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Why the Amish Birth So Well.

I’ve been really interested in how Amish women birth recently as they nearly all birth at home, unless there is a medical risk. This is partly cultural but also because of expense of going into hospital or antenatal care, many Amish don’t have insurance.  Interestingly, research shows that despite a higher prevalence of several risk factors for perinatal and infant death among the Amish, neonatal and infant death rates for Geauga Settlement Amish in Ohio have been very similar to the corresponding rates of white children in Ohio State.

Amish women do not tell people apart from their midwife or husband that they are pregnant, it’s said that when they go “they go quick”, probably because they are not tied to due dates. Neither do they have pain relief during labour. They don’t believe in birth control so they often have huge families, sometimes around 10 -12 children. As a result pregnancy and childbirth is a normal part of everyday life, someone is pregnant or in labour all the time and they don’t fear it. Children see this natural process and, as they grow up, girls are not exposed to the international culture of fear and uncertainty around childbirth. Amish children don’t grow up  fearing that there is something wrong with their bodies or that they are incapable of a normal birth.

Amish women birth quietly, often just with their husband a birthing mother, and older woman from the community, who often plays a similar role to a Doula. When in labour, very often they continue doing their daily chores around the home until they are unable to any longer. They certainly aren’t preoccupied with imminent birth or early labour itself!   Research also shows a link between their psychosocial state, which is typically secure and unstressed, and positive birth outcomes.

Ina May Gaskin works closely with the Amish communities, which are close to her birthing centre, in fact it was from the Amish that she first learned breech birth was possible. Nowadays we know that the Amish have a c-section rate of around 2% similar to the Farm, Ina May Gaskins Community.

What is also interesting is the absence of autism in Amish communities. Amish women are very rarely induced as they don’t have ‘due dates”. Recent research shows that some forms of autism are associated with oxytocin deficiency, and questions are currently being raised about the links to this and the use of artificial oxytocin, syntocinon (Pitocin) or other drugs routinely used in labour. There have been very few studies done, but there are calls to investigate this link further. This article explores that link further.

Here is an extract dictated by a midwife with experience of working in Amish Communities.

Taken from http://www.citypages.com/1999-05-01/feature/the-culture-of-childbirth/

Sarah* is a direct-entry midwife in New York state. She practices in rural dairy country near the Canadian border among the many Amish and Mennonite families living there. Currently, Sarah attends more than three-fourths of the births that take place within these close-knit, insular groups of highly-religious families. In Sarah’s own words, here is what is like to attend an Amish or Mennonite childbirth at the beginning of the new millenium:

“The women I work with give birth at home, almost exclusively. This is a matter of finances, for these folks mostly milk cows, which isn’t a big money maker if you have a small herd and milk without machines, as they do. They do not carry health insurance because of their religious beliefs. Additionally, they feel very suspicious of the medical establishment not honoring their beliefs and treating them with respect. They prefer to remain at home, where they have control over such things as allowing nature to take its course rather than, for instance, trying to save a very premature baby.

When the time comes time for an Amish woman to give birth, there is always an older woman from the church community with [the birthing mother]. The mothers have their husbands present as well, but the whole thing is a big secret to their other kids. The Mennonites usually do tell their other kids. Many of the Mennonites prefer to birth with only their husband present. When a young woman in either of these communities gives birth for the first time, she has never really heard much about what the birth experience is going to be like. I usually tell first-time mothers what to expect and that’s all the education they get, except for what their mothers tell them. The pregnancy is absolutely hidden until the baby is born.

I have never seen one of these women ask for medication for the pain of childbirth. I don’t know why they don’t use pain relief. The one time I asked, the woman acted as if she had never heard of the idea. They just don’t seem to have terrible pain.

These women have between ten and twenty children each. They give birth well into their forties. The Amish seem to have as many babies as a human can, spaced according to how long they can go without having another child, usually one per year or year and a half. I have personally delivered the sixteenth baby of a forty-six-year-old. The Mennonites–some of them–use birth control.

The women almost always give birth in a semi-sitting position.They wait until the baby is about to crown to even lie down. They stay clothed the entire time, but the women have special dresses that they wear at birth where the belly can be exposed so that the baby can be immediately placed on the mother’s belly after birth.

The Amish women in the community who attend births are called “catchers,” but since Amish religion prevents anyone from getting an education past the eighth grade, the catchers are not formally educated, carry no equipment or drugs, and generally do not know how to treat most serious complications, although they are very well-versed in herbal medicines and I have learned a lot from them. Their main role when I am there is taking the baby immediately after birth and wiping it from head to toe with baby oil, binding its belly, and dressing it in a special dress and bonnet. The young brides seem to take great pleasure in sewing the dark blue baby dresses and caps and quilting a baby blanket. They like to get the baby dressed as soon as possible, with his belly bound and feet wrapped, and covered with many blankets.

One thing the Amish believe is that there is no breastmilk at first, and some don’t feed the baby until the next day. Some give the baby things like jello water or watermelon seed tea, which is supposed to be good for preventing jaundice.

For postpartum women, they use sheperd’s purse tea for bleeding. For a month after birth, the new mother has a ‘hired girl’: an Amish neighbor who, for $15 per week, lives there and does all the household chores including cooking, child care, canning, and quilting. Occasionally another one will stop by to help with laundry.


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Help I’m a terrible mother!

“You’re going to think I’m a terrible mother….” is one of the most frequently heard phrases in my consulting room. I always think “yup you are a terrible mother, a terribly wonderful mother that the thought and instinct to do the best you can for your child is always there and that you are looking for ways to manage your frustration and anger”.

The guilt that women feel for snapping or shouting at their child is a cruel thing, perhaps there are some of you out there who have never yelled at their child, wished they would just shut up, or wanted to lock yourself in a room with noise cancelling headphones on. If you’re a mum like that I salute you, because you’re better than me.

The truth of the matter is, things are harder for new mothers than they ever have been. Two generations ago, or even a generation ago, we lived much closer to our families. We had trusted support networks that gave us a well needed break and the opportunity to find the space to care for our own wellbeing. It is hard to be mindful of ourselves and our actions as a parent, when we are so busy with interruptions and the spaces between time seem to get smaller. Thich Nhat Hanh a Buddhist monk who has done a lot of work on mindfulness in Western culture, said that children create one of the most beautiful but the most challenging lessons in mindfulness. Jon Kabat-Zinn speaks of your time with the children as a meditation and an opportunity to become more self aware. This great blog by Myla and Jon gives wonderful guidance on how to tune into yourself.

These types of approaches are still on the fringes of our culture however and the overwhelming sense is that women are quite far removed from the opportunity offered through parenthood to become more self-aware, to adjust, to enjoy and to learn. We don’t have the networks we need to support us in that journey and often our sense of self as a parent is obscured by thoughts and feelings of what is expected of us as a mother.

Historically, as women moved more and more into higher education, several things happened, we migrated away from our families to university, we became independent, we got jobs, and we stayed away.Then we got married and had children but we held onto that independence, onto our jobs and onto our children, our right to have it all. The right to be equal to men was something our mothers and their mothers before them had worked hard for, the suffragettes, the 60’s feminist movement sacrificed much to bring equality in the home and in the workplace and there is an inherent responsibility to honour that fight.

I grew up on Virginia Woolf, Mary Wollstonecraft, Germaine Greer and many more but now as a mother and career women I’ve come to realize that I can’t do both and give them 100%, it’s a cruel fallacy. Apparently Nicola Horlicks, Karren Brady and other women are proof that you can have it all, but Karren was back at work 6 weeks after the birth of her son. 6 weeks! It was the right choice for her and that’s fine, but it shouldn’t be sold as having it all, it’s being a full time businesswoman and part time mother.

My instinct is to be at home with my children, making sure that the home is running smoothly (If I’d said that to my 19 year old self, I’d have had a good talking to) but there is also my job which I love, but which I squeeze in around my children, rather than my children squeezing in around my job. That’s my choice and that’s fine too, but I’m a full-time mother and a part-time businesswoman.

When you first become a mother, balancing all these demands is tiring, it’s exhausting, often mums can become brittle and then snap.Most of us are awfully British, even when help is offered we say “no no no, don’t worry I’m fine”, when it may be abundantly clear that you are not.

So when people come and see me saying they’re a terrible mum or that they can’t cope, I remind them of how important their network is, how important that ‘holding’ has been to women throughout time, from the ancient Greeks up to the present day. When you are challenged, be mindful of the feelings and thoughts that arise in you, observe them, understand where they are coming from. Sometimes the fear you have of your child hurting itself while exploring the world around it, may have been learned by you as a child by your mother, awareness of that emotion gives you the chance to know yourself more deeply than before and to let go of obstructive thoughts.

Don’t be afraid of emotions however strong or upsetting they may be, find space to explore those feelings and above all remember that as your child learns its way in the world, you are still learning to. Be kind to yourself.

Here are some quick ideas to create space to breath, focus and tap into your inner strength.

 

  • Say yes to offers of help. If you are away from friends or family consider a postnatal doula or a night nanny. If you haven’t heard of a night nanny have a look at this site by Elizabeth Stokes who is based in Nottingham.http://www.eastmidlandsnightnanny.co.uk/
  • Put your baby in a sling and go for a walk, perhaps turn it into awalking meditation.
  • Use a talking meditation with your baby: Describe, the sunset, or a tree in the park, or a beautiful view in as vivid detail as you possibly can to
    your baby.
  • If you ever feel at breaking point or feel you are going to snap, put your baby in safe place and go into the garden. Getting in touch with nature can be very calming, and you can use a simple walking mediation in a circle, breathing in and breathing out until you are aware of that emotion subsiding.
  • Make yourself a cup of tea (even better get someone else to make it for you) tea has magical properties!

 

Don’t….

…..Think that you can manage on your own all the time, it’s ok to ask for help and if you do ask you will probably get it!

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Gentle birth and Sarah Buckley

Last week I had the absolute privilege of attending a workshop with Dr Sarah Buckley.As luck would have it Annie a colleague had forwarded an email about it a few months back, and I booked it within minutes.Someone like Sarah is rare gem and a shining light in the gloom of medicalised birth, so I was sure that once word spread it would be booked up.

I give out Sarah’s article on ecstatic birth after all of my classes as I view it as essential reading for mothers to be. Her articles also pop up rather frequently on the Mindful Mamma facebook page! Our Mindful Mamma classes focus on the mind body connection, the need for mums to understand why they have to dampen down their neo-cortex during birth, and how to do it.Sarah’s work is crucial to this and this workshop a great opportunity to sharpen our message to mothers.

Sarah’s take home message was that a woman during birth needs to feel

  • Private
  • Safe
  • Unobserved

A simple message, but one that gets lost in the morass of information that women are subjected to during their prenatal period.This message was the golden thread that bound her three sections together, ‘the safety and logic of normal birth’ ‘the impact to interventions’ and ‘the hour after birth and postnatal period’.

Her comparisons with animals, and her references to our mammalian instincts and old brain reminded me of the book that I sometimes share in classes by Desmond Morris, some may not be aware that he wrote a book called ‘Babywatching’, many years ago after observing human and animal behaviours during birth and early parenthood. Fortunately this accessible book has been republished.

His view was there are two p’s that are important for birth, not pain and pushing but position and place! He talks of horses, 90% of which give birth in the dead of night, when they know that they are unobserved.It was the place aspect, which came across so strongly in Sarah’s presentation, not just the physical space, what’s in it, how it looks, is it light, dark, but also a sense of the sanctity of that space.

Sarah spent a lot of time discussing the role of hormones – this is something we also spend time teaching, specifically in relation to our unconscious responses to the environment.These unconscious responses are triggered by instinctual reactions to our environment and our very basic survival functions that rest within our old brain.

When birthing we are actually more alert because we are more vulnerable, and so it is crucial that the sounds, voices, lights are kept to a minimum, so mum feels totally private, safe and unobserved.

The section on intervention, made me feel overwhelmed with sadness.The evidence to support normal birth and the benefits of uninterrupted birth to our children as well as to humanity is so compelling that, when weighed up with the incredible risks of some pharmaceutical and physiological interventions, I for one find it hard to believe that we are still having to shout so loudly about normal birth and its link to the psychological and physical wellbeing of mother and baby.

Sarah twice put up this quote by the Dutch obstetrician G. Loosterman and invited reflection on the last words, “do no harm” which of course are fundamental to any doctors commitment to care.

“Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine–nil nocere [do no harm].”

Her final section on post-birth was longer than I expected but which gave her the time to emphasis how important this period is. She spent a lot of time focusing on the cord and why it is so important to leave the cord until it has stopped pulsating. In fact Sarah had what’s known as a Lotus Birth with her children where you leave the cord attached to the placenta, even after the placenta has birthed, until it drops off naturally. I would urge anyone who is thinking of their options after birth to read the chapter in her book ‘Gentle Birth, Gentle Mothering’ or her article on lotus birth. It makes complete sense, and dispels any concerns about the purported ‘risks’, that mothers sometimes ask me about, such as it increases jaundice.

I cannot even begin to go into the detail or do Sarah’s observations justice in this blog, but I would urge anyone expecting a baby to read her book, it is an important book, a very important book as she is a thoughtful and enquiring physician whose aim is to do no harm.We are at a tipping point with birth and Sarah describes birth how it’s meant to be.Babies should be born into this world with love not violence.Our attachment to each other, to our baby, the absolute joy of birth is important, it’s natures design.This complex exchange of hormones isn’t accidental these hormones actually have, paradoxically, a very simple purpose, which is to anchor the fundamental requirements of life and successful evolution – attachment and love – deeply in our brains.

Many thanks to Patrick Houser at Fathers to Be for organizing this wonderful event and to Janet Balaskas and her team at The Active Birth Centre for hosting it.Especially thanks to Sarah for coming over to the UK and her incredibly patient daughter Maia (who sat quietly and played the whole afternoon!) to share her work with us all.