Mindful Birthing

Speaker 1 · 0:00Welcome everyone. I'm gonna go ahead and introduce our guest, Jennifer. Jennifer is the director of community partnerships and a senior faculty member at Mindful Birthing. She has been teaching mindfulness-based childbirth and parenting, MBCP, since 2014 and has dedicated her career to working with high-risk, marginalized, and underserved populations. Her passion lies in the intersection of mindfulness, birth, early parenting, and health equity, all is both intervention and prevention. And she is committed to training and mentoring perinatal and mental health professionals to deliver MBCP programs around the world. We are grateful to have her here today to share more about both mindful birthing in general and her organization, Mindful Birthing. But right now, I will give it over to Jennifer to

Speaker 1 · 0:56take the rein. So welcome, Jennifer. Great to have you here. Thank you.

Speaker 2 · 1:00I don't know why it doesn't say in my bio. I've been a midwife since 2003. I've been at over a thousand births. And I actually met Nancy Bardequi, who wrote Mindful Birthing in 2003 in her living room where she was teaching childbirth classes. And we were required in midwifery school to go take a childbirth class series. Here I was, 29 years old, type A, nurse midwifery student. And I had seen Nancy speak. And so I called her and said, Could I shadow your class as part of this midwifery school requirement? She said, You can, but you also have to practice with the class if you shadow. I said, Okay, and maybe I should take your MBSR for healthcare providers also. So I ended up taking a couple of different classes from her at the same time and then started teaching MBCP, which we actually now call mindful birthing. We've made it a little bit easier for people not to have to remember the acronym in 2014. So I've been teaching it ever since then at a community health center. And so what we're teaching in our childbirth classes is not just for pregnancy and labor and birth and postpartum, but also your 16-year-old is learning to drive, or your five-year-old fill in the blank, or your 32-year-old. You don't have to have heart complications to be a cardiologist. You don't have to have given birth to be a midwife or teach childbirth class. And so one of the things we're also cultivating when we teach mindfulness is deep trust in ourselves and in our capacity, but also just our own wisdom. So we know that we don't know what's right for any particular human being in terms of their own birth or their own family. And yet lots of people feel very much at liberty to give advice when people are pregnant. I mean, people feel free to give advice all the time, but when folks are pregnant, the advice just keeps rolling in. And lots of people will talk like the way they ended up doing something is the right way. And so, yeah, just being able to identify with your own wisdom in your own stillness can be life-changing for some of our participants. We say you can't plan a birth like you're driving through a McDonald's drive-thru. You don't just get to order. We wish you could, just like we wish we had more control over life sometimes. And don't know is a theme that is threaded throughout the curriculum. We don't know, even from the very first day when people are introducing themselves, and we invite folks to tell us their due date range, because only about 5% of people actually give birth on their due date. And so if your due date that you got from your midwife or your doctor is July 1st, your due date range might be mid-June to beginning of July. Your due date range.

Speaker 2 · 4:05So bringing don't know into this sphere. So we're gonna spend a little bit of time centering embodiment, bringing trauma-informed mindfulness into perinatal care, and we're gonna speak to our experience in mindful birthing. And so today we'll have our own experience of mindfulness. We'll talk a little bit about the links between stress and perinatal outcomes, including health disparities. You'll hear about the five intentions of mindful birthing or MBCP, the health benefits of mindful birthing being with the contractions of labor and life, and identify how self-compassion and embodiment can be transformational. Nancy Bardequi started teaching after creating MBCP, started teaching it in 1997. It is rooted in the integrity and evidence base of MBSR. And Nancy was friends with John Capitzin and got his blessing to create mindful birthing. It takes the formal mindfulness practices from MBSR, brings them into a nine-week childbirth education program. Many people expect to take some kind of childbirth ed when they're pregnant, and adds to that some pain work for labor. So in three classes, folks are holding ice for the length of an average contraction and practicing different ways of dealing with discomfort. And then there's also some didactic pieces on physiology of the pregnant person, newborn needs, breastfeeding relationships, and building community. Here are the five intentions of mindful birthing: mindfulness for decreasing stress during pregnancy and for decades to come. Mindfulness skills for working with pain and fear, parenting mindfully from the moments of birth. So incorporating the attitudes of mindfulness into one's parenting experience. You can see there's nothing that talks about calm in these intentions. There's nothing that talks about being perfect in these intentions. So we're not saying that you have to be calm all the time to be a mindful parent. And you know this already, because all of you are mindfulness practitioners or mindfulness teachers or trainees. Parenting mindfully from the moment of birth includes all of it, includes being with whatever is here. Number four is a real big one, especially with all that we know about epigenetics, interrupting intergenerational patterns of suffering. And then, of course, many people really enjoy the creation of community that happens when folks come into either a virtual or an in-person classroom together during pregnancy. And so mindfulness and embodiment overlap to create an embodied presence, bringing curiosity and kindness to this present moment experience. So much of mindfulness has to do with remembering to come back again and again, beginning again. And so much of embodiment is around remembering that there is a body here. It's not just our thoughts, but instead we can be grounded in the felt sense of the bodily experience.

Speaker 2 · 7:28And so before we go any further, why don't I stop sharing for a minute and we just experience a little breath and body awareness together right now. And so I'll lead us in this brief mindfulness practice. But of course, if any words that I'm saying don't fit your particular body or mind right now, or you want to just do your own practice, feel free to let the instructions of your own heart and mind be your guide right now. Maybe letting yourself have a little wiggle or a little stretch. Whatever your body is asking for on its way to some relative stillness. One of the things that Rashmam Menekim, who wrote My Grandmother's Hands, one of the things he says is you don't need permission. So letting ourselves be unpermissioned right now and just responding to whatever the body is asking for. And then when you're ready, maybe coming to a sitting or standing or laying down posture, feeling the body connect with the surface beneath, perhaps feet on the floor, body on the chair, hands in the lap. What is here to be sensed right now in terms of contact points? Choosing an anchor in this moment. Maybe the anchor is the breath. The breath which is always in the present moment. Seeing if it's possible to sustain the attention for one complete in-breath. Noticing the pause between the in-breath and the outbreath. And sustaining the attention for one complete outbreath. The breath is with us and within us from the first moments of life until the last. And the breath is always in the present moment. Not trying to change the breath in any way. It might be slow or fast. Smooth or choppy. Just letting go of trying completely. Just being here with this breath. With this body. However it is. And anytime you notice that the mind has wandered away into thinking or planning, story making or judging. Not a problem. Just congratulating yourself for waking up to where the mind is. Escorting the mind back to this breath. And as this brief period of practice comes to a close, perhaps just appreciating yourself for showing up in this way today. Bringing curiosity to the felt sense of being alive in this moment. As your life continues to unfold. So when you're ready, opening the eyes if they've been closed, it's amazing how we can go through the whole day and not realize that that has been a pattern throughout the day. And then, wow, maybe I just took my first deep breath of the day. There's so many things calling for our attention all the time, so many thoughts. And so to be able to start again and have practice and training and starting again, so powerful. So embodiment in pregnancy just makes sense because often it is a time when people are more in touch with what's happening in their own bodies. And that can be hard sometimes for folks who have had traumatic experiences or difficult relationships with their bodies, which, of course, in our culture, so many people have had that. It's also a time when many people are able to tune in to how remarkable it is for a human being to grow and nourish another human being within. And so coming home to the pregnant body, bringing curiosity. We have a practice in mindful birthing called being with baby, which is basically just when you notice your baby's movements, when they're calling for your attention, letting the attention go to the baby. It's that simple. Just allowing yourself to be with this profound sensation within.

Speaker 2 · 13:22So let's get into perinatal health in the United States. We teach mindful birthing in 40 countries all over the world. I'm focusing in on the United States in this moment because we're going to get a little bit into health disparities. But we know that our statistics in the United States are not great. A third of U.S. counties in the U.S. lack adequate maternity care or perinatal care. We know that among developed in quotes countries,

Speaker 2 · 13:53we have one of the highest maternal mortality rates, which is 18.6 per 100,000 live births, that 80% of pregnancy-related deaths are preventable, and that there are great racial disparities and complications. Part of the way that I feel that mindful birthing is making a difference with perinatal health disparities, is by offering this opportunity for decreasing stress. And there are a few different models of how anxiety or stress, including the chronic stress of racism, can impact perinatal outcomes. This is one model where you can see that major life events, chronic stress and racism, depressive symptoms can lead to low birth weight. Pregnancy anxiety has been shown to link catastrophic events, major life events, chronic stress, and the chronic stress of racism has been linked to lower gestational age and preterm birth. And then, of course, these things can also lead to particular maternal outcomes, infant and developmental outcomes, and family outcomes. More of the physiology around stress and preterm birth. We have all of these things that are stressful here. And then the stress can sometimes lead to particular perinatal health behaviors. And stress can also just lead to changes in the maternal HPA axis, hypothalamic pituitary adrenal axis, meaning that the pregnant person is secreting more stress hormones, which cause immune changes in inflammation, cause placental changes, and can lead to preterm birth. This is not theoretical. It used to be, now we have enough research to show us the direct links between stress and preterm birth. I mentioned earlier today epigenetic modulations. So now we're not just talking about this pregnant body and this baby, but also future generations and past generations. So different environmental exposures, stresses, diet, and lifestyle can introduce epigenetic changes that can determine whether genes are turned on or off and can impact health.

Speaker 2 · 16:13And so right now I'm going to take you into one of the teachings in the mindful birthing class. This is a teaching on exploring pain. We very much encourage folks to be with pain and to be with fear. And so in this particular teaching, we're exploring pain. What is it? And why are you in a childbirth class in the first place? And many people are because they're concerned about this thing that's coming that they have heard from their friends and family is painful. And so we start out by asking, what is pain? We know that pain essentially is just sensations in the body which signal the brain to tell it to pay attention. And for many people, in your life up to this point, until you got pregnant in your life up to this point, pain has often been a signal of either one of two things, either injury or illness. It's saying something's wrong. Maybe you burned your hand or you broke your leg, something is wrong, or you have the flu. It's helpful to have that signal of pain because something's wrong and you should do something. Is the pain of contractions in labor about an injury? No, it's not. And when you're experiencing pain in labor, is it because of an illness? It's not. And so we need a new word, a new category that describes the pain of labor. And that word is transformational. The pain of a big transformation that's happening in a very short period of time, transformational pain. It took about nine months usually to grow this baby, and the baby is going to go from inside the body to outside the body in a matter of hours to days. So that is a huge transformation. So not an injury, not an illness, but transformational. And the baby's going to have transformational pain as well. When will the baby have transformational pain? Yes, growing pains. When their little bones are growing, or as teenagers, people often have growing pains. How about when the baby's teething? When they're teething, when they're getting their little sweet little teeth, that's not because of an injury. They're not sick, they're not injured. It's transformational pain. So then we break down the components of pain into the sensory component, the physical sensation, the emotional component, how I feel about it, and our cognitive component, what I think about it. And when we're practicing mindfulness, we are essentially uncoupling the sensory component, how it feels in the body from the emotional and the cognitive, how I feel about it and how I think about it. And essentially that means we are separating pain from suffering. The pain is the physical sensation. Often the suffering is our feelings about it, our thoughts about it. So we're uncoupling or decoupling the pain from the suffering. And every time we practice and we bring our attention to the physical sensations that are here, we're practicing for that. And of course, in labor, we're not just talking about physical pain. We're also talking about in life in general. So the next time something hard is going on, whether or not it's physical, just noticing where you feel that in your body. So you get an email that doesn't lay and rate with you, or you're in a conflict with someone, or you name it. We have contractions of life all the time. How does it change the experience if you bring the attention to what physical sensations are here right now? Experiment with that. And then we ask participants to do the math. So let's say you're having contractions every five minutes lasting about 60 seconds. How many minutes of pain is that in one hour of labor? That's 12 minutes of pain in one hour of labor. Can you do that to get your baby born? What about if the contractions are coming every three minutes lasting a minute? That's 20 minutes of pain in one hour of labor. There are less minutes of pain than breaks in one hour of labor. And that is partly because the baby couldn't handle more contractions than that. Even in the most intense part of labor, your contractions are coming every one and a half to two minutes. And if you're really paying attention, if you're used to paying attention to body sensations, you'll notice that your contraction starts less intense, builds up to a peak of maximum intensity, and then gets less and less and less intense again. And if you look here, how long is one breath? It's about three to five seconds. How long is the peak of maximum intensity? About three to five seconds. So we have 12 breaths of maximum intensity in one hour of labor. And of course, when we're actually in a mindful birthing class, we definitely bring don't know mind to this as well. We contextualize the fact that the same day you give birth, 300,000 other people around the world will also be giving birth. And most of the time, that is relatively uncomfortable. Complicated. And we also just make sure folks know that for some people, contractions don't come regularly. It might be every five minutes for half an hour, then every two, three minutes, then seven minutes in between. So it's a little bit deeper when we're in an actual mindful birthing class. But still, the bottom line is the same. More breaks than pain in one hour of labor. What's happening during the breaks inside the body? Your body is pumping in all kinds of endorphins and feel-good hormones in between contractions. And so many people can feel rest, ease, can actually fall asleep in between contractions. And so then the question is well, why aren't all of our friends talking about how great the breaks were in between the contractions? Why aren't people coming and saying to us, you should have felt it. It was so amazing. In between the contractions, I felt so good. All my body's natural opiates. Well, for most people in the untrained mind, in between contractions, people's minds are doing this. Oh my gosh, that last one was so hard. Oh my gosh, I don't know how I'm gonna do the next one. Oh my gosh, I hate this. Missed it. People miss the breaks completely. And of course, we're not just talking about labor, we're also talking about life because we do this all the time because we have human minds. Our minds want to go back to that thing that happened yesterday or two weeks ago or 20 years ago, or to what if instead of what is right here, right now. And so when we're bringing ourselves back again and again, we are cultivating the capacity to be in the breaks in between contractions in labor and in life so that we don't miss them because they're easy to miss. And of course, we don't want to give birth when a tiger is chasing us, of course. And so when we go into fight or flight, our bodies have the capacity to run. The blood is shunted towards our major organs of heart and lungs so that we can run away from a tiger who's chasing us if we're feeling afraid or if we're in fight or flight. But what happens physiologically if we get into that state and we don't have a way to get off that train of suffering is that our blood is actually shunted away from the uterus. And so that oxytocin, the love hormone, the contraction hormone that helps our uteruses to contract efficiently, it's not getting to the uterus because the blood is going to the heart and the lungs, and that can make for less coordinated labors. And where did that start in the untrained mind?

Speaker 2 · 25:00That's just a tiny little piece of the whiteboard. But part of bringing trauma-informed mindfulness into our mindful birthing classes, and then also just to people in general are these four R's and these four C's. There's the word calm, but it's not a requirement to feel calm all the time. But as a mindfulness teacher or someone who's working with pregnant people, being able to have tools for grounding can be helpful. Being able to bring care and compassion to our participants in our classes and ourselves, recognizing signs and symptoms of when people are feeling elevated. And really offering, I would say, another C is really providing choice for folks. We don't know what's best for anybody. We really don't. Supporting folks. I'll just let you read this. One of the pieces that feels most significant and integral to our teacher training is the fact that we tell our trainees that you can't call yourself a mindfulness-based childbirth and parenting teacher or a mindful birthing teacher if you don't have your own mindfulness practice. If you don't have your own mindfulness practice, however it looks, then you're a childbirth teacher. You're not a mindful birthing teacher. Really prioritizing your own practice so that you can come from an embodied place when you're teaching, so that you're not asking your participants to do anything that you don't do yourself feels central to us. Because you don't support embodied learning by reading about it. You support embodied learning by exploring what's happening in your own body, noticing your own physical cues, which is so sweet to be able to hear some reflections on that, even after our very short practice, your own patterns, your own nervous system responses. That's how we learn to provide embodied support for our participants. And engaging in embodied inquiry, being able to focus on the people that we are communicating with and also what's happening in our own bodies. A lot of embodiment and somatic experiencing is kind of grounded in this idea of safety being associated with co-regulation. We are getting our safety cues from each other. And then we had to put in this quote from Lila Watson about your liberation being bound up with mine because safety and liberation in all forms is part of the work that's important to me. So we want to prevent stress and prevent the chronic stress of racism as well as treating it and providing tools for folks who are suffering.

Speaker 2 · 27:56What we're seeing is a significant decrease in depression post-course, post-partum, and even eight years post-course, which feels very striking to me. This is something that folks take into their parenting. Even higher newborn apgar scores, better maternal fetal attachment. That word is gendered because that was what the research was, better infant social emotional development at three months of age, and better infant stress resilience at six months of age. This is powerful stuff. And all the references for this research are in at mindfulbirthing.org/slash research. And what do participants say? So patients at my health center have said some of these things. I'm learning that the stories that I've told myself about myself, my whole life, aren't true. I can stop thinking so much when beautiful things are happening. That's about the breaks in between the contractions. This participant was from a rural community in Maine, and she posted this on social media, which was herself at seven centimeters, approaching eight. The smile is for real, and standing and not delirious, spectacular. And of course, that's beautiful. And her partner also took the class with her. Another very powerful story that came out of that particular class is that he had gotten arrested for driving under the influence about a year before he took the class. And during the time that he was taking MBCP, he decided that he wanted to write a letter to the editor of his local paper in Maine. It's just really powerful to witness both participants and their support people being impacted by their own mindfulness practices. As teachers of mindful birthing, I talked about this a few minutes ago, but we ask our teachers to commit to having their own regular personal mindfulness and movement-based practice, whatever that means for your own life and your own body, engage in regular retreat practice, which again, many of our trainees have caregiving responsibilities and would not be able to think about doing a five to 10 day retreat at this moment. But the intention is to be able to deepen one's practice by doing some kind of retreat when possible, and then doing some annual professional development and supervision on these particular topics.

Speaker 2 · 30:35All of these embodied practices are included in the teacher training. The curriculum is designed as nine weekly sessions. Each of them are three hours, except for one, which is in between class six and class seven, we have an all day. So it's a six-hour session, similar to the all day in MBSR, where folks come for the day and we practice mindful walking. And it's mostly a day of silence, except for speaking and listening practice. Mindful eating, of course, there's time for a nap because pregnant people are needing naps or often appreciate naps. And so the reason that it's that long is because it's very beneficial for people to have the experience of practicing in between the classes and coming back and having inquiry about their formal and informal practice during the week. This course is designed to be taken in the third trimester, starting around 28 weeks, but it could be a little earlier or a little bit later. Sometimes people start it late enough that they give birth before class nine. But we actually treat ourselves as midwives of people's mindfulness practice without being inflexible or rigid, encouraging people, as midwives do to practice. Practice is more important than reading about labor, just getting practice, coming back to the felt sense of this moment over and over and over, and experiencing contractions of life, and then noticing places where there can be space, noticing thoughts as thoughts. So lots and lots of practice. We also do a pleasant events calendar, I think after week three, and an unpleasant events calendar after week four, that people reflect on those things in their life and come back. Lots of exploration about places where we notice liking and not liking in our lives. Because of course, labor and birth and parenting are full of potentially pleasant and unpleasant moments and lots of contractions. If people can bring their support person with them or a support person with them, that can be really

Speaker 2 · 32:56helpful. And one thing that's super important for me to say here, too. I know that we've used the word natural a couple of times. Nancy Bardecky says, what is natural is having a baby come out of your body, however it happens. And one of the things I think is most powerful about MBCP or mindful birthing is that we are not promising a particular kind of birth experience that actually is not honest to do that. And it grates on me a little bit when I see advertisements for come to this class and you'll have a beautiful birth. We don't know. All we know about your birth is that it's going to be different than you expect it to be because the future is a fantasy, and there might be such incredible surprises, and you're going to meet your new family member, and we don't know how it's going to be. One of the things that we have witnessed with mindful birthing is a huge decrease in PTSD, which is something that in our society at large is actually going up. There are many people who are experiencing traumatic births. And one of my favorite stories about this was a couple who came and took the class. And I was also their outpatient prenatal provider. So I was reading our hospital sign out, and I saw she had had her baby, healthy baby, but unfortunately she had had a third degree tear and a vacuum delivery. And so my heart sank for her for a minute, like, oh, she went through a lot. And in that moment, my phone rang and I picked it up and it was her husband. And he said, it worked, it really worked, which is just to say, and she came in saying the same thing. This experience is going to be what it is. And a lot of the teaching in class six about causes and conditions, there are many things that we do have control over. And here are some tools. And you know, practicing with ice three weeks in a row, there are many things that we can do to have control over this experience to relate to discomfort. And just like in life, there are a whole lot of things we don't have control over, too. That honesty, I think, is pretty powerful.

Speaker 2 · 35:18If you want to go further in terms of becoming a mindful birthing teacher, we would love for you to train with us. Nancy Bardiquay's book is available, Mindful Birthing. We would love for you to connect with us. At this point, we have 500 plus professionals across six continents who are teaching mindful birthing. And we do have scholarships and payment plans for all of our programs. It's an investment that should pay off over time. A full tuition covers a 10 or 11 month program, including all three levels of training, plus eight free, eight mentoring sessions that are also included in the cost. And if you want to just enroll in the first part of the teacher training, which is called foundations, the first module is available separately. I could just give you like a two-minute or less breakdown of the different levels of our teacher training. The first level is just called foundations. And in the foundations level, you are taking a mindful birthing class from either Nancy Bardequi, who created Mindful Birthing or MBCP, or another one of our teachers, Claire. So you're watching videos of them teaching and you're going through it each week and you're practicing the same practices that the participants are practicing. And we have five synchronous, two and a half hour dialogue sessions during those 12 weeks that you're participating in Nancy or Claire's classes. That's foundations. In level one, folks have a chance to practice doing a bunch of the didactic teaching and also leading mindfulness practices that you would then hold and lead in mindful birthing. So level one is 12 weeks long, and each week you're practicing in breakout rooms and also practicing with a practice partner. That's weekly meetings. After level one, we consider you ready to teach, hopefully starting with a smallish group and then expanding. Level two is kind of taking a step back more philosophical, theoretical, the Buddhist underpinnings of mindful birthing, which is a secular program, but of course has its roots in practices that started 4,000 years ago. Western psychological development theory, a lot about creating community and belonging in the classroom, no matter who walks in the door. So that's level two. It's more of a lecture style, but you're still practicing with a practice partner. And that one is 10 sessions, and we meet weekly. And then you can use your eight mentoring sessions anytime in the first couple of years after you graduate. We suggest that you time it with your first or second class so that you can get some support as you start teaching for the first time, mindful birthing. You get a certificate of completion and you're ready to teach mindful birthing. But then if you want to be a certified mindful birthing teacher, that's a different process. It's kind of similar to MBSR, mindfulness-based stress reduction, where you are expected to teach for a couple of years and then submit some videos to be considered certified. Certification is not required ever. It's not required to teach, but some people want to be certified to have the credential, but also might open some more doors in terms of practicing in particular institutions or whatever.

Speaker 1 · 38:53I'm curious, just you said practicing in different institutions. And I know the videos from a family health center, which I assume is like a nonprofit organization, perhaps. Or could you say a little bit about where people are doing these courses and are some people privately offering them?

Speaker 2 · 39:11So because I see it as having so much potential for decreasing outcomes related to stress, my dream would be that it would be in every healthcare setting offered to every pregnant person, that mindful birthing would be just as much of a household word as like hypnobirthing or lamas or whatever other common childbirth education you can think of. And currently in these 40 plus countries, it's being offered in such a variety of locations. So it's being offered in yoga studios, a lot of different healthcare settings at the Mayo Clinic. I work at a federally qualified community health center. So that's what Family Health Center is. And all of it since 2014 has been grant funded. So grants related to infant or child mental health, related to postpartum depression. There's grant funding. Lots of people teach online. A lot of parents love being able to come from the comfort of their own couches, especially when pregnant. So there's been lots of success with that. It really varies, it's whatever works for your own particular community.

Speaker 1 · 40:21It's really, really beautiful the work that you're doing. And yeah, I don't have kids and I'm not a mom, but I can really relate to it on this level of mindfulness applied to any situation, anywhere and everywhere, is like the best possible way that we can respond or be in or be present with that situation. And so it's just really wonderful to have that confirmation. Like you said, remembering again.

Speaker 2 · 40:49And the advantage to not having kids and teaching this is people who have their own birth experience are at risk of seeing things through that lens. And so it helps with your don't know mind. This really is for anyone who's interested in teaching.

Speaker 2 · 41:09Thank you so, so much for all of your presence. And it's been really fun to be with you and such a huge pleasure. Thank you so much. Thank you.