The Processes of Birth and Death -- a Comparison

In the year 2000, my mother was diagnosed with terminal lymphoma.  She was a strong believer.  After listening to the pros and cons of medical intervention -- which might extend her life by six months -- and of hospice care, she chose hospice.  This was my first experience with what hospice was about.

One thing they did was to give us a packet of information.  In that packet was an article on what happens as a person begins to die, until the moment of death.  This process can take several weeks, especially with death is due to dying.  By that, I mean that a seemingly healthy, but old, person, just starts to feel bad, slows down, looses his or her appetite, becomes weaker, goes to bed, and eventually dies.  The dying process is also seen in people with terminal illness, including Alzheimer's dementia.
I was so impressed with what I read, and then what I experienced with hospice care for my mother that I developed a presentation entitled "How to Support a Terminally Ill Christian Loved One" which I have used in women's ministry.

While I was reading the paper supplied by hospice for the first time, I was struck by similarities between labor and birth, and the "labor of dying" and death.  I could immediately see God's design in both.   I also could see that many of the interventions the health care system routinely implemented in both cases actually made each process more painful and more difficult.  Some interventions, thankfully, have been abandoned on a routine basis, but others have not.

Let's look at some of the parallels.

Food and Drink

During labor, women giving birth in most hospitals are not allowed to eat.  Some are allowed clear liquids, but are often discouraged from actually taking them ("You'll regret it later when you get sick and throw  up because you have this on your stomach!")   Instead, IV fluids are ordered.   These practices, on a routine basis, are not supported by the research.  Withholding food, and often, drink, is based on an outdated approach to the management of labor.  At one time, most women giving birth in the hospital were given medications which caused sedation and also decreased emotional control.  The benefit of these was that when the women woke up after their baby was born, they said "I slept through the whole thing!".  The truth was that many of these women cried out in pain and distress during labor.  Some had to be physically restrained in their beds.  If a Cesarean was needed, it was performed under general anesthesia.  In a few cases, the mother vomited during surgery (or during vaginal birth if "gas" was used).  In some of these mothers, stomach contents went into the lungs.  This is known as "aspiration".  In some of these cases, the mother developed aspiration pneumonia.  In some of these cases, the mother died.

In modern day obstetrics, most C-sections are done with epidural or with spinal anesthesia.  The mother is awake and thus the risk of aspiration approaches zero.  Only in rare circumstances is general anesthesia required.  In some of those, the C-section is planned, without the mother going into labor.  The typical "NPO after midnight" (no oral intake after midnight), can be implemented.  Still, in most of these scheduled C-sections, the mother remains awake for the surgery, and aspiration is of little concern.  

Statistically, a pregnant women if more likely to die in a car accident or from being struck by lightening than from aspiration syndrome.

In our lawsuit happy society, anesthesiologists still prefer to force women to fast during labor, no matter how long the labor, and no matter how uncomfortable and hungry it makes the mother.  Any honest anesthesiologist will tell you that fasting does NOT prevent aspiration in 100% of cases.  Any good anesthesiologist will tell you that they can manage anesthesia quite successfully in the patient who left a restaurant after a full meal and was involved in a car accident which resulted in injuries requiring immediate surgery.  However, by forced fasting, she experiences additional risks from the results of fasting, and from interventions used to address those problems which can arise.

Yet, for some reason, most women, except those giving birth at home, most birth centers, and a few hospitals, are required to fast during one of the most physiologically complicated and physically intense events of their lives.

IV fluids have no research to support their  routine use during labor.   First, it communicates to the woman that she is not a healthy woman giving birth, but a "patient" who is undergoing a medical procedure, which, hopefully, will go well.  Secondly, fluids over hydrate the mother and the baby.  This can lead to the unnecessary use of formula when a baby "looses to much weight", when in reality, the birth weight was skewed from the IV fluids received by the mother and passed to the baby.  Mothers can have trouble with breastfeeding because of breast and nipple edema which makes it difficult for the baby to latch correctly.  Also, if hormones which control labor are flowing through the mother's body, dilution of the blood stream by added fluid might cause labor to slow and contractions to be less effective.  Obviously, if a mom is dehydrated, or wants pain medications, or is considered high risk due to current complications, an IV is appropriate.


Fasting in labor not only makes most women uncomfortable, it can lead to problems with the birth process.  The contractions themselves may be more painful as the muscle known as the uterus is not getting the nutrition it needs to do its work properly.  Labor may last longer due to nutrient restriction.  Complications can accompany the use of Pitocin which is often administered to strengthen weak contractions.  Some women end up with a Cesarean.  And, in a few cases, some women die from complications of the surgery . . . including massive hemorrhage, infection, pulmonary embolus, and, once in a while, aspiration.

Women may have a decreased appetite during labor, but if labor is long, most women want to take in some nourishment. (My own mother told me that she wanted a steak just before it was time to push.  Since she gave birth at home, someone cooked one for her and she ate it!).   The energy supports the normal process.  There are fewer complications which require interventions which, too, carry risks.

A person who is dying will typically begin to loose his or her appetite.  This becomes more pronounced as the process continues.  At some point, they do not want to eat, or even drink.  Forcing foods and fluids can cause great G.I. discomfort in a digestive system which is shutting down.  This can make the dying process more painful and often longer than it would have been.  In such a terminal state, nutrition and fluid is not saving the person's life, but prolonging death in a way which is more uncomfortable for the patient.

I recently heard a relative state that another relative did not die from advanced Alzheimers, or heart failure, but from starvation after having received hospice care.  If food and drink was withheld from the patient, causing pain and distress, that would be starvation, but that is not the practice of hospice.  If the patient refused food and drink during those last days or weeks, then signs of starvation would likely show up on the autopsy, as it would if nutrition was intentionally withheld.  The difference is in WHY and HOW the starvation occurred.  When no appetite is present, then lack of nutrition does not cause the same discomfort that withholding food when appetite is present can cause.

A woman in labor will eat and drink as she desires.  This makes her labor more comfortable.  A dying person will eat and drink as he or she desires.  This make the dying process more comfortable.

Activity

Women in labor typically find that moving around and changing positions to those which bring comfort help them cope with pain.  These also help facilitate labor.  When movement is restricted, women experience more pain and longer labor.

Again, some of the reasons for restricting the mother's movement is not based on the research evidence.  For decades, women giving birth in the hospital were forced to remain in bed so they could be continuously hooked up to the electronic fetal heart monitor -- which, in  itself, was an unproven, experimental intervention.   Epidurals became common because most women could not tolerate the added discomfort bed restriction caused.  With both limited mobility and the use of epidurals (not to mention limited understanding of what those monitor tracings meant), it is no wonder the C-section rate skyrocketed from around 5% to close to 40%, and even higher in some hospitals.  More recently, it has been around 33% on average, but varies according to place of birth and whether the birth is high risk or not.  Thankfully, a better understanding of why those C-section rates escalated has occurred and new guidelines regarding monitoring the baby's heart rate, allowing the mother more time to reach active labor, and others, should result in a reduction of C-sections.

The person who has begun the dying process slows down physically.  While there is merit in suggesting (like food and drink) some light activity, it is better to let the dying person take the lead.  Of course, a bed ridden person benefits from being turned every two hours to minimize pressure sores, but at some point, near the end of life, this can become very uncomfortable to many patients. 

A few years ago, my neighbor, a wonderful Southern gentleman in his early 90's, was dying from COPD.  He had just arrived home from yet another hospitalization because he chose to die at home. He was in the bedroom with his nurses aid, and his two daughters were waiting to come in.  As he sat in his favorite recliner, he told the aid that he just could not move right then.  She responded "You don't want your daughters to see you without your pajama top on, do you?".  As a gentleman, he forced himself to put on the pajama top, gasping for breath even though on oxygen, and collapsed back into the recliner -- and died.  Poor man! 

When my own mother was in a hospice facility, very close to death, I had noticed that it had been about 8 hours since she was turned.  I asked the nurses about this.  They said that they had been discussing turning her, but believed that, if they did so, it would lead to her immediate death.  They were right.  When they did finally turn her, she took her last breaths and died.  Thankfully, in this case, my mother was deep into the death coma, and did not suffer, like my neighbor did.

When a person is dying, especially when he or she is quite close to death, the desire for movement or no movement should be respected.  Is it really worth forcing movement which causes pain just because "this is what we are supposed to do (in healthier patients)" or because of social propriety?

Women in labor should be allowed to move and to assume the positions most comfortable for them.  People who are near the end of the dying process should be assessed to determine how much movement they can tolerate, and the indicators of how well they tolerate the movement and positioning (grimacing, crying out in pain, etc.) should be considered.

Focus, Zones and Euphoria

God's design for natural birth includes "pain medication" in the form of endorphins.  The hormone oxytocin facilitates normal contractions and also an increasing trance-like state in late first stage labor.  Both of these help the mother rest between contractions and helps her to better cope with the contractions.  As labor advances, the mother "withdraws" from everyday life to becomes birth focused.  All attention is on dealing with each contraction, and, near the end of the first stage, just before complete dilation, on resting between them.

Likewise, as the dying person nears the end of life, they leave everyday life and are engulfed in the "valley of the shadow of death".  

For the woman in labor, giving Pitocin, a synthetic form of oxytocin, disrupts the path toward the "natural pain relief" provided by her body.  While Pitocin causes contractions, they are often harder and have a different form from natural contractions.  We have already discussed the effects of forced fasting.

The epidural, too, interferes with the natural flow of these hormones.  Thankfully, most women in this country have access to epidurals if they want one.  My personal position is that all women have the right to make an informed decision on every intervention or restriction ordered or suggested in labor and birth.  Like all options available, the epidural has benefits and risks.  Women who have an epidural will miss out on the special mental and emotional status provided by endorphins and oxytocin.  They will miss out on an intense "high" experienced by most women who have had a totally natural childbirth.  As one of my clients loudly exclaimed after giving birth without pain medications last year, and holding her newborn daughter skin to skin at hear breast, "I am SO HAPPY!".  That was the hormones talking.

Forcing the basic things which sustain life can interfere with the floating, trance like, "far away" state the dying person enters into.   Giving oxygen, when the dying person is not experiencing air hunger, interferes with the euphoria which can occur when carbon dioxide builds up in the body.  Again, forcing fluids and food can disrupt the "fading away" and the "floating" and the more euphoric state which God has integrated into His design for the dying process.  Oxygen is a comfort measure to the person who is exhibiting signs of air hunger, but not for those who do not.

The process of labor itself, correctly understood and supported, provides for some natural pain relief and for positive emotional and mental states. The process of dying, correctly understood and supported, also provides for some natural pain relief and positive emotional and mental states.  In both cases, additional pain relief is, and should be, available for use as needed.

There are other parallels, but these are the most important, in my opinion.  Whether a woman is giving birth, or someone we know is dying, even though we live in a fallen, imperfect world which prevents both the natural process of birth and of death from being universally experienced, the basic principles are still in place.  If we trust these designs as a gift from a God who loves His creatures, even those in rebellion to Him,  we can experience His blessing whether giving birth, or leaving this world.

For more information on the evidence for the labor and birth procedures noted above, go to www.EvidenceBasedBirth.com.

"Mommy Wars" Commercial by Similac™

Well, since Similac™ (or other formula companies) can't attack breastfeeding and breast milk on their merits, it is trying another approach.  With this approach, the artificial baby milk manufacturer does not have to state that it's products have forty-ish components, and that human milk has a minimum of two hundred.  Similac™ does not have to state that formula feeding is associated with juvenile onset diabetes, asthma, and reduced cognitive abilities as compared to breast milk fed babies, among several other deficiencies.  They do not have to disclose that formula feeding increases the mothers' risks of a variety of cancers, heart disease, diabetes, and more.  They do not even have to disclose that most, if not all of their formulas contain GMOs.

What they have done is divert education regarding nutritional and developmental facts so women can make an informed feeding choice to something strictly emotional.   The first, and most memorable barb in the commercial is "Oh look!  The breastfeeding police have arrived."  They go on to parody other mommy "groups", except for perhaps those moms who choose to smoke legal or illegal marijuana or indulge in street drugs or excessive alcohol.  Formula feeders in this formula company sponsored commercial somehow escape being categorized negatively or ridiculously.  I doubt this is due to an oversight.  For decades, formula companies have proven to be expert at providing misleading -- even totally inaccurate -- information in their ads and printed "educational" literature.  From photographs of disinterested looking breastfeeding mothers to statements like "Let's be honest.  Breastfeeding is hard (hurts, etc.)", formula companies are world class manipulators of the emotions of expectant and new mothers. 

The theme of this commercial would be like a maker of a less healthful snack, say, a crunchy fried cheese flavored crisp taking on the sellers of healthful, organic, nutrient rich foods.  The point would be "proving" it is not about the snack one chooses to feed one's children, but that every option is equal, that it simply "fits" the parent's lifestyle and values, and in the end, we all want to save the baby in the runaway stroller. All this other stuff doesn't really matter -- especially the choice of what to feed the child.

I have made my position on infant feeding clear in previous posts. As a mother, grandmother, RN, certified lactation consultant, and childbirth educator, I have come to believe that every woman deserves objective information on the benefits and risks to her baby and to herself regarding infant feeding choices.  From there, she owns her decision.  When things don't work out as she desires, a Christian woman can trust God's sovereignty and His plan for her and her baby. For women who wanted to breastfeed, but an illness or circumstance prevented this from occurring, formula is the commonly selected option. (Some mothers elect to secure milk from one or more breastfeeding mothers -- an option with it's own benefits and risks). 

Women know the situation they have gone through and are going through and will likely be facing in their lives.  They will factor these things in when they make their infant feeding decisions.  Some will feel guilty, knowing that they are not providing the proper, optimal nutrition for their babies' growth, development, and immediate and future health.  Some will grieve if their choice does not work out.  Some will feel very satisfied with their choice.  Many will learn things as a result of their choice and may make a different choice the next time -- for either option.

But, if Similac™, and other formula companies -- whose primary aim is to sell product and make big bucks-- continues to focus on the emotional instead of the physical aspects of infant feeding options, they are doing a disservice to mothers and babies.  In their attempt to make ALL breast feeding women look like anti-formula feeding "police", they inaccurately portray MOST breast feeding women. More importantly, they are communicating that they do not respect the mothers' RIGHT to an INFORMED infant feeding decision.

Perhaps, in reality, they are engaging in a de-escalation of "infant milk wars" and not "mommy wars" for THEIR OWN benefit . . . and not for the benefit of the baby in the runaway stroller.

Skin to Skin Care is for Fathers and Babies, Too

On occasion I will hear of a woman or man saying that she or he does not want to hold his or her newborn baby skin to skin until the baby has been "cleaned up".  I also hear sometimes that a dad may laugh and joke at the concept of skin to skin with his newborn.  

I actually feel a little sad because I believe a special opportunity for the baby's health can be missed.


Is it better and more acceptable that a baby be taken from her mother and be held only when she is enveloped in a blanket or "onesie"?  Should a dad only hold his "baby in a blanket"?  Does it matter?

We are used to running water and all manner of sanitation promoting options.  But imagine, even hundreds of years ago, that many babies were born where there was not running water.  Yes, newborns are "gunky", but the are NOT dirty!  

Vernix, the cream cheese looking coating on a newborn has a couple of purposes:  the help make the baby slide through the birth canal easier, to provide a protection to the skin soaking in amniotic fluid for many months, and to provide protection against exposure to a blast of micro-organisms once baby leaves the womb.

The excess fluids and solids of birth can be wiped away while baby is resting on mom's abdomen, immediately after birth.  The World Health organization recommends NOT wiping the newborns hands as they state the scent of amniotic fluid helps them find the breast, which is also emitting a similar scent.

We are now learning more about the original design for protection of babies in their new environment, even before birth.

1.  Amniotic fluid probably contains "healthful" bacteria and also growth factor allow the villi in the intestinal tract to develop properly AND to set up an optimal, healthy microbiome.  This impacts the baby's immune system in both the short and long term.

2.  Babies should be "inoculated" with the flora (germs/bacteria/microbes) from their mothers and fathers -- ideally before being exposed to the flora form hospital equipment, linens, and personnel.

3.  Breastfeeding exclusively (no formula) is necessary to establish the optimal healthy gut microbiome in newborns.  Skin to skin with mom and dad helps to establish and perpetuate the family microbiome, including skin, respiratory, gut, and others.

4.  Skin to skin helps the baby better regulate his heart rate, respiratory rate, blood sugar, and emotional state.  A crying newborn uses a lot of energy and is at risk of disturbing its acid-base balance.  Low blood sugar increases the chance that a baby will be given artificial baby milk to correct that problem -- only to increase the chance of other problems.

Skin to skin with either mom or dad is good health care practice -- not silliness.  A man is no less a man when he holds his newborn close to his heart.  In fact, he is being a good FATHER.  It can even be argues he is being a good husband because by helping his baby maintain better stabilization of the infant's blood sugars and ability to eagerly breastfeed, he is minimizing the potential for his wife to experience trouble with breastfeeding.  Lactation success provides life long benefits for her as well as for the baby.

Some of my favorite moments as a doula when assisting with births if when "daddy" assumes this role of protector and involved father.  Below are two of my favorite photos of this experience.

The dad is this photo is a 6' 4" military man.  He is no sissy for caring for his one hour old baby in the best way possible.

This dad, who holds a doctorate in pharmacy, knows that skin to skin with his newborn when mom is resting will promote optimal health for both mom and baby via the direct contact and the secondary support of exclusive breastfeeding.

So, it is safe to say that REAL MEN, who are educated about the health benefits, HOLD THEIR NEWBORNS SKIN TO SKIN.  It's not only OK, it is advisable.

Forget the "Ewwwww" or even "girly" factors.  "Man up", in this special way and give your newborn the best.  Encourage his mother with skin to skin from birth and with breastfeeding before the baby goes to any one else.   When mom is ready, take the baby from mom and hold her a few moments to inoculate her with your flora before your baby is exposed to that from others.  Help your baby transition to extra uterine life with less stress on his or her body systems and decrease the chance of your baby receiving foreign proteins and other substances via artificial baby milk by incorporating best practices of care.

Change -- The Tenacity of Just One Woman

Tonight I met an amazing woman in my Comfort Measures class.  She is planning to deliver at a hospital different from the one where I teach. She and her husband have given me permission to share her story and I will do the best I can to express why I was touched by her.

She has older children, as well as school age, and is pregnant after giving birth a couple of years ago to a baby who did not make it to his birth day.  This woman had done a lot of research and insisted that her doctors allow her to deliver her baby vaginally . . . after three (3), yes, that's THREE previous C-sections.  Now, I personally an aware of and support what is typically referred to as VBACs (vaginal birth after Cesarean.  I was just surprised that this mom demanded . . . and got . . . her VBAC after three C-sections-- and at this particular hospital.  This woman had done a lot of research, took copies of that research to her care providers, and convinced them to support her efforts to avoid another C-section.

She delivered her baby . . . who was also in a frank breech position . . . vaginally, and without an episiotomy.  This amazingly strong woman -- even with the grief of the expected loss of her baby due to a birth defect incompatible with life (past a short period of time) --worked to have the birth experience she wanted . . . and was very empowered by it.  Not only that, she was likely the catalyst to encourage her physician to support other women who had 2 and 3 previous C-sections to deliver vaginally their healthy babies.  Her doctor has become known as THE physician to go to for VBAC births in this geographical area.

This amazingly strong woman said that the empowerment she felt two years ago to stand her ground in her desire was a gift from her baby.  In my opinion, it could be one of the purpose's of his brief life.  Because no one expected him to live, even if born alive, her health care professionals were more open to the VBAC.  The success of the birth with regard to the mother's health made a real impact on her care providers.  It made an impact on his mother too, as she described the vast difference she felt physically after having C-sections and then having a vaginal birth.  I could see it's effect on her as she told her story. Women remember each birth the rest of their lives, and even "re-feel" the emotions of each experience.  I could hear sadness,  determination, strength, intelligence, and bittersweet joy in her story.  Obviously, I was very moved.

This mother has now planned for the birth of this healthy little one.  She has hired a doula, taken a comfort measures class, takes good care of herself, and continues to do research.  Her husband is a quiet man, yet very supportive, and must be a man of great strength himself.

Yes, I was very impressed by this woman.  Her efforts have educated her care providers.  They have made birth better for others.  I hope . . . no, not hope .  . . I trust she will have a very special birth experience this time.  Her last one was special, too -- even though it was heart breaking.   This one will be "the one" that all women should be blessed to have.  In reality, it will be the one which women were designed to have.  I'm glad, because of her determination and work, she will likely experience natural childbirth -- as it was designed to be -- with it's pain and it's joys, and this time, with a baby she will be able to keep and love in more than in her heart and in her memories.

God bless you, dear lady and husband.  I am honored to have met you both.   Thank you for making birth more positive and safer for others by your desire to understand it and your determination to experience it.  Your little one is in Heaven now, whole and happy, in the presence of the One who made that child and gave him a special purpose . . . one which could, in fact, save the lives of other babies and mothers.  May God give you and your husband much amazing joy and minimal bitter sweetness with this new baby's birth.

The Power of "No".

I recently was involved with putting together a conference entitled "Birth Really Matters:  Optimizing Maternal and Neonatal Outcomes".  We had a couple of physicians, half dozen midwives, several RNs, several doulas, several lactation consultants, and a few childbirth educators attend.  A certified nurse midwife from VCU Centering Pregnancy was a speaker.  She showed a video (link to be displayed at the end of this post) on the rights of childbearing women.

As a childbirth educator, I am often asked "Will they let me . .  .?".  To this I usually respond, "What you want to say it 'My plan is to  . .  .',  or, 'I will be doing . . . '.  Avoid asking if something is OK.  A nurse or physician could be having a bad day, and you can get a "no" when that should not be the case." 

At the conference, a midwife in the audience talked to us about the power of "no".  If a nurse says, "I need to take your baby to weigh and bathe it", you can say "No.  I want to hold my baby and let her breastfeed for a while longer.  I do not plan to for my baby to have a bath today."  If a physician says "You have to have IV fluids", you can say "No.  I will be taking in fluids orally.  I do not want to be connected to IV fluids".

So, what if you have signed all kinds of consent to treat forms?  "No" trumps these.  No matter what you have consented to allow to be done, or to do, at any time you can invoke the power of "No".  At this point, without a court order, no one can force you to do anything.

My advice?  Use your power wisely.  If necessary, ask questions, and use your BRAIN (benefits, risks, alternatives, intuition, and "no" or "not now" if applicable).  Christian women have a great resource:  prayer.  Ask for wisdom in making your decision (James 1:5).

Do not be intimidated.  It is your body.  It is  your birth experience.  To the care provider, it is just another day at the office.  You will remember this experience -- and deal with any effects -- for the rest of your life.  And, most importantly, it is YOUR baby.

http://www.youtube.com/watch?v=K105F9o3HtU

http://childbirthconnection.org/article.asp?ck=10084&ClickedLink=0&area=27

So What Do Doulas Do? Watch This Video!

This will be a short post.  There is a 50 minute video on how doulas support women in labor.  Benefits include less need for pain meds and reduced chance of having a C-section.  

Click on this link to watch the trailer, to rent or to purchase the video.  The trailer is free, and prices are reasonable for either option.

http://muvi.es/w3219/283382

Disclosure:  The organization which put out this video has a system where the person who provides a link will receive a small fee for sharing if the movie is rented or purchased.  I have not idea what that fee is, but it is probably very minimal. My goal is to inform women of the fantastic benefits of having a doula.

Noise Making: Friend of the Woman Giving Birth

One of the Power Point slides in my class shows three names:  Grantly Dick-Read, Fernand Lamaze, and Robert Bradley.  By each name are a few sentences describing the philosophy of their approach to birth.  Somewhere in each of those descriptions are the words "relaxation", "breathing", and "painless".  I explain that these physicians were known for developing a way of approaching childbirth in the previous century, with Dick-Read's work in the 1930's, Lamaze's work in the 1950's and 60's, and Robert Bradley's in the 60s and 70s. I then ask the class to see if they find common themes, or simply anything common among the physicians as they read the blurbs.  

Most of the time, members will identify the three words noted above.  And, in most cases, they notice that the physicians were all men.  "This is why they think birth can be painless if you can only relax enough.  They have NOT given birth", is my response, which typically brings about some laughter.  I also point out that they deserved some kudos for trying to make birth easier for women, and in some ways, they did.

However, these men were probably very uncomfortable with women making noise in labor!  Why?  In the context of the culture from which these physicians came, men did not want to hear women crying.  They typically wanted to "rescue" women in distress. It naturally followed that they would look for a way to keep the women they cared for in childbirth from making noise because crying, moaning, etc. meant the problem of pain and her response to it was not fixed.

The patterned breathing and the relaxation techniques were supposed to help a woman CONTROL her response to pain, but it also lessened or eliminated any noise she might make during contractions.  This is not a natural thing for women to do.  Therefore, "natural childbirth" practiced this way, is not really natural.  Even women who manage to "hee" and "hoo" their way through most of labor often make the hard "aaehhhh" sounds of work when pushing. Finally, women who are feeling their contractions seem to emit an almost primal scream as the baby is exiting her body.

Tears, too, are a natural part of many natural birth experiences.  Years ago, a young woman, around 18 years old came to my childbirth class.  Her mother was her "coach".  They wrote back that during labor, K., young woman, sat on the toilet to use the bathroom.  She found it comfortable and stayed there.  Her mother brought a pillow and placed it on the floor in front of her daughter.  She knelt down, and her daughter leaned against her during contractions.  At one point, K. began crying quietly, releasing tears.  The nurse came in, saw the tears, and said "Oh no!  Don't cry!".  K. told the nurse "I -- i-- it's  al --- right. (Sniff.)  I'm O -- oK" and continued coping the way she was.  K. ended up delivering without any pain meds and was thrilled she reached her personal goal of a natural childbirth. 

A friend something to me.   She told me how she tripped on her friend's deck, and hit her elbow.  She said, "All I could do what hold my elbow, rock back and forth, and moan.".  My response was "Somewhat like a woman in active labor".

I am convinced that women in labor naturally make noise (along with rhythmic movements) as a method of coping with pain -- and SHOULD be allowed, even encouraged, to do so.  I am not talking about screaming with fists clenched and back arched.  I am talking about tension releasing noises like moaning, or staccato sounds like "oh, oh, oh, oh, oh" vocalized in a tension releasing way.  A good cry during advanced labor helps to release tension, also.  Crying is part of the Master's design for tension release.

I also think that many nurses and physicians in today's hospital setting are uncomfortable with noise women make as a way of coping with contractions.  Nurses are trained to ask about and document their patient's level of pain based on the "faces" pain scale where "1" is a happy face and "10" shows an agonized countenance.  Then, they are trained to "fix" the patient's problem by medication until she can give a lower number when asked to rate her pain once again.  Our normal reaction is to want to help the woman "not to suffer", so drugs, or breathing techniques are offered, sometimes with intense pressure to comply. 

In order to really help a woman prepare for her labor, she needs to be encouraged to surrender to it.  Learning to relax or "let go" at will is also important.  She needs to be told it is OK to cry (real tears) and to make tension releasing noise.

It is especially hard for the woman's husband or other support person, unless that person is a doula or someone who understands natural birth, to listen to his loved one "suffering".   But, it really is not suffering when the woman is not crying out for help.  It is coping, and needs to be supported and not discouraged.

This does not mean that you should not learn breathing techniques.  You might find them, particularly Bradley's show abdominal breathing, to be helpful, especially in the earlier phases of labor.  But don't feel like you have to stay with them when your body is "telling"  you to make noise.

If you are planning to have a natural childbirth, you might need to write something in your birth plan along the lines of  "I plan to use vocalization as part of my coping techniques.  Please encourage tension releasing noises instead of returning to more artificial breathing techniques if I am finding vocalization to be helpful."

I have a feeling that Dr. Lamaze, especially, would abandon his "hee-hee-hoo"s for some "ohhhhhhhhhhhhhhhhh"s moans if he actually labored and gave birth.