Birth Pain: Power to Transform by Verena Schmid; reviewed by Ruth Weston
Radcliffe Publishing London 2011
Just when you think that everything that needs to be written about loss in childbearing has been written, you find yourself reading a book like this one. And in many ways it is a very welcome and refreshing revelation.
The opening self-introductions by the two authors, though, create a feeling of 'Oh dear, this is going to be a sorrowful read.' But it is not long before you realise that this personal information is crucial for the reader to know from where Doreen and Mavis are coming. These sad self-introductions mean that the reader is better able to understand the authors' views on the multiplicity of vital issues which this book and topic raise.
This book comprises, effectively, a research report. That said, it is worlds away from the standard dry-as-dust account of a research project. The authors provide, as part of the findings, a wealth of graphic illustrations of precisely what happened at the interviews. The reader feels privileged to be a fly on the wall during these highly emotive yet painfully insightful interactions.
In many ways this book is a good read to the extent that some of the material is highly reassuring. An excellent, though possibly unfortunate, example is found in the inability of midwives to compartmentalise their midwifery practice from other aspects of their lives. This inability means that the feelings which midwives express about loss in their practice are all too genuine.
The exception to this observation of reassurance is found in Chapter Nine in which Mavis reports on a small series of in-depth interviews which she under took with independent midwives (IMs). Some of the IMs had been through disciplinary procedures and the associated trauma. I have to suggest that it is time for a researcher to investigate this experience because, largely due to the statutory body's witch-hunt for independent midwives, such scenarios are not that uncommon.
For me, an equally difficult finding related to Doreen's work on the allocation of midwives to provide care for bereaved women or couples. The data showed that the midwife managers took little account of the experience or the emotional robustness of the midwife at the time of the allocation. The phrases 'it's your turn now' and 'passing the buck' were used to describe the managers' decision making. While such staff allocation would clearly be hard for the midwife, it is equally difficult to be certain that a vulnerable or otherwise challenged midwife would be able to provide anywhere near optimal care for the grieving woman or couple. This form of allocation may resonate with other midwives, but I know to my cost that sometimes in such circumstances staff allocations do not necessarily have the welfare of the woman as the prime concern.
This book is an important contribution to the literature on loss in childbearing. It provides a welcome opportunity for midwives to reflect on their practice.
Fresh Heart Publishing UK 2011
Verena, an Italian mother and midwife, who started her own practice and her own midwifery school, and has written and spoken widely, here challenges the pain taboo of childbirth.
She does it in two ways. On the one hand she challenges the movement that says childbirth should not be painful and we should only use words such as sensations, surges and rushes, by acknowledging the existence of pain in childbirth and deliberately using the word. On the other hand she challenges the medical pathological approach to the pain of childbirth by asserting its necessity in a normal physiological birth, indeed asserting its transformative and orgasmic qualities. I really enjoyed the discomfort of being challenged in this way, and certainly the knowledge and philosophy that permeate the book made me re-examine attitudes and knowledge I have long held.
Chapter 1 introduces the author's deeply spiritual and emotionally intelligent approach to the pain of childbirth and what that might mean. The second chapter dives headlong into a full description of the physiology of pain, including a full explanation of the gateway theory and brain function, and an exploration of the psychology of pain in childbirth. The third chapter examines caesarean section as the solution to pain, discussing the nature of fear of pain and how caesareans do and do not solve the problem, whilst giving sound advice on how to make a caesarean work for you and baby.
Chapter 4 examines pharmaceutical solutions to pain – and looks at how they all fail the three-fold test of being harmless to mother and baby, of being effective, whilst also not affecting the progress of a normal physiological birth. Chapter 5 looks at non-pharmacological forms of pain relief or natural pain relief – covering massage, hypnotherapy, acupuncture, birth companions, inner resources etc., but notably omitting the use of water. Natural pain relief, Schmid believes, does not numb pain but enhances the flow of endomorphins, strengthens the woman inwardly and enables acceptance.
Chapter 6 is a sort of practical workbook of how women can work through the information they have just read and find their own path through the battle of childbirth. This includes everything from ideas lists to antenatal classes, to birth care guides to postures and exercises to try. Chapter 7 is a short summary chapter which starts with the essence of Schmid's philosophy of birth as an opening up – opening up to the baby and the new role you have as a mother – with acceptance, the path is easy; if you struggle with opening yourself up, then birth itself will reflect that struggle.
Finally the role of the midwife and the importance of finding the right people to share the birth journey are emphasised: 'Cherish this process' she says, as the opportunities to go through it many times are limited. My only key concern with this book is that whilst it is addressed to the mother, the information and the manner of its delivery seem more suitable for professionals, in the view of this well-informed but not medically trained reader. In some ways this book, at its heart, is a textbook for professionals – both midwives and childbirth educators; if it were truly written to address the woman it would need to take it more slowly and go easier on the medical and anatomy and physiology side. For the nonspecialist, chapter 2 was particularly difficult, with solid text, and no diagrams, notes or summaries to help the reader navigate new territory. Because of this, readers could miss some real gems such as this towards the end of chapter 2:
'during a natural physiological birth, the verbal expression of pain usually increases, and the need to move around will continue to encourage you to be active during contractions. As a result, to outside observers the pain will often seem unbearable, while in reality your actual perception of pain is reduced ... many women later report they mostly had feelings of overwhelming strength or of intense effort. Their pain had therefore already transmuted into something else.' (p28)
On the other hand, chapters 5 and 6 give a really good workbook for exploring and resolving the pain issue, and chapter 3 gives good advice for women choosing a caesarean section.
The author's passion for normal physiological birth shines through the book but it is unflinching in confronting the greatest hurdle modern western women face in childbirth. She looks at it from many different angles, reflecting on why women turn to caesarean section as a solution, or seek pharmacological pain relief, challenging both women and professionals about the efficacy and health of these 'solutions' to pain, whilst supporting women who do choose these paths with practical information. Although she argues on an intellectual level, it is clear that in her view the solution to pain is on the spiritual, instinctual and emotional levels – women transform pain from suffering to ecstasy by their acceptance of pain; by working with their pain, opening themselves up on every level, they are rewarded by a cocktail of hormones that make the experience a wonderful life-landmark of love and joy. It is this philosophy that permeates the book and puts it on the shelf of the midwife rather than the clinician. The purpose of natural pain relief is not to block the sensations but to enable women to accept and transform them.
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