A Conversation with Three Midwives
Extract from “Dance of the Womb” by Belly Dance for Birth expert Maha Al-Musa
I asked three midwives who have been practising in both hospital and home environments to answer some questions about bellydance for birth as an aid in pregnancy and labour. Each has been aware of my ideas over the years and so have a basic background of my work. I wanted to document how my ideas may be interpreted from a medical perspective and whether they would reasonably support my instinctual knowing in conjunction with a physical application.
'Bellydancing was taught traditionally in North Africa apart of fertility rituals to mark a girl's passage to womanhood and women attending a birth danced while the mother rolled her pelvis in a similar way during contractions. Any movement like this that frees the pelvis can help the baby's head to rotate and descend deep into the pelvis.' (Homebirth, Sheila Kitzinger, Dorling Kindersley Limited London 1991, P. 91)
Background of Each Midwife
Midwife One - Sarah Doherty: Mother of two teenage sons, has been a midwife for 15 years in Australia and Saudi Arabia. Her passion is homebirth. She is also a rebirther, childbirth educator and body awareness teacher. She was responsible for designing pre and post natal programmes at a women's hospital in Saudi Arabia.
Midwife Two - Jayne Alder: Became a midwife after the birth of her fourth daughter, and specialises as a homebirth midwife and energetic healer. She has worked in Australia and Ireland doing both home and hospital midwifery.
Midwife Three - Ann Bernauer: Midwife since 198, two sons born naturally at home and hospital. Supported women in home birth, birth centres, hospital and childbirth educator. Semi-professional bellydancer since 1995 facilitating pregnant women in bellydance classes.
What is your first spontaneous response when I mention the word 'bellydance?'
Sarah: Cabaret dancer, women, beauty, feminine.
Jayne: I visualise a beautiful Middle Eastern woman with a full figure dressed in traditional dress moving gracefully to Arabic music.
What is your first impression when you hear the phrase ' bellydance for birth ?'
Sarah: Great! Bellydance as a labour movement. Active and meditative. Circular movements of the hips help to rotate the baby. The more the mother is moving the less likely her muscles will cause her pain and the quicker the labour will be. The movements of the bellydance can be particularly helpful if the baby is in a posterior presentation (babies back to mothers back). The baby needs to rotate 180 rather than 45 so the action of a gentle pelvic rotation encourages the baby into its own rotation into the birth canal. And remember the birth canal is not just the vagina it is the whole pelvis. The baby has to manoeuvre itself down into the pelvis (particularly second and subsequent babies who are often floating high) and so these bellydance movements are fantastic to support the descent into the pelvis especially if the mother is focused and in an upright, active position.
Jayne: Joy, as I know the huge benefit for women who dance through pregnancy and labour.
Ann: An active birth where the woman is in tune with her body, where a woman is working with her body in labour. If I know that a woman already has a deep connection with her body before she embarks on labour then as a midwife I would feel considerably reassured and it would give me confidence in how she would give birth.
As a birthing preparation the bellydance for birth is surely an emotional opening. For a woman to feel beautiful and share this feeling of beauty with other women is a delight. Most women feel critical of their bodies and other women's bodies. The dance allows a woman to embrace her physicality, giving her confidence and a sense of adoration. Her support people and partner can also embrace her and see her beauty radiate through the bellydance regardless of her shape or size. Bellydance for birth crosses all boundaries.
Can you describe the basic structure of a woman's pelvic region?
Sarah: There are four flexible bones connected with cartilage that softens toward the end of pregnancy because of the hormone 'relaxant'. The cartilage softens to such an extent that the pelvis has enough capacity to open up to allow the baby through. Mother Nature is miraculous!
Jayne: The female pelvis is gynaecoid in shape and has been adapted for childbearing because of the increased width around the brim (top).
Ann: The bony female pelvis has joints that can move more easily in the latter stages of pregnancy and birth because of the increased secretion of the hormone progesterone. The passage within the pelvis for baby to be born is also influenced by its connection to the mothers' spine and legs and largely affected by labour positions. If a woman leans forward her coccyx is able to move backward to help create an openness for the baby to descend. As a simple exercise if a pregnant woman stands up, bends her knees slightly and pushes her pelvis backward she will immediately notice an expansiveness in her lower body.
Do you believe that a pelvis can be too small to deliver a baby?
Sarah: No. I believe that maybe less than 5% of pelvises are too small and that if a mother is given the support, time and feeling of safety with an active birth a small pelvis woman can deliver a large baby.
Jayne: A very minute % of women have CPD - cephalopelvic disproportion - when baby’s head is too large to pass through its mother's pelvis. I believe that the condition may be attributed to unresolved emotions held by the mother. These may be fear of giving birth, past life experiences, relationship difficulties, sexual abuse and other emotional and physical traumas.
Ann: No, I believe that it is a very rare condition. I have known countless women to have been diagnosed with CPD in pregnancy, some having had first baby caesareans and who have gone on to deliver subsequent babies (who may have been bigger) vaginally. There may be other factors to consider including position of baby, strength of contractions, environment, birth support issue etc.
So as a labour preparation would you agree that bellydance movements are powerful and positive?
Sarah: Definitely! The movements encourage all the essential elements to aide birth. Relaxation of the pelvic muscles, unlocking of the hips and knees, movement in the lower back and sacrum.
Jayne: Yes powerful, mainly because they allow the mother to relax and let go as well as to connect with her body and baby. The 'femininity' of the dance is so precious, it helps the mother feel her inner beauty and connect to the strength of her feminine energy.
Ann: Yes because the movements put the mother in touch with her body allowing her to enjoy and feel positive about her body. They help to relax her bottom, pelvic floor and by bending her knees she gains greater connection to the earth below. Bellydance offers a sense of comfort and freedom to soothe.
Specifically how would the pelvic circular and pelvic rocking movements aide a woman and her baby in pregnancy and in labour?
Sarah: Well in pregnancy they would strengthen the back and abdominal muscles, increase stamina, bring greater volume of blood to the belly, help with breathing, oxygen flow and bring a focus into the pelvis which in my midwifery experience can be a real place of tension for some women. In labour many women can become distracted by the pain as though it were an energy outside of themselves. The bellydance movements enable a woman to connect with the pain and the bulge of her belly with a sense of acceptance rather than denial.
Jayne: I imagine that the pelvic circular movements allow baby to feel loved, relaxed and nurtured in pregnancy. In labour they would give the mother a sense of central focus. This can encourage baby to move into the correct birthing position placing pressure of baby's head onto the cervix. They also assist in getting mother to cope with the intensity of the contractions by grounding her to earth energy. If mother is at peace so is baby, making for an easier transition to the Earth plane.
Ann: The use of gravity, moving hips, swaying, circling all help to ease backache and encourage baby into optimal position. If baby is lying in the unfavourable position of posterior (babies back against mothers back) the pelvic rocks (forward, backward and side to side) with a forward position by the mother may help to turn the baby into an anterior position by manoeuvring the weight of baby’s back forward. The pelvic circular movements would also be beneficial in dispersing the pain of contractions in a positive manner.
How would you describe the physical and emotional signs in the first stage of labour?
Sarah: Physically there are the uterine contractions, opening of the pelvis, softening and thinning of the cervix, dilation of the cervix. Emotionally an acceptance or rejection of the woman that she is actually giving birth, loss of the maiden, a need to surrender and open the way, relationship with the partner.
Jayne: There are many physical signs in the first stage labour and as it progresses from latent to active phase a woman may pass through many doorways. There may be diarrhoea, vomiting, pain across the lower abdomen, vagina, anus, cramping as the uterus tightens.
Emotionally a woman may feel different in herself, introverted, excited, wanting or not wanting to be touched, spoken to. She may cry, laugh, scream, be silent, angry, unsure of how she feels, easily annoyed by little things, loving, scared, scattered and more!
Ann: Signs of first stage labour may include diarrhoea, feelings of excitement, chatty, gradually becoming withdrawn as contractions become stronger, unable to talk through them, resting in between becoming sleepy with the body’s release of endorphins - a natural pain relief. In transition she may have outbursts of anger, feeling ambivalent, nothing’s right, panic, giving up – can be a very changeable time. She may become more or less reliant on those around her to give her comfort, protect her environment, give fluids etc.
In the latter stages of first stage the environment of a labouring woman is very delicate almost sweet and any disturbance can have a profound affect on the woman and change the course of her labour.
How would the bellydance for birth movements aide the work of the cervix in the first stage of labour?
Sarah: The baby's head is applying pressure onto the cervix and the more efficiently this is done the more effectively the cervix will efface (thin) and dilate hence open in readiness for second stage labour. If the mother can be in an upright position, using gravity and preferably in a forward position rocking, circling, moving, bellydancing the greater the pressure of the baby’s head onto the cervix helping him to descend. Doing deep pelvic circles during a contraction is ideal - it is one of the best things a mother can do.
If the mother becomes fearful or frozen a support person, partner or midwife can stand behind her holding her hips and guide the pelvis to make figure 8 movements so she can loosen up and drop into the movement on her own. It becomes a connective shared experience.
Jayne: I feel the main benefit of the bellydance for birth in relation to the thinning and dilatation of the cervix is in their relaxing influence upon the mother, taking her inward and centring her. If the waters are gone the rhythmic nature of the bellydance would help baby’s head to put gentle pressure onto the cervix.
Ann: Because the bellydance movements encourage baby into a beautiful position placing firm pressure on the cervix. This encourages good dilatation, helping to disperse pain enabling the mother to relax into each contraction and increasing endorphin levels and hence oxytocin. So 'letting go' equates to big, beautiful contractions whilst 'tension' produces the hormone adrenal, which does not support her labour but rather creates a sense of rigidity.
There is often a perceived notion that mothers must avoid the pain of labour - I am more inclined to advocate 'dancing into the pain' even honour it for its initiative qualities. By using bellydance for birth a mother can embrace this idea with a sense of inner strength. What is your impression?
Sarah: Pain ..yes...I am all for the idea that if a mother can directly connect with the pain and make the contractions work for her and her baby she will feel greatly empowered. Deep circles and squatting get that baby into the pelvis, onto the cervix and thus each contraction is maximised. Avoiding too many contractions takes the baby’s head off the cervix and this will just prolong labour. So reclining positions, lying down, avoidance means that the cervix will be less efficient. It is a pain of life!
What is strongly coming to me is that bellydance for birth can help a woman focus onto her uterus, belly, pelvis, hips the whole area doing the labour work so that she is not avoiding anything. If she can take space between contractions to rest, sleep, eat, drink when the next contraction comes she can fully focus and be present rotating, rocking, opening. The beauty of this approach is that the mother can go into the painful process deeply and transform it into a powerful state, even a deep meditative state where the body’s natural pain relief, endorphins, are released. Acceptance and release go hand in hand with bellydance for birth. Moving past the point of distraction....continual focus....continuous labour.
Jayne: Yes I agree. Pain is an initiation and if a mother is surrendering through the bellydance positions she will release her body’s natural pain killers endorphins and the experience can be one of intense joy rather than intense pain.
Ann: Absolutely, dancing into the pain is to dance into surrender. There is an almighty sense of empowerment for a mother to surrender into her contractions. In the context of 'giving birth' it is probably the only time that pain has a 'normal positive' connotation - everything's ok - this idea may go back to primitive times when women were led to a place of safety to give birth, a calling for women to surrender with positivity.
Do you think bellydance for birth could initiate a premature birth?
Sarah: There is no indication that this could happen. There are many other factors that can contribute toward premature labour. Women do all sorts of exercise during pregnancy. Consulting a doctor before 12 weeks is a good idea and being aware of your fitness levels pre-pregnancy.
Ann: No. Sometimes we don't know why women go into labour prematurely. Some are at high risk because of an underlying medical condition, fever, incompetent cervix etc. Exercise has always been encouraged in pregnancy particularly walking, swimming, dancing and gentle activity. Looking at a woman's exercise history is also helpful to gauge her fitness. Listen to your body, only do things that feel comfortable. The bellydance is subtle, you can do a lot by not doing much!
What is the connection between breath, bellydance and birth?
Sarah: The breath is a connection between the physical and spiritual body. The spiritual realm internalises the breath for a meditative purpose and the bellydance connects this breath between the spiritual and physical essence to aide the flow of birth. Labour is softened with the use of breath as opposed to tensing the physical body through holding one's breath and being uptight and fearful. Meditation and relaxation techniques equate to opening the birth channel both physically and emotionally.
A mother can channel light using her breath from the crown chakra at the top of her head, down to her baby and belly and further into her vagina.
Breath = light = bellydance = open pelvis = ease of birth = baby.
Jayne: Breath is our life force, our existence depends on it. So to be connected with our breath, our very essence, we connect to our baby who is oxygenated. Through our breath we birth. Working with breath is essential, DO NOT hold your breath while pushing your baby out, you will instinctively know what to do. Work with your breath, you will know what to do, your body will birth your baby beautifully. Listen to your inner voice, breathe how you feel you should, there is no wrong way.
Ann: Breath and the dance are both the release of the contraction, the surrender, both are so important. They are the release as the body works. To dance, to move and keep the breath flowing enables the mother to stay relaxed. Breath is directly connected to the 'letting go' as is the dancer’s movement, they are embraced hand in hand, the sure release of tension.