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While in Malaysia this past week speaking about respectful care, I always love the opportunity to open up the topic of pleasure, ecstasy and Orgasmic Birth. It is too often a forgotten aspect of childbirth, or the one aspect that is avoided, as to talk about pleasure and/or the sexuality of birth can make many people uncomfortable. Yet, for me it is an essential topic if we are to look at the ways to honor, respect and offer women the options and care that will make childbirth as safe and easy as possible. To only talk about birth in our current medical, technocratic paradigm of pain and fear is to miss key elements that can transform childbirth and a woman’s experience of pain into pleasure, bliss and joy.

At the closing panel for Women Deliver, Kavita N Ramdas (Ford Foundation representative in New Delhi serving India, Nepal and Sri Lanka) gave a wonderful presentation summing up all the topics 4500 people from 159 countries had come together to discuss and brought up how we need to talk about pleasure too. I smiled, as I could not agree more. In addition this week Science Direct published Childbirth Climax: The Revealing of Obstetrical Orgasm stating, “Some mothers report experiencing intense physical pleasure during childbirth, which conflicts with popular belief and cultural taboos.” The author surveyed midwives; “the survey showed that 85% of the midwives questioned knew that it was possible to experience physical pleasure during childbirth. Nevertheless, 31% of respondents never observed a case, while 99% of the cases reported were observed by only 50% of the midwives questioned.”

Sitting in my hotel lobby in Kuala Lumpur, I was interviewed by Stephanie Pappas for my comments on the new study. I shared how many women have told me they never told anyone, including their partners, that birth was pleasurable as they felt ashamed that something our culture tells us should be only painful can be pleasurable. So, when asking caregivers how often they see pleasurable birth, I am not sure they always know what the women are feeling. Would you feel you need to share with your doctor or midwife if you had a pleasurable or orgasmic birth?

I am so grateful to the author of the study T. Postel, who adds another layer of information to open up our minds to all that birth can hold. In the conclusion: “by producing proof that a mother can experience physical pleasure during childbirth, this study constitutes an additional element in the understanding of the already- polymorphous female orgasmic response, and calls the function of orgasm back into question (Reich, 1986). It sheds new light on birthing conditions, midwife education, and labor preparation (Van Der Schueren, 2003).”

It is time we acknowledge scientifically the ability to find pleasure in childbirth. In addition, as T. Postel suggest we must look at the birth environment or as I call birth ambiance, we must include training on the natural physiology and the hormones of childbirth that can lead to pleasure in education for our midwives, nurses and physicians. As well as, we must provide education and offer preparation for women and men so that we recognize the connection between pain and pleasure and help women find the path to a safe, satisfying and pleasurable birth. As the article states, and I could not agree more, Orgasmic Birth should not be a performance standard, yet we should honor the potential for birth to be pleasurable and offer the options, environment and respectful care that optimizes the possibilities. I believe we must address why many people feel more comfortable with birth as painful and the mention of birth with pleasure as controversial.

Please share your thoughts and comments with me on this blog, the study, and the follow up article. To read Stephanie’s follow up article please visit: http://www.livescience.com/37039-orgasmic-birth-real.html.

I continue to collect women’s stories and comment and as I am preparing a webinar series, article and more on pleasurable birth, I hope to hear from you!

Pleasurably Yours,

Debra

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I began my doula work before I knew the word “doula.” As a childbirth educator in 1986, I attended my first birth with a couple from one of my childbirth classes and immediately knew that this was what I wanted to do with my life. As the mother, I felt that it would be an honor to nurture women and their partners at such a critical time. In 1987 I  read an article in Mothering magazine about Doula, Inc., of Rhode Island. As I read the description of a doula, I said to myself, “I am a doula.” It was a magical moment. I called the organization and spoke with Cindy who knew of a woman named Jane Arnold in Westchester County, New York (across the Hudson River from my New Jersey home) who was running a doula service called Mom Service, Inc. I soon had Jane’s brochure in-hand and called her. I was pleased to learn more about doulas, what they do, and how to run a doula service. Jane was hosting a picnic that weekend for her doulas and invited me and my children to attend. I will never forget driving across the Tappan Zee Bridge that warm sunny day and arriving to meet Jane and her children and her doulas, as we laid our blankets out and had a picnic in her yard. He warmth and passion embraced me. She shared her dream to become a nurse, then a midwife and to bring doulas and midwives together, with a passion to serve underserved women.  I remember thinking how will she do this and Do this and more she has!

Jane became my mentor. As the mother of four, running her own company, she helped me to begin MotherLove, Inc., and to learn and grow as a doula. In those early days, no one knew what a doula was, friends called us “granola and oatmeal women.” Hospitals and medical providers wouldn’t even return phone calls. On many days when I was ready to give up, Jane helped me regain the vision of a doula for every woman who wants one. She kept me focused on the work we had done and what lay ahead, reminding me that change is a long, slow process, but well worth the effort. Jane began nursing school soon after we met. I greatly admired her determination to achieve her goals. Her example kept me focused on mine: to bring doula care into mainstream medical care.

I grew interested in the role and history of doula care and maternity care around the world. I reached to anyone who knew how different cultures or countries cared for women around the time of birth. I talked with anyone who would listen about doulas and the importance of caring for women and children.

Jane completed nursing school and began practicing as a registered nurse at North Central Bronx Hospital in New York City. Although we had less time to speak on the telephone, she kept encouraging me to carry the doula torch. Jane went on to midwifery school through the Frontier School of Midwifery in Kentucky, and was soon a certified nurse-midwife (CNM) working at the Morris Heights birthing Center in the South Bronx.

One day in 1994, Jane called to say she had been awarded a grant from the Robin Hood Foundation the Aaron Diamond Foundation to begin a doula training program, to be called the Morris Heights doula Program, in the Bronx. To my delight, Jane invited me to participate.  She was bringing midwives and doula together for the very first community doula program. I will never forget the first day I drove to the Bronx, a community not far from my own geographically, yet so very different from my suburb. I felt excited, nervous about not knowing what to expect, and keen interest in how this ethnically diverse community would react.

The training was exhilarating. To hear women from many cultural backgrounds share their stories to share their visions and hopes for nurturing support for pregnant and birthing women justified the days I had spent learning and planning. I knew then that Jane and I were right: Women everywhere would embrace this concept. We would work hard to return caring, education, and nurturing to communities everywhere. The Morris Heights Doula Program reignited my passion and determination to bring doula care to all women who wanted it.

In 1992 I attended the first meeting of Doulas of North America (DONA) in Boston and found myself a member of its first board as chair of public relations. I was to work with Penny Simkin, Dr. Marshall Klaus, Dr. John Kennell, Phyllis Klaus, Annie Kennedy and many other wonderful people. My horizons continued to broaden and my views expanded.

In 1994 I was invited to speak at the White House to the Task Force on Health Care Reform about doula care. A few years before, I had been unable to get a local obstetrician to speak with me. Now Hillary Clinton wanted to know more about doulas and the role we could play in rebuilding our families and communities.

In 1995, as a board member of the Northern New Jersey Maternal Child Health Consortium, I had an opportunity to participate in the development of a grant proposal to provide doula care to women in treatment from substance abuse and alcohol addiction in Paterson, New Jersey. The Neighborhood Doula Project was founded with a grant from the Robert Wood Johnson Foundation of Princeton, New Jersey, and later Healthy Mothers, Healthy Babies of Paterson. Again Jane provided guidance and wisdom as we brought doula care to a community burdened with difficult issues. Unemployment is rampant. More than 30% of homes with children have only one parent. High rates of violence and child abuse and widespread distrustfulness cry out for emotional and spiritual nurturing. I trusted my heart that doula skills were needed here. One cold winter morning in Paterson after a month of training- five talented black women spoke passionately of the need to reduce the high rate of black infant mortality in their communities. They vowed to help raise the low rates of breastfeeding, to lower the incidence of postpartum depression, and to reduce ever-increasing rates of child abuse and neglect. They proclaimed their determination to assist teenage mothers, to help women stay off drugs while pregnant, and to prevent child abuse.  Hearing my words echoed in theirs, I felt fiercely proud of them.  If training and education no longer come automatically from one’s actual mother, sisters and friends, they can come from surrogate mothers… from doulas.

Directing the Neighborhood Doula Project enriched my life in ways I had never anticipated. I learned so much from the doulas and the women we served. Running this program reinforced my belief that caring for pregnant, birthing, and parenting women and their families is necessary if we are to provide the next generation with the love and family values we hear thrown around in political speeches.

In 1996, with a grant from the New York State Department of Health, Jane was hired by the Department of Obstetrics, Gynecology, and Reproductive Medicine at the State University of New York at Stony Brook to begin a midwifery practice there. As Director of Midwifery, and with the help of other key nursing personnel within Women and Children’s Hospital at Stony Brook, she prepared to bring doulas to the surrounding community. In 1998, Jane and I began to train doulas at Stony Brook.

Jane and I and the Midwifery Practice and School of Nursing at Stony Brook are honored that our work to return education, caring, nurturing, and high-quality medical care through midwives and doulas into communities was featured in “Indivisible,” a national documentary funded by the Pew Charitable Trusts. (www.indivisible.org)

Our journey has continued to include bringing Midwives and Doulas together in North Carolina and Botswana- Africa. We don’t know the next place we will be together,  yet,  Jane will always be in my heart as I pass along the warmth and wisdom she greeted me with years ago. I now train, speak, consult, and design doula programs for hospitals, medical providers, and doulas globally.

Doula programs are regularly being started in new communities around the world.  Jane and I continue working together to bring midwives, doulas and doula training to all women and all communities.

Wherever the doula heart and spirit live, the interrupted tradition of woman-to-woman, mother to mother care resumes and prevails.

I thank all the doulas and midwives who have joined us on this journey. They bring their dedication and love to grateful families every day.

Thank you Jane for starting me on a journey that continues to evolve. Looking back to that day on your lawn, I could not have imagined the many places around the world we have reconnected the circle of support of midwives and doulas. Thank you for sharing your vision and making it happen.

With love and gratitude,

Debra Pascali-Bonaro

Debra and Jane collaborated on Nurturing Beginnings, found on the DONA Post Partum Reading List- an updated, digital version of Nurturing Beginnings will be available later this year. If you’d like to receive announcements about this updated, electronic version of Nurturing Beginnings please sign up here.

I love when three powerful things happen all at once, showing a sign that we are shifting.  My mother always shared with me “the one constant in life is change.” Yet, sometimes it is hard for us to see or feel the change.  The landscape of maternity care in my state of NJ and in the U.S in general has been far from what I hoped for.  A day that can transform women, as Deepak Chopra said:

“Labor is an opportunity for women to learn about themselves and discover the strength and wisdom inherent in their bodies.”

Yet sadly a day that can be ecstatic, powerful, blissful or orgasmic is  turning traumatic for far too many women.

As I drove into NYC to attend the UN meeting on Respectful Care I listened in to the press conference for the release of the Listening to Mother’s III Survey.

It was sad to hear the data, but not surprising.  The last few years I have seen both women and providers so filled with fear of childbirth that they are using technology as false safety nets, not wanting to acknowledge all the risks we are putting our Mothers and Babies thru and the poor outcomes we have for a country that spends more on maternity care than any other country in the world.  “The United States spends $98 billion annually on hospitalization for pregnancy and childbirth, but the US maternal mortality rate has doubled in the past 25 years. The U.S. ranks 50th in the world for maternal mortality, meaning 49 countries were better at keeping new mothers alive.”  http://www.huffingtonpost.com/2012/08/24/maternal-mortality-rate-infographic_n_1827427.html

For all our interest in eating healthy and organic, many women turn their bodies and their babies over to medicine and allow many drugs and procedures to be given to them, some that we know are harmful or ineffective and many that we don’t know the short or long term consequence for MotherBaby  What happens when we disturb a healthy process and replace our natural hormones with drugs and surgery at alarming rates? We are only beginning to ask these questions.

Here is what I heard on the press conference of what women shared about their birth experiences that rang in my ears as I walked into the Respectful Care meeting:

• Few women used simple, low-risk, drug-free measures to ease labor pain, like taking hot showers or baths. Women who had taken childbirth education classes were more likely to try such measures.
• Many women report experiencing pressure from a care provider to have a cesarean, labor induction, or an epidural.
• Many women reported that they held back from asking questions because they were concerned about being perceived as difficult, they wanted maternity care that differed from what their health care provider wanted, or their provider seemed rushed.
• Most women who had an episiotomy, an incision in the skin around the vagina made during delivery, were not included in the decision to undergo the procedure.

There were some good findings: Women’s readiness for pregnancy appears to be improving. Hospital support for exclusive breastfeeding is improving, although women’s intentions to and experiences with exclusive breastfeeding appear to be declining.

The room was full, I quickly found a seat up front and just settled in as the presenters began to speak about Disrespect and Abuse, D & A and defined Respectful Care through the White Ribbon Alliances Universal Rights of the Childbearing Woman http://www.whiteribbonalliance.org/WRA/assets/File/Final_RMC_Charter.pdf

I wanted to call out and say we need to frame the LTM III survey results within this same human rights framework.  How have we silenced American women so that we accept institutional abuse and disrespect?  Thinking back to the survey, we cut women’s vaginas without their permission and this is acceptable?  If a woman were cut on the street she would know it’s abuse, but in a hospital it’s allowed?

It’s your body and your baby, you should be able to ask questions, to be respected, treated with dignity and fully involved in collaborative decision-making.  In addition, the proportion of women with a prior cesarean who reported a lack of access to VBAC grew to 56% in the current survey from 42% a decade earlier.  This is putting women at three times greater risk of dying in childbirth with major abdominal surgery. Yet, many women report experiencing pressure from a care provider to have a cesarean, labor induction, or an epidural.  Many women reported that they held back from asking questions because they were concerned about being perceived as difficult.  Would you buy a computer, cell phone, car from someone who is pressuring you and that you don’t feel comfortable asking question?

Yet, we trust our health and well-being to a maternity care system that is clearly broken giving us care that is not supported by the best research and women are made to feel as they are the ones that can’t speak up?

It’s time we speak out about abuse, speak out to have access to more effective, low cost comfort measures that are not available to many women such as tubs, balls, doulas that we know make a difference!

This is a human rights issue!

I am getting ready to fly to Malaysia to speak on the Respectful Care Panel at www.womendeliver.org with over 5000 global leaders and change makers coming together.

“Women Deliver 2013 will serve as a global platform for ensuring that the health and rights of girls and women remain top priorities now, and for decades to come.”

I will be sharing about the International MotherBaby Childbirth Initiative www.imbci.org that offers quality evidenced based care, within a human rights framework and a caring heart.  Honoring each woman’s right to choose where, how and with whom to safely give birth.

Please join me in one of these ways:

• Liking this post and sharing it with your friends.
• Share your birth story with us
• Were you offered access to the Lamaze Healthy Birth Practices that provide the safest birth we know based on the research? Share what you wished you had know or received.
• Visit http://www.whiteribbonalliance.org/index.cfm/the-issues/respectful-maternity-care/ and share their video Break the Silence.
• Support the US  Mother-Friendly Childbirth Initiative www.motherfriendly.org and the global version the International MotherBaby Childbirth Initiative www.imbci.org.
• Globally next week is World Respected Childbirth Week, http://www.smar.info in many countries there are events, education, films, discussion and a look at birth as a human rights issue. If there is an event in your community join it, if not, consider creating one.

We have the information and the knowledge to make a change, now we need you to Stand up and Deliver, Don’t take it lying down!