Birthing inside and out

Virginia Bobro prepares mothers, and couples, for the personal experience of giving birth.

By BARRY DAVIS
Virginia Bobro 311 (photo credit: courtesy)
Virginia Bobro 311
(photo credit: courtesy)
Regardless of our outlook on the best way to go about it, a birth is a momentous occasion – both for the parents and for the new arrival. But according to Virginia Bobro, there is far more to the event than just taking care of the mechanics of producing a (hopefully) healthy, bouncing new baby.
The Santa Barbara, California-based Bobro, a 41-year-old mother of three, will be in Israel next month to present a threeday workshop in Jerusalem based on the Birthing from Within approach to giving birth and early parenthood.
For the last 10 years, Bobro has been working alongside Birthing from Within founder Pam England as the organization’s managing director, to help parentsto- be prepare for an approaching birth and to work through the subsequent challenges and emotional residue.
So what is the “within” part of the approach all about?
“Some people say, ‘Of course it’s birthing from within, where else would the baby come from?’” says Bobro. “Our focus is on the emotional and psychological preparation, and the experience of the birth, not the physiology.
“When people hear about a birth, they may think about things like, how long did it take? Or they may ask if the mother had to have a Cesarean. There’s a lot of focus on the mechanical elements of the birth. Of course the physiological elements are an important part of giving birth, but we look at it on a broader or deeper level, at the inner experience, especially of the mother who is giving birth.”
Both England and Bobro were prompted by their own experiences to look for a new take on pregnancy and birth. When England became pregnant for the first time, in 1982, she planned a home birth and was confident all would go smoothly. After all, she kept fit and healthy and followed a definitively wholesome life ethos. She was an experienced midwife who firmly believed in following Mother Nature’s original way of producing offspring. But things went awry with the domestic delivery process, and she ended up in the hospital in her most feared scenario – having a Cesarean section.
On her website (www.birthingfromwithin.com), England says that, as she was being prepared for surgery, two questions sprang to mind: What did I need to know to give birth as a mother that I didn’t know as a midwife, and what did I need to know to give birth-in-awareness in a medicalized birth culture? It was quite an eyeopener for her.
Bobro, too, had something of a rude awakening with her second delivery, after a mostly smooth maternity debut.
“My daughter’s birth went so well and was so fast – I almost gave birth at home because it turned out there wasn’t much time to get to the hospital before she popped out,” Bobro recalls.
But things were very different the second time around.
“Halfway through the pregnancy, I discovered I had twins and, naturally, that meant I might give birth very early,” she says. “Suddenly I had to change all my plans, and to replan for a hospital.”
Like England, Bobro felt she had done everything she could to lay the foundations for a problem-free delivery. “I started the pregnancy healthy. I thought it would be a breeze, but in the space of one hour, everything changed. All of a sudden I was a walking time bomb.”
Still, Bobro’s second time around gave her valuable hands-on experience to help other couples facing the prospect of dealing with two babies at the same time.
“At the time, I thought, how was I going to deal with two babies?” she remembers. “Today, one of my personal joys is working with mothers of twins.”
Like England, Bobro’s brush with the uncalculated outcome of her pregnancy gave her more insight into what other expectant women encounter, and made her more accepting of different paths of action, even if they happen to be somewhat off the hoped-for natural beaten path.
Unscheduled developments before, during and after the birth are one of the main focuses of the Jerusalem workshop.
Bobro gained firsthand experience of postpartum challenges following her daughter’s birth, when the baby developed complications and had to be hospitalized shortly after the birth.
“I was not prepared for that. That was very difficult to deal with,” says Bobro, “and a lot of parts of the birth, before and after, can be very challenging.” Like many first-time parents, she also woke up to the reality of being a parent, that the idea of having a baby had materialized into a much-loved but also highly demanding corporeal being.
“I suddenly realized, after my daughter was born, that my entire life had changed,” she says. “Everything had changed, and I had to deal with it. I had all these questions, as a mother and as a person, asking questions while I was exhausted and not being able to breastfeed.
I was young when I became a mother, just 25, which was much younger than any of my peers. My family lived far away from me, and I had no support. I reached an emotional crossroads, and that led me to doing what I do today with Birthing from Within.”
Birthing from Within attempts to help mothers, and couples, get ready for the grand event, although a large part of that is realizing that it simply is not possible to foresee and deploy for all eventualities.
“We can prepare parents for situations when they encounter things that are unexpected, but we can’t tell them everything that can happen in birth,” she explains. “‘What do you do when you don’t know what to do?’ is one of our mantras.”
Bobro says that having a baby can also have positive, practical effects on other areas of life. “Women are very motivated to figure things out, but you can’t figure everything out when it comes to giving birth. And we also tend to procrastinate a lot, but you can’t put off having a baby when you’re pregnant, you’ve got to get on with it. There are lessons to be learned.”
While the woman is, of course, the focus of attention during pregnancy and delivery, Bobro says that the father-to-be also has work to do and an important role to play. Part of that takes place before the birth.
“When the woman is having contractions, she doesn’t want to be worrying about what her husband is thinking, and whether it’s okay for her to make a lot of noise. So he has to be in the right place emotionally before the birth, too.”
Bobro says Birthing from Within is designed to accommodate that. “The partner supporting the woman must also get some preparation to provide the necessary support. We have to honor the fact that they will be seeing a person they love going through pain and, if they are not prepared, they can be traumatized.
They may be worried they cannot ‘fix’ the situation. I tell fathers their job is to get comfortable with being uncomfortable.”
The Birthing from Within approach also includes postnatal sessions to help mothers and fathers process some of what they went through during the birth and, possibly, bring out and deal with some deep-seated trauma or other negative baggage sparked by the delivery process.
“Several months after the birth we have the mothers and fathers come back and ask them to talk about the experience,” says Bobro. “I ask the fathers about the moment they were in absolute awe of what their partners were doing. The father casts his mind back and suddenly accesses a memory he may have forgotten about. It may be a moment of eye contact between him and the mother during a quiet hour. Some say ‘I saw inside her how determined she was.’” The sessions can produce some surprising revelations for both partners. “The mother may say she thought her husband was grossed out by the whole birth, but when he talks about it at the session, she gets a completely different picture.”
Bobro also says the popular image of the paternal performance is not always a flattering one.
“Our culture makes fun of births, and especially the father’s role,” she notes. “In movies, fathers often pass out or are seen to be helpless. That’s a huge disservice to the men. They have a place to share the emotional experience of birth.”
Bobro also brings some of her formal education into play at the sessions. “I studied art history at university, and art can be a powerful tool in processing the birth experiences. One of the things I do at the post-partum sessions is to ask the mothers and fathers to draw something that expresses the birth experience.”
That frequently provides surprising added value.
“Some say they haven’t drawn since they were at school, or that they didn’t know they could draw. That is also a positive aspect of the process.”
England also brings extracurricular elements into her Birthing from Within work, incorporating topics such as birth trauma, Cesarean birth, prenatal nutrition, storytelling, visualizations and hypnosis at workshops and conferences all over the world.
There is also an important art-based stage in the prenatal Birthing from Within process that involves the parents putting the way they envisage the progress of the birth process into specific graphic form.
“I ask the couples to make a chalk-on-paper drawing of a birth labyrinth, one continuous path that coils back on itself,” explains Bobro, adding that the session does not always run smoothly from start to finish but that there is an important cerebral and mind-set benefit to be had.
“Sometimes they think it is a bit odd, but once they get going, it can become a bit of a meditative activity.
They move into the right brain, which the mother will use in the birth. She will probably be less verbal, which comes from the left side, and she moves into the more intuitive side, the side of stories, images and songs. A woman can more easily access that in labor, and we drop the seeds for that to happen during the pregnancy.”
Once the drawings are complete, the prenatal workshop participants discuss their creations. “We talk about how labor is like a labyrinth, with twists and turns, and with an unknown length. But it is also clear that you will get there in the end.”
Bobro is quick to point out that the drawing session is not aimed at producing any Rembrandts or even any Doonesbury images. “The focus is on art as a tool of learning, and maybe discovering a new aspect and opening a door a little bit, and not necessarily making a pretty picture to show the world.”
The session participants often leave with food for thought ahead of the approaching birth.
“Often a father-to-be may go away with a new question.
He may want to ask his mother about his own birth. Sometimes he may make a drawing in which his wife looks really big and he looks really small. That could make him change his mind about not needing someone else, like a doula, at the birth,” says Bobro.
Both England and Bobro feel that technological advances, and the mainstream Western medical mindset, do not always go hand in hand with allowing the birth process to develop as naturally as possible.
“In most Western cultures, there’s an emphasis on the technological aspects,” notes Bobro. “In the United States most births are attended by obstetricians who have attended medical school, learning all the things that can go wrong. That’s what they are trained for and they are very good at it. They are excellent at saving lives.
“However, 90 percent of births don’t involve any emergency or need for medical technology. Doctors and most nurses are trained in a very different perspective.
They are paid by the birth, and the longer the baby is inside the mother the more danger they associate with the birth, because that’s what they have been trained for. Once the baby is out, they don’t have to worry. They won’t be liable for any problems, and they don’t need to be involved. The point of their job is to have a good medical outcome, that the mother and the baby are physically healthy. The emotional and psychological well-being is not at the forefront.”
SO HOW can Birthing from Within help to get conventionally trained medical personnel on board, to facilitate deliveries that are as natural as possible, and leave the mother with a positive birth experience? Bobro feels that the bedrock is fertile for improvement, but there is a lot of work to be done.
“I mostly work with midwives. So many women who go into nursing care, especially the care for birthing women, go into it with a really powerful positive intention.
They want to make a positive difference for families.
But after going the system of being trained, they get worn down by the technological treadmill system,” she points out. “They see a lot of women who don’t care what happens to them. They sometimes see a father sitting in the corner of the [delivery] room looking terrified, and see the relationship between the partners is not good. Or that the partners do not take care of their health. So there is a lot of trauma, and even anger, among a lot of birth professionals.”
Birthing from Within addresses this minefield at its workshops, and the Jerusalem course will aim to provide local doulas, midwives and other birth-related carers with more tools to deal with this aspect of their work.
Bobro says that birth professionals have plenty of challenges to deal with in the course of their duties, which can eventually impact the way they function.
“They work in a hospital, always under the supervision of a doctor. They have a sense of having a lot of responsibility, and trying to make everyone happy, and they have a lot of paperwork to process, but they don’t have much power or authority. They may not be respected by the parents either, or by the doctors. I think it is an extremely stressful job, emotionally, and it is understandable that even the best-intentioned nurse will not be able to bring her best help to every birth, day after day, when she may not be appreciated.”
By now it has become clear that having a baby involves a number of parties, each of whose needs have to be addressed to ensure a happy and successful process for all concerned.
“We have to allow nurses to examine their own experiences, and look at the assumptions they are making and at when they feel helpless and angry during a birth.
The situation is much bigger than just saying, ‘Parents need to be informed, and say what they want.’ We need to work with the whole culture, not just with the woman who is having the baby.”
Part of the social-cultural milieu in which Bobro and other birth carers work is a Western society that has an increasing tendency to try to arrange life in as tidy and convenient a manner as possible. In the context of births, that translates into elective Cesarean births.
“In 2009 the rate in the States was 31 percent, although it varies from place to place,” says Bobro.
“That was primarily because the woman had a previous Cesarean delivery, but the prevalent mind-set in the US is to get what I want when I want it and I shouldn’t have to suffer. Cesarean births are not recommended by the American College of Obstetricians and Gynecologists.”
Still, Bobro and England have hope for a better future on this front.
“Pam says the pendulum has to swing, and has to go to crisis before it swings back,” says Bobro. “Medical technology and drugs are overused, and this has been scientifically proven to be bad. There is a reason why babies are supposed to come out in a certain way [through the birth canal]. And there is a growing environmental awareness that sees the woman’s body as an ecosystem, and that what the mother feels and eats during the pregnancy, and how the birth happens affects the baby later on.”
Bobro says that one of the strongest messages of the Birthing from Within approach is learning how to relinquish control – not an easy philosophy to embrace in an increasingly “customized” Western society.
“There is a reason why women have pain in labor, and that pain should not be seen as suffering. And it’s not just about the pain, it is about a gestalt experience.
What do you do when you think you are going to die? You keep going. You let the mind and the body do what they have to do.”
The Birthing from Within workshop will take place at Beit Hagat, Simtat Hagiva, near the Sisters of Zion convent in Ein Kerem, Jerusalem, on May 23-25, from 9 a.m. to 6 p.m. For more information: www.birthingfromwithin.com, http://www.facebook.com/Parparim.Babeten, or contact Danit Tsur at danit@haolam.co.il or 050-862-1822.