The Red Tent of My Heart
(May Contain Spoilers)
I read the Red Tent, by Anita Diamant, when I was in nurse midwifery school. It was was an assigned book for the last class I took before I switched programs. I went tent camping with my husband and three children and threw it in my bag so I could keep up in class. Once I started reading it I could not stop. I was swept up into Dinah’s life. Sitting in woods, by a fire I read about the lives of women. I recognized the women from long ago in myself, my sisters, mother, daughter and friends. It may have been the romanticism of reading the story while living in a tent, but I fell madly in love with it. I was already infatuated with midwifery and birth. The way that Diamant described the interactions between women, birth and death struck me to the core. Although I did not pursue the midwifery path, I still feel the burn of the call. I get a glimpse of it from time to time in the hospital. Women supporting each other in the most intimate way while walking the line between death and birth. Although birth has become safer in many ways, birth attendants still feel and fear death lurking in the corners of every delivery room. I believe that is why a lot of well meaning over medicalization has occurred. Not all of it, but a lot. The novel did a wonderful job capturing the beauty and struggle of a guiding women through childbirth.
I was giddy when I fount that the novel was being made into a mini series. Lifetime did a decent job telling the plot of Dinah’s life. They were’t able to capture the beauty of birth and midwifery as well as the novel. The relationships between the women were recognized fully in the last few minutes, but were not given as much development as in the book.
I have recommended this book, over the years, to everyone that has the look of wonder in their eyes. I recognize the look right away. It is a look that belongs to a person that is in complete awe of birth and the power of women. I am not the only woman that loves this story. Red Tent communities have popped up all over social media and in real life. Women crave the type of connections found in the red tent. Many of us have few, if any, sisters, move far from our mothers, do not get along with our mother-in-laws and do not make time for our girlfriends. Twenty-first century life can feel so isolating. Births continue to bind us together. I step into a stranger’s room and become a friend/sister/mother within moments.
The bond of women during the sacredness of birth is strong. The trust they give me is an honor. Like Dinah, I will carry all the special women from my life with me. There is not a red tent for us to take refuge. I will carry my red tent in my heart. With it I will create the safe and beautiful places for my sisters to bring their babies into the world.
If you enjoyed the miniseries, read the novel. You will laugh and cry and love all the things Dinah loves.
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One of my favorite parts of being a labor nurse is to help a mom through unmedicated labor. Not all experiences are the same. It can be the best of time and the worst of times. The labor nurse has the supporting role in the drama of birth. She plays her part and then melts into the background so that the stars, mom and baby (dad too) can shine.
The best of times.
A mom was having terrible back labor. My arms shook with each contraction as I gave her counter pressure for two hours. Every time my arms would ease up on the pressure she begged me to please keep going. I usually would have her partner take over this physical intervention, but there was not partner in this delivery. That hurt my heart and made it more important that I help my patient in the way that she needed. When the baby changed positions the back labor subsided. She progressed into transition. Transition is the time that women change their minds about wanting an epidural, being pregnant and that they ever liked the baby’s father. Her eyes locked with mine and she reached for my hand. She asked me to not leave her. So I stayed. I stood by her side and tried to forget that I had not eaten all day, that my bladder was full and my charting was getting farther and farther behind. I was present with her through every contraction. I praised her through every break in the pain. When it was time to push she did amazing. Soon she was rewarded with a quick pushing stage and a healthy baby on her chest. It was easy to forget my aching arms when she asked me to lean in and take a picture with her and her new baby. I was pleased with her satisfaction with her birth. I was thankful that everything went well for her and her baby.
I love when I can play my designated part in the story. I don’t like when I am forced into the villain role.
The times that test.
Another nonmedicated mom was not the grateful variety. She was suspicious of everything I did. This is always difficult for me, as a nurse. I am 100% supportive of my patient’s birth plans. I do everything in my power to ensure the safety of the mother and baby, provide an environment that the mother desires, carry out the doctor’s plan, and fulfill my legal and hospital mandated responsibilities. These are difficult responsibilities to juggle at times. When I am crouching on hands and knees, chasing fetal heart tones while a mom is bouncing around, changing positions and barking orders to her family, I deserve a little respect. When I am plunging my hand into the bath water mixed with vernix and other bodily fluids to make sure your baby is not stressed from the heat of the water, I am not trying to control you. When I am holding your hair while you vomit and it gets on me, when I wipe away your poop so you don’t know it happened, when I breathe in your body odor right next to my face because you need someone to lean on, I’m doing it because I am on your side. When you get to the point where you are asking me for narcotics and its dangerous for the baby I am going to say no. When this mom got to her breaking point she demanded I give her medications and it was too late. She was so angry I stepped back a bit because I was afraid she might hit me. I knew that the baby was coming. I knew that if I gave her what she wanted the baby likely would not breathe when he came out. I let her rage and continue to labor. Her baby was born within 30 minutes and was perfect and beautiful and breathing. She never will never know that I was scared of her or that her words hurt me or that I gave up time with my family to stay late to help her.
Not every birth is fun or rewarding. Sometimes my thighs hurt from squatting by my patients side. Sometimes I’m exhausted from trying to help. Sometimes I stay after my shift for an hour to finish the charting that I couldn’t do while I was helping my patient accomplish her goals. When my patient is happy with her delivery it makes me happy.
Mamas thank your labor nurses. We are on your side. It is our job and we love it, but it is not easy.
I am extremely sore today! I am not in pain from working out at the gym, playing soccer with my kids or golfing. I am sore because I labored two unmedicated births yesterday. Tired feet and sore backs are standard fare for a hospital nurse. Swollen legs are also common, due to long hours standing in an operating room or by a critical patient’s bedside. It may be surprising that laboring a mom, that wants a natural delivery, is a full body work out. My shoulders are stiff, my arms are aching and my thighs are sore.
Birth is magical regardless of the mode of delivery or the use of pain medications. That being said, I love unmedicated births. I love helping a mother work through the process of labor and accomplish her goals. I love the moment that the baby is born and is placed on mom’s chest as she sighs with relief. I love all of it, but it can be intense for the nurse.
Confession time, patients with epidurals are generally less work for nurses. Plain and simple, an epidural and a urinary catheter make my job a lot easier. Monitoring the baby is easier, since mom is generally resting and immobile. There are no hasty trips to the bathroom between contractions, because the catheter is draining to gravity on the bed frame. I can relax at the nursing station, charting comfortably while watching my electronic fetal monitoring strips. I am reassured that my patient resting comfortably, with the her call light within reach. Transition consists of some rectal pressure or napping, occasionally vomiting and shaking.
Moms that go natural need their labor nurses more. Transition is different without an epidural. Mom’s have looked me in the face and begged me to cut their babies out during contractions. Then, in between contractions, insist that they don’t need pain medication. I have learned to go with what my patients tell me when they are not contracting. I know my patient, with an epidural, is complete by watching the early decelerations on the monitor or because she suddenly says she needs to poop. I can tell when my natural mom is completely dilated by the involuntary pushing she starts to do at the peak of her contraction and the change in her demeanor from desperation to intense focus.
I have been in that patient keeping her nurse busy. During my first unmedicated birth, I begged my nurse to help me during transition. She thought I meant medication, but I wanted her presence. I knew I could have the baby without drugs, but I did not want to do it alone. I needed her there, to silently bear witness of my labor and remind me that it would not last forever. She ended up catching my baby during change of shift. The doctor was trying to gown up for the delivery. He had one glove on when the baby shot out. It made me secretly happy that my attentive nurse had been the one to catch my baby.
Now its my turn to catch precipitous deliveries and bear witness to women as they labor. When I am lucky enough to care for two moms in one day that are skipping pain medication I am elated. I am also worn out!
THE BUS!!! I jumped up and ran outside to the bus stop when I realized I was late to pick up my boys. It was a nice day and I was picturing them alone waiting for me. In my rush I didn’t slip on my shoes. I slowed down when I saw that the bus hadn’t arrived. Then something unexpected happened. I became aware how wonderful my bare feet felt treading along the side-walk. I could feel ever pit mark and seam in the concrete. I felt the difference in temperature when I crossed from sun to shade. I arrived at the corner and let my toes wander into the grass. What ecstasy! I walked around relishing every texture. I couldn’t remember the last time I had been outside barefoot. I felt like I had as a child.
Being a birth nerd, I quickly realized my barefoot walk was similar to my unmedicated birth experience. My journey was comfortable and enjoyable. I felt the roughness of the cement, but it added to my experience. I noticed more about that walk than any previous ones. If I had worn shoes, I would have missed out on connecting with my environment. Wearing shoes simply does not feel the same as being barefoot. I feel the same about natural childbirth. Bringing a baby into this world is a miracle under any circumstances. Natural childbirth is the barefoot version of birthing. There is an added dimension that going natural brings to the experience. The difference between my medicated and natural births were marked and undeniable. I was more in tune with my body. I was at peace during the storm of contractions. I felt euphoric and energized after my 3 natural deliveries, which was a surprise after my first two medicated births.
The conditions were perfect for my barefoot adventure. If the temperature had been different, or if there had been broken class on the sidewalk, shoes would have been necessary. Similarly, it is not safe or prudent for every labor to be unmedicated. When the conditions are right we have a choice. Our society has become accustomed to a medicalized model of birth, just as we have become accustomed to wearing shoes. We forget that there are other choices. We absentmindedly slip on heels or tie on a pair of sneakers. In the majority of our healthcare experiences we trust in the safety and necessity of our medical ‘shoes’. Birth is not inherently medical in nature. We have been conditioned to believe that the monitors, drugs and interventions are just part of giving birth. Medical intervention is a luxury and a safety net for a natural process. If a mother chooses to have an epidural for comfort, great! If a mother needs to be induced due to a medical issue, we are grateful for the medical technology. Just as I chose to walk barefoot, natural birth is a choice. It doesn’t mean I think my birth is better than yours. It especially does not say anything about any one else’s choices. It doesn’t mean that I would want to have a surgery without medication, or try to heal my hypothyroid with herbs. Sometimes its just nice to experience life in a basic way. I experienced birth with all my senses and I loved it.
I learned a lot about labor from granola nurses and crunchy parents. Here are my favorite lessons that I learned taking care of laboring patients whom were skipping pain medications. It has made me a better labor nurse for all my patients. What lessons have you learned in the world of labor and delivery?
Response to the uproar over the “cult of natural childbirth”
I am not a cultist. I am not a home-birth advocate, although I think it can be done safely. I am not a highly medical intervention advocate either. Both extremes put our mothers and babies in danger. I have been witness to some train wreck births on both ends of the intervention spectrum. Women and doctors can become fixed on an idea and cannot be dissuaded from their perspective despite their current situation. This can lead to mistakes on both sides, resulting in poor outcomes.
I am a childbirth educator, advanced practice nurse and a mother. I am passionate about low intervention, natural childbirth and breastfeeding. I am an advocate for informed parents making decisions collaboratively with their provider of choice. I am an advocate of the use of the fewest medical interventions necessary for the comfort and safety of mother and baby.
If a mom plans on an epidural, formula feeding and an induction at 39 weeks my job is to educate her on the best way to make her plan safe and effective. I will ensure that she know that she has alternatives. Many women are not empowered to know that they have choices, relying on what their mother, aunts or friends tell them is appropriate. Likewise when a mother desires zero interventions, I will carefully explain the risks and benefits so that she can make an informed decision about her and her baby’s care. Women are influenced by media, social interactions, and past experiences. Doctors and nurses should not discount those influences, but add to it the knowledge that they bring, as health care providers.
Women such as Elissa Strauss and Amy Tuteur, M.D. have recently shared their outrage over extreme, natural childbirthers that are glorifying childbirth, sometimes at the expense of their baby’s life. I have seen that type of misguided activism and the sad outcomes that can occur. Although I agree that some advocates are taking the movement too far, care needs to be taken not to discredit and marginalize the natural childbirth movement as a whole. There is room in feminism for all of us women if judgmental ladies would move over.
There is power in childbirth. It is an amazing feat that only women can accomplish. Some women choose to exercise their power by having a scheduled, medicalized, epiduralized experience. Good for them! We should celebrate that we, as women, have healthcare choices and autonomy to demand that type of childbirth. Women who choose to have a more natural childbirth experience should also be celebrated and encouraged. I have been moved to tears watching women find strength, that they didn’t know they had, during natural labor and childbirth. I have also been amazed at the miracle of birth in the operating room. The bottom line is that women have choices. Women must not check their autonomy at the labor unit door. Women deserve be informed of risks and benefits to all medical procedures and their choices should be respected. Women need to respect other women’s decisions about childbirth. There is not a right or wrong way to give birth. Each woman, baby and situation is unique and options and choices need to reflect the details of each childbirth situation.
Let’s take a step back and remember what is important in this discussion. If women are happily foregoing epidurals and Pitocin, then why should the media and medical professionals discourage it? Identify, criticize and educate about the real dangerous ideas that are out there, like completely unattended births or home VBACs. When women raise such a huff over what other groups of women are doing it smacks of jealousy and esteem issues. If you are secure in your woman and motherhood then seeing a bunch of crunchy moms blog, about how they are potty training their 4 week old or how they didn’t make one sound in labor, will not affect you at all.
Live and let live sisters.
Congratulations on your natural, unmedicated birth. You did your research, hired a doula, wrote a birth plan, advocated for yourself and got your OB to agree to your plans. Labor was intense, but manageable. Your moment of triumph came when your sweet baby was placed skin to skin on your chest. It was a perfect end to a beautiful story…well, not quite.
Women are often surprised that they must continue to defend their birth choices and deflect negative comments, even after the birth. One new mom, a labor nurse herself, was mocked and shamed by the doctors and nurses with whom she worked. They taunted her about how she had struggled with her intense labor. They made comments to her that she “wouldn’t make that mistake again,” about refusing an epidural. They even used her as an example to persuade their patients to get an epidural.
This birth-choice shaming is repugnant. Especially when it comes from the healthcare professional that should be supporting mothers and their birth choices. A mother’s decision to decline pain medication, to have an epidural or any of the many other choices she will make need to be respected and honored. Trying to shame someone, about how she could have done better, is not a welcome or productive practice.
Strategies for moms dealing with birth-choice shaming:
1. Interrupt when someone is incorrectly speaking about your birth story and set the record straight.
2. Prepare a phrase to repeat when someone is pushing their opinion on you about YOUR birth experience. For example “I loved my daughter’s birth, even the difficult bits.”
3. Offer to give them information about your birth choices so that they can appreciate your point of view. Most people do not want homework so they will probably not bring up the subject again.
4. Respond: I am glad/sorry that you enjoyed/did not enjoy your birth, but every person has a different experience. I am happy with my choices.
5. When the subject is brought up, stop the conversation by saying that you feel the experience is too personal to discuss and you hope that they will respect you by not speaking about it.
And finally, surround yourself with positive and supportive people. You ultimately shared your birth experience with a very small group of people. Everyone else is a Monday morning quarterback, so go ahead and leave them on the bench.