The Last Days of Pregnancy: A Place of In-Between

The Last Days of Pregnancy: A Place of In-Between by Jana Studelska

 She’s curled up on the couch, waiting, a ball of baby and emotions. A scrambled pile of books on pregnancy, labor, baby names, breastfeeding…not one more word can be absorbed. The birth supplies are loaded in a laundry basket, ready for action. The freezer is filled with meals, the car seat installed, the camera charged. It’s time to hurry up and wait. Not a comfortable place to be, but wholly necessary.

 

The last days of pregnancy— sometimes stretching to agonizing weeks—are a distinct place, time, event, stage. It is a time of in between. Neither here nor there. Your old self and your new self, balanced on the edge of a pregnancy. One foot in your old world, one foot in a new world.

 

Shouldn’t there be a word for this state of being, describing the time and place where mothers linger, waiting to be called forward?

 

Germans have a word, zwischen, which means between. I’ve co-opted that word for my own obstetrical uses. When I sense the discomfort and tension of late pregnancy in my clients, I suggest that they are now in The Time of Zwischen. The time of in between, where the opening begins. Giving it a name gives it dimension, an experience closer to wonder than endurance.

 

I tell these beautiful, round, swollen, weepy women to go with it and be okay there. Feel it, think it, don’t push it away. Write it down, sing really loudly when no one else is home, go commune with nature, or crawl into your own mama’s lap so she can rub your head until you feel better. I tell their men to let go of their worry; this is an early sign of labor. I encourage them to sequester themselves if they need space, to go out if they need distraction, to enjoy the last hours of this life-as-they-now-know-it. I try to give them permission to follow the instinctual gravitational pulls that are at work within them, just as real and necessary as labor.

 

The discomforts of late pregnancy are easy to Google: painful pelvis, squished bladder, swollen ankles, leaky nipples, weight unevenly distributed in a girth that makes scratching an itch at ankle level a feat of flexibility.  “You might find yourself teary and exhausted,” says one website, “but your baby is coming soon!” Cheer up, sweetie, you’re having a baby. More messaging that what is going on is incidental and insignificant.

 

What we don’t have is reverence or relevance—or even a working understanding of the vulnerability and openness a woman experiences at this time. Our language and culture fails us. This surely explains why many women find this time so complicated and tricky. But whether we recognize it or not, these last days of pregnancy are a distinct biologic and psychological event, essential to the birth of a mother.

 

We don’t scientifically understand the complex hormones at play that loosen both her hips and her awareness.  In fact, this uncomfortable time of aching is an early form of labor in which a woman begins opening her cervix and her soul. Someday, maybe we will be able to quantify this hormonal advance—the prolactin, oxytocin, cortisol, relaxin. But for now, it is still shrouded in mystery, and we know only how to measure thinning and dilation.

 

“You know that place between sleep and awake, the place where you can still remember dreaming? That’s where I’ll always love you, Peter Pan. That’s where I’ll be waiting.”        -Tinkerbell

 

I believe that this is more than biological. It is spiritual. To give birth, whether at home in a birth tub with candles and family or in a surgical suite with machines and a neonatal team, a woman must go to the place between this world and the next, to that thin membrane between here and there. To the place where life comes from, to the mystery, in order to reach over to bring forth the child that is hers. The heroic tales of Odysseus are with us, each ordinary day. This round woman is not going into battle, but she is going to the edge of her being where every resource she has will be called on to assist in this journey.

 

We need time and space to prepare for that journey. And somewhere, deep inside us, at a primal level, our cells and hormones and mind and soul know this, and begin the work with or without our awareness.

 

I call out Zwischen in prenatals as a way of offering comfort and, also, as a way of offering protection. I see how simple it is to exploit and abuse this time. A scheduled induction is seductive, promising a sense of control. Fearful and confused family can trigger a crisis of confidence. We are not a culture that waits for anything, nor are we believers in normal birth; waiting for a baby can feel like insanity. Giving this a name points her toward listening and developing her own intuition. That, in turn, is a powerful training ground for motherhood.

 

Today, I am waiting for a lovely new mother named Allison to call me, to announce that her Zwischen is ended and labor has begun. I am in my own in between place, waiting. My opportunity to grow and open is a lovely gift she gives me, in choosing me to attend her birth.

 

About Jana Studelska

Jana Studelska CPM/LM, is a licensed midwife practicing in northern Minnesota and Wisconsin. She has been working with babies and mothers since 1998–as a La Leche leader, a certified doula, a childbirth educator, a regional birth network board member, and finally as a credentialed midwife. She is an author and writer, and has won several national awards for her work. Currently, she is the MANA Region 4 Representative for the Midwives Alliance, representing the upper midwest. She lives in Duluth, MN, with her husband, teen-aged boys, and a herd of dogs.

Emotional and Physical Terrain of Miscarriages

Navigating a miscarriage can be tricky and complicated. There are a whole matrix of emotional, societal and biological questions that come up when a woman is faced with losing a pregnancy. In times prior, whispers spread throughout the community about what might be wrong with a woman that she can’t carry a pregnancy. Currently, many receive mixed messages from friends, family and care providers. Numerous woman I have worked with have expressed deep emotions over losing a pregnancy, but felt like they had to ‘get over it’ as if it is ‘no big deal. I have always felt that it is an important event with lasting emotional impacts. There is now fascinating new research showing how each pregnancy alters a woman’s body, having long term impacts on her health.
Miscarriages can bring up such a host of emotions for women whether they were intending to be pregnant or not. Women sometimes invalidate their own strong feelings of attachment, grief, sadness and anger over a miscarriage. Many question themselves, as if they have done something to cause such an event. Miscarraiges also brings up questions about fertility and whether the said woman can have a baby particularly if you are part of the growing category of older ‘mom’ or AMA (Advances Maternal Age).
Societal norms are still judgmental about a woman losing a pregnancy; however also send the message that it is ‘no big deal.’ And it is often interpreted as a cause for worry and concern, rather than what is really is– a healthy part of the reproductive system and way the body lets go of life that isn’t going to be biologically viable.
The following radio show is on research showing how the cells of every pregnancy that a woman has stay in her body for decades, regardless of how long she carries the pregnancy. In some cases these cell can act to support the woman’s health and in others they are a hindrance. In my view, this research validates what I have always known, which is that each pregnancy a woman has, has profound and lasting impacts emotionally, and even biologically, regardless of whether it was planned, unplanned, carried to term or not.

http://www.radiolab.org/blogs/radiolab-blog/2012/apr/30/fetal-consequences/

Help this Beautiful Couple have a Home Birth!

http://ourhomebirth.blogspot.com

What Do Fathers Need to Prepare for Home Birth?

Appropriately so, there is tons of focus on what a mother needs in order to dig deep and move through the enormous, joyful task of birthing a baby. But what do fathers need to hold the space, witness deeply and support this experience? It is overwhelmingly my experience that most women in labor want to be supported primarily by their partners. Of course there are exceptions to this, but when a father feels empowered to help his sweetie during her labor, something miraculous grows between them. This something is indescribable and precious.  Whether you want to call it primal bonding, deepening love or a hormonal cocktail; it is just the delicious stuff we want our children to be born into. So as a midwife, I wonder what I can do to facilitate and support this kind of experience for women, men and families.

Is it Safe?

One of  the most commonly asked questions by men in interviews is “What do we do if there is an emergency or, if we need to go to the hospital?”  This is such an important question and I am always grateful that it is on their minds. When men ask me this question, I feel their protective sides coming out, wanting to make sure that the people most precious to them will be safe.  Building trust with expecting fathers through prenatal care seems foundational.  In order for them to be relaxed, at ease and able to support their women during the birth, I let them knows the ways I am monitoring the mother and baby’s well being, and that I am partnering with them on this mission.

Can I Give My Family What They Need?

Expecting fathers frequently have concerns about how they will provide for their new or growing family. Whether it is providing on a material, emotional, or spiritual level, I see fathers asking themselves whether they have enough to give at the birth and beyond. Often, they will express to me that they are unsure how they will perform under the challenges of labor. Similar to the expectant mother, the father can’t know how it will be until the labor is in full swing. I have never seen a father who has the desire to be supportive, not rise to the occasion and find their way.  I generally see fathers at home provide beautifully for their partners, whether it is a sip of water, problem-solving, encouraging words, or tender touches. Cultivating trust, breathing and staying in the moment are all great strategies for encountering the unknowns and questions that don’t have answers.

Will I be Included or Is This Just a Women’s Thing?

One of the primary difference between an expecting mother and father is that the baby is not inside the father.  This makes his connection to the baby different from the mothers’.  The mother can not avoid being woken by the baby moving at night and other pregnancy discomforts, while the father has a less visceral and sometimes more cerebral connection to the baby.  I believe that this lends itself to fathers sometimes wondering anxiously, “how will I be included in this pregnancy, birth, and child’s life in general?”

Men find their own ways to connect with babies during pregnancy. (I would love to hear from dads on this topic!) I encourage couples to have daily or weekly ways to connect with the baby and birthing process. Childbirth classes can be a wonderful way to engage fathers on various levels.

Since my prenatal visits are around an hour, there is always plenty of time to focus on father’s questions.  We talk about what their role and jobs will be during the birth and postpartum. I work with fathers to find how they can connect to the process, through prenatal education, and impressing the importance of their bond with the new baby.

Men sometimes express how they would like to be a different kind of role models than maybe their fathers were. After the baby is born, I encourage dads to have their own rituals with baby whether it’s giving the bath, dressing the baby, or changing diapers. Never underestimate the importance of your role in your baby’s life and how much you can contribute postpartum.  Being needed spontaneously by the baby, gives fathers a sense of involvement under which the precious father child bond can flourish.

When men are fully supported in pregnancy, then they can show up powerfully to the birth, providing crucial stability for laboring mamas. This then sets the stage for the  baby to be welcomed and received by the parents. As a midwife, this is why I am always looking for new ways to facilitate women and men through childbirth. Each birth presents unique and individualized lessons for all involved, lessons that if welcomed, change people forever.

I am still learning about much of the above so any any thoughts, feelings or resources you (particularly men) would like to share are welcome!

What’s on his mind?

I always wish I could tell what babies are thinking, sensing, seeing and smelling, especially when they make distinct expressions like these. Health care providers and society in general used to think that babies had no memory, emotions, or capacity to process their surroundings. Thanks to the work of pre and para natal psychologists, we now know that babies have incredible capacities. Now we know that babies are take in every experience in like they a sponge. This is why how a baby is born and how they are treated at birth matter. Here is an NPR interview with Dr. Gopnik, author of The Philosophical Baby.

http://www.npr.org/templates/story/story.php?storyId=112481229

US home births increase 20 percent from 2004 to 2008

US home births increase 20 percent from 2004 to 2008.

How to Choose a Home birth Midwife

 

Interviewing midwives for a home birth can be an overwhelming yet very rewarding task. Be assured that finding the right match will be worth the work. Birth is a very intimate event and the person attending yours will by default become part of your growing family. It can be a bit like dating, in that you have to find the right chemistry as well as someone who is skilled at their job and inspires confidence in your ability to birth your baby. It’s also important to keep in mind communication and if the care provider  you are considering communicates in a way that is easy for you to relate to.

The following questions are complied from the book Ina May’s Guide to Childbirth as well as from clients over the past few years.

How, when and where did you receive your midwifery education?

Are you certified or licensed? By what organizations?

Do you have physician back-up? How do you collaborate with OBs?

How many women are due within a month of my due date?

Do you have a limit to how many women you take with due dates in a month?

Do you work with a partner? What is her education and credentials?

Who do you bring with you to births?

Do you work with apprentices?

How do you approach prenatal complications?

What prenatal tests do you require?

Do you work with nutrition? Do you have a weight gain requirement or limit?

What emergency equipment and medications do you carry?

Do you bring oxygen to births?

Is your certification in Neonatal resuscitation up to date?

Do you use pharmaceuticals to induce labor?

What alternative medicines do you use throughout pregnancy and birth?

What measures do you suggest or use to alleviate pain in labor?

To what hospital do you go, if transport to a hospital is necessary and who goes with me?

How often do you do postpartum visits?

Do you participate in a regular peer review?

What inspired you to become a midwife?

What are your favorite things about being a midwife?

What do you think is your unique offering or strengths as midwife?

Why do you think homebirth and midwifery is important?

How do you practice trust and surrender in your own life?

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