Cesarean Voices -A web site by, for, and about cesarean born people
home | links | topics | contributors | networking

The Ideal Caesarean Birth - by Robert Oliver, M.D.

Introduction

The beauty of birthing, gestation itself, appears to me, a man, a totally foreign experience. I cannot even imagine the feelings, anxieties, anticipations. fears, hopes, and physical experience that a woman has during pregnancy and birthing. Even though I have attended many pregnancies, worked with and assisted many birthings, and intervened in many ways during my career as an obstetrician, I still honor the birth mysteries.

What is this experience that so engulfs the totality of a woman? Is it just biological, a process of an animal reproducing its species?

Is it more - a psychic transportation into a world of the spirit - a transformation? What happens within the woman, to the soul, spirit, persona, that this hero's journey is the ultimate magic which completes a cycle? What can make motherhood so deeply vital to a woman that she would seek pregnancy and labor and birth like a shamanistic rite of passage - with all the pain, fear, and loss of control typical of shamanic journeys?

I could not find any answers to my questions, not as a medically-trained technician. I can't even get from the woman any answer, if she knows an answer; and if she does, it is always couched in terms like:

"It is an empowerment.

"I don't know. It's just like I have to."

"What a stupid question!"

"Because it's beautiful."

"It is a natural thing to do."

So as I talked with women, listened to their guidance, worked in the alternative health field, and read (and oh how I read!) the literature which is published outside of the scientific (now called "peer review") literature which continues to espouse the medical model - as I listened to the pioneers, the midwives, the few brave obstetricians and family practice doctors who stepped out of the standard of care to "participate in birthing" instead of "doing deliveries," - I became progressively aware that what I had considered sacrosanct was in fact a victimizing of women and the woman's quest of the "golden fleece": an affirming experience through birthing.

For me, Stan Grof, Thomas Verny, Dick Grantly Reed, Michel Odent and many others over the years took the place of the "great men" of obstetrics, the professors in their ivory towers, and my own and medicine's absolute fear of the courtroom. I realized I had a new paradigm as the criterion upon which I should base my work. Stan Grof pointed out the intensity of the experience of the fetus in the birth canal and the effect of interference on the newborn. Frank Lake (unpublished paper) spoke of remembered pain and the "cold womb" that impressed the first trimester fetus and affected the emotional or psychological being of the child grown into an adult.

The implications of the interferences and good medical intentions that I had been practicing crashed in on me. What had I done? What am I doing in my pressure on a woman to force a good medical result? What is this result? Medically it is survivability. Quality of life or psychological and emotional peace is not considered. By contrast, holistically the most value is placed on the total process with each aspect juxtaposed in a whole.

For the first time I looked at my work with pregnant women and realized I was doing three very wrong things:

1) I was getting great medical results.

2) I was getting terrible results for the woman with regard to her needs and self-esteem.

3) I was unconscious of the baby, the conceptus to fetus to neonate, and of the effects of standard care on this new person.

I hated it. Really, I hated it. I hated the thought that all my good intentions were wrong. I hated knowing I had not aimed the care-giving at what should be vital in the transformative event of birth - the woman transformed into mother and the conceptus into a new human being. I hated knowing all of the shortcuts I took to long labor - operative delivery by forceps and caesarean section just to get on with it, the inductions of labor for my own convenience not for the safety and integrity of the woman, the application of technique and technology to make my job safer from lawsuit and peer criticism and to meet demands of hospital policy. I remember and recognize the anger I felt at women who wanted "natural childbirth," home delivery, and non-intervention. I am ashamed, and I am also satisfied that whereas I was once stupid but medically sound, I am now awake and profoundly aware that I know nothing about the experience of gestation, birthing, and the transformative experience of becoming a mother. I can only view it, this process a woman passes into, from the outside as a father, a man, and a professional male in obstetrics.

I have to thank Spirit for the skills of medicine I have learned, for the many, many times my ability to diagnose and intervene has resulted in an positive outcome when otherwise there would have been a disaster for mother or baby or both. I am glad I had the skills to really serve when the outcome appeared to be going in directions the mother did not want. As my skills broadened with the new perspectives I was learning, I became aware that to serve truly, skill must include art - creative, imaginative, and insightful art. I needed to become an artist to really support the transformative cycle of womanhood, to celebrate a new life. Michel Odent was the artist and naturalist who taught us through his book, Rebirthing Birth, and the midwife and doula have long promoted the purity and integrity of woman.

Every cell in my being tuned itself to my position outside of this passage, and I listened to woman's voice within me and her. Early in my career, I was clear about medical technology and interventional technique. But as the years passed, and as my power of observation improved, my own self-awareness improved, my level of consciousness regarding gestation and birth progressed: as my ability to hear the need that a woman had for her transcendence into motherhood and the "full cycle" completion of her womanhood, I questioned the medical mode and standards of care.

In the medical model, gestation and birthing are a managed event where standard care is demanded of the doctor, the hospital, and the labor room. Unfortunately, the woman is forced into the system. The child becomes incidental and is only considered as a result, good or bad, of our delivery.

It is vital in considering the ideal caesarean birth that the intelligence of the prenate, its truly astounding state of being, be remembered. We are becoming more aware of the prenate's "control" over the events of gestation and birth. Previous dogma was, "the fetus is only a passenger" with no thought, awareness, or influence over its intrauterine life. Thanks to many astute observers, regressive therapy, and the observations of people in alternative states of consciousness, the unborn child is found to dramatically affect gestation and birthing. David Chamberlain's Babies Remember Birth and his contribution to this book summarize this new knowledge convincingly.

There are new models being practiced by many, some outside the law of the state yet inside the law of humanness. There are new researchers' works on providing care alternative to allopathic care, care which not only works but which supports the woman and her birth process, correctly assists the bringing forth of the child, and more maturely accepts the risks of pregnancy and birthing.

Cesarean Birth

There is one area, caesarean birth, that is not addressed in most of the new models except by condemnation. Caesarean birth has become the means of delivery for more than one fourth of all newborns. As one labor room nurse said, "It is a vaginal bypass." Those of us who have monopoly on caesarean birth, obstetricians, have remained unchallenged except by people like Jane English who through her book, Different Doorway, reminds us that though we were successful in saving a mother or child by the surgical, vaginal bypass, we have given far too little respect to the baby and the baby's well-being. While the procedure undoubtedly rescues many from the brink of disaster, the unfortunate truth is that far too many babies, in fact most, need not have been born by caesarean delivery at all.

How can an increased awareness of all this reach into the procedures surrounding a necessary caesarean birth? What would be an ideal caesarean birth? I suggest that there are three levels on which we can focus:

1) the preconceptual months

2) the prenatal months

3) the intrapartum events

There is another area that must be considered in the "ideal caesarean birth" and that is the post partum phase. But that is not the topic of this chapter.

Who does the operation? The procedure itself is the realm of the obstetrician. No one except those specially trained is allowed in any American hospital to do any caesarean sections. It is a fact that obstetricians have the corner on caesarean birthing.

Preconception

We can definitely assume that no one has been trained to be a parent. It is remarkably clear to me that as a father I did not have any training for that role. It has been an on-the-job training program, probably to the detriment of my children. Parenthood begins with the first sexual contact that is not contraceptually safe. Yet parenthood goes even further back than that. To have an ideal caesarean birth, we must consider the preconceptual phase vital to the onset of the pregnancy. Our literature in pre- and perinatal psychology is now demonstrating the incredible effects of unwanted birth and unwanted conception in the cellular memory of children and adults who through regression revisit those moments when they discovered they were not wanted. The cold, unaccepting wombs of women with inordinate fear of pregnancy or fear of motherhood, of women who are forced to carry a pregnancy as punishment for their sexual behavior, and uneducated women who have, with their men, created pregnancies just because it is "natural," all these jeopardize the ideal birth, caesarean or vaginal. Conception requires serious consideration of diet, health, spiritual connection, and value of pregnancy and the new life.

A surprise pregnancy is not doomed to lead to a non-ideal birth; however, emotional and psychological work may be required during the gestation so that the unborn recognizes its full acceptance and its anticipated birthing. Principal in our consideration of the preconceptual phase is the spiritual and emotional maturity of the mother, her assurance and clarity in becoming a parent, and her ability to share her love with her child. She will be greatly benefited in this by a supportive environment. All women, all couples, even for second and later children, should seek preconceptual counseling.

Prenatal

I will assume that the pregnancy is planned, that the parents have deeply and passionately wanted the intensity of their relationship to bring in, through their love, a being for the being's sake, a new life's opportunity. Or if the woman finds herself pregnant as a result of failed contraception, we will assume she has chosen to birth the child, not because she has to, but because she wants to. We assume there is welcome for the child. When the new life is planned for, the uterus can be a home of nurturance and love. The cold womb results when a woman doubts her ability to be a mother or when the woman, consciously or unconsciously, rejects the conceptus. When, however, the conception is mutual, unforced and passionately intentional, the preparation for the ideal birthing will be more successful.

When it is known in advance that the birth will be a caesarean, the ideal caesarean birth will include emotional as well as physical preparation of the mother before she "goes under the knife. She must fully explore her feelings about and fears of the operation and recovery. She must identify with the operation and "own" the procedure and see it as the means for her transformation to motherhood, not as a failure of herself or of her womanliness.

Since babies are conscious before birth, an ideal caesarean birth would include intensive prenatal preparation of the mother and child. This would include a full acceptance of the baby, a wanted pregnancy, communication within the positive uterus, and a clear forward looking integrity between mother and fetus regarding the impending caesarean delivery. Labor should be allowed to begin, when the cesarean is medically necessary (as with placenta previa or spina bifida), as an indication that the baby is ready and to reduce post operative complications.

Emotional preparation for pregnancy and birthing creates the one most important factor toward good outcome: motivation. Removal of fear by combining education with experience of progressive alternative states of consciousness prepares the woman, her intended child and the support family to create an ideal caesarean birth regardless of the medical model or hospital environmental conditions they may encounter (the protocols at most hospitals do not allow much latitude for different birthings or for ideas that contradict "scientific" dogma).

Intrapartum: Labor Caesarean

Intrapartum means the period from the onset of true labor through delivery of the placenta and includes the recovery room.

There are two very different situations which might occur for the Birthlette (new word) and mother during labor which might end with caesarean section to achieve birth:

1) There may be an emergency for the unborn - fetal distress, hypoxia (loss of oxygen and blood supply), infection inside the uterus, late discovery of fetal abnormality, and extreme prematurity, or the mother may be hemorraging.

2) The mother's medical status during labor (e.g., severe high blood pressure or toxic debilitating illness) and obstetrical conditions (e.g., contraction of the pelvis, or malpresentation).

Any of these problems can arise in any woman. It is interesting to me, however, that caesarean birth is rarely needed in the woman who has truly prepared herself for pregnancy and birth, who is highly motivated with all the systems being well supported by friend, family, and doula (birth assistant); a four per cent caesarean rate seems to be exactly right. Obviously the obstetrical approaches to the two situations are different.

Emergency Cesarean

In an emergency caesarean it is essential to get the baby into saving hands or the mother back from severe life-threatening events, whereas with failure to progress in labor or cephalopelvic disproportion, time is not a factor before the operation. In an emergency the surgeon is faced with getting the baby out of a life-threatening environment rapidly, when there has been a major separation of the placenta from the mother's blood supply (called an abruptio placenta) or when the umbilical cord has preceded the head and the blood supply to the baby is cut off, and the infant must be birthed as rapidly as possible to prevent progressive brain damage and death. We have, most of the time, less than ten minutes from the discovery of the problem to the birth of the child, sometimes far less.

Nonetheless, even in these circumstances, the ideal caesarean birth can occur. Rapid, accurate diagnosis of the problem, maximum rescue of the fetal circulation, and clear contact with the mother is vital and definitely required as part of an ideal caesarean birth. The mother must be consciously informed of the situation facing her and her baby, reassured that she can contribute to the birth of the baby by focusing all her healing energy into her unborn and communicating to her baby her readiness for the baby to come to her arms and to be safe.

With the prepared mother, this is easy, for the lines of communication are wide open between her, her obstetrical team, and her child. Mother can speak reassuringly to her unborn and guide healing light to this child in jeopardy and to the baby's process, for we must remember at a deep level this emergency is the baby's doing and the baby's way.

At the moment of decision the team must be efficient, be respectful of the feelings of all the members of the mother's support team, and act with calm determination for a good result, in spite of knowing there could be medical failure. There could be failure in the sense that the child might be beyond recovery or revival, or might have physical damage due to the prolonged anoxia.

These events are rare, but the possibility of need for an emergency birth is the reason most people, medical as well as lay people, want the "safety" of a hospital and condemn home births. Doctors fail to realize that they are penalizing 96 women and 96 babies with the medical approach, hospital-bed birthing, and electronic monitoring, to "save" four babies - really much less than four, as this kind of event actually occurs in fewer than one birth in a thousand. But in a hospital with several thousand deliveries every few years there are a lot of high risk pregnancies.

The attending obstetrician, birth attendant, family practitioner, or nurse-midwife must be with the mother as she is prepared to move to the operating suite, giving her his or her healing energy and loving concern. The attendant and the father can "lay on hands" carrying their affection and encouragement to the unborn, desperate fetus as an anaesthesia is started and before surgical drapes are applied. As a surgeon, I enter the womb rapidly and gently, my touch affirming this different doorway, elevating the fetal head gently and reassuringly applying oxygen, and allowing the child to come out into the light. I make sure rapidly that there is life. At the same time, as best I can, I duplicate the passage through the birth canal as the baby continues to deliver through the surgical wound. I insist that the cord be allowed to stop pulsating before clamping, thereby continuing the supply of placental blood and oxygen to the baby. Also, I assist in stimulating breathing only if needed. I cover the infant's body with a warmed towel if the condition which necessitated the emergency birthing is corrected by the birth. The infant is handed to the waiting neonatologist if resuscitation is required. The neonatologist must, ideally, be in the same calm and accepting frame of mind to reach the barely alive consciousness of the child, talking quietly and reassuringly to this fresh-born, and avoiding excessive traumatic stimulation.

Once in a while it is necessary to place a tube to the lungs of a severely stressed infant . At all times the child should be spoken to and informed. Vigorous stimulation of the skin should be avoided - a child who has never felt the roughness of a towel would want to avoid this horrid event.

If the child is beyond rescue and is stillborn, we must remember that the mother and father have a right to the dignity of their grief for the loss. We can, and ideally will, support contact with the spirit abiding in the baby and the parents by allowing the goodbyes necessary for all. The operating room team will also have their grief and self-criticism for the loss and the inability to rescue the baby, so they can join in the grief relieving contact with the new spirit by joining, each in his or her own way, with the child. Respect, mutual and shared, is the valued action now.

Non-emergency labor cesarean

Through no fault of the woman, for her preparation has been complete, mechanical events are leading to the need for caesarean birth. In this case there is time for emotional preparation of the mother, time for connection with the unborn and time for unhurried operative preparation. Often the woman has gone through hours of labor and is tired. The baby may appear to be in good shape but it has also undergone stress and fear in loss of its oceanic, cosmic ecology during labor. The family, through their own anxiety, may be overwrought with fear for their loved ones, mother and unborn child. The father is feeling helpless in the face of his inability to help his loved partner and his child. The staff may be frustrated and anxious for the mother and child. The labor room is tense, thus not reassuring to the mother. In the ideal situation we would already have the mother, her unborn and her personal support people in tune with the melody of this birth. We would then only have to quiet the medical staff and have them focus on the dynamic duo, the mother and her unborn. Ideally, and I have not seen staff this enlightened, we could gather around the informed mother, join her in a meditation, surrounding her with healing, loving light and energy, and respectfully do our jobs, which would lead to achieving the goal of childbirth - a child alive with this mother and father, ready for a full life.

At and during the operative procedure, we can, by means of regional nerve block anaesthesia, allow the woman to be awake with her partner by her side. She can continue singing to her child, reassuring it that the invading hands are safe and that she, the team and the father are all there only for her or him, the child. Those on the operative team can focus their energies on the child by directing their energy to their hands, and on receiving the baby, not delivering it. The presenting part can be lovingly handled to make the move out of the uterus into the air emotionally, gently and assuredly. Resuscitation can be accomplished with concern for the infant's own desire to clear fluid and achieve breath. Gentleness and unhurriedness is vital at this point. The team should be concerned for the infant's somatosensory apparatus.

The infant can be gently compressed by the hands of the obstetrician to simulate vaginal passage, and the infant can be covered with more warm, wet hands or a warm towel while waiting for fetal circulation to stop and the mature infant circulation system to take over. I have a big, gentle hand, and I speak softly to the child while I cover its whole body with my hand, which is gloved, wet, and smooth - like the uterine wall. I allow the child to breathe on its own, reasonably, instead of forcing it to breathe, and when all is ready, part the child from its mother by clamping the cord and presenting the child to the mother and father. Only if the infant is struggling and needs help from the pediatric team for resuscitation would I give it to them (pediatric teams tend to believe the child belongs to them to do with what they please instead of allowing bonding by contact and joining of the now enlarged family). Complaints of the child in later recalling his or her birth can be kept to a minimum. Where possible, the operating room can be less cold and the light less bright; one can shade the eyes of the newborn and avoid the glare and sounds that are harsh and urgent. A bath, Leboyer style, can be ready, and the infant cradled in the father's arms in the bath. The child can then wait in the father's arms beside the mother while her wounds are being repaired. Breast feeding can occur almost immediately; the only restrictions are the surgical drapes and the flat position of the mother on the operating table. The mother may have to wait until she reaches the recovery room to breast feed. With new anaesthesiological techniques the first hours are pain-free, so the child can remain with the mother instead of going to the brightly lit, noisy nursery where there is only aloneness and plastic boxes.

In both of the above situations the baby and mother are at risk, and it is our intention to maintain the mother's control of the events. She must at all times feel she is important to and guiding the birthing, regardless of the emergency and the operative procedure. This also goes for the baby in a spiritual and metaphysical sense. Ideally the obstetrician and labor room personnel will honor these two people most strongly.

Intrapartum: Non-labor Caesarean Birth

There are few reasons for non-labor caesarean birth: 1) placenta previa, 2) previous classical caesarean scar, 3) previous invasive uterine scars, 4) repaired cervical incompetence, and 5) invasive cancer of the cervix. Additionally, in the past and perhaps still today, active herpes cervicitis may also be an indication for non-labor caesarean birth.

In the ideal non-labor caesarean birth, the mother's prenatal course has been free of complications, and she is looking forward to the birth. Her pediatrician and anaesthesiologist have agreed to cooperate in a consciously attended birthing and are very aware of spiritually welcoming the baby and facilitating bonding and breast feeding. The labor room staff is excited about the new approach, the opportunity to participate with the mother and father in the birthing of their new baby and to be integral to the experience. The obstetrician and his team have spent their prenatal time responding to the mother and the child and the family.

The baby has been a welcomed passenger in the uterine environment which has become a lot less roomy over the last month of pregnancy. The infant is contributing its readiness to birth. The baby's position is set, the lungs are mature, and the mother is ready emotionally and physically. Ideally we wait for labor where it is safe to do so, though certainly not with previous classical (vertical) scar, for rupture occurs most often in labor. Nor do we wait for labor when the placenta is placenta previa, covering the cervical canal, for hemorrhage is a severe, life-threatening event. Otherwise it is safe to allow labor to start. In fact, when labor is allowed to begin, there are fewer complications for the mother and the maturity of the baby is assured.

After the appropriate laboratory work, which is done for the unlikely occurrence of serious complications during surgery, the mother is admitted to the labor suite - she has visited this unit and spent time with the staff responsible for her. On admission, time will be set aside for completion with her and her significant others, including her children if she has them, all recognizing that she will be different in a transpersonal sense after the birth of her unborn. The group will meditate together and give affirmations to each other. Then they will all "hold the baby", letting the baby know everyone is ready to share their lives together and reassuring this child it is wanted and they will be there for her or him. The process has been ongoing and now only lets the child know it is time. The obstetrician is there not as leader of the meditation but as an agent who will be responsible for the birthing of the infant. It is imperative that the obstetrician be part of the meditation, as well as be involved during the pregnancy.

Once completed, we - those of us on the surgical team, the waiting pediatrician and his staff, the scrub nurse, the circulating nurse, anaesthesia and their staff - all gather around the mother on the operating table. Conduct in the operating room will be affirmative, positive , even lightly humorous. We will be careful not to project our anxiety, though we know that in every case the unexpected can appear. Instead, we will have confidence in our skill and affirm the outcome. The parents will feel safety and peace only to the degree that the team has a sense of safety and peace. We will tune ourselves together by a mantra, a prayer of welcome, a song, or some music, and begin.

Anaesthesia will be spinal or epidural, so that there will be no drugs in the mother or the baby, and the uterus opened transversely. The transverse incision of the lower uterine segment is imperative, so that the mother has the opportunity in the future for a vaginal birth rather than "once a caesarean, always a caesarean." The bag of water will not be ruptured. The baby's presenting part, hopefully the head, will be elevated gently into the surgical entrance to the uterus. With gentle pressure on the uterus, the baby's head will be delivered slowly inside the bag of water (delivered in the caul). This is not the same as a vaginal birth - it is quicker, and there are no titanic contractions over time - but the move through the vagina can be simulated this way, though it is a very poor substitute. The face is exposed only after the intense light has been deflected, and the bag of waters is opened over the face. We will maintain quiet at this point. The bag of waters is further opened, and, if needed, the nose and throat are gently aspirated before the baby aspirates excess amniotic fluid. (Amniotic fluid aspiration syndrome, with its attendant collapse of the lungs and bronchi, is still a danger, rare but life-threatening.)

Gently, with pressure on the dome of the uterus, the anterior shoulder is delivered not by pulling on the head as though it were a handle, but rather lifting and depressing the head, guiding the shoulders out of the womb and through the wound. The newborn is now born and is covered by all operating hands, briefly simulating a vaginal passage, our voices quietly welcoming him or her and reassuringly stating all is well and safe - it is safe to breathe and to be here. As the cord stops pulsating and the infant-maternal circulation system has separated, the cord is clamped and cut, and the infant is given to the mother and father. Thus, the newborn's first sensations will not be of masked noisy giants, but of dim shapes speaking lovingly with rapt attention to the neonate's emotions. Bonding, as the infant's vision clears, will be with mother's voice, face, and eyes, and the infant will be lying on her chest recognizing the sounds it has grown used to, her heartbeat and breathing - the music of the womb. Loud noises are avoided, for the infant's hearing is acute. Pediatricians will judge the condition of the infant now, and if needed will assist the first moments of breathing with gentle stimulation.

Meanwhile, the surgeon completes the delivery of the placenta, awaiting its delivery instead of jerking it out, and closes the uterus and abdomen. The operation is complete, and the music playing on the tape recorder is a soft happy melody. The operating staff will gather around the mother, significant other, and baby and whisper, each in his own way, a greeting and appreciation for having been a participant in the baby's birth. Mother, baby, and significant other are taken to the recovery room, where together they recover from the event. Mother is encouraged to allow her feelings of joy or sadness. (Many mothers report the first hour or so after birth is so overwhelming they need time to gather their wits.) Allowing time and supporting any kind of reaction by the mother or father is important for the recovery room team. No feeling is to be discounted, and an emotional space is provided for the transformed woman and her newborn child within which to play. Ideally, the nursery staff will never touch the baby. They come to the mother and child for cleaning, pictures, and medication if needed, rather than moving the infant. It would be wonderful to avoid eye medication, but it is the law.

Ideally, mother and child will be together skin to skin sharing the recovery, and will be rooming-in. Medication for surgical pain will often be little needed, but will be available during the post-operative stages. This will allow conscious contact between mother and baby, will allow deep bonding with the significant other who can stay in attendance until discharge. The child will be treated with loving touch and respect for its intelligence.

So, ideally, we will have completed a cycle, a cycle of intention, conception, gestation and birth, all the while conscious of the transpersonal experiences of all involved which will dominate the cycle.

Is this ideal possible? Yes. But there will have to be a tremendous awakening of the medical community to the need for this ideal caesarean birth.

Perhaps this article will be the alarm clock.



Robert Oliver, MD is a retired obstetrician living in Arizona. He is on the board of directors of APPPAH, the Association for Pre- and Perinatal Psychology and Health.

(For a descrtiption of an actual cesaran delivery that was very similar to the ideal described above, go to Joanne Steele's article.)


Conversations on Cesarean Birth
Jane English and Bob Oliver

October 7, 1999

Hi Bob

The following two quotes from your article intrigue me. I used to be reactive to suggestions that cesareans need to somehow "go thru the birth canal" in order to be OK. Now I have evolved far enough to be just curious about such suggestions.

From the section on labor cesarean:
"At the same time, as best I can, I duplicate the passage through the birth canal as the baby continues to deliver through the surgical wound. "

From the section on non-labor cesarean:
"The infant can be gently compressed by the hands of the obstetrician to simulate vaginal passage, and the infant can be covered with more warm, wet hands or a warm towel while waiting for fetal circulation to stop and the mature infant circulation system to take over. I have a big, gentle hand, and I speak softly to the child while I cover its whole body with my hand, which is gloved, wet, and smooth - like the uterine wall. I allow the child to breathe on its own, reasonably, instead of forcing it to breathe, and when all is ready, part the child from its mother by clamping the cord and presenting the child to the mother and father. "
Reading these quotes I find questions arising:

What aspects of the vaginal birth experience are to be simulated? What aspects of vaginal birth are to be avoided?

Why? What are the benefits of this simulation?

Ideally, "who" is the birthlette (Bob's new word!) before this simulation and "who" is he/she after it? Here I mean "who" in terms of state of consciousness and self-image, as well as physiological state.

How can a vaginally born obstetrician step behind his own birth learning (what he learned in his own birth) in order to really be with this differently born child during the process of birth?

How do you train new obstetricians to be able to do this simulation?

Then there is the question of striking a balance between attempting to make the cesarean birthlette as much as possible like a vaginally born birthlette, and honoring their uniqueness, the gifts and learning they get as a cesarean, learning that the vaginally born don't have.

 

October 10, 1999

Jane:

As always you capture thought like a spider web's dew drops in the early morning.

I agree with your contention that there are boundary issues in the non-labor cesarean born child extending into adulthood. I attempt to create "passage" thru the vagina with firm, yet gentle hands. Did this do good - who could tell. I did it anyway and still do. Have I taught it to others? I would love to and perhaps through the article someone will read and pick it up. But have I done did larn it to another? No, for no one listens believing still the baby "can not recognize birth"! I tried to train OBs for two years but the powers that were did not like that so let me go. The best thing is you and others like you who can move the thoughts of the profession.

The passage is the part I wish to duplicate. The vaginal birth canal walls are smooth and slick as are my gloved hands. I felt that in my imagination I was creating vaginal outlet; my hands are large and strong. If as you and Grof indicate the passage into the world creates boundaries and rebirth, then I had imagined this would simulate that passage. Does it do good? I do not know. I assume that you, Grof and Chamberlain all are correct in your assessment. I am willing to agree and to practice the only means I could come up with that might simulate that magical passage from inside to outside and from death to rebirth. David Chamberlain in his book describes the trauma of the terrible skin sensation reported by his clients in birth regression. Therefore, in theory smooth, slick latex gloves intentionally drawn over the entire baby lovingly and firmly might be interpreted as vaginal passage

What are the benefits-- I have no idea. Perhaps the only benefit is the release of my remorse at having to do the section, knowing the risks for mother and child. There may be benefits. What they are is mysterious to me for I have not followed any of their infants into childhood. Yet if I can lay ground for possible benefit then good. If this is damaging, I don't know how. Like so many things in medical obstetrics concern much we do is not science, rather is supposition and art.

I will not argue for vaginal over cesarean birthing. Is one better than the other, is the surgical by-pass better than the vaginal birth? I do not know. They each have their unique values. Is a midforcep delivery under spinal anesthesia less traumatic than a section? This question plagues me. Is a head being squeezed so hard as to change its shape by the passage less traumatic that delivery through an open wound? I have no idea.
It would seem that all birth must be traumatic. After all the child has had to choose a new life and then forget all it learned in all the lives before it. Is the process of living from conceptus to old person part of what we have chosen or does the OB make a difference. I am awed by every child who has chosen this life they have chosen. And we are at the effect of that choice.

We choose to be and we choose to have what we have chosen. So who we are is less a question than who we continue to be out of our choices. I know not the fetus yet find a powerful entity, psychically connected. Sometime in the birthing process the child forgets who he/she is and grows back through time and experience into who. If I can assist that child in its earliest course through prenatal-hood and birth then I will use all the means be they medical or philosophical to support that fetal, neonatal life. I have to reject much of my medical training about birthing and about the consciousness of the fetus to do this, but, hey, who said we really know anything anyway.

December 7, 1999

Bob -

It was good to see you again at the APPPAH Congress in San Francisco. The bearhugs and belly laughs get lost in these emails!

Looking over our October email conversations I realize I too need to form some answers to the questions I posed. Your answers are based on years of experience as an OB; mine are based on a different kind of experience - that of being born non-labor cesarean then chasing down for 26 years the footprints of that birth experience, and on almost 58 years of living as part of a cesarean minority in a world of vaginally born people.

I don't know much about vaginal birth (This body of mine - she hasn't experienced labor either coming or going, as I have no children). So when I talk about vaginal birth, its simulation and the benefits thereof, I am speaking of things my vaginally born friends have taught me.

Some of the good things about vaginal birth are "relationship training" and its teaching about step by step process. I go into these in some detail in my book, Different Doorway, and in more recent papers.

In addition to the simulation of the birth canal you do with your wonderful big hands, you might pay even more attention to timing. To the extent that it is medically safe to do so, you might give the "birthlette" a taste of not having to be born all at once. Occasional brief pauses might give him or her a chance to respond and to learn a bit of the relationship dance and of mutual respect. If you are receptive and observant during these pauses you might learn ways to make the birth easier for the child. You are already moving in this direction with your time of waiting for the circulation changes to happen and breathing to start.

In my question about who the birthlette is before and after birth, I was thinking about how birth is a processing of limiting, of becoming less than the great one-ness of spirit, the oceanic union Stan Grof speaks of in his first perinatal matrix. I think there is less of this forgetting for a non-labor cesarean. We discussed the lack of oxytocin in the non-labor cesarean. I was interested that both you and Thomas Armstrong agreed that oxytocin is the biochemical aspect of "lethe," of crossing the river of forgetfulness. This lack of forgetting is not necessarily a positive thing, as living in the world requires a sense of boundaries and of discrimination. We need both, the limitations and the connection to the infinite.

Here I think of the piece in the art show at the congress that showed Stan's drawing of the cesarean and the vaginally born babies teaching each other. It is so important that cesarean born people are not seen just as defective vaginally born people. There are traumas to be healed and gifts to be shared by both.

We're all still at the beginnings of learning what cesarean birth is, and by contrast what vaginal birth is. I'm enjoying this "dance" with you that is a part of the learning process.

Back to the top of this page
home | links | topics | contributors | networking