Part of the problem, Simkin says, “is allowing the clock to be our guide.“ Many providers will give up and resort to induction when a woman’s cervix has not dilated more than 6 cm in a certain amount of time; Simkin calls for more patience. “Let’s stop blaming the mother” for what might be going wrong, instead, “know that she is the key to the solution.”
Steps can be taken early, according to Simkin, that can improve the birth outcomes, including waiting full term (37 – 42 weeks), early movement when labor starts, acknowledgement that normal labor is strenuous physical work, sleep (even if induced with drugs). “Also, don’t tell women that because they have a big baby they will probably be induced, that scares them!”
Eating, drinking, distraction (Simkin suggests kneading bread), acupuncture. And support during the contractions that goes beyond the pain scale (1 – 10) and instead observes the level of suffering a woman is experiencing during her contractions. “Ask her, ‘What was going through your mind during that last contraction?’ Pain does not mean the inability to cope; suffering does.”
“When a woman is in pain, but not suffering,” explains Simpkin, “she can still practice her three Rs – She has the ability for relaxation, rhythm and ritual. If she’s suffering, she won’t be able to sway, rock, breathe in a pattern or even moan rhythmically. If she can’t stop crying even in between her contractions, if she says ‘I can’t do this,’ she is suffering, and she should probably have the epidural.”
Birthing positions are powerful and empowering tools: “It’s important to use gravity,” Simkin says, “not stay in a victim position lying flat in bed.” She showed slide of an all-fours, open-knee position; a squat with support; lap squatting, even an ingenious sling that allowed the woman to dangle, lengthening her trunk and allowing nothing to impinge her pelvis.
Penny Simkin continues to be optimistic, and feels we are moving forward to educate women about their options, and even more, attracting them to those options. And she believes much starts in medical school. “It’s so important that residents and students get exposed to midwives, that they get a chance to work with them and see that being with a women in labor is a privilege. Then, they grow up and become chiefs of staff, and will open doors to midwives and doulas.”