In her 28 years as a childbirth educator, Ellen Chuse, CCE, has built a huge following in New York. Week after week, young couples file into her cozy Brooklyn brownstone to prepare for birth and bringing home a baby.
I’m always thrilled when I hear Ellen speak–she’s funny, she’s frank and she knows everything about birth (seriously). In her class, a topic that may seem overwhelming becomes an opportunity for connection, humor and insight. Ellen, who is also a birth counselor and former president of the Childbirth Education Association, has been an inspiration to me and many, many others.
Here she is, on topics ranging from why childbirth hurts to why you don’t have to love it to how birth has changed over the years.
In your classes I always love it when you say, “you don’t have to like it.” Can you expand on what you’re getting at with this statement?
Birth is an extraordinary event in the life of a woman—one she carries with her throughout her entire life. But a woman’s experience of birth is completely diminished in our culture and as women we tend to internalize that. In recent years, especially in the natural birth movement, there’s been an implication that to truly birth naturally the experience must also be ecstatic, orgasmic and spiritual. I would argue that all birth is spiritual but it’s also hard, sweaty work. Could you have an orgasm? Yes. Is it likely? No. Are you less of a wonderful, powerful birthing woman because you moaned, yelled or cursed your way through labor? No. As women we have a tendency to focus only on that which didn’t go as we had planned while ignoring all that we did successfully. I want to give women permission to find labor difficult or their responses unorthodox but still have positive feelings about their accomplishment. That’s what I mean when I say
” you don’t have to love it, you just have to do it”.
Why does labor hurt? Does it always hurt?
Although there may be a few women who claim to have experienced labor without pain, most women find labor contractions painful. The degree of pain and the effect that it has on labor can vary from one woman to another but most of us would say that labor hurts! I believe that the pain of labor is different from other kinds of pain we experience. Rather than telling us that something is going wrong, it tells us that something is going right. Mother Nature wants to get our attention and hold our attention to make sure that we don’t confuse this with anything else. Longer, stronger and more painful contractions are Mother Nature’s way of telling us that we are getting closer to the birth of our baby – that we need to be in a safe place with all our support available. After all, Mother Nature’s primary concern is the continuation of the species. Since the beginning of human existence babies needed to be born in a safe environment in order to survive. Mothers needed to know that something extraordinary was happening and make preparations to receive their babies safely. Even today we evolved humans tend to avoid, deny and rationalize that which we don’t want to deal with. The intensity of labor overrides that inclination and forces us to pay attention. And understanding why the pain is there – the normalcy of labor pain – can help to remove some of the fear of pain that is so prevalent in our culture. Without the fear we just have to deal with the pain, which is often manageable with active coping strategies.
A woman in labor is vulnerable. A woman in labor is powerful. How can she be both of these things at once??
The process of labor and birth takes us to a primal place. Letting ourselves go into that place makes us feel vulnerable. We no longer have our usual “sense of self” to protect us. But primal is also powerful … often without inhibitions that are unimaginable in ordinary circumstances. That primal place has a force and power beyond our control, which is why we can feel both powerful and vulnerable simultaneously.
You’ve been teaching for 28 years, do you think your students have changed?
The world has changed and so have my students. Information overload, competing experts, and Internet chat rooms have changed the face of childbirth education. Students arrive with more information but not always better understanding. Most of my students these days will say that they “hope” for a natural birth but often the choices they have made make that unlikely. The co-opting of the natural birth movement of the 1960s and 1970s by hospitals and doctors in recent years has created an illusion of support for normal vaginal birth, which the high rate of inductions and cesareans belie.
Years ago the choices were clearer. Hospitals offered a very medical approach. Birth Centers and home birth offered the possibility of a truly natural, un-medicated birth experience. My students then were clearer about the choices they had made. I find today’s students often clueless about the current state of birthing and the actual choices available. In some ways, that makes my job even more essential, if sometimes depressing.
Why do we need childbirth education?
Childbirth education—particularly group childbirth classes—provide both information and integration of information and experience. Often couples feel that simply by doing lots of reading they can adequately prepare for labor, birth and parenting. However, the emotional work of preparing for birth and parenting takes place in the group. Sharing preferences, questions and concerns with one another in class expands the knowledge base of all the students. The childbirth educator has a unique role—creating a bridge between pregnancy and parenthood. She can also provide personal, individual support where needed and open couples to options and possibilities they hadn’t considered previously. And in today’s medico-legal environment prospective parents need help negotiating the hospital and medical establishment to avoid unnecessary interventions and especially unnecessary cesareans.
Are there ways to prevent feelings of disappointment or failure if birth doesn’t go as you would have liked?
Oh boy. That’s a big question – especially since I do pregnancy and birth counseling. Through that work I am very aware of the disappointment some women feel about their births. Birth is both simple and complex so that while we can have a strong intention, birth can unfold in ways we hadn’t imagined. Having good, basic information about when and why a birth plan may need to change can help – which is another good reason to take a childbirth education class. Childbirth educators can also provide what a colleague called “anticipatory healing”. In other words, we can normalize feelings that may come up around a birth experience and encourage women and partners to acknowledge them. As I mentioned before, a big problem in our culture is the lack of concern about the woman’s experience of birth. “Well, you had a healthy baby. Isn’t that what you wanted?” Of course that’s what she wanted! But that woman had an experience and that experience needs to be acknowledged. She may feel great joy about her baby and still need to mourn the loss of a birth experience she didn’t have. Some women will seek out the help of a counselor or therapist after the birth. Others may wait until they begin to think about another pregnancy when those memories and feelings can return with force. I’m not sure that there is anything one can do to protect against feelings of disappointment or failure but I would encourage women to seek help and support in working them through.
If you could do one thing to tweak the maternity care system what would it be?
A small tweak: No separation of mother and baby after birth – no exceptions without major medical issues.
A bigger tweak: Adopt the midwifery model of birth in all hospitals.
Even bigger: Single Payer National Health Care!
Quick, Top Five Tips for partners:
1. Stay with your partner emotionally.
2. Offer physical and emotional support.
3. Take care of your own needs without involving her.
4. Make sure your partner is getting plenty of fluids as well as rest and food in early labor. Stay home as long as possible!
5. Remember that you know your partner better than anyone else in the room. Support her preferences and take charge when needed.
This is the latest installment in a series of interviews with my mentors in the field of pregnancy, birth and becoming a parent:
Here are two others:
What Do New Moms Need The Most? The Answer May Surprise You