not to have the intervention. Negligent care such as leaving women naked in stirrups with the door open can be intensely degrading and stressful. Many of the traumatising aspects of childbirth could be reduced with consistent and considerate care from maternity staff.

    What to do if this has happened to you

    If you have had a traumatic birth and don’t know how to get help, the first step is to contact the Birth Trauma Association (BTA; www.birthtraumaassociation.org.uk) who give information and support. They produce a leaflet which you can print out and take to your GP explaining the condition (your GP may not have heard of postnatal PTSD), and you can ask for a referral to specialist psychotherapy services. If you’re in the UK, you can also contact the hospital where you gave birth and ask for a debriefing session with a midwife or consultant to go through your birth notes. This is not a counselling session but may help you to understand what happened during the birth and why events proceeded as they did. If you have physical problems following the birth you can also ask for a referral to a gynaecologist or physiotherapist. If you do not feel able to go back to the hospital where you gave birth, because memories are too painful or it causes you too much anxiety, you could ask your GP for a counselling referral or you could consider contacting a private psychotherapist. Make sure they are registered with the relevant professional association (BACP or BABCP in the UK). Recently in the UK you can “self-refer” to psychotherapy on the NHS through your local IAPT service (www.iapt.nhs.uk). Talking to other women who have been through similar experiences may help, the BTA can put you in touch with other mothers.

    And Dads…

    It can be traumatic watching a partner go through a harrowing experience while feeling helpless and horrified. The information on PTSD above can also apply to partners. The BTA has a section on their website for dads or partners. It is worth reading this and seeking help for yourself if you feel this applies to you.

    More resources and support

    I’ve added some links below (this is MidwifeThinking). Please let me know if you have any other links or resources that you think should be included.

    Blog posts about birth trauma:

    References

    1. APA. Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington DC; 2000.
    2. Wijma K, Soderquist J, Wijma B. Posttraumatic stress disorder after childbirth: A cross sectional study. Journal of Anxiety Disorders. 1997;11(6):587-97.
    3. Czarnocka J, Slade P. Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 2000;39:35-51.
    4. Ayers S, Harris R, Sawyer A, Parfitt Y, Ford E. Posttraumatic stress disorder after childbirth: Analysis of symptom presentation and sampling. Journal of Affective Disorders. 2009;119:200-4.
    5. Ford E, Ayers S. Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms. Psychology and Health. in press.
    6. Soet J, Brack G, Dilorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth. 2003;30:36-46.
    7. Cigoli V, Gilli G, Saita E. Relational factors in psychopathological responses to childbirth. Journal of Psychosomatic Obstetrics and Gynecology. 2006 Jun;27(2):91-7.
    8. Kennedy HP, MacDonald EL. “Altered consciousness” during childbirth: potential clues to post traumatic stress disorder? Journal of Midwifery & Women’s Health. 2002 2002/0;47(5):380-2.
    9. Olde E, Van der Hart O, Kleber RJ, Van Son M, Wijnen HAA, Pop VJM. Peritraumatic Dissociation and Emotions as Predictors of PTSD Symptoms Following Childbirth. Journal of Trauma & Dissociation. 2005;6(3):125-42.
    10. Soderquist J, Wijma B, Wijma K. The longitudinal course of post-traumatic stress after childbirth. Journal of Psychosomatic Obstetrics and Gynecology. 2006 Jun;27(2):113-9.
    11. Brockington I. Postpartum Psychiatric Disorders. The Lancet. 2004 January 24;363:303-10.
    12. Slade P, MacPherson S, Hume A, Maresh M. Expectations, experiences and satisfaction with labour. British Journal of Clinical Psychology. 1993;32:469-83.
    13. Ayers S. Post-traumatic Stress Disorder Following Childbirth Unpublished Ph.D Thesis, University of London; 1999.
    14. Soderquist J, Wijma K, Wijma B. Traumatic Stress after Childbirth: the role of obstetric variables. Journal of Psychosomatic Obstetrics and Gynecology. 2002;23:31-9.
    15. Charuvastra A, Cloitre M. Social Bonds and Posttraumatic Stress Disorder. Annual Review of Psychology. 2008;59:301-28.
    16. Ford E, Ayers S. Stressful events and support during birth: The effect on anxiety, mood and perceived control. Journal of Anxiety Disorders. 2009;23:260-8.
    17. Hodnett ED, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews. 2003(3):Art No.: CD003766. DOI:10.1002/14651858.CD003766.

    Wow! This was exactly what I needed to hear right…

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    Wow! This was exactly what I needed to hear right now! I am 38 weeks pregnant, and at my ob appointment this week I was told that my cervix was "unfavorable" for vbac at that point and that a c-section would be in my near future if I didn't begin to dilate. Thank you! Thank you! Thank you!

    Writing A Path From The Center by "Living the Questions"

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    “…have patience with everything unresolved in your heart and try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, far in the future, you will gradually, without even noticing it, live your way into the answers. ”

    ~ Rainer Maria Rilke, 1903, in “Letters to a Young Poet”
    We are all familiar with this quote from the poet, Rilke, from a collection of letters he wrote to a young friend of his, an aspiring poet, who had gotten it into his head that he had to know what he was about in life, know what he was doing and who he was, before anything of value could be accomplished with his writing. Rilke was a loner, a social misfit and a wanderer; he found it difficult to stay in one place, to hold a job, to maintain a home, or a relationship. He lacked the ability to read social cues and had minimal tolerance for interpersonal machinations, yet his observations and insight on the human condition are precise, clear and evoke a sense of intense focus and devotion–he could read people and society, and his intellectual prowess made it imperative that he set his soul-readings to poetry. He offered, through his writing, a path from the Center of his being towards that of the reader and within the context of his art, crafted a profound “word medicine” that could heal people, give them guidance and shine light on the next step of their journey. It is a mistake to conclude that Rilke, who today probably would have been diagnosed with Asperger’s Syndrome, or placed somewhere on the ubiquitous “Autism Spectrum” lacked the capacity for intimacy when his poetry goes straight to the interior of the heart in ways that can only be accessed by intimacy. Rilke’s long familiarity with solitude and silence conferred upon him a deep wisdom about the nature and needs of the human person; his self-awareness, consciousness and intimacy with his own interior world enabled him to write poetry stunning in its ability to speak to our various conditions and to offer healing and peace, but not by providing answers to our questions; he encourages us, instead, to “love the questions themselves” and to wait patiently for our lives to speak. We have to write a path from the Center of our lives if we are to find our answers.
    The internet and social networking culture seduces us with the idea that information and answers are synonymous. It further persuades us that asking questions, seeking answers, can be accomplished in whole, or at least in very large part, this afternoon…at the latest.
    So many people spend hours and hours of precious, unrepeatable time scouring forums and polling their online friends for answers to the difficulties of life and those who spend the most time doing this seem to be the most unhappy and desperate in their desire for someone else to tell them what to do…how to be…where to go for more…answers. Our culture enables and encourages this kind of anxiety-provoking and superficial social discourse because planting seeds of doubt, fear and anxiety creates a market. People who are afraid that their lives won’t hold up under the scrutiny of others, are easy prey to be marketed to in all kinds of ways. Those who live, not from their own Center, but through the eyes of others, become victims of their own projection that somewhere, someone “out there” has the answers to questions that can only be found “in here”. Happy, satisfied people who are willing to live out the questions of their lives by seeing, in the quotidian mysteries, our daily life and work, that the answers unfold organically, in their own way, fail the “market test” every time.
    When I first began writing here, I was in the midst of transition–I had lost two of my children in the previous 7 years and had another born with a serious disability. I was leaving my childbearing years, being then in my late 40′s, had three teenage and young adult children going through their own growing pains, and I was leaving a way of working and being in the world that had defined and informed my life for many years. I was responding to a deep calling, a leading towards a very different life that was, at the same time, beckoning to me like a homecoming; I was being called inward and towards more depth and focus. I was intensely craving solitude, silence and contemplative action in the world, through my writing and new work involving sacred listening to others, giving them the space to tell their own stories and find their own path within the ‘true self’ that was intended for every person. And yes, dear Rilke, some answers have come through living out those questions but they can, of course, only be partial answers…I am still living, and loving, the questions. As another favorite writer, Isak Dineson, once said, “God made the world round so that we could not see too far down the road” in this, she echoes and reinforces Rilke–we can only live the questions, embrace them, love them, and with humility accept and live with the partial answers as they present themselves.
    And now I am 51. My life has sorted itself out and I am living, imperfectly of course, the quiet, simple and creative life I had been trying to give an affirmative answer to for several years. I have lovingly let go of many people in my life over this time, knowing that I was simply not able, or no longer willing, to give them the time and energy they needed from me. I embraced fully a simple truth given me long ago by a very wise woman friend and mentor–”Compassion is mandatory, personal involvement isn’t”– I finally accepted the truth that being loving isn’t measured by how willing I am to allow others personal dramas to invade my life and disturb my peace. I cannot give to others with the kind of spacious love I need to offer when I am being drained by relationships with people whose lives are chaotic and who are living out what Psychologist Carl Jung called “Shadow” in unconscious ways. These patterns are not always easy to see when they are taking up space in your life, but one of the many gifts of embracing solitude, quiet and simplicity is that those people and situations that are noisy and disruptive to our peace become very apparent indeed. I’ve cultivated some new friendships, blending them with deepened and rejuvenated long-term relationships into a community of loving, “learning partners” who are supportive, authentic, genuine and life-giving. I, like Rilke, am a solitary social misfit who prefers quiet and the “Peace of Wild Things” as in the poem by Farmer and Writer, Wendell Berry. I have more of myself to offer to the world; more love to give, more work to do, and a great and driving energy to do my part to leave a legacy of healing and wholeness behind when I take my leave of this world.
    So, my writing going forward will not offer you any answers…but I will accompany you on the road of living the questions. My intention now is to “write a path from the Center” of my own life as I respond to the challenges and questions presented by a complex world mired in painful dilemmas and difficulties. I have also come to know other thinkers and writers who are my kin; those I’ve come to recognize as members of my extended “Tribe” and and as my soulmates and fellow sojourners and I will be introducing you to many of them.
    Love and live the questions themselves. Pay attention to the “quotidian mysteries” of your own life. Trust and have faith that the answers will come and know that there will always be enough light shown to illuminate the next step. “God made the world round, so that we could not see too far down the road.”
    ~ Peace and Courage.
    Michelle