Birthing from Within: An Extraordinary Guide to Childbirth Preparation.

Book by Pam England, CNM, MA & Rob Horowitz, PHD Partera Press, 1998

I'm getting the impression, based on reading journals and magazines such as Mothering, that this book, Birthing from Within: An Extraordinary Guide to Childbirth Preparation by Pam England and Rob Horowitz, is taking the birthing community by storm. I have read the book twice and feel that it is a valuable resource for birthing couples. I have included it as part of my tuition "package" for my students, and the feedback has been very positive.

Birthing from Within, in my opinion, communicates many truths about labor that have been glossed over in birthing literature and classes. Birthing is hard, dirty work that is also blissful and rewarding. Birthing classes have tried for so long to make women think that with education and practice they can relax and have a peaceful delivery. I don't believe that is ALACE's philosophy and it has never been mine.

After having two great homebirths myself, I know what it takes to bring forth a baby and it isn't always serene; and even knowing what I know about labor and laboring techniques, I couldn't always relax. To paraphrase England, "There is no one who would rather relax than the laboring woman and she can't until after the baby comes." I love that.

It is true that relaxation isn't so much the key as surrendering to the process and finding the strength within, as the cover of this book so beautifully illustrates. Relaxation still has its place, and I feel that place is between the contractions. That is what I emphasize in class--that the use of relaxation activities is to help one keep from getting caught up in the fear of the next contraction and to spare her energy for the contractions.

The labor techniques included in this book are so realistic for working with labor. Using breath awareness rather than controlled breathing lends itself well to letting go of the urge to try to control the whole process, which doesn't work. And the authors give great ideas for verbal cues to work on awareness of one's breathing; for example, "Notice when exhalation begins / end," "Is this breath shallow / deep," and "What is the sensation in your belly as you breathe," are all great questions to help a woman learn about her breath.

The technique that England calls Non-focused Awareness, and its variations, is another excellent way to get through contractions and, really, any other discomforts one may have to face in life. Both of these techniques are fun to practice, too. And, speaking of practicing tools for labor, I love how she suggests that these tools become habit rather than technique, and should be practiced in stressful times more than when life is quiet and peaceful.

I also feel that the book has great tools for facing the pain. The tools called edges, spiraling, and centering are perfect for "looking pain right in the eye" and really getting to know it. This reinforces the idea that fear is really fear of the unknown, and when you face fears and dispel them things may not be as bad as you imagined.

Working in conjunction with this labor tool is the pregnancy activity she talks about called a "Worry List." This is a great activity, I am having success with it. The questions that England uses on her clients to "pick apart" their fears/worries are very therapeutic. Questions such as, "What would you do if this actually happened?" and "How do you see your partner/birth attendant reacting if this happened?" are among the helpful questions used to examine fears.

Other techniques mentioned in the book are: developing a partnership with the baby and a self-hypnotic jingle, which are nice for two reasons. One is that a woman can create a kind of "mantra" for labor that creates a strong mind/body connection. The other way in which these tools are beneficial is that they create a stronger bond with the baby as a partner in labor, maybe making the isolation of "laborland" less overwhelming.

The authors also discuss vocalization, aromatherapy, hot packs, the use of a TENS (transcutaneous electrical nerve stimulation) unit, and an interesting method for encouraging a "stuck" labor. England calls this "making it stronger." If labor is not progressing much, she suggests that the woman and a support person rate the contraction pain on a scale of 1-10. After the woman picks a rating for the pain, say a 6, she has a few contractions and mentally reinforces that 6. After a bit, with cues from a support person, she asks her body for a 6.25 and hopefully has a few of those. This is to continue slowly and steadily for awhile. She says you need to allow at least thirty minutes to work with this and get things going. I think it is a great way for a woman to dig deeper into herself and find strength, which is frequently a barrier to birthing. Labor pain causes many to try to escape it, which only slows things down. Using this method gets a woman, if she is determined, to face labor.

Birthing from Within is not only a book of labor tools, but a book full of information and advice on a variety of topics related to pregnancy, labor, delivery, and postpartum. England suggests doing a labor project in early labor--something to make labor just another part of life. This is good advice for first-timers especially--it keeps them from putting too much energy into early labor. She gives brief, but solid nutrition information.

Great activities for pregnancy are included such as emptying your mind of thoughts, allowing you to be open to any and all outcomes. She has an activity for clearing your mind of preconceptions about pregnancy, birthing, and motherhood by writing them down and really examining them and their purpose for you. She talks about the "compassionate use of epidurals." Those chapters are full of really good information to help couples make decisions "in the moment."

There are a couple of great chapters on how babies change our lives forever. She talks about some of the exact reasons why relationships can get so difficult that first year. I know in our home that was very true, and for many of my former students it is also true. I used to gloss over this in my "Newborn, Postpartum, New Family" class because I didn't want to scare people (so I focused on the joy of the baby). But after maintaining friendships with many former students and hearing their laments and concerns regarding their relationship, I decided to really work with this in class. I was thrilled when I discovered this book and its tangible, realistic activities for couples to use both preventively and in a crisis.

Finally, a large part of this book is the use of artwork prenatally as a means of self-discovery. I have incorporated many of her suggestions for art projects into my classes and all I can say is, "Wow!" I felt silly at first asking grown-ups to draw a "Door to Birth" or "what does `being in birth' look like to you?" or have them sculpt "Pregnant Woman." But, after one time, I was convinced this is a good and fun thing to do, and is more important than lots of lecturing. The end results are amazing.

One woman's "Door to Birth" was a granite-like mountain with a door closed shut with rocks that she had to "remove one-by-one," she said. Outside of that door she drew a rainbow with a pot of gold that represented the baby. I felt she had a realistic idea of what was required of her during labor (she's not had the baby yet so we will see).

In one assignment, parents are asked to draw their "Fantasy Birth." One woman drew the baby literally flying out of her body, which told me she wants this to happen quickly (which seems to match her personality). I feel this is good information to have in order to continue working with her. In knowing this, I can work on helping them to prepare for all possibilities, and, at the same time, it may be a suggestion for her self-hypnotic jingle. She may pick a chant to say repeatedly in labor that guides her body toward an efficient labor. This has definitely become a favorite part of my classes and I love seeing what people come up with and how they relay their thoughts; there is always giggling and sometimes tears, and all-in-all it has proven to be a great release for the couples in my class.

Birthing from Within: An Extraordinary Guide to Childbirth Preparation is just that, in my opinion. For me, it has taken what I have been trying to say and communicate to students over the last two years, and said it in a much better and more "digestible" way. It has really helped me to transform my classes into what I have wanted them to be for so long--more "hands on" and interactive. My classes are more activity (journaling, art work, discussions) oriented now, rather than so much lecture. I am so excited about the direction my classes are taking and hope the students are too. The feedback has been great.

--Joy Coin received her ALACE childbirth educator certification in 1996, inspired by the wonderful homebirth of her first daughter. She's been teaching almost non-stop ever since. Her background is in elementary/early childhood education, but she loves working with adults during this very special time in their lives. Joy teaches out of her home in Ft. Collins, CO, where she lives with her husband, Steve, and her two daughters, Natalie and Dana (another joyous homebirth).

--Readers may order Birthing From Within for $19.95 from the ALACE Bookstore. See page 27 for ordering information.