I was exploring the peaceful birth project's wall (http://www.thepeacefulbirthproject.com/) on Facebook and came across the article about perineal integrity from Midwifery Today 2005.
Honoring Body Wisdom - by Pamela Hines-Powell
Pamela has some wonderful insights including:
"... there are very few things I personally can do to really prevent tearing in a client, but there are a whole host of situations and instances where I could actually create an environment for perineal tearing".
Our role as midwives is to create the environment where a woman can find her own way, get in touch with her inner power, her inner intelligence and innate guidance system. A woman can find her own way when there is an atmosphere of loving, capacity building trust in the process of birth and the woman's ability that the midwife engenders by having a mindful approach to her role in creating that environment. A mindful approach for the midwife involves awareness of and congruency in her intention, focus, thinking patterns, body language, movement and words. A midwife's mindful approach also includes attention to those aspects of the woman she is working with. Such an environment optimises a woman's birthing psychophysiology. A woman's optimal birthing psychophysiology means her mind, body and spirit are in harmony, her brainwave patterns are in gamma, alpha, theta and delta wavebands (known as a 'flow' state) a relaxed, focussed mode; her brain's attentional networks are focused on her baby and her baby's impending birth; the woman is able to let go of her orienting and alerting brain networks with their beta brain waves. When a woman is able to be in that biobehavioural state, genetic switches are flipped to parasympathetic mode; oxytocin and endorphins flow and the woman is able to respond instinctively to her body cues; labour progresses and birth happens.
Pamela asks a really good question: "As midwives, are we finding ways to support women's instinctive behaviors or do we undermine their instincts by directing them?"
How we look, how we move, everything we do and say has an effect on the labouring woman.
"The birthing woman is highly susceptible to suggestion—even if very subtle. For instance, a midwife lays a chux pad on the bed. The message received is "sit here"—many women will follow the placement of the chux and reside wherever it is placed, even if there is no spoken direction by the provider. However, left to her own devices, a woman will rarely lie down to push her baby out".
There is so much wisdom in that information. The first job for a midwife on the learning curve of being 'with woman' is to understand and integrate that truth into their practice.
I'm reminded of the words of the wonderful Nicky Leap, a brilliant midwife. Nicky said "the less we do, the more we give". That 'doing less' has to come from a position of trust in birth, trust in women's innate capacity to give birth well as well as being mindful of what is happening with that woman, her baby and the labour process. 'Doing less' is not about being lazy or lassez faire about women and birth. Doing less, is actively mindful, fully present and conscious in the moment, actively aware of the ebb and flow of labour and birth; being a source of feedback for the woman when required; subtly monitoring the woman, her baby and her experience; ready to support adjustment if needed. 'Giving more' in this context means that a woman who is supported to be instinctive feels powerful, her capacity is strengthened, she emerges from labour and birth feeling amazing. Barbara Katz Rothman says that birth is about building strong, capable mothers as well as welcoming new life into the world.
As midwives, we can create a safe, nurturing, protective environment where a woman can express her individuality, her innate wisdom and feel free to make the changes needed in becoming a mother. We can provide a supportive environment within which a woman can empower herself, find her innate power and utilise it; we can't empower her. We can however, disempower. We can 'pull the rug' from underneath a woman, destabilising her so she doubts herself and loses her confidence.
Pamela's question is a good one. We can extend that question and ask ourselves "am I creating an environment where a woman feels safe to be herself and does she feel better about herself when she leaves my presence?" We need to ask ourselves that frequently. We need to ask the women we work with for feedback about that too.