Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation

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by Pam England, CNM, MA, Rob Horowitz, PhD



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Product Details

ISBN-13: 9780965987301
Publisher: Partera Press
Publication date: 07/28/1998
Pages: 309
Sales rank: 137,914
Product dimensions: 7.00(w) x 10.00(h) x 0.83(d)

About the Author

Pam England, CNM, MA, has been a nurse/midwife for 20 years and is the founder of the Art of Birthing Center. Rob Horowitz, PhD, has been a clinical psychologist for 20 years. They live in Albuquerque, New Mexico.

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Birthing from Within

An Extra-Ordinary Guide to Childbirth Preparation

By Pam England, Rob Horowitz

Partera Press

Copyright © 1998 Pam England & Rob Horowitz
All rights reserved.
ISBN: 978-0-9659873-0-1


Finding Your Question

Understanding birth technology shouldn't lull you into thinking you understand birth. The profound mystery and spirituality of birth can never be understood with the mind, they are known through the heart. A good place to begin preparing is with your heart's burning question.

A journalism student once asked me, "If there is one thing a woman should know before going into labor, what would you say it would be?"

I mulled this question over for a while. In the past, women knew what had to be done, and with a mixture of fear, power and surrender — they did it. Giving birth was part of their normal lives. Only now are women drawn off course by exotic (yet peripheral) choices: which books to read ... and what to believe; which tests to accept or decline; where to give birth and ... with whom; to flee from pain ... or not; and finally, which interventions, if any, would be right for them.

After contemplating the journalist's question, I finally responded, "For each woman, the most important thing she needs to know will be different. I would encourage a mother to ask herself, 'What is it I need to know to give birth?' Her answer must be found within, not given to her by an expert. Each mother needs to find her personal, heartfelt question."

The journalist wasn't sure she understood what I meant, so I asked her, "When you were expecting, what was it you needed to know to give birth?"

She thought a moment, and smiled as she remembered, "My question was 'Am I strong enough to give birth?' That's what I worried about, that's what I had to look into before I felt ready to give birth ... and I did use that question to help me prepare mentally."

Mothers wonder things like:

* "What kind of mother will I be?"

* "Can I ask for help if I need it?"

* "Can I trust my body and my judgement?"

* "What will people think of me if ...?"

* "Who gives birth?"

* * *

Knowing your personal question is central to birth preparation. Whatever your question is, leave no stone unturned: ask your question often and look at it from every angle until your conscious mind is exhausted, and your heart is receptive to answers.

Don't limit yourself to a superficial question like, "What should I expect ...?" If someone else can answer your question — you're not going deep enough. The answer will not come through intellectual pursuit; nor will you find it in a book (books can tell you about birth, but not about you).

Sometimes true understanding comes in a dream, when you're gazing into a fire, writing in your journal, after a good cry, or when you finally give up! Be patient: sometimes the answer doesn't surface until the throes of labor!

Pregnant women face a dilemma:

Do they take the risk of knowing too much, or of knowing too little?

What Do Women Need To Know To Give Birth Today?

Contemporary women who are birthing in a hospital need two kinds of knowing. The first, and most basic, is primordial knowing, that innate capability which modern women have but must rediscover (and trust). The second kind is modern knowing: being savvy about the medical and hospital culture and how to give birth within it. Birthing from within requires both these kinds of knowing.


Emptying Your Mind

The mind of the beginner is empty, free of the habits of the expert, ready to accept, to doubt, and open to all the possibilities.

— Richard Baker From Introduction to Zen Mind, Beginner's Mind by Shunryo Suzuki

In one sense, you've been in childbirth classes since you were a toddler. The world you were born into is the blueprint for your thought patterns and assumptions about what being human means. As a girl playing house, you internalized your culture's messages about motherhood.

So, long before you discovered you were pregnant, your capacity to experience pregnancy and birth had already been constricted by years of "schooling." This process is both seamless and invisible.

To the degree cultural assumptions go unnoticed or unquestioned, you are limited by them. Not so long ago, pregnant women were afraid to hang their laundry, believing that raising their arms above their head would cause the cord to wrap around the baby's neck. In every phase of history, including our own, practices based on erroneous assumptions are the norm.

The more aware you are of what has been your unconscious or conditioned learning, the more you can actually see what is, and embrace whatever comes up in your pregnancy and birth. Question assumptions you've accepted as "true." True understanding springs from an open, curious mind, and can be achieved only after the cultural blinders of conditioned learning have been removed.

Much as a Zen practitioner works years to eliminate internal "chatter" to be in the moment, you, as a mother, must learn to put aside preconceived notions and judgements to be-in-birth. Your quest, like that of the Zen student, is to clear the clouding layer of thought between you and your experience.

In birth preparation, your first task is to empty your mind of expectations and judgements that narrow the possibilities for coping with pain, surprises and the hard work of labor. Being "empty" will allow you to receive, moment-by-moment, the messages conveyed by your body, mind and heart.

A genuine emptying of the mind requires a commitment to sustained attention. Paying attention creates opportunities for a powerful birth in awareness, be it natural or not. Just as an embracing of life includes, inevitably, an embracing of death, there will be some women for whom an embracing of birth must include their experience of a difficult birth.

Just before women give birth, many experience the primitive "nesting" instinct: an intense surge of energy to clean and prepare the home for the imminent arrival of the new baby. There is also a psychological nesting to be done throughout pregnancy: a "housecleaning" of the mind.

Something which comes out of nothingness is naturalness,
For a plant or stone to be natural is no problem.
But for us there is some problem ...
To be natural is something which we must work on.

— Shunryo Suzuki, Zen Master Zen Mind, Beginner's Mind


Worry Is the Work of Pregnancy

Our study group in Albuquerque resisted when DR. LEWIS Mehl, a psychologist who specializes in childbirth-related issues, said, "Worry is the work of pregnancy." We were all holding on to the notion that women who appear relaxed, confident and together, birth normally.

We were intrigued by his story about a childbirth class in Georgia. There were six couples in that class. One of the couples was particularly concerned about how to avoid a Cesarean birth. Every week, they stretched the patience of their childbirth teacher with questions. Later, at the group's postpartum reunion, everyone was amazed that the couple who had worried so much about a Cesarean birthed normally, while the five couples who had sat quietly all had Cesareans!

In the years to follow, my midwifery practice taught me that for some women, worry is the work of pregnancy. In fact, an overconfident first-time mom who thinks she has it all figured out, worries me. I worry she will not be truly prepared for what awaits her.

Women all over the world worry about pain, the health of their baby, and of dying in labor. Western mothers have additional worries: whether their own doctor or midwife will be on call when they're in labor, avoiding unnecessary interventions, separation from their newborn and the cost of medical care.


Hannah, a second-time mom, wanted to have a simple, natural birth experience after having had a highly medicalized birth. Her worry that this birth would be another painful disappointment clouded her pregnancy. She remained immobilized and ambivalent into her eighth month.

She longed to hear me say that everything would be all right. Even though her problems were not likely to recur, I resisted the socially expected, "Don't worry" response. Empty reassurance might have supported her avoidance of the hard, painful work she still needed to do.

Hannah wanted to believe that positive thinking would make this birth work out, yet intuitively, we both knew that more was needed. Instead, I encouraged her to face what she feared. In trying to control her fears, Hannah hadn't been worrying enough!

The first task I gave her was to write down all her secret worries. "Some of your worries may be genuinely trivial," I suggested, "but look closely at the ones you are trying to minimize or ignore. Pay particular attention to worries that create a physical tension in your body."

When Hannah brought her worry-list to our next session, we explored each worry using the following questions:

* What would you do if this worry/fear actually happened?

* What do you imagine your partner (or birth attendant) would do/say?

* What would it mean about you (as a mother) if this happened?

* How have you faced crises in the past?

* What, if anything, can you do to prepare for, or even prevent, what you are worrying about? What's keeping you from doing it?

* If there's nothing you can do to prevent it, how would you like to handle the situation?

Some people believe that exploring fears or worries make them more likely to happen. In fact, worrying effectively helped Hannah shift from frozen, fearful images of not being able to cope, to more fluid images containing a variety of coping responses. Weeks later, Hannah gave birth simply and normally to her daughter, Laura, in a hospital birthing room.

Ten Common Worries

* Not being able to stand the pain

* Not being able to relax

* Feeling rushed, or fear of taking too long

* My pelvis not big enough

* My cervix won't open

* Lack of privacy

* Being judged for making noise

* Being separated from the baby

* Having to fight for my wishes to be respected

* Having intervention and not knowing if it is necessary or what else to do


Every time one of my babies was about to be born, I'd think to myself, "You're going to die! This time you're going to die!" Then it'd come out. Somehow — I don't know how to explain it — but somehow it was like I had been born again.

— In The Words of an Italian Peasant From Kathryn Allen Rabuzzi, Motherself

Women the world over worry when facing the daunting task of navigating the unknown journey of labor. The three worries shared among women everywhere are: fear of pain, fear of having an abnormal or dead baby, and fear of dying in labor.

We seldom hear of a mother dying in labor. So learning that some mothers have fleeting fears of dying surprises, and perhaps unnerves us. Interestingly, mothers tell me that when the thought of dying surfaced near the end of labor, they were simply aware of the thought or feeling, perhaps surprised, but not disturbed by it.

Why does this thought of dying come up in a healthy labor, often just before giving birth? The mounting intensity of labor forces complete surrender of our body and will, dissolving our egos, ideas, and familiar sense of self. We're not afraid of dying because there is no "self" left to resist and fear. At that transcendent moment we have become birth itself. This is the spiritual birth of woman into mother.


Connecting With Other Women

In the last, most intense hours of labor, I had unexpectedly become mindless, floating in boundless empty space between contractions, unoccupied by any thoughts whatsoever. This timeless bliss was regularly pierced by sharp pain reminding me that my head was still attached to a body! But in between contractions, my mind would simply float away.

Near the end of labor, my ego, mental chatter and birth plans all receded into the activity of birth. My thinking-mind plummeted into an immense silence in which I felt bathed in love and well-being.

It was then, for an unforgettable moment, that I felt a oneness with all mothers who had ever given birth, and to mothers all over the world who were laboring and giving birth with me that night. For a fleeting moment, I saw all of us reaching deep inside for strength to break through the mental and physical limitations which we, as maidens, had assumed to exist.

No longer feeling isolated, I noticed a surge of compassion and vigor. Strange as it may sound, it seemed that my effort was in some way helping others through labor, and their effort was helping me. In giving birth to Sky, I had become a link in the eternal chain of Mothers.

This profound sense of connection with other women was a turning point, not only in my labor but in my understanding as a childbirth teacher.

Your next task then, is to renew and affirm your connection with other women. This chapter revives three traditional ways of doing this: 1) Sharing Birth Stories; 2) Mother Blessings; and 3) Making a Butterfly or Friendship Crib Quilt; Reviving the Quilting Bee.


Women, traditionally, have turned to other women for advice and sustenance during pregnancy. Sometimes I begin a class by asking couples to recount family birth stories. I ask them to share their mothers', grandmothers' and great-grandmothers' birth stories. These accounts range from inspiring to hilarious — and teach us a great deal. Listen to these stories:

My Grandma Mary's Story

My grandmother had only one child, to whom she gave birth in a cold-water flat in Chicago in 1930. When I asked her to tell me her birth story, this is what she said:

I kept working around the apartment when I was in labor. What else can you do? When I knew that your mother was going to be born soon, I sent someone for the doctor. Doctors came to the house in those days, I didn't know of any midwives.

He must have brought a nurse who was new to this. I remember he told her to "tie some sheets around the legs." And she tied torn strips of sheets around my ankles. I didn't know why she was doing this. I never had a baby before.

The doctor got flustered with the nurse and scolded her, "No! Not around Mary's legs, around the legs of the bed!" I guess the [strips of] sheets were to help me pull on something when I pushed. I don't know what happened then, but before she could get the sheets tied right, your mother was born.

My grandmother laughed to herself when she told me this story. She was gazing downward as though seeing it again for the first time in years.

A few months later, at the time I discovered I was pregnant with my first child, my grandmother died. But her story of my mother's birth is alive in me and preserved in my journal.

Fina's Story Told By Paula

This story was told to our class by Paula, who had grown up in Brazil. Fina, short for Josaphina, was the family maid during Paula's childhood.

Fina had six children born between 1953 and 1964, and liked to tell her birth stories. She told me that she gave birth to her first two by herself, but her mother was with her for the last four.


Excerpted from Birthing from Within by Pam England, Rob Horowitz. Copyright © 1998 Pam England & Rob Horowitz. Excerpted by permission of Partera Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents


Section I: Beginning Your Journey,
1 Finding Your Question,
2 Emptying Your Mind,
3 Worry is the Work of Pregnancy,
4 Connecting With Other Women,
5 Eating in Awareness,
Section II: The Art of Birthing,
6 Black Cloud Over Birth,
7 Birth Art Teaches,
8 Taking The Plunge,
9 Discovery Through Drawing and Painting,
10 How Birth Art Helped Donna Become a Mother,
11 Revelations Through Clay,
12 Preserving Your Shape Shift: Making a Belly Cast,
13 Birth Art and Insights from Professional Artists,
Section III: Preparing Your Birth Place,
14 Ask Questions Before Your Chile is Roasted,
15 Where Mothers Build Their Nests,
16 Childbirth as a Rite of Passage,
17 The Birth Plan Trap,
18 Birthing With Wolves,
19 Home Birth,
Section IV: Being Powerful In Birth,
20 Even Paper Tigers Can Bite,
21 Labor Means Hard Work,
22 Out of Control: How to "Lose It" In Labor,
23 These Bones Were Made for Birthin',
24 Stand and Deliver,
25 How to Give Birth if You Need a Cesarean,
26 Being at a Birth Doesn't Make a Man a Father,
Section V: Fathers and Birth Companions,
27 Getting Dads Involved,
28 Pitfalls of Labor Coaching,
29 What's a Father To Do?,
30 The First Moments,
31 Laborland Etiquette,
32 Gathering Information: Guidelines for Making Decisions and Giving Informed Consent,
Section VI: Birthing Through Pain,
33 Looking for a Way Out,
34 Exploring Beliefs and Attitudes About Pain,
35 Endorphins,
36 The Ecology of Pain,
37 Don't Give Birth Without a Doula,
38 Proven Pain Techniques,
39 The Compassionate Use of Drugs and Epidurals,
Section VII: Gestating Parenthood,
40 Gestating Motherhood,
41 Baby-proofing Your Marriage,
42 Swaddling the New Parents,
43 Preserving Your Birth Memories,
Afterword: Birth as an Adventure,
Appendix A: Special Diets for Special Situations,
Appendix B: Breech Tilt,
Appendix C: Worksheets for Learning the Pain Techniques,
Appendix D: Reminder Cards,
Appendix E: Circumcision,

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Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation 4.4 out of 5 based on 0 ratings. 11 reviews.
Guest More than 1 year ago
I'm in the midst of my first pregnancy, I don't know it all. I'm not really the artsy type either, and while there's a lot of 'art stuff' in this book, I have learned so much from Englund's analyses of the artwork of her students. It's true that it is very difficult to discover what your fears are unless you dig them out - and art is a good way to do it (even if you're not an artist, she shows that stick figures mean a lot). Moving beyond the art stuff, the actual science of natural childbirth is brilliant and refreshing. Books recommended to me by an OB I saw left me feeling helpless and frightened (eg. 'Your Pregnancy & Birth'). 'Birthing from Within' made me not only feel like I could do it, but provides excellent tools for coping when things don't go the way you wanted them to. I highly recommend this book!
Guest More than 1 year ago
I was pregnant with our first child and my husband saw this book and thought it would be very helpful. He is a practicing zen buddhist and wanted to have everything as natural as possible. We read the book together every night, did the exercises and the crafts. This book also solified our marriage as well as allowed us to have the natural birth that we wanted to experience with our child! (I have a big fear of pain and did NOT have pain medication/epidural for my delivery). I am pregnant with our 2nd child and we have just started to read it again!
Guest More than 1 year ago
I am a mother of two, training to be a doula, and have read a lot of books about birth. I loved this book! The reading is so easy and I had a hard time putting it down! I plan to start teaching childbirth classes and this will be a great book to recommend to read. I love the information and the art and imagery in this book. Every pregnant woman should read this, and her partner too!
Guest More than 1 year ago
This book is a unique gem among childbirth books. Its approach is wonderfully comprehensive & answers almost any question a pregnant woman might have. Highly recommend!
Guest More than 1 year ago
I highly recommend this book to any woman who is even remotely considering a natural birth. Beautiful imagery, great exercises, and lots of facts.
Anonymous More than 1 year ago
Anonymous More than 1 year ago
I love PAm's approach to childbirth preparation. Where most concentrate on the medical, Pam addresses the whole person, particularly psychological and emotional aspects of pregnancy. She brings a unique sensitivities to this topic. However something is wrong with the Nook book. Sometimes I had trouble "turning" pages... Both the Nook Color and my Nook App on ipad would stall. Sometimes rather than Continuing to the next page it would jump around or just refresh the same page. I was able to read the book, but it was frustrating at times. I'm not entirely sure if I ended up skipping pages.
Xakana More than 1 year ago
While the book is a little "Hippie Dippy" (particularly the chapter titles), I credit this book with helping me come to terms with a lot of experiences that didn't go how I wanted them to and giving me the strength to go again without being afraid that they would repeat (and they did not!). It explains a lot of the natural responses of the body in interesting ways and I love the drawing exercises. This was probably the most helpful of all the pregnancy books I read, even if it made me roll my eyes here and there.
Anonymous More than 1 year ago
Good read!
Anonymous More than 1 year ago
Guest More than 1 year ago
I returned this book after trying to get through it - it just wasn't for me at all.