Interview with WinteGreen – Common Knowledge Trust Trustee and Developer of the Pink Kit Method for Better Birthing®.
Goals
The goal of the Pink Kit Method For Better Birthing® developed from a stated need by expectant mothers and fathers. They wanted a greater sense of control and participation in childbirth. Therefore, the goal sought to fulfil the need which was to improve the perception and participation on the birthing experience by both women and men.
Those pregnant women who were planning a vaginal birth, they wanted to feel more in control of their birth experience and to work with the medical care necessary. This sense of ‘control’ was not satisfied through Birth Plans.
Pregnant women planning a surgical delivery wanted to participate more in birth preparation yet were too embarrassed to attend convention birth classes focused on natural birth. They also wanted to participate more fully in the birth experience now that they could be awake for the cesarean delivery.
Expectant fathers really wanted to know how to help the partner cope with her subjective experience of birthing. Women who had fought for husbands to be present in labour and delivery, wanted more than support
A secondary goal was to reduce/prevent/eliminate some of the common frustrations experienced in birth:
- Delayed dilation in 1st stage
- ‘Back labour’
- Delayed delivery in 2nd stage.
Some of these birth frustrations appeared to be caused by tension in a woman’s body in response to pain felt. Although we could not necessarily reduce the pain level, we could put into place birth skills for managing the pain … coupled with coaching skills to help.
Without intent, the use of these skills has also resulted in positive changes in the objective experience of giving birth: both birth outcomes and the reduced need for medical intervention as a management tool for birth delays not associated with direct medical co
When medical care was needed these birth and coaching skills adapted well so that families could work with and around medical assessments, monitoring and procedures. This reduced the shame, blame, guilt and negative birth stories so often connected to contemporary childbirth experiences.
Background Information
These birthing skills were developed in the U.S.A. in the early 1970s through trial and error, used in hundreds of diverse birthing situations and through direct interaction by Wintergreen and expectant parents.
The skills grew from body-work for pregnancy and birth. They developed as a self-learned set of skills to prepare the pregnant body for birth – that is, to create as much space and mobility as possible to facilitate the baby’s birth journey. The decision to develop self-learning was simple. More families could do this rather than rely on a trained provider.
The ability to produce a publicly accessible resource became available when Wintergreen immigrated to New Zealand. Wintergreen chose to put these skills into a charitable organization and registered Common Knowledge Trust. One branch of CKT is The Pink Kit Method For Birthing Better®.
Understanding Birth Stories
When you listen to contemporary birth stories there are three types:
- Temporal linear. ‘My membranes broke at 11 am, active labour started at 2.30pm, I went to hospital at 6 pm etc’. These stories tend to correspond to birth notes.
- The Subjective Story. Women recall what others did or didn’t do to them during their labours and birth. This can be either negative and/or positive. For example, ‘I pushed for 3 hours, they gave me a rough internal’. Or ‘My husband sat and read a book’. Some stories are very positive such as ‘My midwife was great, I couldn’t have done it without her.’ These types of birth stories predominantly lead to either the positive or negative recollections of the childbirth experience.
- The Body’s Story. These stories are much more about the personal physical experience of the childbirth process such as the ‘my contractions were too painful’, ‘I had pain in my hip’, ‘I felt I wanted to push’ etc. These stories can indicate feeling in or out of control such as ‘The pains weren’t as bad as I was told they would be and I managed well.’ Or, ‘I thought I was going to die.’
As BirthingBetter skills evolved it became apparent something could be done about the body’s story. This did affect the ‘subjective story’ hugely and had an anecdotal impact on the temporal story such as ‘I didn’t waste one contraction’.
A woman does not know what birth will be like so it makes sense that she should work to prepare her body for this unknown event that will unfold. It also makes common sense that the activity of giving birth in all its forms should be infused with the appropriate skills for the two intimate roles/jobs: the birthing woman and her ‘support/coach’ husband, partner, friend or relative.
Mainstream Population
This programme was developed within the mainstream, middle of the road people with a tendency to conservatism. Regardless of personal background, these people shared one goal …to feel more in control of whatever birth experience they were going to have. Without a formal study, the demographics of the initial birthing population who were instrumental in developing these self-learning/using skills during the ten years of evolution were this:
- Ninety-five percent from religious communities ranging from those religions where blood products can not be used to groups who have a firm belief about how women should birth (often Fundamental) or the value of whether the birth was surgical or vaginal (Orthodox Jewish)
- Five percent would have been considered ‘alternative’.
- Of the 95% over 80% birthed in hospital for medical or personal reasons or through lack of choices.
- The remainder birthed at home or Birth Center.
- Taking 100 families with whom Wintergreen worked with over any specific period of time, she attended 15% of those births in hospital, the remainder at home/Birth Center. The rest gave feedback about the self use of these skills.
Developing these skills into a public resource was motivated by the acceptability of them by families of extremely diverse backgrounds AND their ability to be used without professional guidance.
No formal study was done at this time. Births occurred in different locations. Birth providers were not interested in how the woman coped with her labour although they all loved seeing women who coped well and loved husbands/partners who could really help.
Statistics were collected in New Zealand from 2001-present by two New Zealand Independent midwives who could report that couples felt better about their birth regardless of the situation and they appeared to self-reduce all forms of medical interventions.
Birth Plans
At the time of development and presently, Birth Plans and informed decisions based on gathered information have been promoted as the steps toward better maternity care. This is a common statement heard … ‘Improve maternity care by providing childbearing women and families with the information necessary to make fully informed decisions relating to how, where, and with whom they will give birth’.
In New Zealand where midwives are the Lead Maternity Carers and who have set up a Partnership model of maternity service, the midwifery guidelines state that they midwife’s job is to support ‘birth choices’.
We were able to look at how birth plans and skills interfaced as far back as mid-1970s. We discovered that Birth Plans are changeable and that you can expect the unexpected in child birth. We also discovered that birth skills were adaptable and could be used in any birth in which the woman was conscious – from unexpected births at home alone to emergency deliveries to elective operative deliveries.
If a woman was, for whatever reason, planning/needing an elective caesarean she and her husband could still enjoy learning birth skills during pregnancy because the body was still preparing for birth and she could use these skills through delivery and recovery. As a result all Pink Kit families felt more connected to the birthing process.
Politics of Birth
At that time, the political conversations around childbirth were focusing:
- On the need during pregnancy to gather information so parents to be could make informed choices so that they could formulate a Birth Plan; informed parents could decide what they wanted and did not want during birth.
- On the appropriate maternity provider, place of birth and need for medical care – obstetrician versus midwife, natural birth versus medical intervention; home versus hospital births
Within the ‘natural birth movement’, the belief was spread to expectant parents that birth was a natural process and it was not necessary to learn how to birth. Parents were told that birth would be an instinctive and intuitive process. Learning birth skills was discouraged as artificial.
The message given to expectant parents was that there was no way to know what the birth was going to be like so there was no way to prepare for it.
Two conflicting viewpoints
This division in birth produced two conflicting opinions.
Natural viewpoint – birth innately safe, just happened so no preparation is necessary.
Medical viewpoint – birth innately risky and unknown so it is not possible to prepare for it.
Debate Ignored
We ignored the debate because we could do nothing about it. Instead we acknowledged that there other naturally occurring physiological processes human beings share – hunger, sex drive etc. We recognised that huge skills are attached to these processes. As a result we treated child birth as a physiological event that could couple skills with human behaviours during the birthing process. These skills could be applied because they were appropriate to the task of pregnancy and birthing. We knew that the task of birthing was challenging to women because of the naturally occurring pain; when a women felt overwhelmed by the pain she felt out of control. This left the father concerned and feeling uncertain.
Having birth skills enriched the birth experience through preparation and use of skills in birth by working with the baby’s efforts to be born.
Father’s Viewpoint
Men know that women of our species have always given birth and that men don’t. However, this truth is coupled with an inaccurate belief that women then know how to give birth. This inaccurate connection has to be pointed out to fathers-to-be. If not then fathers will often usually draw the conclusion that the way the woman is behaving or acting during labour and birth is how women are meant to behave when they gave birth. At the same time the woman in labour wants his help to cope with the pain. This produces alienation between the woman and man.
Even when a man is trying to help, he usually doesn’t have the appropriate skills to be successful. This leaves him feeling helpless and useless.
Having a set of skills based on the 99% similarity in women and men’s bodies has given fathers a realistic way to be the labour coach. This strengthens families.
The Woman’s Viewpoint
From a woman’s viewpoint, knowing that only women give birth, there is often confusion at the personal anxiety felt during pregnancy about coping with labour. If during birth a woman feels out of control she is left feeling helpless and these feelings remain as memories throughout life.
Because the naturally occurring child birth pain is not associated to any KNOWN ‘problem’ (there is no greater pain if you have twins or a heart problem) when a woman feels unable to control the pain by helping herself and there is no one helping her, she is more likely to use pain medication.
We might feel confused about the lack of intuitive skills for childbirth since the experience is so physiological. However to make a comparison … hunger should intuitively be connected to knowing what plants we can eat and what are poisonous or even how to prepare food instinctively. Knowing what foods to forage, how to grow foods and how to cook are learned skills.
Response to Pain
The natural response to feeling any intense pain is often to tense up. When a woman tenses her body during the birthing process; this tension makes it more difficult for the baby to passes through her body and be born. There is a mechanical/physical relationship between the woman’s body (which is a container in which the baby develops and lives) and the baby ( which is a relatively large object that must move out of a container).
There were basically two patterns during childbirth that were expressed in birth stories:
- A significant numbers of woman who find themselves struggling during birth will say afterwards: “What I learned is that I need to relax more.”
- Women who cope and manage their labour pain actively put in place both relaxed breathing skills and body relaxation and will comment on this afterwards.
Therefore we looked at the extremes of specific behaviours: relaxation/tension; relaxed breathing/stressed breathing; good communication/miscommunication; effective touch/irritating touch; body awareness/body ignorance. Instead of believing that women who didn’t cope were just afraid or didn’t trust birth or that women who coped had some higher level of intuitive power, we assumed that good labour management skills could be taught.
Since all humans, both women and men can feel the differences; therefore, it’s quite simple to create skills easily learned by both of us.
We also included women having non-labouring caesarean deliveries as a way to prepare for birth, be able to enjoy that process and to realize that a surgical delivery was still an activity that could involve both skills and working with the baby’s efforts to be born. This reduced the alienation often expressed by women having surgical delivery.
How-to Of Childbirth
Not only did we focus on breathing, relaxation, communication and touch skills we also focused on the 3 areas of our body through which the baby needed to navigate in order to be born.
- The pelvic opening,
- The dilation of the cervix
- Opening of the birth canal.
We looked to develop skills that created mobility in the pelvis; creating motion in the sacrum and the big hip bones to allow the baby more space to move through this bony structure.
By learning how to create and maintain internal relaxation inside the bony structure at the soft tissue level, birthing women could reduce or eliminate tension which might restrict the dilation of the cervix. This did not necessarily reduce the pain.
We also found that as women learned to soften the internal tissue of the birth canal in the last 8 weeks of pregnancy previous tension in this last portal did not delay the final egress of the baby. Women could now successfully reduce or eliminate trauma to the perineum and decrease the delay of delivery that could result in an episiotomy.
After the Birth
The woman is left with positive memories of how she managed herself during painful contractions and proud of this accomplishment even if she did not like the experience. The skillful efforts of her partner are appreciated. More women and men express their readiness to put the birth behind them and move into the next phase of parenting, rarely with the shame, blame or pain of guilt so common in birth stories today.
Fathers know they have helped because they could see or hear when the woman felt challenged by the sensations. The skills were easy to use and did not tire them. The skills worked within the professional environment and didn’t create an antagonist relationship with either either the labouring woman or the birth professionals.
As a result fathers know they have been a significant participant in helping their babies be born. Fathers lose their fear about childbirth pain and know they have kept the woman from suffering. They also have no fear of their newborn. This means that families approach the 6 week period after birth with a greater ability to work together and problem solve. Birth stories there changed.
Changed Birth Stories
We still heard some of the Temporal Linear Stories but much less of Subjective Stories (what they did/did not do to me), much more of the Body’s Story and a new type of birth story … ‘What I did, what we did.’
Women talk about the skills put in to place during the progression of labour and how helpful the father has been. Women will also honestly talk about whether they had done enough practice and enough of the internal work.
Women are much more likely to say she would prepare her body more next time.
For men, their birth story is much more about how he could read (see and hear) what was happening for his partner and how he could help appropriately and feel appreciated.