The other day, I was talking with my daughter, telling her about the research I've been doing at the intersection of doula work and linguistics. I explained to her that linguistics is all about words: what we say, how we say it, why we say things certain ways, etc. And I told her that I was writing about words and why they're important in doula work: what are good, helpful things that we can say to "mommies having babies," and what things aren't helpful or good. I asked her if she had any ideas about that, and her response gave me lots to think about!
She said, "well, it wouldn't be good to say, 'I don't think this baby is going to come out. It's not going to come out. You better just stay here until it comes out.'" I then asked her about what would be good things to say, and she said she could only think of silly ideas. I pressed her, asking what ideas seemed silly that she had thought of. She said, "Well, you could say, 'Are you hungry?'" I assured her that this was not a silly idea, but rather a really important question to ask! A laboring woman may very well be hungry (especially in early labor), and it would be very helpful to check in about that need. I thanked her for her great idea and asked her if she had any other ideas about good things to say. "You could say, 'Are you feeling okay right now?'" When I asked why that was a good thing to say, she explained, "because you want to make sure she feels safe." I again thanked her for her very thoughtful and important idea and asked if she had any more. She told me she had one last idea: "Are you comfortable?" Again, I told her this was an excellent idea and that she would be a great doula! She told me she'd consider adding it to her future plans. :)
As I thought back on our conversation, I really was struck by the simple dichotomy in what she labeled as helpful versus unhelpful things to say to a birthing woman. Few people would actually say to a woman in labor, "I don't think this baby's going to come out; you better just stay here until it comes out," but what's the underlying message here? It's a lack of confidence in the woman and her body and an assumption that birth is something that just happens to a woman while she "stays there" and waits, without confidence that she can actually do this. Are there times when words uttered in the birth space have these unhelpful dubious underpinnings? Instead, let's aim for our words to share Ina May Gaskin's message:
“Birth is something that women do—not something that happens to them. The birth-giving woman is the central agent in the ancient drama of life bringing forth new life.”
So let's turn to the second set of suggestions my daughter gave, of helpful things to say. The obvious similarity among all three suggestions is that they are questions. Rather than projecting a certain sentiment about the birth experience onto the laboring woman, these questions value the woman's role as an important individual with unique needs. The questions seek to discover those needs, with the intent of helping to meet them. I was especially struck with the explanation she gave regarding her second question, "Are you okay right now?" about how it's important that she feel safe. This is so true for a laboring woman! Her physical progress in labor can be impeded if she feels unsafe: physically, emotionally, or otherwise. This is a basic need that all in the birth space should be sensitive to! And attending to her other physical needs of hunger and comfort are helpful ways of showing support for her in the valuable work she's doing. As participants in a birth experience, let's always be mindful about the underlying messages our words send and thoughtful about sharing confidence and support.
I'm grateful for the wise words my daughter shared with me! What wisdom have the young people in your life shared with you?
I read an interesting article yesterday with some important implications for labor and birth. It was aimed at an audience of anesthesiologists, but it raises some important questions about how laboring women frame their own experience and how they're cared for.
The authors had conducted a study to determine the effect of language when checking in with post-cesarean patients. The assessors came into the room of the recovering patients in the first day after their cesarean. To half of the patients, the assessors asked the patients, "Do you have any pain at the moment?" 63 of the 116 patients (54.3%) responded that they did. To the other group, the assessors used more positive language, asking, "How are you feeling?" and "Are you comfortable at the moment?" In this group, only 28 of the 116 women (24.1%) reported that they were in pain. And these women were recovering from a major surgery!
For the most part, this study was well-conducted, although it did have a few limitations, which were acknowledged by the authors (like the fact that study's design meant that only the patients, and not the assessors, were blinded; and the difficult-to-define spectrum of pain and comfort affected the results). However, I think it offers important food for thought in the care of laboring women.
Imagine how a similar phenomenon might happen with a woman in labor. If asked how she's feeling and if she's comfortable, the laboring woman and her friends and care providers can work to help her find optimally comfort and find a rhythm with the work her body is doing. If confronted with the question of her pain, she may pause, get out of her body's natural rhythm, and focus more on the pain she's feeling. The authors of this article point out that, during pregnancy and the postpartum period, women are increasingly susceptible to the power of suggestion. This is acutely true during labor. We need to carefully consider how our language frames the mother's birth experience.
I certainly don't want to discredit women who have felt pain during childbirth. Although I believe there are ways to manage pain and increase comfort in labor, I feel that it would be more beneficial to reframe our perception of pain in labor. As the authors of this study pointed out, pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." This definition, and the common perception of pain, is that it indicates that something is wrong. Sometimes this is the meaning of pain in labor, as when the baby is malpositioned, or the mother is in an unfavorable position. This pain can alert the mother and her care providers to take action to correct this.
Often, though, the "pain" of contractions is a sign that everything is right, that the body is doing just what it needs to in order to birth this baby. For this reason, hypnobirthers have chosen to linguistically reframe many of the sensations of labor. Rather than "contractions," they refer to "waves" or "surges." These words are inspired by images of nature running its right and proper course, and help a laboring mother realize that her body, too, is doing what it naturally should. Many hypnobirthers speak of intense pressure, rather than pain, as they experience the sensation of the uterus working to open and thin the cervix.
Many women feel that hypnobirthing isn't for them. I still believe that these women benefit from linguistically reframing the sensation of labor and birth! If a mother says she's in pain, we should believe her and work with her to manage it! But if she hasn't said anything of pain, then let's not introduce the word into the vocabulary of the experience. Let's talk about optimizing comfort; let's compliment her for beautifully handling the intensity of the experience; and let's remind that her body knows what to do, and that she is doing just what she needs to be doing.
What terms or phrases have been helpful for reframing labor sensations for you?
Chooi C. S. L., Nerlekar R., Raju R., Cyna A. M. (2011). The effects of positive or negative words when
assessing postoperative pain. Anaesthesia and Intensive Care 39(1), 101-106.
One of the things that drives my linguistic study of the birth environment is that so little has been done in this area so far. In situating my contribution to the literature, I've had to go back a few decades to find relevant books. So here's this beauty: published in 1984, Birth Stories, edited by Janet Isaacs Ashford, is a collection of birth stories (bet you couldn't have guessed that!).
An interesting feature of this book, though, is that the stories collected range from 1915 to 1983, so it really gives a big picture of a variety of obstetric practices and childbirth tendencies over several decades. You may have heard of some of them: overuse of forceps due to complete unconsciousness of the mother during delivery; "Twilight Sleep;" women being left alone, without friends or family, to labor; routine shaving, enema, and episiotomy... Unfortunately, the list goes on. I'm so grateful to be mothering in an era when most of these have faded into the past. I watched many of them fade as I turned the pages of this book.
Throughout the decades, themes persist. There are women who feel there must be a better way, who seek alternative care. Some of these women find it. They deliver at home or birthing centers with the care of experienced midwives. Some are treated with respect in the hospital and voice their preferences and are listened to. Birth empowers them. Some go without care and face unfortunate consequences. Some feel that they can't find it, and end up being subject to the interventions they were hoping to avoid, even though they vocally protested. These women feel a loss of control, and birth is a severely disempowering experience. Their stories are told in this book.
After reading this book, I believe more strongly that birth is a story we must keep telling. We must tell our experiences, good and bad, and seek to make birth better and better for our birth-giving posterity.
Now to close, I have two questions for you, dear reader: 1) Would you be interested in also reading article reviews of the journal articles I'm reading about language and childbirth? and 2) Do you know of any books I'm missing out on that talk about language and birth? If so, comment below!
In September, I'll be presenting at the Evidence Based Birth Conference in Kentucky. (Can I just pause to say about how thrilled I am to be able to present at this amazing conference!?) I'll be leading a workshop about the critical role that our words play in shaping the birth environment. I can't wait to share how my passion for birth converges with my passion for linguistics and give other birth workers tools to use their language for good!
In preparation for my workshop, I'm familiarizing myself with any other texts that are relevant to this topic. It turns out that there aren't a ton of super-relevant texts, but I'm reading what I can about the overlapping spheres of language usage and childbirth. Enter Women Writing Childbirth: Modern Discourses of Motherhood by Tess Cosslett. It's an older book (published 1994) that synthesizes and analyzes literature of the 20th century that addresses the topic of childbirth. While it's well-done and thorough and has a few good themes, it's not a book I would widely recommend. If you're curious about what (mostly female) writers have written about birth in both fiction and non-fiction works and want to read one critical interpretation of those texts, it's a worthwhile read. It's certainly got its own biases (which the author acknowledges), and I disagreed--either in part of in whole--with several things Cosslett writes. However, she does uncover a few worthwhile themes in her analysis. Here are the ones that stood out to me:
Cosslett teases out these themes as she examines several works of literature, both fiction and non-fiction. This book certainly provided food for thought and insight into potential themes in the language that surrounds birth.
Stay tuned for more reviews of the birthwork/linguistics literature and a preview of my EBB workshop!
“When you change the way you view birth, the way you birth will change.”
-Marie F. Mongan
Before I'd learned much about HypnoBirthing, I had some negative associations with it. Whenever I heard about using hypnosis for birth, my mind went straight to the cartoons: one character swings a yo-yo back and forth in front of an unsuspecting victim, whose eyes then turn into crazy swirls. (I mean, if you do a web image search for "hypnosis," you get dozens of iterations of crazy swirls.) I thought that hypnosis meant being totally outside of and separate from the birthing experience, and that wasn't something that appealed to me. I want to be present and an active agent while giving birth, not a hypnotized object.
Then, as I learned more about it, I realized that (as is normally the case with stereotypes), these perceptions were wrong.
Speaking of terrible stereotypes, let's think for a moment about how birth is often portrayed in the media: mom, confined to a hospital bed, screams and looks completely out of control. Her husband is completely helpless to do anything useful, and looks rather terrified himself. Even the birth attendants are often portrayed and frazzled and behave more like they're managing the victims of a fire or another emergency than joyfully welcoming a baby to the world.
Addressing these sorts of stereotypes and their effects is one of the main tasks of HypnoBirthing. If a woman has grown up in a culture that emphasizes pain, panic, and pandemonium in birth, it affects the way she thinks about it and approaches the birth of her child. Even if well-educated about birth, she probably expects a significant amount of pain to be involved in labor. And her body expects that, too. Mongan explains Grantly Dick-Read's fear-tension-pain cycle that affects many laboring women: They come to birth fearing pain, which causes the body to tense up, which makes laboring painful. Having once experienced pain as part of the childbirth process, the body tenses up in fearful anticipation of each contraction and feels more pain.
As I learned more about HypnoBirthing, I realized that a lot of it ties in with my interests in linguistics. HypnoBirthing takes many of the negative terms that are associated with a painful, clinical birth experience and reframes them as more positive terms: contractions are called surges; rather than pushing baby out, HypnoBirthers speak of breathing baby down; cervical dilation and effacement is instead called opening and thinning. The terms help the process be perceived more as an natural process than a medical procedure. A natural process that the woman's body was created to do and is perfectly capable of doing! What a freeing paradigm shift!
To help laboring women overcome the fear they may have of pain during childbirth and to help the body be relaxed and relieve all tension, Mongan introduces a variety of breathing, relaxation, visualization, and ultra-deepening techniques for use during labor. Many of these reminded me of similar techniques I'd used to relax and relieve tension when birthing my son, though I didn't use the HypnoBirthing method.
In summary, reading this book taught me that HypnoBirthing is not nearly as "out there" as I perceived it to be. I am hooked and interested in learning more about HypnoBirthing, and I'm grateful for Marie Mongan's work in helping many women reclaim their birth experiences as peaceful and empowering!
Hi, I'm Sara. I'm a birth doula serving Utah county and the Wasatch front. I'm a twin mom (plus one!), natural VBACer, and birth lover!