“Normal” Birth Paradigms

This month I have the honor of teaching a midwifery module of normal birth. I am excited since I am very protective over what I see as being “normal.” However, I find myself asking two questions: 1) What is “normal?” and 2) How do we teach, mentor or learn normal birth?

First, this idea of being “normal” is quite a quagmire. I see all three of my own births as normal, and I know that at least the first and third may not be considered “normal” by a good deal of people. It is easy to list some things that are normal for home birth, however: eating and drinking during labor, movement, use of coping tools including water or massage, balancing rest and activity if there is time, and the baby comes out the vagina with mom’s efforts and goes straight to her chest where baby eventually nurses and continues to bond with mom. But what about long labors? Or precipitous labors? Or labors that come and go for a full week? Or an unassisted birth? Or the easy posterior birth? Or a difficult posterior birth with the baby rotating? Or a mom who doesn’t realize that she is in labor until the baby is coming? Or long pushing phases? How about a baby born en caul? Or a mom who spends a lot of time at a particular dilation but continues to make other forms of progress at this dilation?

So in teaching normal birth I decided to draw upon my Birthing from Within skills and mentor birth class to midwives. Why? Because the vast range of normal birth or even others’ experiences of birth are not necessarily viewed from a normal direction. Ok, so what I’m saying is that even if I could figure out some ranges of what constitutes normal birth, the paradigms we use don’t necessarily come from those who believe in normal birth. For instance, teaching the stages of labor sources from a particular cultural paradigm (and, yes, I’m still going to teach it as a particular perspective). For the stages of labor, we are using dilation as the demarcation between first and second stage. If we aren’t checking mom, do we call those initial grunts second stage? If not, what if she births her baby quickly? How about the initiation of active labor? Was that 4 minutes apart for contractions or 3? And what about the 5 minutes between contractions and then the baby was born? Do we just ask mom and she can call the time she thought it seemed active? It can be frustrating fitting normal birth into paradigms that may be less than normal or fitting. (See more information at http://midwifethinking.com/2010/12/22/stages-of-labour-and-collusion/ )

Using the labyrinth seemed the appropriate addition to the module as far as a paradigm for labor. And although I think it is important to look at what that experience might be like from a birthing mother’s point of view, we also must look at it from the midwife’s point of view. For every birth that we attend, we are walking this labyrinth as well. Our threshold might be getting woken up in the middle of the night by a phone call instead of contractions. Our journey into the labyrinth may also include acclimating to the birth space. This could include washing hands, doing vitals, and setting up supplies. But it also includes how the room feels when you enter it. What sounds do you hear? What do people’s faces say? How are you grounded in your own body? And how are we going to truly be present with mom during her gates of fear, doubt and unknowing, for that is commonly a part of a woman’s journey. How are we going to be able to play all of the roles that midwives play during this journey? The ascent out of the labyrinth will also be a different journey from the mother or the family. For the midwife will mostly likely exit the labyrinth much more quickly. Although there might be various births that you take into your next one or lessons learned that stick with you as you grow, we generally exit births as we finish the postpartum care and touch back upon them as we see the mother for another pregnancy or just to touch base. And as the mother is walking her worn path, we too are walking a path that our preceptors and mentors have walked and midwives from many many years ago and many places have walked.

So next week at school, I plan to have some “normal” birth story telling before breaking out some models of newborn skulls to discuss sutures, fontanelles and molding. I’m hoping to have them access some memories from normal births and have them think about how they were in their body at a particular moment. How did they feel and know that things were normal? What around them told them it was normal besides the information written down on the paper? Maybe they arrived and things seemed crazy and mom was “losing it” but they still knew things were normal. How was that? Was it because their preceptor or the mom knew it was normal? Anyways, just some ideas to add to our midwifery curriculum as we already have a cellular repository for normal. We can draw from obstetrical models and learn from those, but we can also look to tradition or create or own.