Exploring birth options during the coronavirus pandemic isn’t what anyone expected.

In our earlier blog, we explored the conditions that would make out of hospital birth a safe and feasible alternative for families exploring birth options during the pandemic.   But informed decision-making involves a process more complex than weighing risks and benefits.   Is the choice fear driven?  If so, is a decision truly informed if it’s driven by a fear or trauma response?   How can we not overlook the qualities of readiness, trust, and confidence as a screening criteria for home birth candidates?

For many, birthing at home claims birth as a family event, and rite of passage.  Home birth providers are offering dedicated time and attention to the laboring family, and shared decision-making and trust are more than invitations- they form the foundation of the midwifery model of care.  These qualities draw people around the world who HAVE choice, to choose home birth 1% of the time in the U.S, and up to 28% in the Netherlands.

In our earlier blog, we discussed the rational choice for home birth.  In this discussion, we explore how reproductive health advocates and providers can encourage a deeper inquiry for those who are exploring home birth as a response to coronavirus.

Expecting & Afraid

There are many attributes of a birth at home or in a home-like birth center that might bring up visions of security, safety and intimacy.  Certainly, that was the case for me. But for some, the concept of a tidy, clinical hospital room feels ‘safe’.  Access to pain medications or interventions feels more secure.

Have you ever had an experience supporting someone with a precipitous birth, a baby born unexpectedly at home?  It’s possible that while you experienced a powerful, calm, moment, the family experienced something that they experienced as traumatic.

Feeling out of control, backed into a corner, experiencing an absence of choice is the underlying condition that leads to a sense of powerlessness. And is the making of a traumatic experience.  As we explore the question, “Do I have to go to the hospital?,” let’s consider how it’s not the same question as, “Is home birth a good option for me?”

Trauma-Informed Care

As we move through these times, let’s consider how to acknowledge trauma, how to prevent it when possible, and how to lay the ground for buffering trauma and healing.

SAMHSA defines trauma in this way:

1. Individual trauma results from an event, series of events, or set of circumstances
2. That is experienced by an individual as physically or emotionally harmful or life threatening
3. That has lasting effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being

Might we agree that our experiences in these last weeks, even in the most protected of circumstances, fall into this description?

 

We’ll also have a discussion in an upcoming blog about Pregnancy Specific Anxiety, known to impact maternal/fetal outcomes.

Let’s look at this criteria for identifying PSA

• fears of hospital and health-care experiences
• fears of one’s own survival
• fear of childbirth and
• fear of parenting or maternal role
• of impending childbirth and its aftermath, and of parenting or the maternal role

 

So as we consider someone’s inquiry about a change of birth settings, is anxiety or choice the driver?  For homebirth providers, how might un-managed anxiety impact pregnancy?  Are we creating trustworthiness so needed for traumatized persons if we’re not realistic about the limitations of plans B, C, or D?

Is the promise of an out of hospital birth a way to avoid the fear of the unknown?

We can always explore options and alternatives and it is an important component of an empowered approach, a building of self-efficacy that buffers stress and trauma.  But how might we build a self-efficacy and resiliency that does not depend on conditions?

Those conditions are never, in the best of circumstances, a guarantee. In the time of pandemic conditions, choices are simply limited at best, and in many cases, unavailable.

 

We hope that you’ll join the discussions about providing Trauma-Informed Care and serving families in these extraordinary times.  Awareness of secondary and vicarious trauma is equally essential. 

Join us for Refuge and Resilience:  a free webinar.

Grass isn’t always Greener: Let’s address the FEAR

When home birth comes up, it may well be a good alternative.  It’s not uncommon for expectant parents to decide on out of hospital birth later in pregnancy, once they have learned more, gained more trust in the process, let go of fears or lack of confidence that were dislodged by gaining information and new perspectives.   If the parent is low risk, and otherwise a good candidate; if they (and their partner) trust the process, trust their provider, it is likely to be a set up for a good, peaceful home birth.

But if they feel shaky, afraid, and aren’t ready for a birth away from the elements that they envisioned as ‘safe’, or maybe aren’t ready emotionally for birth in any setting, it can easily be a set up for trouble.

The hardest part of advocacy, especially for those giving birth during coronavirus, is supporting someone when they are facing two imperfect choices or what may feel like none at all.  But if you’re supporting someone who is exploring their pandemic birth options now, you’re given important opportunities to support them not just with the lists of risks and benefits, with ‘this’ plan or ‘that’ plan, but with the opportunity to serve as a guide through fear itself.

 

Radical Acceptance

When we use the tools of radical acceptance, we find a peace that is not bound by conditions, by things going a certain way or writing a script for what we want to happen.  We learn to be confident with what IS happening, as it is happening.

When we feel confident that we can move through any terrain that is on our path, we can choose to move in the direction that feels most fitting, rather than being chased by fear.

Radical acceptance involves a practice of finding a sense of wellbeing in the midst of even very unwelcomed circumstances.  It means practicing being with things just as they are.  Radical acceptance means being with the painful emotions, the undesired outcomes, and finding an ‘unshakeable confidence’, a term that Mare Chapman used as a title for her book on mindfulness for women.  Because this quality of confidence is not built on being ok because we’ve been successful, or because things turned out just as we hoped, unshakeable confidence is a refuge that is enduring.

This quality of confidence reminds us that we can do hard things.

My daughter’s birth

I very much envisioned a home birth for my daughter.  It was never a question for me to birth anywhere else.  I did all that I could to be and to stay low risk.  But I did pack a bag, write a hospital birth plan, and otherwise spent time making peace with the possibility that I might need to transport.  I had no particular reason to think that I would need to, but in the end, after 12 hours of pushing, and an asynclitic baby, the heart tones were getting less and less reassuring and it was clear to me (as a midwife and a mother) that I needed to go.  My team of loved ones and my doula and midwives were conferring in the next room about how to help me cope.  They expected me to be upset, maybe even resistant.  But I was riding on the power of labor and the fearlessness of radical acceptance.  Pushing all those hours with such fierce determination, I could cope with anything.  I truly felt like a powerhouse of infallibility.  I was already making my way down the stairs of my second floor apartment.

While the hospital prepped an OR for me, the resident certain that I would need to have a cesarean, I felt things shift walking down those stairs, and by the time we arrived, my midwife didn’t announce our arrival, and I had pushed out my daughter before the attending physician could be woken up to check on us.  Within 8 hours, I packed myself and my daughter up and we left on early discharge.  I was exhausted but elated.

I didn’t birth exactly how I had hoped, but I was confident in my capacity to do anything that I needed to do as a mother.

16 years later, there were many aspects of my journey as a mother that were unlike my vision and hopes.  Unspeakably hard times came, and went.  And came again.  But I still draw on my ability as a mother to do hard things with grace and confidence.  And my daughter?  She is an inspiration. Each day of  her young adulthood she trusts herself more and is getting more and more ‘unshakeable’.

As I think of all these parents who are feeling afraid, powerless, and daunted by the unknowns – I believe that the best way to support them is to help them in the cultivation of that fearlessness and confidence that they will know how to be with each new moment, whatever it brings.

This quality of trust is an essential ingredients for birthing at home, for birthing in hospital, for getting through this pandemic, and for creating a lasting resilience as a family.

Giving birth during coronavirus pandemic aren’t perfect conditions.

But sometimes, holding your baby when you feel ready to carry them through anything, is better than perfect ever could be.

 

To learn more about cultivating confidence for yourself and those you care for, explore our mindful caregiving and mindful doula offerings.