Let me ask you a question. Have you ever been to a public toilet, sat down to do a number 2 (yes, I mean poop), then realize you forgot to lock the door when a stranger suddenly opens it wide and tries to walk in? Yes?
Follow up question. When this happened, did you lean back and continued your business peacefully, unbothered by the person who just opened the door on you, or did you startle, tense up and hold back perhaps?
If you're anything like most people, you probably prefer to go about your toilet business in privacy and peace, undisturbed. And yes, this preference also applies to parents, even though many parents, like myself, get ourselves used to having an audience once there are toddlers in the house. For us, the public bathroom scenario is less likely to be caused by you not locking the door, and more likely to be caused by your impatient toddler unlocking the door and swinging it open for you. I know I'm not alone in this.
But let's back up. Why am I going on about bathrooms and pooping in this post titled Your Birthing Environment? Don't worry, there is a connection.
Have you ever heard about something called The Fetal Ejection Reflex or the Natural Expulsive Reflex (NER)? During a normal and healthy labour, this is a reflex that will kick in at the end of labour when your cervix is fully (or almost fully) thinned and opened and your baby is ready to move out from the uterus, through the birth path, and out in to the outside world. The top (fundus) of your uterus has gathered strength and is bearing down on your baby, while sphincter muscles at the vaginal outlet open and pulsate to move the baby down and out. This is a natural and involuntary reflex in a birthing woman's body, that under the right circumstances will automatically expel the baby when the time is right, without any forced pushing on the mother's end. It's involuntary because you cannot and do not need to control it, it happens by itself.
You see, nature has it all figured out like that. If we trust in our bodies and in birth, there is really very little we need to actually do to make things happen. In fact, we are often better off doing and intervening less (unless there is a medical necessity of course), as this can actually interrupt the natural process.
Now, what you need to know about this automatic reflex is that it works best in the right environment. And by right environment, I mean an environment where you feel safe and calm and where you have privacy to let go and give in. Hence, the bathroom comparison.
Sphincter muscles are circular muscles located in different places in the body, usually remaining closed and contracted until it's their job to release and open to allow something to pass through. In the book Ina May's Guide to Childbirth, the midwife Ina May Gaskin describes what she calls the Sphincter Law. Some of the basic rules of Sphincter Law as she describes them are:
Excretory, cervical, and vaginal sphincters function best in an atmosphere of intimacy and privacy (think of a locked bathroom door).
These muscles do not respond well to commands.
A sphincter muscle that is in the process of opening could close down if the person becomes upset, frightened, or self-conscious.
The state of relaxation in the mouth and jaw is directly correlated with the ability of the cervix, vagina and anus to relax and open to full capacity.
(Ina May Gaskin, 2003, Ina May's Guide to Childbirth, p. 170)
Now, keep these basics of Sphincter Law in your mind while you consider the typical birthing scene in just about any movie or TV drama. A woman on her back with her legs up, surrounded by nurses and doctors she probably does not know, being told to hold her breath and push with all she has.
There is absolutely nothing about this scene that gives us a picture of calm, privacy and trust in the woman. Commands are being yelled at her, strange people are coming and going while she is at her most exposed and vulnerable state, checks are being made according to procedures, bright lights are often directed at her. It gives us the feeling that birth is always a medical event, one that women cannot accomplish without someone telling her what and how to do it.
The problem with this is, that an environment like this is the complete opposite of what a woman typically needs for labour to progress smoothly.
Let's go back to the toilet. A stranger walks in (or your toddler flings the door open) - you tense up and hold back.
Compare that to being in your birthing room, exposed and vulnerable, strangers walking in and telling you what to do - you tense up, and hold back.
Have you ever reflected over how other mammals labour and birth? Typically the pregnant mother, when the time is right, will seek out a safe and cozy place where she can be undisturbed and labour in peace. If by chance a predator or other perceived danger should appear, the labouring mother will shut down labour and run for shelter.
Humans are mammals too. Our instincts and reflexes are controlled by the primitive part of our brains. Birth is a primitive and instinctual process. We do not need to think about it and be told what to do in order for it to happen. In fact the more that we think and are told what to do, the more likely we are to interrupt the process. A perceived interruption or fear can cause a mother to pause or shut down her labour. It does not have to come in the shape of a sable toothed tiger, but could well be disguised as the wrong choice of wording or an ill timed vaginal exam by a well meaning care provider, some noisy medical equipment, or fearful thoughts in the mother due to lack of confidence and trust in her own ability.
So how do we avoid this situation?
A good start is to take the time to carefully plan your birthing environment. Consider what kind of environment will make you feel safe and calm. For some this is their own home where they are more in control and familiar with their surroundings, and for some this will be a hospital environment or a birth center. Where ever you do plan to give birth, a few things you might want to take into consideration.
Create a cozy and calm environment by dimming the lights, maybe lighting some candles (electrical candles are also an option here if you worry about forgetting to put them out).
Make a "nest" for yourself out of pillows and blankets, where your can lay down or sit comfortably.
Make yourself a playlist with calm and soothing music that makes you feel good.
Choose your care provider carefully, make sure that they are on the same page as you regarding what you want your birth to look like and that they support and respect you in your wishes.
Make a birth plan and discuss it early on with your care provider.
Consider who you want to invite into your birthing room. One way to go about it is to ask yourself, could I go to the toilet in front of this person? Make sure to surround yourself only with people that supports you and helps you feel calm and safe, and around whom you feel comfortable to let go.
Consider actually spending parts of your labour on the toilet - a place where you are already conditioned to relax and let go.
Consider listening to the birth story in this Mamamoon Podcast episode for some inspiration for your birth environment and the importance of surrounding yourself with people that support you. This woman created the ultimate birth tent at home in preparation for the birth of her baby.
In addition to all this, remember that knowledge is power. Educate yourself in regards to how your body and birth works, don't trust that what you see in movies and hear from others tells the whole truth. Research your options and rights, don't expect them to be laid out for you automatically. Because often when we don't look into our options and consider what we want, we receive the default, which you might later find out is what you actually want for your birth. Ask questions and make sure you get all the information you need to make good decisions for yourself and your baby.
If you're interested in learning more about birth and how to prepare for it, consider joining some of the birth prep classes at Mamamoon School, or perhaps look in to attending a HypnoBirthing course, where there is a big focus on providing education about how the body works during normal labour and how to make informed decisions, in order to create trust and help parents feel more confident.
And don't forget to lock that door next time.