When I counsel mothers during their pregnancy, or when they attend one of our Healthy Mother Lamaze Programs, one of the first things I assure them is that I believe in their bodies’ ability to give birth naturally. I also tell them that I will spend as much time as they need to overcome their concerns, fears, and anxieties – not how much time I am able to spare for them on a given day.

I think that giving mothers the confidence in their bodies’ ability to give birth naturally starts with good prenatal care and counseling. The paramount factor in a normal birth and in obtaining a fulfilling outcome for mother and her baby is the ability of care providers to ensure continuity of care. As the relationship between the health care provider and mother develops during the course of prenatal care, a mutual trust between them brings a sense of safety, security and openness. When it comes to the time of birth, rarely do we have to deal with psychological issues which may stall or impede labor, since many fears and concerns have already been dealt with during the prenatal period. This is great comfort to a mother who is going to give birth for the first time and who has so many questions. Through the consultations and the prenatal sessions, we have not only taken care of most of their immediate needs, but we have also taught the mother what to expect during labor. In addition, we have given them the tools and techniques to overcome the challenges of labor. So, even when the going gets tougher, the mother – who by now knows that we will give her the best possible support – is free to focus on the task at hand – giving birth! Often, I have sat with a first-time, would-be mother in labor, when I can feel a particularly difficult wave of contraction coursing through her body, when I know she is in slight panic, and I know she is wondering if she will be able to complete the task that she started, I look straight into her eyes and say to her, “You have just a little further to go.” She grasps my hand a little harder, nods, breathes and blows through her contraction and replies, “OK”. Then, we manage the next contraction together. In fact, many a time, after giving birth my new mother will say “I don’t remember the pain – I just remember you saying “you are almost there” and this gave the strength to finish what I so strongly desired.”

The amount of time spent by us during prenatal visits, using our powers of observation is the second most important factor impacting a normal outcome. Most of today’s prenatal visits are assembly line in nature, and may be worse than no visit at all. This is particularly true when a woman has a condition that requires more frequent visits. Today’s routine prenatal exams in which the blood pressure is taken, fetal heart tones quickly found, a quick check done on the ultrasound monitor, and various tests ordered, may have little relevance in determining the normalcy of a woman’s pregnancy. Of course, it is important to do all of these as standard care practices. However, in my consultations and in my Lamaze classes, I am much more interested in how a mother carries herself. Does her back hurt? Can I teach her better ways to improve her posture, and teach her husband / family members some massages to help relieve her discomfort? Should she be adjusting the way she works at her workplace? Can I teach her ways to avoid pulling some of the muscles and ligaments that are lax during pregnancy? How’s her energy level? Perhaps she is anemic or depressed. How’s her self-esteem? Perhaps she is constantly being reminded that she has put on too much or too little weight. Is she anxious about something that she has perhaps been unable to voice? How is her appetite? Is she able to sleep well at night? Can I show her some comfort positions to use during sleep, or some relaxation and breathing exercises she can do before she goes to bed?

Then, when I examine her and feel her belly, it is wonderful to have a baby who responds to my touch – the personality of the tiny being is probably mirrored in the tenor of her prenatal movements! If the baby is found to be in the breech position (head up and buttocks down within the womb), I take time to teach the mother exercises and positions to try and invert the breech. More often than not, the baby does turn to the head down position within a week to ten days! All in all, it takes time to “tune in” with the mother’s pregnancy—to talk about nutrition, her groin strain, the things that she has heard from her cousin about cesareans, what her friend has told her about “how wonderful it was to have a “painless” epidural birth”, and many, many other things that are not a part of usual hospital case sheets and charts.

This does not mean that labor is not hard work for both the mother and for those of us who provide continuous labor support. However, in order to help each of my mothers and their families achieve the best possible labor and childbirth outcomes I try to spend the bulk of my energy during the prenatal period.

A final important factor in assuring that birth will proceed normally is the birthing environment. Where does the mother feel safe? With whom does she feel confident? A couple of years back, I was talking with my cousin’s daughter who had just finished her 3^rd year physiotherapy exams. She was feeling very exhausted and yet was not satisfied with her performance. She had studied very hard and felt that she had a good grasp of the subject matter, yet when she went to take her practical exams in Electrotherapy, she had been overcome by feelings of fear and anxiety. Although she did well in all the other exams, she felt she should have done better in her “practical”, and that the marks that she got did not reflect her knowledge of the subject fairly. I asked her why she had suddenly developed feelings of fear, and she told me that the testing site was a room she had not been in before, and full of equipment with which she was not familiar. There were about thirty others being tested whom she did not know, and the invigilator was a stranger. To top it all, the room was very hot! As she was talking, I felt like she could be describing the conditions that are present when most women walk into a typical hospital for delivery! No wonder so many women have “failure to progress” when exposed to an unfamiliar environment. Recently, I read a wonderful article about the functioning of sphincters and privacy – it is commonsense – we all know that our bowel and bladder sphincters do not open up and release in public; they need privacy. Why would the “cervical sphincter” be any different? The article reinforced my belief about calm, quiet and privacy and familiarity that are needed to “progress” labor and to give birth.

It has been my experience that when the mother is able to labor in an environment of her choice, with people surrounding her who make her feel respected, loved and safe, she feels empowered to give birth to her baby, rather than be delivered. I have read some wonderful birth stories written by midwives in Europe and US, of short, almost painless labors that they were a part of. Although I used to be somewhat skeptical of these birth stories, I am starting to believe that they are probably true. Belief, faith and spirituality are in equal measures important for the wonderful transformation of a woman into a mother. I am left wondering how much of an effect does my belief in the mother have in her final birthing outcome? The more I believe that “mothers birth their babies”, the more I am able to facilitate mothers to have a better birthing experience.

My musings for today….. feel free to write in your thoughts and experiences…

Dr. Vijaya