BERRY LIBERMAN: How would you describe what you do?

RHEA DEMPSEY: [Laughs] difficult to say. I guess one way of talking about it would be that idea of being “with woman”. In the eons of women birthing and having other experienced women around them… That’s where the word midwifery comes from. But in the modern era of course, it’s sort of separated into a few distinct roles; one being midwifery, which has always been to have some particular body-handling skills or understanding of the body, and now is even more specialised in terms of combining some of the best of medicine with those skills.

But as midwifery has been sort of subsumed into that bigger medical scene, a lot of midwifery has become “with machines”, “with paperwork”, “with hospital protocols”, “with bureaucracy” and not actually “with woman”. So the role of the birth attendant — or whatever you want to call it — is being emotionally and energetically present, knowledgeable and just to be with the mother through whatever those hours are, not having other responsibilities that have to be fulfilled.

The research says that it’s not only having somebody with you one on one, continuously, throughout labour, but to have somebody who’s not part of your social circle. So this role of being “with woman” is taken up by the doula…

You talk about the “work” of it. What are you talking about?

It’s important to be present with the mother’s body and her instincts, particularly in her first labour. For some women, that work of staying with their body, staying present with their body, their breath, being attuned and working with their contractions… there can be a kind of separation, where they don’t want to stay engaged. So the “work” of it is to stay present, to feel it, work with it.

What is natural physiological childbirth to you?

There is a physiological template — the hormones and the patterns in the female body and in the baby. There is a strong dynamic in how births play out — a dance between mother and baby. The hormonal physiological process starts the labour, drives the labour, completes the labour… The uterus opens, the uterus closes, the baby’s born, the placenta is delivered — all of those things happen within that context of the body’s own instincts.

So you’re talking about childbirth without intervention, childbirth without drugs. But why engage in that, why is that important?

Yeah, an increasingly necessary question — a question that has only really come forward in the last 10 years or so.

Sure, because as a very well known doula in this country, you’re working against the system. For many women in the West, it’s a totally crazy notion: to want to feel the pain of childbirth, the epidural is God’s gift. Why the hell would you bother going “backwards”, to feeling the pain, to being an animal?

Yes. To frame it, that’s only a question that could be asked since epidurals came along and since caesarean births have become a much safer procedure. That question gets asked now because there’s an alternative. Of course, in eons gone by, there was no alternative. So, if we’re now asking the question and many women are asking it, why?

What are the benefits in staying with that process in the body? There are a whole lot of ways to answer that. Physiologically, we are mammals. The physiological process has evolved over however many millions of years in order to fulfil certain functions of safety and survival and, in particular, strong bonding mechanisms.

So the physiological process of the hormones works to not only open the body and let the baby out, but also to trigger the behaviours that are going to have the mother bond with the baby and the baby with the mother and then therefore hopefully ensure the survival. That’s still the same in our bodies even though lifestyle is different and, as creative human beings, we can find other ways to bond with our babies.

On the other hand, if you could have that birth process and have those hormones add another rich layer to that connection, why not? And, in particular, if the only reason is that you don’t want to engage with the pain, why not?

You’ve also talked about the possibility of personal transformative experiences for women in childbirth. How can one be transformed through birth?

Again, across eons, there’ve been those rituals, those rites of passage that for women, in particular, have been around how their bodies change across their life span. Menstruation and being pregnant, then having babies… The rite of passage is something to temper you or strengthen you; to make you ready for this wider, more complex, more demanding role that you’re stepping into.

So having a baby — that first baby in particular — is a major rite of passage for a woman. The labour itself can aid that strengthening of emotion that sets a woman in a stronger place within herself to then take on the role of mothering.

I’d have to say that’s true for me. I was blessed to have an incredibly beautiful natural birth in hospital. I felt like I was born when I gave birth to my son. I changed at a cellular level. I wouldn’t trade that for anything. My life is full of contradictions, but that deep commitment to that internal and physiological process had incredible results. A lot of my peers though ask, ‘Why the hell would you go without epidural?’ They get that stunned look on their faces, like I’m totally nuts.

I know. It seems that there’s a pathway into the world that many women have taken — and by “into the world” I mean into a career — that apart from being tinkered around the edges is a very masculine pathway.

Women have to control their body more and more to fit that. How do we make having children convenient, timely, without too much absorption into our body process, without having to be slowed down or diverted? Well, what we see is what’s happening with birthing: epidurals, caesars…

Bottles.

Bottles. So they fit. And if that’s the way you’re attuned, it’s a pretty good fit. Some women though are swept into it without actually consciously pulling it apart. You’re probably somebody who likes to take on challenges, so, maybe you took on a normal physiological childbirth in the context of a personal challenge.

But there are many people who don’t see taking challenges in their life as useful for personal growth. They don’t want to. They take the more convenient pathway. Or maybe there are challenges somewhere else in their lives, so they don’t want to have to take on another challenge in this regard.

So what kinds of women come to you?

Well, I’ve always been around the home birth scene but my early work was with the Childbirth Education Association, which at that point was a voluntary organisation — there weren’t even classes in hospitals then. It was for women and their partners who wanted more information, some deeper understanding about the process of childbirth.

The women who have been drawn to my work have been women who somehow or other wanted to consciously engage in what they were doing. In more recent years, childbirth education has gone into hospitals. But there are still some independent childbirth educators. The women who come to independent educators like myself are women who are either not going to hospital, or if they are, they want some different sort of information. In the hospital they’re often given the procedures, the protocols, the “what to expect”, but women who come to do other education want to know how to work with their labour.

So in hospital you get educated about protocols and processes…

Whereas I guess most independent education, and certainly mine, would be about what you, as a birthing mother, can do.

Consciously, to engage with your birth of your child … [laughs] he’s kicking!

You know, before, we talked about the physiological process that sets up things for bonding. There is also a pressing biological issue. There’s new research about this “epigenetics” idea, that, okay, we have all these genes in us, but which ones are going to get “switched on”, and which ones are going to get “switched off” in the mother and baby’s systems? There’s a concern that given the number of births across the world that are driven by synthetic hormones now — that don’t rely on the physiological hormones of the mother or baby — some of the gene processes that involve oxytocin may be altered. It’s more complex than this obviously, but with oxytocin being such a big driver of personal human warmth and connection — what might that mean when only a small percentage of births in Australia are started and completed without any synthetic hormones? Maybe there’s something in that… generally, in terms of who we are as human beings and what that takes out of the picture.

We’re potentially disrupting that process of human connection?

Well, if we’re disrupting the processes that support and engender “feeling states” that create human connection, in such vast numbers, what might that mean?

Let’s be clear though. You do feel there’s a place for a medicalised birth?

Absolutely, yes! We’re very, very privileged. Caesars can be done so much more readily, so much more safely. There are mums who wouldn’t otherwise be here. All of these things have their place.

Tell me about the figures…

So in Australia the induction rate — that’s using the synthetic hormone oxytocin syntometrine to start and continue the labour — that rate is 25 per cent. Then we have the augmentation rate. That’s when the labour has started, but then for whatever reason, the synthetic hormone is used to speed it up or restart it. The figures for augmentation are 19 per cent in Australia. Then we have an elective caesar rate, which is 18 per cent. So those figures, to me, are quite confronting. To think that really, there are only a few labours where these synthetic hormones aren’t used. Not to mention injection of synthetic oxytocin to stimulate and bring forward the placenta to finish off the birth…

I kind of loved that moment! I’d given birth to my kids and I was like, Okay, wrap it up people. I just wanted to feed my baby and be with my baby. The big event had happened for me. But you’re saying that still, it’s a process of interruption.

Well it’s a process of interruption, but if women want to, let’s let them. But over the years looking at the bigger picture, what might it mean? And what are we missing out on if we make that choice? Maybe there’s something about that completed surge of oxytocin that comes through. Maybe it’s a bit like if you’ve got a fantastic sexual encounter going on where you really love the whole exchange and feel very excited in your body and reach this peak, but then there’s no orgasm. That full flush of oxytocin, that bonded moment with your sexual partner, if you don’t get it, does that mean something?

How many births have you attended?

Over a thousand.

Home births and hospital births…

Yes.

Would you say that you’ve come away and seen the full flush of all those hormones— you compare it to full sexual fulfilment — as a gift?

Yes. Yes.

So this is something people are really missing out on that they don’t know about. But there’s quite a bit to get through to get there?

But for the, “thank God that’s over”, we’re missing out on that deep experience of human connectedness.

It’s like there’s a mist in the room. It’s so thick. Sometimes an epidural is absolutely necessary and we’ve got that as a possibility. We are endlessly creative and can tune into our heart’s feelings and bring those feelings of love forward in all sorts of situations. I’m not saying it’s not possible. But it doesn’t have this other indescribable sort of energy…

Primal.

One of the pathways to finding it relates to how you’re going to work with your body during the labour. That brings us usually to the issue of pain.

So let’s talk about pain.

Mmm. One of the first things I say about pain and childbirth is that it is in the realm of the body working healthily. It’s the physiological, functional pain of a woman’s body working strongly at a sort of peak performance level.

It’s like the Tour de France.

The Tour de France! [laughs].

That’s what I took from the workshop before the birth of my first, my son — that the pain of childbirth is not dangerous. That was a revelation to both myself and my husband. He reminded me of it when I was screaming for an epidural [laughs].

Thinking about pain in terms of danger is very strongly reinforced because we’ve stuck birth into a medical framework. Within a medical framework pain is a signal of danger, disease, things getting worse. But birth is a different sort of pain. I make the analogy of people who work with their bodies for fitness or best performance — situations where people are engaging physically, strongly, with their body; feeling the functional physiological pain of the stretch receptors, their muscles and their heaving breath. This is more akin to what normal physiological childbirth is about. In exercise there’s often a mantra: ‘Pain is my friend, pain is my friend’, because they know that in order to get to where they want to go, the pain is part of the process.

And there’s a huge reward.

Huge reward!

That’s talked about in peak performance. Always. Climbing to the top of the mountain, getting to the end of the Tour de France…

That achievement. Not only at a mental level, because you’re ticking off some goal, but at a physiological level because there’s a whole lot of hormones that are awakened through pain. Certainly in birth there are some things that can be dangerous but the caregivers who are watching a woman to see if things are going straightforwardly are not using the pain level as a signal. The things that can go wrong are things that the mother wouldn’t find painful. The baby’s heartbeat or blood pressure…

The idea that I took in with me was, If something’s not good, someone else is going to tell me.

Yes.

It’s not my job to freak out about it.

I recently went to the most remarkable birthing centre for underprivileged women in Ubud, Bali, run by Robin Lim, who recently won the CNN Hero of the Year award. I was on holiday and hadn’t felt my baby kick so I went in there very, very concerned and about three midwives came to attend to me. They could tell how anxious I was and they started to stroke me — they just calmed me down. I wasn’t in labour or anything! They were laughing a lot and the energy was quite great between them. They said, “Everything’s going to be okay.” And when we heard the baby’s heartbeat, they all went, “Yay!” They kept stroking my arms, touching me and saying in broken English “it’s okay, see?”. I felt such a deep connection to these women. The place felt magical. The thing that most moved me the most was when the lead midwife showed me how she squats down by the pool in the birthing room and sings.

Yes. Singing the baby out.

They sing the mother through a crisis of confidence, through bringing her baby into the world. I was crying because it was so moving. It articulated something that’s hugely missing from our culture. Here it’s almost like going into battle. All I wanted to do was get on a plane and fly to Ubud to give birth to my baby, to have the baby sung into the world, because… what a remarkable way to enter into the world.

There are a lot of cultures that do sing their babies into the world. We’ve lost contact with that. But I have been at lots of births where it has been reclaimed it is very, very beautiful. In a well-supported situation the mother is very attuned and drawn into her body, — she looks like she’s somebody who’s working hard. There’s that physicality of the sweat and the glistening eyes, the change in the colour and the vibrancy in her body as the oxygen and the blood are pumping. All of that’s happening. There’s also what you had happen with those Balinese midwives — they’re more attuned to it presumably because they haven’t had it so interfered with — for mammal to mammal to soothe one another. In a birth experience where women are well supported, they have caring, calm people around them. It’s probably an instinctive thing to know how to calm a woman. To stroke her, touch her or make eye contact. There’s calmness, excitement, as well as this lovingness — I’ve claimed it, “oxytocinised” environment. Maybe singing the babies in is just the spontaneous verbalising that happens when that team is around: the mother, the father, it might be the grandparents, the other people who are there. Those spontaneous gasps of excited, joyous sounds — they’ve been translated into particular songs in particular cultures. But to be able to sing in some way means there’s got to be calmness…

And joy.

And joy, in this regard. That’s the thing I find saddest about this sort of convenient, controlled, painless childbirth — that we’re limiting this range of brilliant expression of the fullness of our human capacity.

Our aliveness.

Our aliveness and our connectedness, as well as our ability to be empathetically attuned to the mother.

It’s interesting, because for me, the person who is my centre when I am giving birth is my husband. He has a natural awareness of the work that needs to be done. After we gave birth to our first child our midwife laughed, she said he must have been a midwife in a past life, because she’d never seen a man like that in childbirth. I just locked onto him. When I was in crisis of confidence, he got me through it, twice. But you talk about how men being in the birthing room has changed the dynamics, that the concern of husbands, their fear for their partner going through that pain can have a negative impact on birth outcomes…

In terms of your husband being your centre — he also had a support in the midwife. So he’s stabilised. That’s ideal. The research says that for normal physiological childbirth, women should have experienced people with them. They’ve refined that research, as I said before, to ‘experienced people who are not necessarily part of her social circle’. So my take on it is that we want those male partners there, as well as someone experienced. We’re seeing the benefits in the wider community in terms of fathering.

They’re having an experience of bonding with these babies, falling in love with their babies, these babies enshrining them so deeply, so early on, that they want not just to be provider fathers, but to be nurturing present fathers. Brilliant. The cost of that though is what’s happening in births. Because in most care settings, women are relying on their partner in situations where they’re not generally having somebody else that they know.

The move in the 70s to bring fathers into the birthing space happened when women were coming into the big hospitals, away from the home birth scenes where you had known people around you. In hospital, they had professionals around them, but not anybody they knew. Women were feeling a sense of isolation. There were people coming and going and checking on them in that sort of medical way, but there was nobody with them. In Western cultures, we’ve made that shift into the nuclear family, moving away from the extended family. So it seemed like the father was the obvious choice. Now, we’re expecting the father to carry all of these other roles, which beforehand had been fulfilled by women from our communities. There are a huge set of archetypal projections that are getting stirred up and being dumped onto fathers. They are carrying the bloody world in terms of expectations on them at a birth. Coming out of that is this idea that ‘it’s going to be a romantic thing between the two of us’. That’s a beautiful sentiment. But there is this aspect about the work of labour. And for many men, it’s a rarefied atmosphere in terms of the intensity, the primal processes, what I call “the evolutionary regression” that women who are working with a natural birth undertake. The sounds, the noises, the sights, the smells, it’s very intense. For a lot of partners, that’s very challenging — particularly if they believe the pain relates to danger or suffering. If the male partner is linked into the pain that he’s witnessing…

‘Get her the hell out of there!’

Yes. Very difficult for them to stay present, encouraging her into that. He wants her to be safe from it. He wants to save her. Often, he’ll call for the epidural before her. If it is a loving respectful, committed, relationship — that ideally can come into the picture. But if there are difficulties, well, they’re also now in the birth room.

So what you’re talking about is a woman and her partner going towards childbirth almost like preparing for a marathon — on a physical and an emotional level, ensuring that they have people in the room who know how to support a natural process, which can be quite confronting. Like you said, natural childbirth is a pretty whacky experience. You have to let go of a lot to be present. But the outcomes are pretty extraordinary, and for us to lose those outcomes is to lose a part of our humanity that might be…

… Otherwise experienced. Yep.

And incredibly valuable to us. I want to ask you about your story. Why is this journey for you? You were a physical education teacher when you were younger.

Yep.

What led you to this path of empowering women in childbirth?

My first baby. I have always been very physically attuned to my body. I had a strong trust in my body and I had a naïve trust in the pathway for having babies, which is, go to a big hospital. So I had an idea that whatever they were doing to me or offering to me was to support my capacity to give birth to my baby. It’s only after the event that I started to realise, Hold on, that’s not quite what’s going on here. There are a whole lot of other agendas that are happening in this big institution. So coming out of her birth experience…

Your daughter?

Yes. My first. It wasn’t overly dramatic, you know. I was in labour, my membranes ruptured. Called the hospital, we were in England. They immediately sent an ambulance to pick me up. I’m thinking, This is all fine. But actually, it rattled me a bit. I got there, they did a vaginal examination — I was six centimetres dilated at that point without even really knowing I was in labour.

You lucky lady! Don’t tell me that!

[Laughs] so that reinforced my trust in my body…

Yeah! This is working.

But without understanding how all those other processes, like fear, can affect what is going on. The ambulance, the strangers, the pressure… everything stopped. We had this whole battle with people wanting to put me on a drip, and we felt it was better to wait — me trusting my body; that it’ll get going. But lying on a bed, with nobody saying, ‘Why don’t you get up and go for a walk?’ of course, nothing happened, and then a drip got put up, and she was born a few hours afterwards. Then in the third stage, they gave the injection, and pulling the placenta out the cord broke, so they had to manually remove it. At the time, the policy was that for the first eight hours the baby would be separated so the mother could have a rest. So when I came out of her birth, I was like, What the fuck happened there? What happened in terms of me and my trust about my body working? It felt like I was steamrolled by this juggernaut of things that were done to me. Even then I wondered, Could that have been different?

I got radicalised quite quickly. I was in that hospital for two days afterwards going crazy. Quietly crazy. Feeling strong things about wanting to have my baby with me. Before I touched her I had to wash my breasts, but everything in me was just wanting to scoop her up and have her with me, and tuck her up in bed — just us. I was starting to feel like I had something going on in me that was…

Wrong?

Yeah. I had certain feelings about what I wanted to do, but I was being told that wasn’t what I should be doing. In the end, I left the hospital, you know, without medical tick-off. But anyway, that was the start. That was really the birth of me as a mother. To say, ‘I’m going to trust my feelings rather than listening to what they’re saying’. In the late 70s, birth education was 300 people in a lecture theatre. Before I gave birth I’d asked about their policy on episiotomies and the obstetrician said, “We only do episiotomies if they’re absolutely necessary.” The hospitals then were big wards with 12 women in each and just curtains around us. I’d had an episiotomy and I went around and asked. Of the 12 women who were on the ward, 10 of us had episiotomies. Two of them had caesars. It just didn’t add up. Firstly, I’d been awakened to something separate to my intellect about how I wanted to be with my baby, which was at odds with the routines. So I started to tease that out, and then of course started to find that there were people who were already on the case. But you can see through the way that I think and talk about birth that that physical education background helps. It is about encouraging people to be in their body, to work with their body, to overcome their fears…

To be empowered.

Yes. Yes.

‘Cause I think most people feel pretty disempowered most of the time.

A lot of the time.

You’re writing a book. You’re still educating. What do you hope for the future?

So that’s okay, that’s fine. I don’t feel like I’m on a crusade to want to change everybody’s ideas. Where my hope lies, is with women who are still in touch with some sort of yearning inside themselves about the potency of their own bodies, who trust their normal bodily process and who maybe have a little bit of an inkling that there’s some mystery here to experience. But, who don’t quite know what they’re up against in terms of that process in their bodies and in terms of what our present birth culture is.

I want to speak to those women who’ve got that bit of yearning. I want to speak to me when I was having my first baby. So my hope is that that body of women are supported, that they can understand the research and understand their choices. And then, when that baby’s born, have that “oxytocinised” experience. That’s my hope. There are many women who are very deeply wounded by their birth experiences, that had the yearning but didn’t have the knowledge. My hope would be that we have stronger processes where women can, just by default, find a more supportive human environment for birth. So it’s sort of two-pronged. It’s more of a political issue.

Well it’s interesting you mention the politics. What is clear to me, as third-generation feminist, is that yearning I have for natural physiological childbirth is about reclaiming my womanhood. There is politics around power. Maybe the locus of power is in us women, in reclaiming something that was grotesque to early feminism — being bound by your body, by your biology. Mothering can be an empowering, almost feminist choice. It is a part of all of this engagement. It’s about making real choices about being empowered instead of making assumptions that being anaesthetised from all your experiences is empowerment.

Going back to what I said before, that pathway for women who have felt they’ve wanted to make a contribution in the world, not just in the home, has been a masculine one. We’ve denied the body so denying the potency of birth is part of that. But for women who are reclaiming that more feminine pathway to empowerment through birth. It feels like we’re on the cusp of something happening.

It’s potentially an incredibly exciting time, but it’s a very political, heated debate. Because a lot of women feel there’s disempowerment in feeling your body. They’d rather run a marathon than give birth naturally to their kids. But if engaging in our physiology is the path to empowerment, and the difference from women to men, isn’t that a contradiction?

We could go on and on. We live in a “labour bypass era”. But I think that it’s by normal physiological childbirth that we deepen that instinctive connection with the baby. Why would you want to bypass that deep knowledge and wisdom that comes through the body process?

Rhea’s book Birth with Confidence is out now.