Internal and External Preparations for Birth

I’ve been working in world of childbirth as a doula and educator since 2009, after the birth of my oldest daughter. I prepared for her birth the way I prepared for anything: I studied. I read Ina May Gaskin’s Spiritual Midwifery and Guide to Pregnancy. I took a 12-week (yikes!) Bradley Method class. I went to prenatal yoga each week. I switched from an obstetrics practice to a midwifery group that attended hospital births, and finally to a homebirth midwife at 34 weeks. I had my birth plan. I purchased a birth ball, learned about breastfeeding, and had the nursery ready and freshly-painted with zero-VOC paint (who was I kidding, my kids never slept in their nursery). I started doing all the optimal foetal positioning exercises when I found out my baby was in an OP position later in pregnancy (OP stands for ‘occiput posterior’ – Americans call it ‘sunnyside up’ sometimes, but I don’t like thinking of my baby like a cooked egg, so I prefer ‘stargazer baby’).

I thought my heart was ready, too. I practiced breathing techniques for labour and even somewhat returned to my meditation practice. People would ask if I was scared of the pain when I told them I was planning to have an unmedicated birth, and I flippantly replied that I had never planned to get an epidural. Not only did I actually want to experience the labour and birth process in all its glory, but I didn’t trust that any anaesthetist would be able to effectively place an epidural catheter in my curvy, swervy scoliotic spine. When I finally decided to have a homebirth, I sat in the radiance of knowing who I was as a woman, confident that those who had birthed before me had paved the way for my own transformation. I felt like I was ready.

Here’s the catch: I had done a lot of intellectual preparation. I had the information I needed to convince my brain that birth was a natural process that women had navigated for centuries, and that other mammals also experienced each and every day. It didn’t need to be managed, only trusted. Like so many women and birthing people, I had turned childbirth preparation into something cerebral. For people like me – reluctant Type Aers who believe their love for yoga, the arts, and all things healthy, organic, and plant-based makes them *almost* Type B– I was falling into an old pattern of thinking that, as long as I studied enough, as long as I had become a relative expert on the physiology of natural birth, then a beautiful and stead journey of hope and transformation would gracefully bring my baby into my arms.

What I didn’t realise at the time was that the work I had done, for the most part, was really only scratching the surface. I had done the work of external preparations, but had only begun to scratch the surface of internal preparations. The external preparations are those practical things that we do – you got it – outside of ourselves. They include the care provider we choose, the location we birth in, the colour of the nursery, even the books that we read. Yes, Spiritual Midwifery is on a different level than the What to Expect series, but the reality is that true internal preparations are a different type of work. Internal preparation is soul work. And it’s one of the most important trainings you will ever do if you choose to embark on a conscious, intentional pregnancy in preparation for a transformational birth.

To some, this language may come off as “woo woo” (I don’t even know that this is real word, but you catch my drift). Semantics aside, though, the reality is that, for most women and birthing people who have been raised in a Western culture, what the journey of birth holds is something altogether different than anything we have ever experienced or prepared for. In childbirth, we find ourselves in a place where we have to either lean into or redefine our understanding of discomfort. The pre-frontal cortex - that part of the brain responsible for our abilities to focus our concentration, plan ahead and behave appropriately for a given situation – must also loosen its control on the limbic system. And I believe it helps to be willing to dive in and trust that there is something bigger than us, yet part of us, that is holding and guiding women and birthing people along the birthing journey. Then we can truly surrender to the sacred unknown that is the both flow of labour and our own unfolding.

This internal preparation is individualised because we each have our own set of limiting self-beliefs, patterns, narratives, and shadows to reckon with. Additionally, the tools that resonate with each person vary. Inspired by my studies with Birthing From Within and Birth Story Medicine, I have found that some combination of mythic story, ceremony and ritual, meditation, and art can help to significantly shift the childbearing woman/person’s ability to make their way through the uncharted territory of birth, and back out again. This doesn’t guarantee an easy and straightforward journey, but that’s not really the point. Nothing can guarantee this. What it does is much deeper, though, and it’s something that will not only shift your experience of pregnancy and birth, but also who you are and how you navigate the world on the other side.

My first birth turned out to be long and challenging. My daughter ended up being posterior and rotated while I was pushing, so most of my labour sensations were in my back as well as my lower abdomen. I persevered with the support of my husband, our incredible midwife, my doula, and my sister-in-law, but the internal journey I went on was not something I felt prepared for. Additionally, navigating my way back out of the labyrinth of birth brought me face-to-face with the emotional rollercoaster of postpartum combined and the shifting identities of motherhood. Once again, while the external preparations were taken care of – friends who brought food, help with house cleaning, a craniosacral therapist who visited the house – the lack of true internal preparation for this part of the journey left me feeling fragmented and unsure of who I was anymore.

Over my last 13 years of working with women and pregnant people in preparation for childbirth, time and again I have witnessed the same focus: we often overprepare externally, and underprepare internally. I have attempted to do some of the internal preparation in my childbirth classes and doula prenatal visits, but the reality is that, when I meet someone for the first time at 28 weeks (the average time when pregnant people begin their antenatal education classes), they have already spent well over half their pregnancy being inundated with modern knowing. Two or three doula visits during pregnancy isn’t sufficient for really doing the deep work of internal preparation. Tapping into intuitive knowing takes time. We need a new model, one whereby we mentor the woman/pregnant person along the arc of pregnancy so that, when it is time to make the journey, the birthing person is prepared for what will be asked of them.