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Birth is Painful for a Reason

Text by Laura Avellaneda-Cruz
Photos by Ash Adams


This is the conclusion I came to after giving birth for the first time in January of 2014 at Geneva Woods Birth Center, and have been thinking often about as I prepare for the birth of my second child there this July:

Birth is painful for a reason, and for that same reason is a process that takes some time. When we embrace this, we can go into a deep and peaceful place inside ourselves, a place that shows us what we are capable of, and that shapes us as people and as parents.

Of course, there is a wide range of how much time birth takes and how much pain the woman/birthing person experiences, but in all cases, birth is a process, an inherently challenging and revelatory and opening process.

I am not someone for whom mindfulness and a peaceful, non-worrying presence comes naturally. Nor has patience always been my strongest, most natural attribute. I am someone who moves through the world to make the world better. I am fiery. I am critical. I am eager and energetic to make change. And, like many other flawed human beings, I do not do this work with the perfect balance of compassionate curiosity, self-reflection and humility. My traits usually serve me well in my work to prevent violence, child trauma, and injustice and to improve systems and create cultural change. However, they also carry with them sometimes painful self-reflection and self-critique, excessive worry, and anxiety. Those things are not particularly helpful in labor – both because they can cause unnecessary suffering, and because they can interfere with the oxytocin and prolactin needed to open the cervix, pelvis, and vagina.

Two and a half years ago as I prepared for my first birth, aware that I have some traits and mental patterns that could get in the way during labor, I invested wholeheartedly into childbirth classes, books, and pain coping meditation practices, and I was gifted a “blessingway” ceremony. I did this because I knew I wanted a natural birth to avoid the effects of pain relief drugs on babies and on maternal oxytocin production for early bonding, and because of the increased risk of a C-section that accompanies epidurals. I also knew I wanted a natural birth because I didn’t see how I could improve on what our ancestors have done since time immemorial, and because my mom, Barbara Norton, is a Certified Nurse Midwife (CNM) from whom I have heard my whole life about the beauty and transformative power of birth. Plus, as a bonus, non-medicated and particularly out-of-hospital births are a lot less expensive. What I did not know then is how grateful I would be for the kind of challenge that the pain and length of birth presented to me, the way it forced me into a deeper place inside of myself than I knew existed, and the way that it brought me and my husband, Oscar, together and formed us as parents.

I should note, as a caveat, that I did not have what many would consider a particularly long or difficult birth: about 3 hours of early labor and 5.5 hours of active labor, including 70 minutes of pushing. However, ~8.5 hours of labor and 70 minutes of pushing out my big-headed baby (her head really is big; it was then and still is in the 80-somethingth percentile) was painful and challenging, to say the least. And I am grateful for this.

In order to cope with the pain—which I felt in my uterus, hips, and low back, and which was exacerbated by a pre-existing back condition I have called spondololysis—and in order to encourage my cervix to open, I had to go inside myself, deep inside myself. I had to turn off my reactionary self, silence the parts of my brain that worry and experience fear, turn off my evaluator self and critical self and activist self, and just ride along with full faith and trust that my body and baby would do what they needed to do, and my midwives at Geneva Woods Birth Center would do what they needed to do. As it turned out, each of us did do precisely what we needed to do.

In early labor, I used a Kundalini breath technique I had learned in prenatal yoga. Then I vomited some, but returned to my breath. As I moved into active labor, I used non-focused awareness, a technique I had learned from the book Birthing From Within and Jen Allison’s class, and later, I used visualization. I also breathed at a natural pace and exhaled with low moaning sounds. Meanwhile, Oscar soothed my body with the shower nozzle and hot water. As I danced my way into transition (the hardest part of labor, when the cervix moves towards complete dilation), I listened to the joyful Brazilian and Malian and Puerto Rican music on the playlist I had made, moaned, and held Oscar’s elbows and arms as he smiled at me calmly. As I pushed, I concentrated on baby’s head moving and my vagina opening, and I relaxed deeply between contractions and pushes as though I were lounging in a hot spring. As baby’s head burned my perineum, I focused on the elation of touching her head while it moved out (per my midwife mama’s advice) and knowing she would soon be in my arms. And then she was! I had gone into a deep, peaceful place inside myself so that I could minimize and get through the pain, and my body responded by opening up and moving my daughter down.

In the months following, as my baby Ida Luna cried her newborn cries and Oscar and I had to navigate the unknown terrain of new parenthood, it became clear how this experience of having to go inside myself to cope and to find peace for labor had prepared me for parenthood. Having done it already while enduring the most intense pain I had ever felt, I knew I could return to peace and self-soothing while experiencing anxiety about my baby’s cries. This is not to say that I always did find peace in those trying moments, but I did have my own example to follow. I soon learned that singing to baby Ida was the most effective way I could calm both her and myself. As she got older and more emotionally and intellectually complex, Oscar taught her to ask for hugs when she would begin to have a tantrum, and this turned out to be the most effective way both for Ida and for us to calm down. We have multiple options now that we can offer her when she gets upset, but they all require us, as her parents, to calm ourselves.

Our ability to prevent Ida Luna from escalating and our ability to self-regulate (calm ourselves down) and help her self-regulate comes both from knowledge of child development and parenting and from our confidence and practice in self-regulation and attuned, compassionate responses. Speaking for myself, it is not always easy and I do not always do it. I have never yelled at or threatened or hurt my daughter, but I have reacted to her behaviors and cries with anxiety, confusion, and impatience, and I have snapped at Oscar in moments of anxiety over her. Unlike the one-day-only, high-stakes process of labor, when I was fully prepared and committed to self-soothing and focus and had the support to do so, parenting is a constant process—sometimes a slog—, and I am not always well enough prepared (or well-rested, well-fed, or well-supported enough) to check in and self-regulate. However, again, I do have my own example to follow, and I know that I can do it, and this does help me more often than not.

As I write this, I realize this discussion of self-regulation all sounds so scientific. I work in the field of child trauma and resilience, so I think in terms like caregiver self-regulation and infant brain development, and see how my natural labor prepared me well for this most important of roles. But zooming out, I also think it’s bigger than this, more philosophical, more spiritual. I believe that the time that labor and delivery takes is an important process, a ceremony even, to move us from the long process of pregnancy into the much longer process of parenting. It is a liminal space between life stages, a ceremony of transition from one to the other. I also believe that coping with the intensity of natural labor teaches us (and teaches our partners or others who are there to support us) that pain and hardship need not lead to suffering; that freedom from suffering and a sense of wholeness is available to us even in the most difficult of moments.

Having experienced this lesson during the birth of my daughter, I believe this equipped me for parenting her—equipped me for hard nights of viruses, hard days of balancing work and meals and bedtimes, and hard life lessons for a child, like how to share with others. I look forward to returning to that deep place inside myself as I give birth to my son this summer. I look forward to the challenge of birth that is forcing me again to practice cultivating peace, and that will make me turn inward in labor and address my pain without suffering. I look forward to applying this lesson as we navigate the new world of parenting two children at once and cultivating healthy sibling relationships. Parenting, which is a mix of the glorious and beautiful with the mundane and the difficult, will certainly require this of me, of us.

I am so grateful to have had a mama-midwife and another midwife, a birth assistant, a partner, childbirth class instructors, and a social support network who believed this about me for my first birth. I am so grateful to have people who believe it about me now as I prepare for this birth. I am so grateful to have friends share with me their strong birth stories and the faith and confidence and healing that was born in them as their children were born. I am so grateful that our bodies work the way they do, and that this process is perfectly built to prepare us for parenting. I am grateful that birth takes a while, and grateful that it is hard.

Laura Avellaneda-Cruz is a licensed master social worker (LMSW) who leads statewide, multi-sector work on preventing child trauma and supporting healthy and resilient families. She is also the daughter of Geneva Woods Birth Center owner, Barbara Norton, CNM.





Update, 5/18/16: While it looks like it may rain on Friday, this event is STILL ON! We will have a large tent under which we can all gather, and hot chocolate has been added to the drinks menu! Our motto is "Don't change your plans; change your clothes!" Despite the weather, we would love to see you all and your little ones, and show you the beautiful new clinic, as well as the birth center space for those whom we haven't seen since before the move in June, 2014!

We would love to see you and your little ones here to help us decorate the outdoors space of our new location (moved from Rhone Cir, and opened in June 2014). You can decorate (or have your child decorate) a rock in honor of their birth (even if they weren't born here - you're all still part of the GWBC family!)"

Please RSVP by EMAILING US!



“On Infant Sleep Practices”

~ By Dana Deane, CNM, ANP, 1/28/2015


Becoming a new parent involves many decisions that you likely never considered as a non-parent.  Like life in general, many decisions happen as you “go with the flow” of parenting, and only in retrospect do you realize that small decisions early on can shape daily habits for you and your family.  I have written this blog post with the main purpose of presenting safe sleeping practices for your infant.  As a secondary motive, I would like to present different continuums and practices within sleeping.  Hopefully this will serve as an example of the breadth of parenting practices as you seek to define your own style.

In my years of working as an RN in the field of maternity nursing, conversations and home visits with women have revealed a variety of opinions and practices about sleeping in the first few months after the baby is born.  If I was to define a continuum of infant sleeping there is, on one end, co-sleeping in the same bed next to the mother, and on the other end, there is independent sleeping in a different room.  And of course, there is everything in between: a crib in the same room as the parent, or a crib that is adjacent to the mother’s bed.  

Do remember that in the first few weeks following the baby’s birth, the baby will be nursing every 2-3 hours. In addition, the mother will be recovering from the birthing process and will likely be nursing lying down.  Over the next several weeks (usually 4-6 weeks), and especially after the baby has gained sufficient weight, the baby may sleep longer stretches at night (4-5 hours).  Knowing this normal progression, and listening to your own baby’s cues, can help you to know the best place for your baby to sleep.

Questions come to the forefront such as: Are my partner and I sleeping well?  Are we disturbed at night by the baby’s noises, or is the baby disturbed by our noises? Are we comfortable with where the baby is sleeping?  Do we think it is the safest place for the baby to sleep?  At what point would we like sleeping arrangements to change?

Many families follow the style of “attachment” parenting, a term coined by Dr. William Sears.  The theory supports the idea that women are more in tune with their babies’ needs if the baby is in close contact.  They are able to breastfeed at any time and the baby is soothed by contact with the mother. At the most extreme, the baby will always sleep in the bed with the mother, sometimes until she or he is a toddler.

Pros:

  • Some women report sleeping more, when they do not have to get out of bed to breastfeed their baby.

  • Studies have shown that babies who sleep next to their mothers demonstrate smooth heartbeat and breathing patterns.

Cons:
  • Baby is at higher risk for falling off the bed, coming into contact with large blankets or pillows, or being suffocated by another adult or child family member.

  • The longer the baby stays in the family bed, the more difficult it is to transition out of the family bed- just think about the difficulty of “transitioning” a 2 week old vs. 2 year old to sleep in a new place.

On the other side of the spectrum are parents who support independence parenting.  A family who chooses this view may have the baby sleeping in a crib in another room as soon as the first few weeks after birth.  Parents that support this view believe that at a young age, babies grow accustomed to a quiet and dark sleep environment and become independently able to fall asleep and return to sleep if startled in the night.

Pros:
  • Baby is never at risk for falling off the bed or coming into contact with other pillows, or family members.
  • Baby will never need to transition into his or her own environment at a later age.
  • Some mothers report sleeping more, knowing that they do not have to worry about the baby in their bed.

Cons:
  • A parent (likely the mother) needs to get up in the night to take the baby out of the crib to nurse.

  • Some parents report feeling more stressed that they cannot see or hear the baby, and that the baby may not feel as close to the family.

  • So in the end, you- the parent, must make decisions for your family.  No matter where you decide your baby should sleep, remember to follow our safe sleeping practices:


Safe Sleeping Practices:

Any sleep surface that baby uses (including cribs, nap surfaces, or adult beds) should be made safe for baby:

  • Baby should be placed on his or her back to sleep.

  • The sleep surface should be firm. Do not put a baby on a waterbed mattress, pillow, beanbag, sheepskin or any other soft surface to sleep.

  • Bedding should be tight fitting to the mattress.

  • The mattress should be tight fitting to the headboard and footboard (or sides of the crib).

  • There should not be any loose pillows, stuffed animals, or soft blankets near the baby’s face.

  • There should not be any space between the bed and adjoining wall where the baby could roll and become trapped.

  • Babies (with or without an adult) should never sleep on a sofa, couch, futon, recliner, or other surface where baby can slip into a crevice or become wedged against the back of the chair/sofa/etc.

  • Do not swaddle your baby when bed-sharing. Baby may overheat (which is a risk factor for SIDS) and a swaddled baby is not able to effectively move covers from the face or use arms and legs to alert an adult who is too close.

  • Other potential hazards: very long hair should be tied up so that it does not become wrapped around baby’s neck; a parent who is an exceptionally deep sleeper or an extremely obese parent who has a problem feeling exactly how close baby is should consider having baby sleep nearby, but on a separate sleep surface.





  • “Birth of a Midwife”

    ~ By Barbara Norton, 9/7/15

    The first time I saw a “midwifery model” birth was in 1986 at Woodland Hospital in California. It was with a male obstetrician. I was a Nurse Practitioner working as a part-time Labor and Delivery Nurse because I missed birth. My previous L&D experience was in a large hospital and I’d simply never seen anything like this. The doctor took off the fetal monitor, saying “all babies have dips in their heart rate when being pushed out”. He then had the mother put her hands on the baby’s head and she guided the baby out. I started sobbing. I had been trained to believe that every mom needed fetal monitoring and an episiotomy and they were not to touch “down there” (the sterile field). I was an instant convert. I spent the next two years working with the midwives who caught 70% of the babies in that hospital, and decided that I needed to go back to school to be a midwife.

    I was trained by midwives who believed in the philosophy of care exemplified by the saying from the Tao Te Ching:
    “You are a midwife assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must take the lead, lead so the mother is helped, yet still free and in charge. When the baby is born, the mother will rightly say, ‘We did it ourselves.’”

    After 20+ years of practicing as a midwife I am no less in awe of the enormous responsibility I have to inform and guide women through the pregnancy and birth process. I’ve learned that, even though women want to be at the center of their birth experience, and in charge, they still look to their midwife for guidance. They trust us to tell them the truth. Sometimes they are uncomfortable truths…like the baby has birth defects, or the baby is breech, or despite pushing for 4 hours, the baby isn’t going to fit this way. They trust us to tell them when they have become too high risk to have a birth center birth, or need to have a doctor care for them because it’s safer. It’s our job to stand back when things are normal, but safely guide them away from their dream birth when things deviate far from normal.

    I spent nearly two decades building up a practice that eventually grew too big with seven midwives and too many clients to provide the model of midwifery that I was taught. The midwifery model is based on trust. The midwife trusts the woman, and the woman trusts her body, and the midwife, and everyone trusts the normal process. It’s hard to cultivate the trust needed in labor when you hardly know one another.

    Having left that busy practice I’m now looking forward to getting back to my roots. I’m excited to get to know women well again and develop that trusting relationship that is so essential for the safe practice of the midwifery model of care. I feel like I’ve regained the passion that I had in my early years as a midwife, the passion that had begun to slip over the last few years. Rhonda and I are excited to be launching this new endeavor… A chance for two Nurse Midwives to have a small intimate practice where we get back to the basics of caring, respect and trust.




    Adverse Childhood Experiences Study (ACES)

    Do you think that traumatic events in childhood could affect a person’s health? From my own experience working as a health care provider for over 30 years, I have always suspected that it does. There is now an enormous body of evidence from studies that have taken place over the last 20 years to prove that there is a strong connection between traumatic childhood experiences and a person’s risk for disease as an adult.

    In 1995 Kaiser Hospital with the Centers of Disease Control (CDC) started collecting data on 17,400 adult patients about their adverse experiences as children. They were looking to see if those who were raised with abuse (physical, sexual or emotional), neglect (physical and emotional), or household dysfunction (household member incarcerated, suffering from mental illness, engaged in domestic violence or substance abuse), were more likely to have disease as adults. They found a strong connection between all of these adverse childhood experiences (ACES) and virtually every kind of disease from which Americans suffer in large numbers, including obesity.

    In the past, studies looked at substance abuse or certain forms of child abuse independently to see the effect on children, and the studies often concentrated on behavioral health or social outcomes only. This was the first study that looked at a broad selection of adverse childhood experiences to see if children exposed to multiple risk factors (you add up the adverse experiences and get an ACES score) have more depression, substance abuse, risk behaviors and physical disease as adults.

    What they found is that the higher the score, the greater the likelihood that the person has health problems as an adult. There is a strong correlation with a high ACES score and heart disease, liver disease, lung cancer, premature death, substance abuse, depression and suicide attempts. This makes sense to most people.

    I’m writing about this for two reasons. The first reason is to emphasize the importance of parents, and all adults, making healthy choices, and creating the safest, most supportive environment for young people. We know now that our choices will have a profound effect on children well into adulthood. If we find ourselves or someone we know struggling to provide an environment that is safe and free from substance abuse for a child, it is important that we ask for or offer help. If children and their families get the help they need, these negative outcomes don’t have to be life-long.

    The second reason is to let you know that most people in this study had at least one adverse experience as a child, and many had four or more. You are not alone if you experienced abuse or neglect, witnessed domestic violence, grew up with other kinds of household dysfunction, or all of these things. You may have been scarred as a child, but as an adult, you can seek the help you need to break the cycle for your children. Awareness is the first step.

    Many people who experienced ACES find that learning this information allows them to see their life differently. Rather than ask, “what’s wrong with me?” this information allows them to ask, “how did the things that happened to me affect me”? And what can I do about this now, for myself and for my children and grandchildren?

    Read more about ACES and also what we can do to prevent and heal from ACES.
    Read more about the original ACES study and get your own ACES score there as well.

    ~ By Barbara Norton




    Group B Strep: Get the Facts
To test or not to test… To treat [if positive] or not to treat… These are questions that more and more women are asking. Women are rightly concerned about exposing their babies (and of course, themselves) to antibiotics in utero. There are studies linking early (in the first year) antibiotic use and asthma in children. We also know that thrush and vaginal yeast are more common when antibiotics are used.


So what are the real risks that your baby will get early onset Group B Strep (GBS) disease? About 20% of all women have GBS in their vaginas intermittently or all the time. When infants are exposed to the bacteria, about 50 % of those babies are colonized (bacteria on their skin and they can get it in their lungs), and of these, only 1-2 percent will actually become infected. Symptoms appear within 48 hours for 95% of the babies that will get sick. If a term infant becomes infected, the death rate is between 5-9%... So it’s a pretty infrequent problem, but one that can have devastating results.

In the United States, the CDC recommendation that most providers follow is to culture all women at 35-37 weeks, and treat with IV antibiotics in active labor if they are positive. There are drawbacks to this formula in that we know some strains of GBS are becoming resistant to certain antibiotics, and up to 10% of women experience an adverse reaction, such as rash or anaphylaxis when given antibiotics.

The assumption is that if you culture positive at 37 weeks, you will still be positive when you’re in labor, but this is actually not true for over 15% of women. For women who test negative at 37 weeks, close to 10% actually had it during labor. There is unfortunately no rapid test on the market to determine GBS during early labor.


What can you do?
There are studies looking at probiotics to keep your vaginal flora healthy and they are very safe in pregnancy. We recommend taking them daily. There is some research on chlorhexidine douches (“Hibiclens”) which suggest that this chemical can lower the colony count of the bacteria, but there haven’t been enough large-scale studies to show that this actually decreases the incidence of infection in newborns. We don’t recommend using this method for two reasons. First, the evidence does not show that douching decreases the incidence of GBS disease. Secondly, douching in general can be harmful because douching takes bacteria that are meant to be drained out and flushes them up towards the uterus where they don’t belong.

In Canada the midwives offer women the option to culture, but then treat only if risk factors arise (water broken more than 12-18 hours, maternal fever, or spontaneous labor at less than 37 weeks). This results in significantly fewer women being treated, but with a nearly identical rate of infected infants. In Great Britain, they don’t routinely culture pregnant women at all. Until we develop a test that tells us if someone is a carrier on the day of labor, culturing and treating with risk factors might be a strategy to consider.

The midwives of Geneva Woods Birth Center are open to working with you to adopt the approach that works best for you and your baby.

~ By Barbara Norton

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