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Miscellaneous Emotional Issues

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Birth Counselors

What is a Birth Counsellor?

A Birth Counsellor is a counsellor who is well-versed in the area of birth. The Birth Counsellor helps women and their families in three ways:

  1. We help the expectant family make informed choices about their preganacy, labour, and birth, as well as act as a resource for information on breastfeeding and parenting;
  2. We help women overcome any fears or concerns they may have related to pregnancy and birth;
  3. We help women and their families cope with emotional pain or grief from previous births.
As birth specialists, we have the responsibility to ensure that our clients get the best care possible. Please contact us for more information on certification as a Birth Counsellor or for a  program calendar with a complete list of communication and  counselling courses.

For more information, please email birthcounsellingskills@bc.sympatico.ca, or call: 1-800-755-3377

MCPAP for Moms promotes maternal and child health by building the capacity of providers serving pregnant and postpartum women and their children up to one year after delivery to effectively prevent, identify, and manage depression. Improving access to and engagement of pregnant and postpartum women in depression treatment leads to improved outcomes for mothers and their babies.  This program is funded by the Massachusetts Department of Mental Health.

Depression and Anxiety During the Perinatal Period (Medscape summary)
Nichole Fairbrother; Allan H. Young; Patricia Janssen; Martin M. Antony; Emma Tucker
BMC Psychiatry. 2015;15(206)

Tess Landey - ovenbuncoaching.com - in Berkeley but all sessions can be conducted in person, on the phone, or via Skype.

This is a fabulous article from Mothering Magazine:

By Naomi Goldberg

Great set of links about birth-related psychology and emotions

Medline Abstracts on Social Support and Childbirth Classes

Partners And Birth

How to Cope with Fears about Episiotomy or Tearing

An annotated bibliography on Development, Behavior, and Psychic Experience in the Prenatal Period and the Consequences for Life History compiled by M. Maiwald - The bibliography contains > 1200 assorted literature references covering prenatal matters including biological, medical and psychological topics which eventually influence later life. An Amazing Site!  [Ed. This title is translated from the German, and I strongly suspect that "Psychic" is meant to be Psychological.]

"Birth seems like a trauma because it brings to a head all the unresolved traumas of our lives."  - Wendy Grace, 7/13/95
[Midwife note - This is why midwives like clients to work on resolving their past traums before going into labor!]

"It's like being in a large corral w/ferocious beasts.  Birth tightens the corral to bring us face to face with our most terrifying demons."  - Wendy Grace, 10/17/95

'Memories' pass between generations [12/1/13] - Experiments showed that a traumatic event could affect the DNA in sperm and alter the brains and behaviour of subsequent generations. This brings new meaning to the phrase "breaking the cycle of inter-generational violence".

If you ever want to apologize to a client for anything, it is a general rule that women like gifts and men like their ego stroked.  I heard it from a professional counselor for healthcare providers!


Ina May Gaskin's TED talk, Reducing fear of birth in U.S. culture - about 15 minutes

Free Birth Coloring Books from Birth Art by Jessica

Empowering Photo Project 'One Day Young' Reassures Women That Childbirth Is Nothing To Fear - The Huffington Post UK  |  By Ellen Wallwork [3/16/15]

Emotional Self Help

See also: Visualization and Self-Hypnosis/Hypnotherapy/HypnoBirthing®

See also: Postpartum Depression and Maternal Birth Trauma

See also: Postpartum Integration of Birth Experience / Resolving Birth Issues

Marika Berman, MS, Emotional Freedom Techniques, "The Tapping Therapy" - some of my clients have benefited tremendously from this approach.  It is a somatic therapy that doesn't require analysis of the root of the problem.  408-978-5427.  Call for a free 15 min. phone/Skype consultation.

Eileen Sullivan, Shekinah Birthing Co. - http://www.shekinahbirthing.com

EFT is a simple and effective tapping procedure that is based on the ancient Chinese technique of acupuncture. EFT realigns the body's energy system without the discomfort of needles.  EFT also incorporates an emotional element into the healing process, to address the unresolved emotional issues that can cause or contribute to psychological dysfunction, physical disease, and perceived limitations that hold us back from what we really want in life.

Specializing in EFT for

Bond Between Midwife and Client

This section has been moved to Midwife / Client Relationships

Singing to Your Baby / Lullabyes

This section has been incorporated into Prenatal Music and Audio Bonding - Womb Song - Lullabyes

Grandmothers at Birth

I've had a few births lately where things did not progress well, and it seemed that part of the problem was that the birthing woman was hypervigilant about her mother's presence.  I think these particular births would have gone much better if the grandmothers hadn't been there, but I find myself at a loss how to help my clients know whether their mother's presence is likely to be supportive.  HELP!

I know what you mean.  Over the years, I've had a few births where it seemed that the grandmothers ruined what would otherwise have been a perfectly fine birth.  Then again, I've had a few births where it seemed that the birth would not have happened at home without the grandmother's loving support.  And, no, I don't really know how to help birthing women know in advance.  This is especially difficult when you don't meet the grandmother until she comes to stay a few days before the birth, or sometimes not even until the woman is in labor.  Any words of wisdom out there?

I work in a hospital setting where many of the birthing women are from other countries, or were born here into immigrant families.  Often, these women come to the hospital in labor with both the grandmothers and often a few sisters, aunts and cousins.  They are often overwhelmingly supportive in exactly the right way, providing quiet, confident support, praising increasing intensity as good progress, and reassuring the birthing woman that they have all gone through this, and they know she can do it.

One of the things I particular like about families from other cultures is that they realize that birth does not always go well, and they accept this as part of life.  They often trust that the medical staff are knowledgeable authorities on the subject of birth and that their recommendations are best.  And they know that even the best care cannot guarantee the best process or outcome.

OK - here's a summary of some of the above and some additional thoughts.  When birthing women are trying to decide who will be supportive at their birth, they should consider:

Quite frankly, I find myself wondering if it is EVER a good idea to have a grandmother at the birth.

If she has a very close, loving connection to the birthing woman, then it is going to be very painful for her to see her daughter experiencing any kind of pain - this is natural for any loving mother.  I've heard a number of grandmothers say that it's more painful to watch their own daughter giving birth than it was to give birth themselves; quite frankly, it's hard to see anyone you love in pain..  Everybody has a limit for what they can endure before they lose their composure, and then their behavior can be unpredictable, usually for the worse.  This is something that women may not understand until they have children of their own and then have to be there to comfort them when something painful is happening - maybe getting a vaccination or other injection, or maybe just the heelstick for the newborn screen.  Birth professionals often have to attend several births before they understand that feeling compassion for the birthing woman is helpful, but feeling sorry for her is not helpful, and that's what family often ends up doing.  It can be very difficult to find the most supportive level of compassion.

If she doesn't have a very close, loving connection to the birthing woman, then there are likely some long-standing conflicts between them, and these will almost inevitably surface under the tensions of a labor and birth.  Sometimes birthing women imagine that they can set boundaries that their mothers will respect, such as having them stay out of the birthing space.  Well, inevitably, the midwife is going in and out of the birthing room, and at some point the grandmother's curiosity will get the better of her, and she'll start horning in on their space.  It's just not good.

I don't know . . . I encourage my clients to ask themselves this basic question: "Would you be comfortable curling up in bed with your mother and falling asleep?"  That's the level of loving comfort that grandmothers need to be able to provide in order to be helpful at a birth.  Obviously, they also have to support the birthing woman's choices and trust her birth attendants, too.

I consider it a red flag if the birthing woman doubts her own ability to be a good mother - this means that she was not mothered well herself - that she hasn't seen a good example of competent, loving  mothering.

I had a client who explained that she had told all her family about being at her birth, "During this time period, NOTHING can be about you."  If a birthing woman can't say that to them beforehand and TRUST them to respect and honor that, and TRUST them to COMPLY with this request, then they are likely to be a negative presence at the birth.

Siblings and Other Family at Birth

See also: Homebirth Siblings

This study about prayer for cardiac patients shows that patients who knew they were being prayed for had a slightly higher rate of complications than people who did not know they were being prayed for.  It occurs to me that for laboring women, knowing that everyone is waiting to hear the news and "judging" the speed of progress is a source of anxiety that will make labor longer and harder and could increase complications. [Am Heart J. 2006 Apr;151(4):934-42]

Every Person at Your Birth is an Intervention [3/11/16] by Sarah Clark from Mothering Magazine

Childbirth is Not a Spectator Sport
-I'm going to make this really easy: if you weren't there for the conception, don't expect to be there for the birth of the baby. by Melissa Charles [4/10/15]

. . . And it doesn't end with the birth. Somehow, in our society, the postpartum period is becoming largely ignored, something to 'get over' rather than being a very real, very valid need, to recover from the birth experience. Instead of being allowed to rest as much as possible, being allowed to focus on her baby and recuperating, more and more new mothers are being expected to host people, sometimes starting with the first day home with the baby. Rather than being able to take her sore, bleeding, leaking, sleep deprived, hormonal, possibly stitched-up self to bed, (worse still if she had a Cesarean section) she's being inundated with phone calls, ringing door bells, and demands to visit with the baby. Or, worse yet, demands that the new family pack up and travel to visit others.

Birth, The Final Frontier Of Spectator Sport? [10/14/05] by Barbara Sumner Burstyn - this New Zealand article is  amusing and insightful.

Great birth story with photos that shows how a two-year-old can participate and really enjoy a sibling's birth.

My daughters, ages 3 and 5 1/2, were present for the birth of their brother 13 years ago.  It was a wonderful experience for me, and they suffered no lasting trauma. ;-)  The pregnancy had felt like a family project, and it just felt completely natural to include them in the birth.  It was *our* baby.  My mother and grandmother were present as support folk for the girls.  I agree that it's vital to have someone there for your son, and it needs to be someone who will be willing to step out and miss the main event if that's what your son needs to do.  The support person should also know enough about natural birth to reassure and explain things if your son has questions.

I wrote a curriculum for siblings attending a birth many years ago.  I only got to run the class once or twice, though, so I can't attest to it's effectiveness.  One of the exercises I did was to have the kids imagine they were pushing something very large and heavy across the room - a refrigerator was the example, I think.  They all mimed pushing this thing, with their faces getting red and making straining noises.  We talked about how Mom might look and sound when pushing out the baby.  We also talked about blood and how the baby might look all covered with gooshy stuff.  We talked about the cord and how cutting it feels like cutting your hair - doesn't hurt.

At my son's birth, my 5-year-old was right into it.  She crouched down in front of me when I was squatting and breathed with me.  She hopped up on the bed and rubbed my back.  She came over to touch the baby shortly after he was born, and congratulated me. :-)  My 3-year-old spent much of the time on her Granny's knee looking at books.  She was as impressed by the popsicles we'd stashed in the hospital pantry as she was by the baby, I think.  Each child brought a backpack we'd packed in advance, and they each had a present for the new baby.  We also brought pictures they'd drawn of the family with the new baby in it, and taped them up on the wall of the birthing room.  Neither child showed any sign of distress at any time.

YMMV, but I think it's a great family experience.

Be sure to tell them about the placenta, too!

How you prepare siblings depends a lot on the birth location. I think it's great when siblings want to attend. It starts with Mom & Dad talking a lot about "when the baby comes out", plans for the birth and what it will be like, watching videos together, age appropriate books on the subject, and having a caretaker for the child at the birth to look after her and explain things to her. My boys are 4&2 and watched their sister born at home. During labor they decorated a birthday cake and colored pictures for the baby, their babysitter brought them in for the last ten mins of pushing then they came and touched the baby and went back out while I delivered the placenta and got cleaned up. It was great. If it's at night I'd recommend not waking the child up until well into labor. If you're in the hospital, check their policies and negotiate with them if needed. I think watching birth is a great bonding and early sex ed for kids--hard evidence that birth happens or should happen in the context of a loving family.

Our oldest child was 3.5 when we had our last baby and she attended the birth.  It was wonderful.  It seems that children are still close enough to their beginnings in this world to understand birth for what it is. It was actually harder for her to understand the contractions I was having before the final labor, because we would be playing and I would have to stop and breathe, and that was confusing for her.  But, once in was the 'real thing', she was totally cool.  It was during the night, and she got up and stayed with me the whole time, sitting at my feet with stuffed animals, kissing my feet, etc.  It wasn't quiet either!  I make a lot of noise.  Deep native american sounding chanting stuff just comes out and rides me through the contractions.

Things went fairly fast, and when I started pushing it was really intense and baby and water and all started coming out together.  That was a little much for her, so she went and sat in the living room and waited until my husband went and got her and lured her back with talk of little toes and fingers.  They know when it's too much for them.

I think having older siblings being part of birth is wonderful and helps them very much with bonding to their new brother or sister.

I am a doula serving women in the southern Maryland area. My own personal birth experience includes having my older children involved at the birth of my last child. My sons were 8 and 6, and my daughter was 4. In addition to sharing age appropriate reading material on the subject and viewing videos, they attended all my pre-natals where my midwife Nancy let them listen to the babies heart, show them the different "baby parts" by feeling my belly, and allowing them to touch and see all the items in her birth bag. Each child was encouraged to participate at their own comfort level and was assigned their own special "birth helper" job. Also important is to have someone other than the father to support the children if they want to "disengage from the birth activity" for whatever reason.

As it turns out, our last baby Sarah came so quickly, that no other support people other than the midwife, made it in time except my close little family group. They expected loud birth noises and blood, but they really did not seem affected negatively by it. My 8 year old shadowed his father, my 6 year old stayed by my side, wiping my face with a cloth and breathing with me, and my four year old daughter was a junior midwife!! She was with Nancy all the way, and seemed much older than her years. She cut the cord.

My oldest son helped weigh and measure our new little one. My second son was given the honor or introducing our new arrival to everyone as they got there (not even knowing that she had been born already).

With each of my previous three births I did not even consider involving the children because I thought that they would be too distracting to me and that I owed all my concentration and mothering to the newly coming baby. I am so thankful that I changed my mind. While it may sound sappy, I do definitely believe that our family bonding was intense with this precious newborn and it made our family complete and connected like no other experience before or since. While the decision to involve children is very controversial and not for everyone, my family and I are blessed to have had this experience. 

Both in RL and via internet I know several families that have had older siblings at births -- from one year old to 10 or 12 years old. One of my friend's 10 year old daughter caught her little brother!

First, explain that mom will be doing hard work, might sound like she's in pain (and be in pain, but it's a 'good pain'), might moan 'to call the baby out' [<-- term we used but our then 2 year old slept through it]. Explain that mom won't be able to help anyone else, and Grandma (or whomever) will be there just for the child.

That is essential -- to have someone present at the birth just to be with any younger children.  Another very important thing to remember is that the child must decide if s/he wants to see the birth. The person there at the birth must be committed to staying or leaving -- whatever your little one expresses a desire to do. So if you think Grandma might try to influence your older child to stay, so SHE can see the birth, choose someone else ...

Then read lots of books that show entire births, watch birth videos. That way your little one will be somewhat prepared.

I've heard varying degrees of whether or not mom was able to deal with an older sibling during labor -- from wanting to be left totally alone to nursing during transition!

So really, you have to play it totally by ear, and roll with it. A lot like labor and birth, eh?

Of the couple dozen families I know only one had a sort of bad experience, because her 4 year old was alone, she was having a hard time pushing (the baby being born had his hand up by his face). Not horribly traumatic -- she just would have felt better with a support person. Everyone else either the kids loved it, or left. 

I was going to add to my comments already posted that these families I know who had kids betw the ages of one year to 12 years present at births were all home births, so there weren't any huge weird beeping machines, no cutting, no unfamiliar hospital staffs (most cases the kids knew the midwife pretty well) ...

And I'd like to reiterate that you need to have a caregiver for the child and the child only. Make it very clear to your child that mommy and daddy will be busy helping the new baby to born for a day or so, and <insert person's name here> will be helping the older sibling. If your child is too young to understand those kinds of things, then you might reconsider. Depends on the child.

Also, the child's caretaker must be committed to either staying or leaving the place of birth, allowing the child to decide with no influence from the caregiver.

We planned to have Amy at Jake's birth, but she fell asleep. She did fully understand that neither Dave nor I would be able to help her during the birth, and her best friend's mom was going to be there or be prepared to take her home with her, if she had been awake.

As it was, she remembered that I had told her several times there would be one or two nights when she would not be able to nurse to sleep, and when I really hit active labor, the moans sort of scared her, so she said she wanted to go to sleep "and I won't even get the mama tonight, right mama?" She was 25 months old.

When she was 16.5 months old, and I told her I was going to have another baby, Amy took her little baby dolly (correctly proportioned for a toddler), squatted on our gliding rocker with her dolly between her legs, started grunting and pulled out her baby (had not yet seen any birth videos). The following day she took a bath with me and started palpating my still flat belly.


This is such an individual choice - it depends on the parents, the particular child, and the person who will be with the child.  I used to teach a class for siblings who would be attending the birth.  The only negative story I ever heard involved a child of I think 8 or 9.  The little ones seem to be just fine.  I was once hired to provide labour support for a 4 year old girl.  She was mostly bored!  Having a support person for the big brother/sister is vital.  Then, the child can decide how much they want to see, and can leave the room if necessary.  Choose your support person carefully - they must be fully supportive of your choice and not easily freaked out - kids will pick up the moods of those around them. Preparation includes going to the doctor/midwife appointments with mom, playing with someone else's newborn if possible, books and videos, and role playing.  In my class, kids had to imagine pushing a refrigerator across the kitchen - what does your face look like? what sounds do you make? - letting them know that mom's pushing noises are just the sound of hard work.

My daughters were 5yrs4mos and 3yrs1mo when their brother was born.  My mother and grandmother were there for the kids.  We packed snacks and juice and books and a present for the new baby from each one.  They each had their own supply bag which sat in the hallway next to mine in the week before the birth.  My 5 year old was totally into it, rubbing my back and breathing with me.  After the birth she said, with wonder in her voice, Oh mommy, congratulations!  That was so great.  My 3 year old mostly remembered that after the baby was born she got a popsicle!

Some women do not want the distraction of having their kids present. That's a really valid concern, and something no one else can decide for you.  FWIW, I found it helpful.  I tend to get lost in the pain, and need to be brought back to earth.  I recall ending a contraction and having my small daughter slip and bump herself.  It felt really natural to go over and cuddle her for a minute and then go back to being cuddled myself during the next contraction.

If you decide to go ahead, know in advance that you'll get lots of opposition.  Just be sure of your choice, and don't bother discussing it with people who will give you a hard time.  Let your instincts - and your child - be your guide.

Pre-School Children At Birth 

I'm working with a labor coach client who wants to have her four-year-old present at a hospital birth.  She describes the child as "very mature", good at keeping still/quiet for a short period of time.  The child has seen some birth videos and expressed excitement about being at the birth.

Does anyone have any experience with pre-school children at hospital births?  Any particular recommendations?

Also, is there one particular video that would seem appropriate for a four-year-old?

I am a Bradley instructor  and the book that I recommend "Children at Birth" by Marjie and Jay Hathaway.  Also, If you can locate a Bradley or any CB instructor that can loan you videos that have children in them. I have attended births with children present. I remember a particular 4 yo girl who was right in the experience. She wanted to see everything. She didn't show any signs of problems and the sisters seem to be very close now.  I believe if we let the kids do what they feel is comfortable for them they will be OK. Some stay and watch, others get bored. They are all so different.

I always had my younger children present for their siblings' births...even when they were under 5.  In my personal experience, it was not only delightful for them, it was actually comforting to me to have the familiarity of them (for they were my life) surrounding me in the hospital.    My suggestions would be:

(Sorry so long)  Hope that helps.  It sure was nice to spend a few minutes thinking about my children at birth!

Our hospitals here require the child to have his/her own "doula" or caretaker. Someone who can answer the child's questions, take him to the restroom, take him out of the room if he gets fearful or antsy and distracting for some reason.

My daughter was just turned 5 when she came to the birth of our third daughter.  She was very "experienced" at seeing birth because she had watched ALL of the birth movies that I previewed during my pregnancy.  She told me that she would not be scared and that if I screamed too loud that she would just cover her ears!  We made sure that Lauren had a lot of things to do i.e. sticker book etc. in case it was a long haul.  Well, the baby was born after only 35 min. at the hospital.  Right after the baby was born, Lauren exclaimed, "I didn't even have to cover my ears!"  And, to show how normal birth is and the fact that children recognize this......as they were delivering the placenta, Lauren rushed over to me exclaiming, "Mom, LOOK!  Look at my STICKER BOOK!!!!"  Lauren is soon to be six now and still is talking fondly about "being there" when her sister was born.  In fact she will still give grocery store clerks etc. a play by play of the birth if they give her a chance!

Here are two videos dealing with children at births.  I have not seen either one and am just copying the information out of my Birth and Life Bookstore catalog.

Children at Birth  Jay Hathaway  - The joy of birth is shown in four natural, unmedicated births at home, in a birth center and at the hospital.  Children are present at all the births. ($39.95)

Lizzie and the Baby: The Childbirth for Children Video - Youngsters who see this video learn from another child how a fetus develops, what pregnancy is like for their mother, what happens during an actual birth and why a new pregnancy is a time for joy and adjustment in the family. Touches the lives of children and parents with its honest, sensitive presentation of birth in the family.  19 minutes  ($250.00)

No, that's not a typo - it really is $250.00.  They also have several books for children dealing with new siblings, but nothing specifically about them attending a birth.  If you are interested, you can get one of their catalogs by calling (503) 371-4445.

I can only speak from my own experience, and it is 10 years old! My older daughter (then 3 3/4 yr. old) went to the birth of my second child at the hospital. I always recommend to have an extra person that the child trusts to keep them company and bring a little bag of stuff for the child to do (in case of long labor). Mine happened to be very short (3 hrs.) so they didn't even get a chance to bake the cake. I might add to be sure this babysitter person also is a little familiar with birth. I put this in because I while I taught my child everything about birth, I kinda assumed my sister already knew about this stuff...she didn't and was a little green around the gills...lol

Anyway, there are lots of books out now-a-days for little ones to look at. Picture books about how mommy might be acting and the sights surrounding the birth. I also showed her videos (but can't remember titles anymore). I can however recommend a book and video I own now by the Bradley Method. They are both called Children At Birth.  I also stressed what I would look like in the pushing stage. The noises and facial expressions I would have. I think the stressful point comes right at the moment when the baby's head is crowning. My daughter would room into the other room and peek her head out once in a while. But she was fine throughout the whole thing and was so happy with her new sister!

I would just like to echo what others have said about needing someone there just for the child-- I have done "sibling support" at a homebirth for a friend, and have seen several children at home births, and a couple at the hospital.  It definitely works best when there is someone whose job is simply to attend to the child.  Make sure there is no ambiguity about this.

Sometimes parents overestimate how mature their children are---and sometimes there are emotional issues that get in the way of being practical about this. I had a lovely client who was very torn up inside about whether or not she would have enough love for her second child, after having been so closely bonded to her first.  And she had trouble looking at this---creating confusion inside her and in our communications about this.  I couldn't figure out why she was resisting my attempts to help her make concrete plans for her 5 year old...it came out during labor, when we were finally alone and she tearfully confessed this guilt and worry.  unfortunately, plans were ambiguous and almost didn't work for this little girl who really needed somebody (besides her mom's doula & her dad) to look after her.

Best recommendation is to have a separate "doula" for each child present- responsible only for that child and nothing else. It can be a relative, favorite person, or doula trainee. Their responsibility is to play with, meet the needs of, explain things to, and generally keep the child amused and informed and comfortable at whatever level he/she is capable.

Also, practice "labor noises"! This seems to be one of the biggies I've seen that bothers kids (even the bigger ones!).

The video I like for this age group is Injoy's "Lizzie and the Baby". It comes in versions for kids attending the birth as well as one for kids not attending.

One of the services that we offer is to provide a doula for siblings at birth. We have had several births where we provided this service and they have been wonderful.  We charge hourly with a minimum of 4 hours and the doula is only there to be with the child (usually the mom has another one of us to be with her)  One of the things that we recommend is to have the child bring a backpack filled with snacks and a cassette player with headphones, book etc. We have them bring their favorite pillow and sleeping bag if they want to "camp out"  We also suggest that they bring a disposable camera to take pictures of their new brother or sister.  The kids love to do this!  (and we have had some really interesting pictures when taken by a 3 yr old!) 

I love having kids at birth.  (I had three 21/2 yr olds and two 6yr olds at my last birth!  It was at home though...)  As long as someone is in charge of the child, it should be okay.  It needs to be someone who is willing to not be at the birth - It may even be dad!  Most moms at that point are more worried about how there child is doing then having dad at her side. (often one of the reasons they hire a doula)  Whoever has the child should have a cell phone, so they can be readily available even if they are playing on the stairs at the hospital!  I think movies or even real life experiences of people working really hard at something are invaluable for kids as they prepare for birth. Olympic competition, marathons, weight lifting, etc.  Show people who are working hard, red in the face sweating, grunting or yelling with exertion and happy to be doing it!  We talk about singing the baby out, etc.

Also, when the time comes, a chair at the head of the bed , kind of behind the bed, can put the child close to mom, out of the way (a good spot to be in charge of wet cloths and ice chips!) and avoids getting the full-on bloody "crotch shot" which can be pretty bloody right after birth  especially if mom tears and needs stitches-    Just some thoughts - Good luck! 

I was just at a birth where the 2yo sibling was present. This was an out of hospital birth center though. But he did well.

A good video for siblings is Lizzie and the Baby: The Childbirth for Children Video. It is available through Injoy productions ( 1-800-326-2082). The listed price is expensive ( 250$) but one of my clients called and got it for 40$ or so because she is a parent and they reduce the price for lay persons! So what we did was have her order it, and then she gave it to me as part of her fee payment. 

I've never had a problem w/ a 4 year old at a  hospital birth, as long as they have a care provider and some entertainment to take down into  the lounge if things are boring or too noisy for the child.

Most children that age seem bothered only by loud pushing, primal  scream noises and benefit from modeling of potential noises, maybe  mommy pretending to make "lion" noises or superhero noises - something  the child would think is cool rather than scary.

Often they prefer to run out of the room during pushes/contractions  and then return between. Most seem mesmerized by the actual birth and  some seem unbothered by anything they see or hear. Often they want to  hold their caregiver's hand or be in dad's arms.

Some want dad to support them if they're scared or bored so couples  need to discuss that possibility to see what they would do w/that  request.

Most are bored by the labor and exploring the hospital w/a pager on  their caretaker so they can come hurrying back if the birth is  imminent works well.

Bradley teachers sometimes have a "Children at Birth" video that kids  seem to like because it has other kids in it and a sheep being born.  Otherwise I've found most all birth films can be appropriate for this  age group if they are edited to make them shorter or you speed through  anything they don't like.

Afterwards, kids this age are generally interested in the baby for a  short period of time and then rapidly become behavior problems,  perhaps from being overtired, frustrated because mom isn't mobile and  playing w/ them after all these hours and just the excitement and  general attention paid to the baby - so structuring something fun for  them to go do afterwards w/grandma or their special friend or w/daddy seems kindest to all. Otherwise they play with the bed, jump on  the couch, run through the halls and otherwise act like typical four  year olds:) 

my oldest attended the birth of our second.  he was 3.5 at the time.  he  attended a sibling preparation class and of course we read books together and looked that the pictures.  we practiced breathing and toning with him.  watched silly sitcoms birth and to this day his response to those are 'that's not the way you have a baby. those women are acting silly.'

the other thing is the child needs a doula.  an adult attended solely there for the child.  not mom not dad not mom's doula.  my was our birth  room crowded.  a close family friend was my son's attendant.  he came and went as he pleased.  she took him for yogurt.  but he was right there to help dad cut the cord and from that day brandon was his baby.

of course it depends on the child.  my son is very verbal and i'm glad because his comment after cutting the cord was 'why did we cut the baby's penis off?' and he was pretty upset by that.  one thing i forgot to go over and over and over with him.  we sort of forgot the placenta and all.  any way it was sweet everyone in the room lifted their shirts to show off their bellybuttons including the MD.  i loved it.  and i was  glad he was there. 

I have done some sibling preparation classes for birth. I think there are three very important elements:

  1. Willingness/desire on the part of the child to attend.
  2. Good preparation, I have the children read books with their parents prior to our class. Then we look at photos and talk about the process, we draw pictures of mommy pregnant and of the baby being born, we get into a pushing position and make "pushing noises" together, we talk about the "good blood" that they will see, and then we watch birth films. Sometimes it takes more than one class to adequately prepare a child, but the important elements are their expectations about the sights and sounds of birth.

  3.  Last but not least, it is very important that the parents designate a support person to attend the birth just for the child, to answer their questions, take them for breaks, snacks etc... and to be willing and prepared to leave if the child wants to.
  4. If all is well thought out, my experiences with children have been great at births, I am reminded of a six year old that watched me do the hand signal for a breathing pattern with his mother, then said mommy look at me and took over coaching her breathing while I stepped back, it was wonderful, best of luck to you and them!

A midwife friend of mine told me about a birth where young siblings were present and the mom made very, very loud noises during the labor.  Afterwards, the dad asked the 2-year-old whether she was frightened during the birth.  The 2-year-old responded that she had never been frightened because the midwives kept saying, "You're doing great.  Everything looks good."

Sometimes we forget how much little ones depend on adults to interpret their experience for them.  There are things that scare adults that won't scare a two-year-old who feels safe because all the adults are acting calm.

I am currently trying to decide if my toddler should be at the birth of the new baby.  She will only be 16 months old when it happens, so I am just not sure if that will be too young for her to understand.  I am afraid that she will just be frightened.

Young children interpret events they observe according to the interpretations of the other people around them.  If other people
are very calm, she'll assume that this is a safe, calm event. I think most people agree that one-year-olds are not inherently
"grossed out" by mud, poop or blood.

I've seen one-year-olds at homebirth, and they were completely fine.

Very young ones often don't understand that anything is "happening" during labor so may become bored.  It often makes sense for them to be taken out to a park or allowed to continue sleeping until there's something for them to see, like a head near crowning.

I'd like my toddler to be present, but my mother and mother-in-law aren't very approving of homebirth, and I can't think who else to ask.

It makes good sense not to invite people to your birth if they're going to bring negative energy.  In this area, there are LOTS and LOTS of aspiring childbirth educators, doulas and midwives who are very eager for the opportunity to observe ANY homebirth.  And even some relatively new midwives might be eager to attend your birth for the opportunity to see another particular midwife at work.

You might ask around and see who's willing to exchange this opportunity for the responsibility of caring for your little one.

Oh, actually, I once labor coached a hospital birth where the mom wanted her five-year-old to be present.  This was going to be a VBAC, and the mom connected with another woman who had had a cesarean with her first and wanted to see a VBAC.  So you might even be able to connect with experienced moms who are considering homebirth.

Camera for Sibling at Birth

After our five-year-old watched the Bradley video, it occurred to us to give him a camera to use at the birth.  This will give him something to do with his hands while he's waiting.

This is a terrific idea on so many levels!  In addition to giving him something to do with his hands, it will give everyone some nice photos, and I can imagine his having his own personal photo album of the birth, which should enhance the bonding even further!  Also, cameras can have the effect of distancing the photographer from the immediacy of the event, so this would provide him with a way of remaining present while reducing the intensity if it's getting to be too much.

Sibling Rivalry

If your older child shows signs of jealousy at the birth of a new baby, he or she will feel better with some extra love and attention. Homeopathic Pulsatilla, given as the label directs, will ease the feelings of abandonment and help strengthen the bonding process with the new baby brother or sister.


The transformation of this woman into someone who can make her own choices, find supportive attendants, work with her partner to achieve a different experience for herself during childbirth, view birth as a healthy event and then go on to birth through her own efforts is no easy task for someone like the one I am describing. Through the process of education she can begin to question long standing beliefs and maybe make changes that will empower her in all areas of her life. Then she can surround herself from truly supportive people.

While we all enjoy having clients who have read everything there is to read about the subject of birth and are totally committed from the beginning to an unmedicated birth experience, it is the women who I describe above that are the real challenge. Don't get me wrong...I don't seek them out! I don't consider myself the 'savior' of these poor lost souls. I just feel that they stumbled on my classroom door because there is something that I can offer them that they very badly need. The others, the ones who come to my classes ready to teach it rather than to learn something new, need my help as well. They need confirmation of their belief system. So my friends, my vote in the empowerment issue goes to education first...the support system soon follows.

A Positive Pregnancy -  These pages were created to give women a voice about the magic... the excitement... the joy... the sensuality... the humor... the empowerment... the creative power that is pregnancy.

Satisfaction and Angst from Birth

Postpartum Rainbow  . . .It's More Than The Blues. . .  about the spectrum of emotional responses around birthing, parenting and bonding.

Birth as a Peak Experience - generalized search

Postpartum Surveys/Client Satisfaction

Notes from Sheila Kitzinger Talk - "Crisis in the Perinatal Period".

Marriage Problems after Cesarean

The Pain Continues - How A Cesarean Birth Can Affect a Marriage

First Time Mothers

I can honestly say, that the first time mom homebirthers are my best homebirthers, so far. In order for a mom to have a homebirth in my area, she must really seek out and research to find a midwife to do it. This requires a lot of commitment, and support in order to get what she wants. She is obviously educated about the options and has decided to have the birth that she wants, no matter what. Her friends and family are probably freaked about the idea, yet she pushes their concerns aside and does not cave in to peer pressure. She must fight the insurance companies, or pay for it herself (approx 2500 depending on area). Because we have regulations here in FL, she must meet all of them, and take excellent care of herself, thus continuing her self reliance and responsibility. She must be completely committed to the belief that birth is a natural process, and know deep in her heart that all is well, even though she has never experienced birth before, she trusts her body to be able to do a beautiful job.

On the other hand, to have a first hospital birth, she just make and appt at one of the hundreds of OBs around, she gives them a copy of her insurance card, and they take care of the rest (perhaps she must pay a deductible of 200-500), she shows up for her appts, and spends 10-15 minutes with the OB or his/her associate. She goes to the prepared hospital childbirth classes (read how to have an epidural [98% rate in my town]and be a good patient), and when her labor begins, gets to the hospital ASAP, to be monitored, IVd, epidural'd, catheterized and DELIVERED of her child, 32% of the time by C/Section. She must trust her doctor, and the hospital to take care of things for her. She not only does not learn how to trust her body to birth, she also does not experience the feel of birth. Definitely the easier route of the two. Should she decide to have a homebirth next time, she will have to unlearn all the negatives she learned in her first birth, and that baggage can be more difficult to deal with then a first time mom's inexperience.

Therefore, what I observe is, first time homebirthers are forced to be so committed to the homebirth that they almost always have wonderful, easy births, with little or no complications, hangups, or problems. By the time they get to the birth, it seems easy compared to the hell they had to get through to get a homebirth in the first place.

Michel Odent feel strongly about having first babies at home: "Zee first birth, this is the most important birth to have at home.  . .  . . because, if the woman has a beautiful  experience with her first birth, then perhaps she can go to the hospital for her second one and she will never let them do anything to her."

Corporate-Type Women Need More Emotional Support

I think society has bred our culture to believe that we have control over our environment, or that we are weak if we don't.  And, this just doesn't work in labor.  Someone who is in their head and trying to control their birth will either "give in" and surrender to the power, or become exhausted emotionally, physically, or spiritually and ask for an epidural to help them get through it or will get lucky with a precipitous labor that cannot be affected by her mind.

Although, I agree that first time Moms often have long labors, or at least statistically over multips, I think the head trip is much more an influence in some people.  And I deeply agree with the thought that the labor process is an integral part of preparing the couple for the challenges of parenthood.

I would agree about the transfers for epidurals (that they are a "a phenomenon of your local culture" . It would be interesting to hear from folks who live in areas where the epidural rates are high.

I did not (in 14 years) of attending women ever have or hear anyone ask for an epidural but I do recall a couple of times, when everything else failed that an epidural saved the day (and the vaginal birth). I am actually curious to hear other stories of transfers of this nature. The births that sometimes were the most challenging were the corporate women. Women who knew enough to know that they did not want to go to the hospital, but actually had the hardest time giving birth. (I am referring to the successful, powerful, tight women. I find them to be smart, but hard to relax into a labor, labor pattern or sometimes even a homebirth). Has anyone else had this experience? Any straightforward answers? Each time I had one as a client, I felt as if I spent an enormous amount of time trying to help her touch in with her feminine side, her nurturing self....but not always successfully....

I agree with you about these women and this is based on my year and a half of apprenticeship. We have had a couple of women like this in that time but one really stands out. She was a primip, 40 years old. She didn't really connect with the baby during her pregnancy and she had fears of the upcoming change in her lifestyle. She actually stopped her labor three times - her cervix would go from 8 back to 3 or 4. She really resisted giving herself over to her labor. She did finally have a homebirth and it is one heck of a story !!!

I see this as a control issue. These women have spent years being in control of their lives. Labor and motherhood are both very contrary to how they are used to living. They can be really resistant to that "out of control" feeling of labor. And, as I mentioned above, there are the fears of the changes that motherhood on the whole will bring.

Are there any straight forward answers to this one ? No way !!! But, since we can seem to spot these types pretty easily, we can spend lots of time focusing on these issues prenatally. I think that they often view this transition as a loss of what they have worked so hard for professionally. This isn't helped by our societies view of the importance of mothering.

You hit the nail on the head. Control is the biggest issue for some women....not safety, nor achievement, nor "a good experience", not even spirituality or convenience....but control. We are dealing with (in some contexts) a generation that has been told that they can indeed have it all (hey, it's my generation to some extent) if they only work hard enough and call all the shots. I'm old enough to realize that I was lied to on that one, but many women 10 years younger (in their early thirties) haven't yet cottoned on to the fact that they have been systematically lied to for years, that they are living a myth of success on male (not meant as a bash, just a shorthand observation) terms. And control is a BIG issue. One things that midwives of all persuasions learn is that you can not control the forces of labor and birth without really screwing things up, but we (the human race) continues to try. So we have the successful middle class middle management woman having her one or two carefully planned and timed children (and let's not even get into the psychosocial issues around infertility or subfertility that I have seen frequently in this demographic) and they want to be in charge. And to many of them that means a labor that is externally managed like so much of their life has been, where "the experts" are treated as consultants on a business fashion. You pay a consultant a lot of money, but you are ultimately responsible for choosing to follow or ignore the advice. So the midwife, the OB, the anesthesiologist all become the consultant but the woman chooses the path that meets her personal needs the most closely. And this is often a "detached" birth, where everyone watches TV or works on pending business while the uterus contracts, watched mainly by a machine, but does not interfere with the really important stuff that the woman is doing. Have any of you read the book "Cheaper By the Dozen"? What is really interesting to me in here is the industrial efficiency concept of "unavoidable delay" The mom of these 12 children considered her "lying-in" periods to be "unavoidable delay" in the grand scheme of things. The Gilbreths (parents in this book) were leading industrial psychologists and work-place organizers of their time (the 20s and 30s) and work of their type had a potent influence even down to our present generation. What is also interesting is the mom's perceptions of her various births (the first 11 at home, including one where she left the hospital in early labor because they took away her pencils and work!).

Anyhow, I'm rambling a little bit here. My current setting we are trying to figure out why the census at our little midwifery model hospital is dropping so fast. We are losing moms to the city where they can be assured of "their epidural" and high tech care. The home birth moms will have home births, and that is not a significant factor here, it is the moms who know we don't do anesthesia and drugs without good reason who are abandoning us in droves........

Signs That Women Will Birth Unmedicated

I got to talking with another midwife about "red flags" that a woman is going to have trouble with an unmedicated labor/birth.  Some of the signs were about how comfortable a woman is with her own body, some are about being able to let go and not try to keep in control, some are about recognizing that labor can be a challenge that is better met with good preparation, and some are about general maturity and responsibility.

I find that women who are orgasmic tend to do well in labor.  Also, those who have used a diaphragm or cervical cap.

The real red flags are the women who somehow think that the midwife can do it for them!

I notice that the women who serve me snacks at the home visit tend to do well.

I find that the women who have the best births are the ones who actually take the herbs I recommend, listen to the guided imagery audiotape I provide and pay me fully in advance!

Women who can pee standing in the shower do better at birthing, too.

Psychosocial Variables Predict Complicated Birth
Lewis E. Mehl-Madrona, M.D., PhD.
Journal of Prenatal & Perinatal Psychology & Health, 2002 Fall; 17(1):3-28

The purpose of this study was to assess the possible contribution of psychosocial factors to birth outcome, through prospective assessment prior to delivery.  Four hundred, eighty-six consecutive pregnant women in their first or second trimester were enrolled along with their partners; interviews were conducted with the benefit of physiological monitoring and a variety of psychological measurements.  Seven categories of psychosocial variables emerged with stability and reliability.  Two psychological factors - fear of birth and support from the woman's partner -  most strongly discriminated between the uncomplicated and complicated birth outcome groups.  The authors conclude that psychosocial factors do influence birth complications and attention to reducing their impact could potentially improve birth outcome.  Obstetrical care providers should no longer ignore these factors.

This journal article has an excellent listing of psychosocial risk factors:
Maternal Self-identity
Psychosocial Support from Baby's Father
Psychosocial Support from Mother's Mother
Life Stress

APPPAH maintains online abstracts.

Post-Traumatic Stress Disorder

Summary of recommendations for a pregnant woman with PTSD: Childbirth preparation techniques that address fears and promote relaxation were suggested (Birthing from Within), including hypnosis-based techniques (HypnoBabies, HypnoBirthing). Diet that promotes stress reduction and healing in the early postpartum period was presented, and therapy targeting negative memories (EMDR) was recommended both prenatally and postpartum.

Written by a mom who struggled to recover from PTSD following childbirth:

"I feel so much sympathy for all of you going through that hard experience right now.  I wish that I had more time to write and address everyone's situation personally.  I don't have the time, but know that I'm reading all your letters and feeling a great amount of love and sympathy for each one of you, as I know others are, too.

The book that saved my life was The Post Traumatic Stress Disorder Sourcebook by Glenn Schiraldi, Ph D*.  It costs $18.95 and is well worth the money.  He reviews what must be about every known therapeutic approach to helping recover from PTSD, along with an excellent description.  Just reading the description and realizing that one is normal is very healing. I would like to quote a little from his book:

We say that PTSD is a normal response to an abnormal event because the condition is completely understandable and predictable.  The symptoms make perfect sense because what happened has overwhelmed normal coping responses.  In another sense, however, the mental and physical suffering in PTSD is beyond the range of normalcy and indicates a need for assistance.  People with PTSD call to mind the Humpty Dumpty nursery rhyme.  They often report feeling:  shattered, broken, wounded, ripped or torn apart, like they'll never get put back together, bruised to the soul, devastated, fallen apart, crushed, shut down, beaten down, beaten up, changed, like life was derailed, as though they are in a deep black hole, damaged, ruined, different from everybody else, losing their mind, going crazy, doomed, dead inside, on the sidelines of life's games"

A trauma is a wound.  PTSD refers to deep emotional wounds.

 In one sense, PTSD can be viewed as a fear of the unpleasant memories of the traumatic event that repeatedly intrude into one's awareness.  Intrusive recollections can occur in the form of thoughts, images, or perceptions.  These intrusions are unwelcome, uninvited, and painful, and the person wishes that they could put a stop to them.  They often elicit feelings of fear and vulnerability, rage at the cause, sadness, disgust, or guilt.

PTSD is characterized by extreme general physical arousal, and/or arousal following exposure to internal or external triggers.  The nervous system has become sensitized by an overwhelming trauma.  Thus two things happen, General arousal becomes elevated, while the nervous system overreacts to even smaller stressors.  Signs of arousal include:  troubled sleep, irritability or outbursts of anger, difficulty concentrating or remembering, hypervigilance (feeling vulnerable, fearful of lots of things, unable to feel calm in safe places, fear of repetition), exaggerated startle response

Because the intrusive thoughts and accompanying arousal are so unpleasant, people with PTSD desperately try to avoid all reminders of the trauma.

PTSD is considered an anxiety disorder... Anxiety seems to take on a life of its own, and is not always proportional to what is going on in your life.  Anxiety accounts for a bewildering array of symptoms:  physical (tension, fatigue, trembling, tingling, nausea, digestive track problems, hyperventilation, pounding heart, suffocating feeling, panic attacks), emotional fatigue (irritation, moodiness, fear, exaggerated emotins, loss of confidence), mental fatigue (confusion, inability to concentrate, remember, or make decisions) spiritual fatigue (discouragement, hopelessness, despair).

The symptoms of enxiety are merely an exaggerated stress response.  They lesson as we retrain our nervous system to be calmer.  They increase as we tell ourselves that they are unbearable and must stop.

As a rule, unprocessed trauma material will continue to intrude until it makes sense, until you have processed it to the point where it can settle into long-term memory.  We shall learn shortly how this is done.

Associated Features:  Self-recrimination, shattered assumptions, mood disturbances, addictions, impulsive behaviors, somatic (body) complaints, overcompensations, death anxiety, repetition compulsion, self-mutilation, other self-destructive behaviors, alexithymia (shutting down of feelings), changes in personality

The seven principles of healing:  1.  Healing starts by applying skills to manage PTSD symptoms.  2.  Healing occurs when traumatic memory is processed or integrated.  3.  Healing occurs when confronting replaces avoidance.  4.  Healing occurs in a climate of safety and pacing.  5.  Healing occurs when boundaries are intact.  6.  Kind awareness and acceptance of feelings aid the healing journey.  7.  Balance in our lives is necessary to heal.

The book is 386 pgs. long, and every one of them helpful.  I will gladly write more if it is helping anyone.  For me, I tried to remember to do two things -- relax the nervous system, and process the memory.  I had some good friends help me role play the birth at one point, and also have it go the way I wanted it to go.  I had another friend who was willing to help me write some healing affirmations for myself, and we darkened the room and listened to soothing music while she read the affirmations to me.  It took a long time and much repetition, but the symptoms have decrease to the point that I'm not that bothered by PTSD anymore (it does come back on occasion, but I can take care of it).  At one point I thought I would have to have another child even though I didn't want one in order to heal, but I can now say that I no longer feel I have that need.

* The Post Traumatic Stress Disorder Sourcebook by Glenn Schiraldi, Ph D

Depression During Pregnancy

See also: Herbs for Anxiety, General Pregnancy Anxiety and Visualization and Self-Hypnosis/Hypnotherapy/Hypnobirthing

See also: "Letters to Our Sisters", a project to collect stories of hope and recovery from pregnancy related mood disorders.

Acupuncture: a promising treatment for depression during pregnancy.
Manber R, Schnyer RN, Allen JJ, Rush AJ, Blasey CM.
J Affect Disord. 2004 Nov 15;83(1):89-95.

CONCLUSION: Acupuncture holds promise for the treatment of depression during pregnancy.

Marcé Society - An international society for the understanding, prevention and treatment of mental illness related to childbearing

Joint APA-ACOG Algorithms for Treatment of Depression During Pregnancy

Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression

Pregnancy and Depression - Treatment of Depression during Pregnancy - extensive listing of Professional Journal Articles


Natural Antidepressants from Mother Nurture, which focuses on practical help for the mother's well-being, and for building teamwork and intimacy with her mate.

OutofStress.Com - professional articles for managing stress

I have found that increasing the raw materials that the body uses to make these brain chemicals can be helpful.  Specifically, the omega 3 fatty acids - there is good research out there on this.  I also suggest a full-spectrum light source be available.  You might also find the book "The Serotonin Solution" of interest.  It documents the connection between carbs and making serotonin biologically available.

For overacheiving perfectionists, I have found that flylady really helps.  I'm not kidding.  www.flylady.com

General Pregnancy Anxiety

See also: Herbs for Anxiety and Visualization and Self-Hypnosis/Hypnotherapy/Hypnobirthing

See also: "Letters to Our Sisters", a project to collect stories of hope and recovery from pregnancy related mood disorders.

See also: Prenatal Emotions

NOTE - It's best to avoid licorice during pregnancy.  Licorice is a hormone mimicker, which can affect fetal development.  Here's the BBC's Warning on liquorice in pregnancy

Anxiety in Childbearing Women: Diagnosis and Treatment By Amy Wenzel, PhD

Breathing: Three Exercises from drweil.com

The Power of the Breath
from mindingyourstress.com

Mind-Altering Microbes: Probiotic Bacteria May Lessen Anxiety and Depression

The research, carried out by Dr Javier Bravo, and Professor John Cryan at the Alimentary Pharmabiotic Centre in University College Cork, along with collaborators from the Brain-Body Institute at McMaster University in Canada, demonstrated that mice fed with Lactobacillus rhamnosus JB-1 showed significantly fewer stress, anxiety and depression-related behaviours than those fed with just broth. Moreover, ingestion of the bacteria resulted in significantly lower levels of the stress-induced hormone, corticosterone.

There is so much work to be done on reducing overal societal anxiety by reducing pregnancy anxiety.  This NYTimes article (Understanding the Anxious Mind by ROBIN MARANTZ HENIG) discusses the lifelong propensity for anxiety, evident from birth.  Those of us who provide prenatal care and care for labor/birth/postpartum are in an ideal position to help women reduce their anxiety during pregnancy.

Exercise May Buffer Effects of Stress - [June 2, 2010] — Short bursts of vigorous exercise -- the kind that makes you really break a sweat and increases your heart rate -- may help buffer the devastating effects that stress can have on cellular aging, a new study finds.

Most pregnant women are taking increased calcium supplements, which help to grow a healthy baby.  Unfortunately, if your calcium isn't properly balanced 1:1 with magnesium, you may be suffering from a magnesium deficiency.  Low magnesium causes increased levels of adrenaline, which can lead to a feeling of anxiety.  You can read about Calcium and its Relation to Magnesium - great explanation of the importance of balancing calcium with magnesium.  Peter Gillham is also the creator of MamaCalm, which is helpful for pregnant women who are experiencing anxiety, constipation or muscle cramping.

Start with the simple things . . . play uplifting music all day long and all night long, too, if you're having trouble sleeping.  I have found that putting A Child's Gift of Lullabyes on infinite repeat helps me to sleep easily and soundly.  It should be called A Midwife's Gift of Lullabyes!  The first song, Playing a Lullaby, is the one that helps me most.

Prevalence, Course, and Risk Factors for Antenatal Anxiety and Depression

More research is pointing to anxiety and depression during pregnancy as a pervasive problem affecting the health and wellbeing of both women and their babies. New findings published in the November issue of the journal Obstetrics and Gynecology suggest that anxiety and depression during pregnancy are both "highly prevalent" and a strong predictor of postpartum depression (PPD). The study found that anxiety and depression are most prevalent and most severe during the first and third trimesters of pregnancy, and that strong risk factors for anxiety or depression during pregnancy include younger age and a history of alcohol use.

Maternal Stress Mid-Pregnancy Raises Risk for Adverse Birth Outcomes [2011]

Enchanted Beginnings for Pre-Pregnant and Pregnant Couples - course offered by Karen Melton

"If your mom was stressed throughout her pregnancy, you may be too. It is not that we are making a conscious decision to be stressed, it is an unconscious imprint stored in our energy, our cells and our limbic brain. These imprints are stored in our body, and that’s why we don’t remember them cognitively. They are present in our daily life, but especially so when we contemplate, or enter into, parenthood. Often they are expressing themselves in relational behaviors and patterns, fears, anxieties and terror, bodily aches, pains and dis-eases, blocks and stuckness, an inability to feel at home in our body, feeling unsettled or anxious, and in many other ways."

Preparation before pregnancy affects birth outcomes.

Prenatal mood disturbance predicts sleep problems in infancy and toddlerhood.
O'Connor TG, Caprariello P, Blackmore ER, Gregory AM, Glover V, Fleming P; ALSPAC Study Team.
Early Hum Dev. 2007 Jul;83(7):451-8. Epub 2006 Sep 26.

CONCLUSIONS: Mood disturbance in pregnancy has persisting effects on sleep problems in the child, a finding that is consistent with experimental animal research. The findings add to a growing literature showing that maternal prenatal stress, anxiety, and depression may have lasting effects on child development.

Utilizing Energy Psychology Techniques During Pregnancy:  Empowering Parents to Decrease Stress, Heal, and Optimize - Seminars, Workshops, and Events by Wendy Anne McCarty, Ph.D., R.N.

Coffee, pregnancy, and stress - A small, preliminary study suggests that drinking coffee may reduce maternal stress in the third trimester of pregnancy. Researchers found that “the relaxing effect of coffee is stronger in pregnant than in nonpregnant women”.

Renee Smith's music is a wonderful combination of more traditional lullaby styles with more nurturing lyrics.  My personal favorite is her Angels & Mermaids CD, with her Lullabies For My Little Angels a very close second.  Her Seeds & Songs To Make 'em Grow is a wonderful collection for "older children", i.e. toddlers and pre-schoolers, not to mention their parents!  I don't know what it is about this music, but it always makes me so happy!  Cheaper than therapy and lots more fun; I call it my "audio prozac".

Risk Of Cerebral Palsy Increased With Constant Mild Gestational Stress [7/13/07] - Chronic mild stress in pregnant mothers may increase the risk that their offspring will develop cerebral palsy -- a group of neurological disorders marked by physical disability -- according to new research in mice. The results may be the first to demonstrate such effects of stress on animals in the womb.

Chronic mild stress during gestation worsens neonatal brain lesions in mice.
Rangon CM, Fortes S, Lelièvre V, Leroux P, Plaisant F, Joubert C, Lanfumey L, Cohen-Salmon C, Gressens P.
J Neurosci. 2007 Jul 11;27(28):7532-40.

"These findings suggest that stress during gestation, which may mimic low-level stress in human pregnancy, could be a novel risk factor for cerebral palsy."

Magnesium can help relieve anxiety as well as relieve constipation.  Especially if you're taking a calcium supplement without balancing the magnesium, you may have a magnesium deficiency.  There's a product just for pregnant women - Mama Calm

Mothers who ate chocolate while pregnant had infants who, at 6 months of age, were less fearful and smiled/laughed more, even if the mothers had been stressed during pregnancy.

Pregnant women may pass stress marker to babies - These studies could actually INCREASE the anxiety of women in pregnancy.  Their family, friends and care providers can help by offering them relaxation tools, including guided imagery or hypnosis.

Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy.
Yehuda R, Mulherin Engel S, Brand SR, Seckl J, Marcus SM, Berkowitz GS.
J Clin Endocrinol Metab. 2005 May 3

"Conclusions: The data suggest that effects of maternal PTSD related to cortisol can be observed very early in the life of the offspring, and underscore the relevance of in utero contributors to putative biological risk for PTSD."

Music May Be an Alternative Relaxation Technique With Cardiovascular Benefit  CME - [Medscape registration is free]

Pregnancy stress linked to child cortisol levels

Maternal stress and child psychology
Meanwhile, US researchers have found evidence to support the effect of another prenatal factor on long-term psychiatric health.

Analyzing information from the Avon Longitudinal Study of Parents and Children (ALSPAC), they showed that 10-year-olds were more likely to have elevated awakening cortisol levels if their mothers were stressed in the late stages of pregnancy. The effect held even after postnatal depression and anxiety were considered.

The findings are consistent with research in animals showing that prenatal stress results in long-term functional disturbance of the hypothalamic-pituitary-adrenal axis, which regulates levels of the stress hormone. Research into possible ways of altering the relationship between psychiatric disturbance and cortisol levels is now needed, says the team.

Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children.
O'Connor TG, Ben-Shlomo Y, Heron J, Golding J, Adams D, Glover V.
Biol Psychiatry. 2005 Aug 1;58(3):211-7.

CONCLUSIONS: This study provides the first human evidence that prenatal anxiety might have lasting effects on HPA axis functioning in the child and that prenatal anxiety might constitute a mechanism for an increased vulnerability to psychopathology in children and adolescents.

There are lots of good reasons to put some effort into reducing the stresses in your life or your response to them.  Not least among them is your ability to enjoy your pregnancy and your new baby, and to develop a joyful relationship with your baby.  There is some research that your anxiety may also cause some serious effects in your newborn:

Psychological Stress May Induce Diabetes-Related Autoimmunity in Infancy [Medscape registration is free]

Psychological stress may induce diabetes-related autoimmunity in infancy.
Sepa A, Wahlberg J, Vaarala O, Frodi A, Ludvigsson J.
Diabetes Care. 2005 Feb;28(2):290-5.

"CONCLUSIONS: Psychological stress, measured as psychosocial strain in the family, seems to be involved in the induction, or progression, of diabetes-related autoimmunity in the child during the 1st year of life."

Marcé Society - An international society for the understanding, prevention and treatment of mental illness related to childbearing. ... evaluate the relationship between maternal anxiety in pregnancy, and reported infant temperament

Placental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: a prospective investigation.
Wadhwa PD, Garite TJ, Porto M, Glynn L, Chicz-DeMet A, Dunkel-Schetter C, Sandman CA.
Am J Obstet Gynecol. 2004 Oct;191(4):1063-9.

"For deliveries occurring after 33 weeks' gestation (the time of CRH sampling in this study), our findings support the notion that in humans placental CRH may play an impending, direct role in not only the physiology of parturition but also in processes related to fetal growth and maturation. Our results also support the notion that the timing of onset of parturition may be determined or influenced by events occurring earlier in gestation rather than those close to the time of actual onset of labor (ie, the notion of a "placental clock")."

Calm vs Stress - A Causative Factor in High Risk Pregnancy (information from a Bradley handout)

Anxiety during pregnancy affects child behavior - The idea that a woman\'s emotional state during pregnancy affects her unborn child has persisted for centuries and has, in recent years, been supported by science.  . . . Our results suggest that the period between 12 and 22 weeks of the pregnancy is a particularly vulnerable period; only maternal anxiety during this period predicted childhood disorders at age 8 and 9. Importantly, the effect of anxiety [during pregnancy] affected the fetus more than any other factor, including smoking during pregnancy, low birthweight, or anxiety of the mother when the child is 8 or 9.

ANXIETY IN PREGNANCY AND THE PUERPERIUM - Cheryl Tatano Beck, DNSc, CNM, FAAN, University of Connecticut, USA

5 Ways to Cope with Stress When You’re Pregnant

Stress causes small babies - Pregnant women who suffer from stress are more likely to give birth to small babies

Babies At Risk From Stress In Pregnancy - Mothers' Anxiety Levels Linked To Autism And Dyslexia

Anji is a company dedicated to helping women improve their daily lives by reducing the physical and emotional effects of stress - "Pregnancy magazines show pictures of glowing pregnant women involved in all activities at all times of the day, with a ready smile. They don't show the pictures of the nauseous, sleep deprived, irritable, crabby, anxious mom-to-be at 2:00 in the morning who is worrying that every action she is taking is affecting her baby. Learn how Anji, Inc. can help you feel better during pregnancy, ease your labor, and give your baby the best start to life possible."

Anxiety and Stress in Pregnancy - Articles and Solutions - Hypnosis for Pregnancy and Birth Articles

The Influence of Maternal Emotions during Pregnancy on Fetal and Neonatal Behavior
Van den Bergh, B. R. H.
Vol. 5 (2), 1990, 119-130 - APPPAH journal

This study was designed to examine: 1) whether the influence of maternal emotions on fetal behavior could be established using real-time ultrasound echography and cardiography; and 2) whether the prenatal influence was reflected in neonatal behavior. In a longitudinal study of 30 women out of a larger group of 70 nulliparous women revealed that maternal state anxiety during echographic recording was significantly correlated with fetal behavior. Moreover, fetal behavior was sensitive to the influence of material chronic anxiety during pregnancy. Results on the subgroup of 30 women and their babies suggest a certain degree of continuity between fetal and neonatal movement patterns, and further indicate that the prenatal influence is reflected in neonatal behavior.

Antenatal anxiety and its effects on the baby

Association between maternal anxiety in pregnancy and increased uterine artery resistance ...

Someone was talking about how to deal with worries during pregnancy and i wanted to put in my .02. I agree that they should be taken seriously and dealt with. It was so much easier for me to release my fear when i could acknowledge my worst case scenarios - let them up and out.

With my 2nd pregnancy (probably my last), i discovered a fantastic book called, Creating A Joyful Birth Experience, written by Lucia Capacchione and Sandra Bardsley (ISBN 0-671-87027-0) $13.00 US Funds. They use a variety of imagery, writing and art exercises to connect you with yourSelf, and provide pretty comprehensive information about emotional self-care, birth plans, working with birthing professionals, etc. The unique angle on their work is that they use a technique using dominant and non-dominant handed writing and drawing exercises that have helped people (not just pregnant women) connect with their inner knowledge, inner child, intuition, etc. (whatever you want to call it)

For example, in working with worries, (one i used for my fear that my perineal tissue would tear through the anal sphincter like my mother's did with me - i decided to refuse an episiotomy after my 1st birth experience), is "From Worries to Wishes"(, and, yes, this is a ghastly run-on sentence): (you need 3 pieces of blank paper and at least one pen)

  1. With dominant hand, draw a picture of what you're afraid of
  2. On another page, make 2 columns. Left side is "Worries" and right side is "Action"
  3. In "worry" column, with dominant hand, write all your worries about the worry you drew
  4. Sit quietly and feel the fear - notice where it resides in your body. Using non-dominant hand, write an action you can take to contest each worry.
  5. Contemplate each action written down and how it feels in your body when you think about taking action. Take a 3rd piece of paper and draw (with non-dominant hand) what your ideal outcome is to each action.
  6. Put the ideal outcome pictures up where you can look at it daily and whenever you begin to worry, look at it and replace the negative mental image with the new positive image.
For example, i drew a picture of what i imagined my perineum would look like if it ripped. One of my worries on the 2nd page was that my perineal tissues wouldn't stretch fast enough. The positive thought action was to imagine heat on my perineum and see it stretching without tearing as the baby's head emerged, and i drew a picture of this on the 3rd page.

I paraphrased a lot here, but you get the idea. This book is stuffed full of great emotional and mental prep exercises, support network exercises, etc. It has my absolute highest recommendation. It made a world of difference in my 2nd birth in helping me take back my power and my body as a birthing mother.

Another favorite of mine for working through fears is a "word web" - starting with a word in the middle, like "fear" or "pain" or whatever, draw a circle around it and write 5 or 6 of the first things that come to you when you think of it, around the center word. Then circle these words and focus on each one separately and write the first words or images that come to mind for each one, connecting each circled word with a line. It gives you a word web or thought-tree. I've gotten some pretty cool insight from these!

PS - in case you were wondering, i did tear, but just up to the sphincter and not through it. I gave birth in the car on the way there and was upright in the front seat. There was not enough time to pull over and lean the seat back so i could lie on my side. But the point is, i didn't spend my whole pregnancy obsessed with the horrible thought of the baby's head tearing half of my perineum apart. OK, enough out of me for now - sorry my post is so long!

Can a Picture Of Your Mother Diagnose Depression?  Although many of Freud’s particular claims feel like cultural relics, modern attachment theory has confirmed the crucial importance of the maternal bond. As Harry Harlow put it, “You’ve got learn how to love before you can learn how to live.” And it’s our mothers who often first teach us how to love.

Pregnancy Optimism

In one of our classes on gestational diabetes, the instructor talked about how difficult it can be to communicate the importance of minding blood sugars when women can't see the symptoms other than on their glucose monitor.  She also said something about how pregnant hormones make women very optimistic, so they have trouble appreciating that blood sugar issues really can cause problems.

I asked an OB about this, and she said that the elevated testosterone levels could make pregnant women very optimistic.  She talked about the dance of hormones between the placenta, adrenals and the liver.  She pointed out that people with liver problems will also be more affected by increases in placental hormones.  She suggested reading more about the endocrine function of the placenta and the role of testosterone from the placenta or from a male fetus.

On Becoming a Mother/Emotions of Motherhood

Time is running out for my friend. We are sitting at lunch when she casually mentions that she and her husband are thinking of "starting a family". What she means is that her biological clock is ticking and has begun its final countdown.

"We're taking a survey," she says, half joking. "Do you think I should have a baby?"

"It will change your life," I say carefully, keeping my tone neutral.

"I know," she says, "no more sleeping in on the weekend, no more spontaneous vacations..."

But that is not what I meant at all. I look at my friend, trying to decide what to tell her. I want her to know what she will never learn in childbirth classes. I want to tell her that the physical wounds of childbearing heal, but that becoming a mother will leave her with an emotional wound so raw that she will be forever vulnerable.

I consider warning her that she will never read a newspaper again without asking "What if that had been MY child?" That every plane crash, every fire will haunt her. That when she sees pictures of starving children, she will wonder if anything could be worse than watching your child die.

I look at her carefully manicured nails and stylish suit and think that no matter how sophisticated she is, becoming a mother will reduce her to the primitive level of a bear protecting her cub. That an urgent call of "Mom!" will cause her to drop a souffle or her best crystal without a moment's hesitation.

I feel I should warn her that no matter how many years she has invested in her career, she will be professionally derailed by motherhood. She might arrange for child care, but one day she will be going into an important business meeting and she will think about her baby's sweet smell. She will have to use every ounce of her discipline to keep from running home, just to make sure her baby is all right.

I want my friend to know that everyday decisions will no longer be routine. That a five year old boy's desire to go to the men's room rather than the women's at McDonalds will become a major dilemma. That right there, in the midst of clattering trays and screaming children, issues of independence and gender identity will be weighed against the prospect that a child molester may be lurking in that restroom.

However decisive she may be at the office, she will second-guess herself constantly as a mother.

Looking at my attractive friend, I want to assure her that eventually she will shed the lbs of pregnancy, but she will never feel the same about herself. That her life, now so important, will be of less value to her once she has a child. That she would give it up in a moment to save her offspring, but will also begin to hope for more years - not to accomplish her own dreams, but to watch her child accomplish theirs. I want her to know that a cesarean scar or shiny stretch marks will become badges of honor.

My friend's relationship with her husband will change, but not in the way she thinks. I wish she could understand how much more you can love a man who is always careful to powder the baby or never hesitates to play with his child.

I think she should know that she will fall in love with him again for reasons she would now find very unromantic.

I wish my friend could sense the bond she'll feel with women throughout history who have tried desperately to stop war and prejudice and drunk driving. I hope she will understand why I can think rationally about most issues, but become temporarily insane when I discuss the threat of nuclear war to my children's future.

I want to describe to my friend the exhilaration of seeing your child learn to ride a bike. I want to capture for her the belly laugh of a baby who is touching the soft fur of a dog or cat for the first time. I want her to taste the joy that is so real, it actually hurts.

My friend's quizzical look makes me realize that tears have formed in my eyes.

"You'll never regret it," I say finally. Then I reach across the table, squeeze my friend's hand, and offer a silent prayer for her, and for me, and for all of the mere mortal women who stumble their way into this most wonderful of callings.

Women Who Regret Motherhood Share Their Stories - This is a somewhat taboo topic, but I have come across it even in my practice.  We know these women are good mothers because we only hear these stories anonymously; they do their best to make their children feel loved and wanted.  But for women who are ambivalent about becoming pregnant, this may be a helpful counterbalance to the overwhelming societal and familial pressures to have children.

Feelings about Being Naked and Bodily Emanations while Birthing

See also: Birthing Noises

[about being naked and putting your butt in the midwife's face]

For me, it was a combination of believing part of it was pregnancy, not fat...and also the fact that I have a hard time *really* seeing how I look.

Hopefully midwives see enough naked (or partially so) bodies that they really don't pay attention anymore.  Besides that, they don't all have figures like Pamela Anderson themselves.

OK, I really had to laugh at this.  I weigh much more than most of my clients, even at term.  I am definitely not the Pamela Anderson type.  [Very Big Grin.]

I just wanted to chime in from a midwife's perspective.

Believe it or not, it barely even registers with me whether a woman is clothed or not; part of my brain might note that she's showing a "loss of inhibition", which is an emotional signpost of labor progress for some women.

Other than that, I just don't care, as long as the baby can find the way out of whatever she's wearing.

Sometimes the line between clothed and unclothed gets really blurred in labor.  We often associate nakedness with vulnerability, but laboring women are so powerful that this gets all skewed. In fact, sometimes I get a little blurred on the clothed or unclothed thing myself and forget whether I'm naked or not. I still do a mental check when I walk out the door of my house to make sure I'm wearing clothes.

About pushing things out in midwives' faces, it might help to know that midwives generally get all excited about any and all excretory functions, because they are often a sign of progress.  We're glad to see waters (in labor), we're glad to see pee at just about anytime, we're glad to see appropriate bleeding as a sign of progress, we're glad to see vomiting as a sign of transition, and we're always very excited to see the "positive poop sign". And we're very, very glad to see that baby coming out!

Truly, anyone who's attended a few births has seen it all; squeamish people don't attend more than a few, and the others are generally quite pleased to see whatever's coming out of your body.

So, let it all come down and out.  [Grin]


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