Friday, February 22, 2008

Taming Tigers (sorry, very long)

Our Birthing From Within class on Wednesday was (in part) about taming tigers. "Tigers" is their term for the fears that may become obstacles in our birth experience. The analogy is: imagine a prehistoric woman, Lucy, who is pregnant. She has no clocks or calendars; instead, she has the phases of the moon and the changing of the seasons. One day something changes in her body. She is leaking. What might she do?

Chris answered that she might go to a haven, a safe place she might have arranged previously, to be alone and protected from predators. (This is something that most mammals do, so it makes sense.) So Lucy's in her cave. Her body is contracting rhythmically. And suddenly she thinks she sees a tiger pass by the entrance to the cave.

How does she react?

My answer was that she would tense up, perhaps even enough to stop her contractions. Adrenaline would come into play and interfere with oxytocin, the hormone that makes the uterus contract. Instead of her body's processes concentrating on making the uterus contract, the resources would be re-directed to the "fight or flight" reflex.

Of course, Lucy wouldn't know any of this. She would just know that she was afraid - for herself, and more specifically, for her child.

There were many points about this exercise that I found fascinating. The fact that imagined tigers have just as strong a physiological effect on us as actual tigers, for example. It's true: you know that feeling you get when you are sure someone's walking behind you or staring at you? The hairs on the back of your neck stand up, your stomach clenches, your palms sweat, your breathing becomes shallow - you turn around, and there's no one there. But your body reacted as if there were. If our brains give the signals for fear and adrenaline, it doesn't matter if there is a basis for that fear or not - the physiological responses will happen. And in terms of birth, those responses can stop labour.

So, the teacher guided us through a long visualization exercise in which we were to confront and tame one of our tigers. I chose forceps. (I have a few labour-related fears - caesarean birth and forceps are at the top of the list.) I am sad to say that in class, I didn't make much progress with taming my tiger. I couldn't think of any resources or coping mechanisms that would help me accept that the first thing my daughter would feel, her first sensation from this world, would be not gentle caring hands but the cold unyielding pressure of metal. On her tiny, perfect, soft head. It was just too cruel to imagine.

The teacher invited me to spend some further time on it, to work through it some more on my own or with Chris. She told us that "taming one tiger often tames them all" and that the effort would be really worthwhile. As a way to start doing that work, she asked me about a time in my past when something happened that I was unhappy about. "You don't have to share that experience with us, but just reflect on it for a moment. What helped you cope, when that happened? What actions did you take to try and deal with it?" Of course, the thing that leaped to mind was the miscarriage, and my answers were that I talked to people around me (Chris, Sara, and close friends), I journalled a lot, and mostly the passage of time helped me deal with it. She asked me to think about how I could use those things to help me deal with an unwanted tiger at my birth.

Last night at yoga, I think I reached some answers, or at least got very close. The result for me has been that I can now vividly visualize a forceps birth without feeling fear or anxiety - just peace and acceptance. What follows is a navel-gazing account of how I got there.

I had asked Chris to do a role-play with me, in which he would tell me that forceps were necessary for the baby to be born and I would react to this. He agreed, but we didn't even have time to do it before I had to go out to yoga. While there, I couldn't help but spend my meditative time imagining how this role-play might go, and trying to access the resources that would help me deal with an unwanted birth intervention. I imagined the following:

Chris: Honey, Lillian says that we are going to need to use forceps to get the baby out. She is stuck and in distress and can't be born without help.
Me: I feel scared. I feel like everything is going out of our control.

It was that phrase, out of control, that was the key for me. Of course, I am afraid of the birthing process being out of our [my] control. And of course, it is pretty much guaranteed that it will be out of our control. That's my true fear - that's my tiger. Any intervention I am afraid of is really a fear of not being in control of the situation.

As soon as I understood this, I instinctively and immediately let go of the desire to be in control. Being in control of the birth is not the end goal - a healthy baby is the end goal, with a side of positive birth experience. As I shared all this with Chris later, I said, "Of course we want a positive birth experience, but if our picture of what that looks like isn't matching up with the reality of how things are happening, which one of those can we affect? We can affect some aspects of reality, but ultimately, what needs to change is our picture of what a positive birth experience looks like."

(All of that, by the way, is so unlike me. Motherhood is changing me already.)

At this point in my thinking, it became much less about the specific (forceps) and much more about the general (any intervention and/or straying from the path of my ideal birth experience). Like Regan said, you tame one tiger, you tame them all. So, in real-world terms, what coping strategies can I/we use to deal with an unwanted intervention?

I view this kind of in circles. I hope I can make sense of this.

Chris: Honey, Lillian is suggesting that we [use some kind of intervention].

In the case of forceps, one reason for their use is that the mother is unable (or, for medical reasons, should not continue) to push anymore. So the first thing I would do is examine my own resources and say, "No, it's okay, I can keep pushing, let me gather my strength." Or, "Yes, it's true, I am completely out of energy, I can't possibly do anymore." I would determine whether or not I could do anything to improve the situation.

Then I would widen the circle to include my support people - Chris and our doula. What can they do, what can they suggest? If the suggested intervention is an epidural, maybe they can suggest a different position, assist with a massage to help relieve the pain, etcetera.

Then the circle widens to include Lillian. Does she have any suggestions for avoiding this intervention? Are there any alternatives?

If all these things come back "No" and the intervention is absolutely required, it is time to adjust that picture of a positive birth experience. It's time to give up control, realizing I/we have done everything we could do to affect the situation, but for whatever reason my body and/or the baby needs more help to be born. In this case, I give up my own sense of control and trust that God is in control - trade my micromanaging for peace, acceptance, and faith.

As I said, since figuring this out I can visualize the scary interventions without getting anxious or worked up. It's hard to put it all into words, but I do feel that I've made some really great strides away from my control-freak self and towards the self I need to be in order to birth successfully.

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