Originally published in Massage Bodywork magazine, December/January 2007. Copyright 2007. Associated Bodywork and Massage Professionals. All rights reserved.
I'm resting on my knees, rib cage indenting the soft lip of a plastic pool that could be mistaken for a kiddy pool. Colorful designs of cartoon animals dance around the outer circle, and a nervous husband pours water from a teakettle to rewarm the pool's contents.
I am not outdoors under the sun, on a lawn in a backyard, but rather on a hardwood floor in the dining room of a small house in West Los Angeles, California.
It is four o'clock in the morning.
In the water, directly in front of me, sitting upright with bent head is a woman, my client, who has been laboring with the birth of her first child for fourteen hours. My hands soothe and smooth away the sharp edges of each and every contraction, penetrating the nerves, warming the muscles, easing the discomfort in her uterus and her legs, quelling the chills that run up her spine and through her neck. "That's right," I whisper. "That's the way. Just let it go. All gone now. That one is gone." This is my mantra for all birthing mothers.The Journey Begins
I recently found a 1986 journal entry. It simply said, "Why aren't I in Africa doing something meaningful with my life?" At the time, I was a corporate executive secretary. Two years later, I was embarking on a career in massage therapy, never imagining that I would ultimately be assisting women in childbirth. In my wildest dreams, I never saw this path as being one I would choose, or more accurately, that this particular path would open before me and continue to call me onward. I remember thinking I wanted to specialize in massage for animals and that some day I might open a veterinary massage center, a health spa, or a school of my own. But mostly, and clearly, I knew that I wanted to be of service in whatever manner called for my assistance.
It was five years after I graduated from a twelve hundred fifty-hour massage program when I entered a course for prenatal massage in order to expand my already extensive skills. In my initial program, we learned polarity, jin shin do, reflexology, Ortho-Bionomy, aromatherapy, pathology, lymphatic and medical massage, and various forms of energy work in conjunction with anatomy, physiology, Swedish, and deep-tissue massage, but no prenatal class was offered at the time. So, in 1994, I added this specialty to my repertoire, and it was in this subsequent prenatal course that I met my first doula. This woman was a fledgling doula who had recently obtained her training from the very first doula program in Los Angeles. I was in the second.
The term doula is Greek for mothering the mother, woman caregiver, or handmaiden. For contemporary usage, a doula assists prenatal parents through the birth of their child. Doulas do not prescribe medical procedures, but support and provide emotional assistance and comfort measures in order to ensure a sense of empowerment, security, and well-being for birthing mothers and their partners. Using a doula reduces the length of labor by 25 percent. "What an amazing career," I thought to myself upon meeting my first doula on the first day of my prenatal massage course.
Once I had graduated from doula training, I began assisting the births of my prenatal massage clients. The wave of doulas as a new career path was just beginning to receive recognition, and I was one of the few in West Los Angeles who provided massage therapy as an adjunct. For this reason, prenatal women requested my presence at their births--one after the other, in quick succession. I was attending natural births and Caesarean births, births that lasted three hours and births that would go on for twenty or more hours. I would mix together special blends of aromatherapy oils, each one as unique as each mother. I'd use clary sage and rose, geranium and ylang ylang, marjoram to stimulate contractions, and jasmine as an analgesic. I became a popular doula in the Los Angeles labor/delivery wards due to the lovely scents that would float down the halls from my birth rooms, affording the nursing staff a distinct change in their mood and attitude.
It's been almost twelve years since my first birth experience, but for the first time, I'm leaning over a plastic tub. My hands glide down her neck and knead the muscles of her shoulders, stopping at the Gallbladder 21 point to apply pressure, to communicate with the uterus for enhanced expansion. I'm assisted by the same blends of essential oils that have helped birthing mothers so many times.
The midwives check the baby's heartbeat with a Doppler and all is well. We wonder why this birth is taking so long, but the machine assures us that "Baby Girl" is happy in utero--there is nothing to be concerned about. One midwife curls up in a big, cozy corner chair to read. The other takes a catnap. At this late hour, I'm in a trance-like state, as is my birthing mother, and together we "tone." We find our deepest voices from the bottom most part of our throats, and we bring this vibrational sound down through our bellies, into our bottoms to assist the cervix in opening, the uterus to quell its physical discomfort, and to encourage the descent of her baby. We could be Tibetan monks in morning ritual should the neighbors hear us through the streets at six o'clock in the morning. It is a beautiful sound--low and rich and full, "Like a big, lumbering mother bear," I remind her, and suddenly her voice drops even lower.Rekindling Passion
After ten or so births--too many of which were Caesareans for reasons based on medical time, rising malpractice rates, fear of malpractice suits, and opportunity for higher income, and had nothing to do with the actual health of mother and baby--I was reading Ina May Gaskin's Spiritual Midwifery. Recognizing what my next step would be, I purchased a plane ticket and ventured to The Farm, in Summertown, Tennessee, for a week of training with Gaskin and The Farm Midwives. I had a new group of prenatal massage clients at this time, and I was pre-hired to assist as their doula before departing my office in Los Angeles. Not only was massage for birthing a comforting prospect to them, but these particular women all desired to birth without pain medication. They felt certain I would be able to help them reach their goal, especially after studying with Gaskin.
Statistics show that one in four hospital births will be a Caesarean, or according to the U.S. Department of Health and Human Services 29.1 percent, showing a 41 percent increase since 1996. Physiologically speaking, due to implementing medications--which often leads to epidural anesthesia--laboring mothers will lie on their backs, unable to feel their legs and unable to stand or walk, allowing gravity to help bring a baby down the birth path. With physical sensation lacking, the pushing stage--"second stage"--may also be challenging.
In a twenty-four year time period on The Farm, out of 1,917 births, only thirty-five were Caesarean (1.8 percent), which is a little more than one cesarean per year. I was committed to learning what these midwives were doing to make this so. On The Farm I learned which herbs and homeopathic remedies enhance the productivity of contractions and which to use for natural induction should a woman be "overdue." My birth bag was expanding with a wider variety of tools, most of which assisted in natural births. By now, the only women who hired me as their doula were those who wished to birth in alternative ways, yet within a hospital environment, and desired the assistance of massage, herbs, and remedies with intention of accomplishing their goal.
Out of the eighty births I've assisted, seventy-eight have been in the hospital, and I will continue to work in hospitals as this is where the majority of women choose to birth. However, I am well aware of the pros and the cons within a hospital setting, and it for this reason that I provide childbirth education to prenatal parents in order for them to maintain a birth experience without intervention (barring any real complications) and in which a sacred space may be created within a technological environment. From my perspective, childbirth may be the most powerful work a woman will ever do in her lifetime, and yet it can result in the most disempowering of experiences when in the hospital, often leading to a sense of humiliation, shame, and postpartum depression unless aided by education and the support of a committed partner, an advocate, and/or a doula. One occurrence during the childbirth process will beget one concurrent emotion, either positive or negative. If, and when, negative, the subsequent bonding process will also follow this course with rising complications between mother and baby, between mother and father as a parental unit, and between baby, child, and world.
My full-time massage practice included working with many illnesses and needs including Parkinson's clients, scleroderma, arthritis, and chronic neck and back pain, and including prenatal, both in-office and in the hospital for birth. I'd often get calls in the middle of the night from one of my doula clients whose water had broken or contractions had begun and off I'd go, sleepy-eyed and wide awake at the same time, anticipating the unpredictability of the birth I was about to attend. If necessary, and this was often the case, I'd call my scheduled massage clients at nine o'clock in the morning to inform them I would need to cancel for that day as I was with a birthing mother. Never once did any of my clients complain, and instead responded with support and good wishes for the mother and baby. In the days following, during their rescheduled appointments, they always wanted to hear the birth story in full detail, and I think, felt a sense of pride in knowing they, too, had participated in this birth by generously exchanging their original massage time for the joyous sake of welcoming in a new life.
The birthing mother who's sitting before me, in this small house today, is quiet and confident. Though she's in active labor, and experiencing powerful contractions every two to three minutes, she remains still, drifting off to sleep in between each contraction, and listening to my voice when another begins. "Rising, rising, rising, peaking, and releasing ... that's right ... just let it go now," and she does. A few days later, upon one of our postnatal visits, and with a satisfied smile, she comments, "We pulled all the stops out." Indeed we did. No alternative tool, technique, posture, or position went untried in this birth. It was obvious that this birth had little to do with enhancing the progression forward, since she was progressing, albeit slowly, but rather it had to do with some unknown factor in the position of her baby. By ten o'clock in the morning, twelve hours after my arrival, I realized that had we been in the hospital, this would surely have moved to a Caesarean. In terms of obvious spiritual lessons, this birth presented my client and me with renewed lessons in patience. It was one the midwives had not forgotten.
At noon, we take a walk through her backyard. We tone and we breathe slow, deep breaths--in through the nose, out through the mouth--bringing oxygen to her baby and helping to keep mom in a state of control. We do spinal twists throughout contractions, attempting to shift her baby into an optimal birthing position. We squat, we writhe on all fours, we move our hips in a figure-eight pattern and pretend we're dark-skinned Bedouin women birthing in a desert. I apply counterpressure to her lower back with all the strength I can muster up after having been awake all night. I press my fist into the sides of her sacrum, lunging forward and tucking my elbow into my hip for deeper contact. I use my right hand to strip down the inside of her leg--from the medial part of her knee, tracing the tibia, right down and under her malleolus where the uterine point in reflexology lies. Beneath my thumb, I can feel the pulse of her next contraction a few seconds before she can feel it. Another dose of gelsemium prompts her uterus to expand and release with strength, and yet this baby is still taking her time. Seeking Longevity
After fourteen years in a full-time massage practice, my hands had become stiff with mild but chronic pain and I had developed tendinitis in my right elbow. Though I continued on a part-time basis, I was aware that I would soon need to add yet another aspect to my holistic practice--one that would not demand the use of my body, one in which I could grow old. I entered a graduate program in spiritual psychology intending to find the answer therein, and during my years in school, I took a hiatus from birth work.
A lengthy program in hypnotherapy followed my master's degree. With this acquired skill, I'd be able to use my mind rather than my body well into old age, but I hadn't realized that I would ultimately return to the birth room providing hypnosis techniques for deeper levels of relaxation to birthing women. Halfway through my program, and again, because this particular school did not offer courses in hypnosis for childbirth, I sought education from an outside source and received certification as a hypnobirthing educator. I was now certified to teach prenatal preparation classes for the purpose of birthing with hypnosis. Since the body/mind cannot differentiate fantasy from reality, it is possible, through hypnosis, to take a client from present physical reality to any imagined location, in any place and time. Suggestions within the subconscious mind will influence the body in sense and experience; in other words, a body will respond to whatever the subconscious mind advises. In addition to this, endorphins, two hundred times the power of morphine, inhabit our chemistries, and oxytocin, one of the many hormones, acts as a natural analgesic. When activated, oxytocin promotes sensations of well-being and love, thus counteracting the release of adrenaline that prohibits the natural release of beneficial hormones and stops or stalls a cervix from opening, and a uterus to contract. This thwarting of the birth process is known as the "Fear-Tension-Pain Syndrome."
My first hypnobirthing clients included three couples. Two of the three women birthed without pain medication, using instead their acquired hypnosis skills, visualization, and guided imagery. The third woman requested epidural anesthesia only an hour before her baby was born. I was present for two of the three births, applying massage and aromatherapy, acupoints and reflexology. But mostly, I kept watch--alert and attentive to every breath, sound, and sense of discomfort. These women remained in deep states of hypnosis, traveling in their subconscious minds to places of peace, beauty, and tranquility--their "special place"--or taking balloon rides through an open sky, drifting and soaring with grace and ease, or sitting on the soft sand of their favorite beach watching the waves and the tide ebb and flow in sync with the ebb and flow of each contraction. I was witnessing a total state of relaxation--women who sat like Buddhas--fully focused, rarely flinching, never doubting their abilities, and utilizing their voices to tone only when contractions became fierce, although with these relaxation techniques, "fierce" is a rare perception to birthing mothers.
It is no different here at this home birth. My client and her husband, along with his eleven-year-old daughter from a prior marriage, participated in my five-week prenatal prep classes, "The Tao of Birthing." This prenatal mother had practiced her hypnosis tools diligently and had integrated many of the philosophies from The Tao Te Ching, the most important of which is that of "surrender." No matter what circumstances should come forward during her birthing time, she knew to allow her body, her mind, and her baby to proceed in the manner they would, void of judgment, fully committed to each moment, and aware that with every birth comes unique experiences, as unique as every child.Seeing the Path
After completing a twelve-month hypnotherapy program, I was once again attracting prenatal clients, but now with the addition of infertility clients (although I prefer the label "fertility" clients). Sessions for fertility include deep-tissue, friction, and energy work to the abdomen and surrounding areas in order to break up adhesions, and to open a path in which to receive. This, in conjunction with hypnosis, has become part of the techniques I offer today, and it's proving successful with women who are undergoing in vitro fertilization.
I began to write the text for my marketing materials, to search for a business name, and to put together a comprehensive manual for my birthing classes. Due to my background, I found myself veering away from the traditional hypnobirthing program and began teaching another branch of a similar path, one that included a combination of all my past education and experience. When people would ask what I did for a living, my answers often caused confusion. I had not yet developed the fifteen-second "elevator speech" recommended by various networking groups I had joined. Would I tell them I'm a hypnotherapist and attempt to build a base of smoking cessation and weight loss clients, which held little interest for me. Or would I say "I'm a birth doula," anticipating interruption with "What's a doula?" which would then mean that my sales pitch would fall on the deaf ears of women over forty-five with children who were entering college, or to men. Would I explain that I taught hypnosis for childbirth, or that I was about to hold my first hypno-doula certification training for previously certified hypnotherapists. Or would I say, "I'm a massage therapist. Eighteen years!" forgetting the physical constraints which prohibited my giving more than one or two massages a day, if that, and only three days a week. There were many options with which I could answer and not enough time at networking mixers in order to explain the crux of what I offered, of what my career and passion had been for so long. Though I was discouraged by marketing experts who advised that I should pick one vocation, I had faith that all my skills could be coined into one phrase. I only needed to discover what that was.
The hours between two and five o'clock in the afternoon are a blur to me now, void of detail; however, I continued to administer the same tools from the previous hours. My client had grown tired of the birthing tub, and I believe she'd grown weary of the people around her. Like any animal in birthing, she had become restless, demonstrating an innate need for privacy by sheltering herself in the one and only bathroom in the house. This indicated that she was probably in transition. The lead midwife closed her book. The other reached for the Doppler, which confirmed that the baby's heartbeat was still faring well. Through a cervical check it was determined that Beth was finally ten centimeters dilated and ready to begin to push. There is a differentiation in the traditional manner of birthing (of "pushing") when one is birthing with hypnosis. The uterine muscles are strong enough to expel a baby without a mother's forced pushing, which may leave her with broken blood vessels around her eyes, swollen cervix, and physical exhaustion. When preparing to birth with hypnosis, a woman will have learned how to breathe her baby down the birth path with the aid of each contraction. This is referred to as "mother-directed," and eliminates the need for the verbal counting from one to ten as is often used in hospital settings, especially needed for those with epidurals. When mother-directed birthing is utilized, episiotomies and tears of the perineum are reduced, swelling of the cervix is eliminated, and the mother maintains her energy.
A birthing stool was brought into the dimly-lit, limestone bathroom and sterile equipment set on silver trays was readily available to the midwives. I followed directly behind with two cameras strapped across my chest, and an intern hypno-doula at my heels. Once my client's husband arrived, although reluctantly, there were six of us and not a foot of space between us. "You're doing great. Perfect. That's the way. You've got it," were the prompts from the four women assistants, encouraging this mother to continue on with strength, energy, and extreme focus.
After three hours of birth breath, faith, surrender, and without complaint or words of doubt from our birthing mother, the head of a baby girl came through from darkness to light. A long umbilical cord had wrapped itself around her neck and her left hand was roped against her wet, white cheek. Finally, the mystery of the hours was revealed before us.
The cord was removed calmly, swiftly, and a moment later the great first cry resounded with echoes from the small bathroom. The rest of her slipped out and into the comfort of her mother's arms. Seven pounds, eight ounces. The time was 8:41 p.m., almost twenty-four hours from the time of my arrival; almost thirty-six hours from my client's first, easy contractions.
Eighteen years ago, my massage program afforded education of a higher consciousness, where work of service was viewed as a privilege, and where nonjudgmental disposition was of optimal benefit to each client for their greatest well-being, and in which intuitive knowledge was nurtured so that possibilities for healing might flourish and extend from therapist to client, and from client to the world. These were the deep teachings that lay beneath the surface modalities. This is what continues to thrive in my hands and in my heart, from mother to mother, from baby to baby, in hope of, and with intention of creating a more peaceful world through peaceful birthing.
My practice--Body, Mind, Birthing--is a business of transformation no matter the work of the day--massage therapy, teaching, assisting women to confidently move beyond limited thought forms (whether in office or in a birthing room) so that they may experience the transformation to a greater self. Then, it is the extraordinary, joyous opportunity to welcome and bless new beings onto our planet, in whatever way they enter. Though I haven't yet made it to Africa, here in Los Angeles, I am doing what feels meaningful with my life, and indeed, what a profound privilege it all is! Caitlin Philips graduated from the New Mexico Academy of Healing Arts in 1989 and became certified as a midwife assistant in September 2006. Her business, Body, Mind, Birthing, encompasses a true synthesis of body, mind, and spirit. She has written The Tao of Birthing--A User-Friendly Guide for Prenatal Parents. Her Tao of Birthing programs extend from Culver City and Tarzana, California to Calcutta, India. A percentage of profit from the birthing programs contributes to midwifery and medical supplies for the Mother and Child Health Clinic of Calcutta Rescue (www.calcuttarescue.org). Philips massages her three cats daily. For more information, visit www.caitlinphilips.com.