StorkNet interview with
Barbara Harper, RN
Author of
Gentle Birth Choices

Barbara Harper, R.N., founder and director of Waterbirth International Resource and Referral Service, has been researching and documenting waterbirth and gentle birth since 1983. An internationally recognized expert, she lectures and consults within hospitals and universities. The Oregonian newspaper referred to her as "the Billy Graham of waterbirth." She is the author of Gentle Birth Choices, new edition (2001) and the producer of Gentle Birth Choices video. She produced Birth Into Being: The Russian Waterbirth Experience video last year after traveling many times to Russia during the previous ten years.

Midwives and parents alike have called both of her videos, "the most inspiring birth videos ever produced." Her newest book, "Waterbirth: Embracing the Miracle" will be available in Fall of 2002. Barbara is the mother of three, two born at home in water, and Grandmother to Alex, now three years old. In her new "Birth and Parenting Connection" center in Portland, Oregon, Barbara and her colleagues provide doula services, prenatal counseling, AquaNatal swim and exercise, pregnancy massage, prenatal yoga, and hours and hours of phone and email support to women throughout the world. Waterbirth International also rents and sells portable birth pools as well as permanent birthing baths to hospitals. Barbara has dedicated her life to helping heal the way we welcome babies into the world. Barbara welcomes you to visit her website where you will find video information as well!


Gentle Birth Choices (Amazon UK)

My copy of Gentle Birth Choices arrived on March 13th and that evening I carried the book up to my bedroom around 9:00pm and got comfortable, thinking I'd thumb through and read a few pages. I didn't move for four hours, and closed the book feeling enlightened, educated, invigorated and proud to be a woman! In Gentle Birth Choices, Barbara takes us on a journey that begins with the birth of her daughter, Beth, which was far from anything resembling gentle. Her experience led her to seek alternative approaches five years later when pregnant with her second child. Her search for information brought her to a small community in France, where she was invited into a birthing center and was allowed to observe a natural, gentle birth. This dynamic experience began her quest for information, knowledge and training with which to help couples take responsibility for their birthing experience.

Gentle Birth Choices covers topics such as birthing centers, birth attendants, water births, home birth and hospital births. Barbara's book offers more than 50 photographs that capture the joy and intensity of birth. She talks to us about birth without fear. You will read about visualization and learn affirmations, redesign your prenatal preparation and write a birth plan. It's all here and I guarantee that you too, will not put this book down.

Barbara visited with StorkNet members to talk with us about all the above childbirth topics, including waterbirth, homebirth, birthing positions, midwives, vaginal birth after cesarean, birth centers, circumcision, and much more. Read her informative replies. Stop by our bookshelf and read a full report of Barbara's book Gentle Birth Choices on StorkNet!
Photo: Author Barbara Harper relaxes in the sun between contractions, a rose on her abdomen, just a few hours before her son Abraham is born at home in the hot tub.

StorkNet members ask Barbara questions . . .

Kate: First I would like to say thanks for such a wonderful book! Gentle Birth Choices was one of the best and most useful books I read while I was pregnant with my daughter. My question is: In my understanding of Gentle Births, they are as non-interventionist as possible, allowing the mother to use her instincts and strengths to birth her baby in the way she feel most comfortable. What, then, should be the primary role of a midwife our doula in this situation? What is the best way to offer support to the birthing woman without interfering with her labour? Thank you for your time, and again for your wonderful book, it helped me immensely. Kate

Barbara: Dear Kate, The most useful way to support a woman who is birthing naturally and gently is to manipulate the environment so that it will be safe and have adequate privacy. When I say "manipulate the environment," I want you to think of ways to provide opportunities for her and her partner to be quiet, alone and yet active in the labor. If your client is in the hospital, look around the room and see how you can make it "her" space. CD player, diffuser for aromatherapy, a birth pool, shower. Keep her out of bed as much as possible. If the staff nurses need her on the monitor for a strip every so often, then make sure they know that they will have to obtain that fetal heart tracing in alternative positions. A mother can sit in a rocking chair, on a birth ball, or stand beside the bed with pillows stacked up for leaning into, all while on the monitor. If she is fortunate to have access to a birthing pool, then the monitoring can be done with a waterproof doppler. I always bring my own doppler to every birth in the hospital.

Women, when they are allowed to become instinctual, are operating from a different part of their brain. One thing that you definitely don't want to do is to ask a woman in labor questions that will make her think or force her to verbalize decisions. Your suggestions to her need to be just that - suggestions, not questions. Do not ask, "do you want a drink of water?" simply hold out the cup or straw for her to sip. If she sees it and wants it, she'll take it. Suggest that she try a new position or go to the bathroom or get into the shower. Don't ask if she wants to. Never tell a woman to relax - do things that encourage relaxation, such as gentle touches, soft words, your own breathing. Labor is one of the most suggestible times for a woman. She easily copies things that you do, such as breathing patterns. Good luck with your clients.

Tracie: I am planning a home waterbirth for the birth of my next baby and I am wondering about something that I am perplexed about. I know that some midwives and providers want women to wait till they are 5cm dilated to get into the pool so that labor is well under way and will not be slowed down by the relaxation that takes place in the water. Others feel that women should get in whenever they feel the need for relief and that it will have little or no effect on the length of labor, and that if it does, at least she has been comfortable in the mean time. What is your opinion regarding when a woman should enter the water? In your experience have you seen it slow labor progress for a woman to get into the tub before 5cm? Thanks in advance. Tracie

Barbara: Dear Tracie, For a home birth I do encourage a woman to use the water whenever she feels the need, especially if she has a bathtub that is big enough. If she is using a portable birthing pool, I generally don't fill it until her labor is well established and she needs to have access to water to help her cope with labor.

In my own first waterbirth, I enjoyed walking and squatting and getting into the shower and by the time my midwife came, I was already past 7 cms. I got into my birthing tub and it was like a lightening bolt hit me. I had several strong contractions back to back and before 10 minutes was up, I was pushing. My body simply took over and I had absolutely no control at that point.

I have witnessed first time moms get into the tub when they were only 1 cm and in an hour an a half they were complete and ready to push. Therefore I don't agree with putting a "blanket" prohibition on getting into the tub only after 5 cm dilation. One of my only parameters is to not keep a mom in the birth pool longer than about 2 hours without making some sort of environmental change. In other words, get out after and hour and a half to two hours and go to the bathroom, take a short walk, dance, do something to change the environment, then get back in. I don't think that women should stay in for five, six or seven hours without getting out for a change.

Remember, too, that the water temperature should never be higher than 101 degrees. If it is higher than that the mother will get overheated and then so will the baby. The mother can always get cooled down, but the baby has no way of discharging the temperature and little babies don't like to get overheated. They will show evidence of this by having a higher than normal heart rate. So, use your intuition, not a rule book, but don't stay in so long that you get exhausted and dehydrated.

Heather: I had a very long labor with my son, but still delivered vaginally (with no perineal damage!) under a midwife's care. I was so tired (after 80 hours) that I had lost touch/connection with my son during much of the labor, up until he was born. My main goal for this pregnancy is to be able to stay connected more to both myself and to the fact that there is another whole person involved. I'm using a hypnosis/bonding hypnosis/NLP program (New Way Childbirth) as one way to help reach that goal, but there are mighty few people around who have used this for me to talk to, let alone professionals... I guess my question is, what is your opinion of hypnosis (etc.) programs like HypnoBirthing and New Way Childbirth? (The two are apparently fairly similar, but NWC focuses a lot on prenatal bonding, too.)

Barbara: Dear Heather, I am not familiar with New Way Childbirth, but if it uses a form of hypnosis, then I would have to say that it is probably a good way to prepare for labor and to bond with your baby. HypnoBirthing is a childbirth method that uses hypnosis to eliminate pain and fear from the birthing experience. In the past, the word "hypnosis" has conjured up images of hypnotists who mesmerize others into embarrassing situations. I have taken a few courses myself and always find that I am very easy to put into a suggestible state. It is common for hypnosis to be used therapeutically in many areas of medicine, dental anesthesia and personal therapy sessions today. What I have learned is that all hypnosis is self-hypnosis, the hypnotherapist is only the guide. A person chooses to enter into a hypnotic state, stay in and come out at will. Most people can be easily hypnotized. Willingness, belief and motivation have great influence over hypnotizability. (is this a word?) During hypnosis you are neither asleep nor unconscious, and will always "come out" when you wish. Stronger-minded and stronger-willed people are easier to hypnotize; not the other way around as is usually assumed. You cannot be made to divulge information or do anything against your will while in hypnosis.

HypnoBirthing, in particular, teaches an understanding of how the birthing muscles work in perfect harmony, as they were designed to do, when the body is sufficiently relaxed. The depth of relaxation necessary can easily be achieved with hypnosis, and couples learn these skills in HypnoBirthing classes, and practice them at home every day until the baby arrives. The Birth Companion, as the partners are called, have a very integral role in the preparation process, listening to the audio tapes, reading the HypnoBirthing book and handouts and guiding the mother into hypnosis with HypnoBirthing scripts. In labor they are an invaluable part of the birthing process as they help the mother to focus and concentrate, as well as supporting her physically. All aspects of labor and birth are covered in HypnoBirthing classes, as well as information on nutrition, exercise, complications, interventions and consumer issues.

One of my former birthing clients used Transcendental Meditation to relax for the second stage of her labor. She was in complete control during the dilation phase using walking, vocalizations, soaking in the bath. When it came time to push, she laid down on the bed and went into a deep self-induced meditative state. Her husband was right beside her and I watched from the end of the bed. She breathed rhythmically and deeply, but never uttered a sound, flinched, moved a muscle other than her uterus. The baby literally crawled out and was picked up by the dad and placed on her belly. She looked down at this point and lifted up her baby to greet her eye-to-eye. That was amazing. I truly believe that childbirth happens between your ears, not your legs and that when we totally surrender, in one form or another, either loudly or quietly as this woman did, we will have quicker and easier births.

If someone can't find a HypnoBirthing class or information in their area they might want to simply start by using the affirmations that are in my book, or writing out affirmations for their partners to give them during labor. During labor women are highly suggestible as they move into the primordial section of the brain to get the baby born. Some of my favorite things to remind women in labor are: "Say yes to your contraction." "You are safe." "No matter how much energy goes through me, I can handle it."

Erica: I've heard getting in the water too soon can slow down labor. When is it okay to get into the tub? My doctor delivers in hospitals, but is willing to do a waterbirth if I so choose...the labor/delivery/recovery rooms are private with whirlpool tubs in the bathrooms. I had a long drawn out labor last time, and I wouldn't want anything to stall my labor further if I try this method. Thanks!

Barbara: Dear Erica, I discussed some of the issues about getting into the water with Tracie in an earlier question. Your first baby is most generally going to be longer and more drawn out than subsequent babies, so that is the good news. I think to avoid the drawn out part of labor you really need to distract yourself when it first begins. Always wait to go to the hospital until your contractions are long, strong and close together. My grandmother was a midwife and nurse and she always said that labor wards needed ironing boards. On further questioning my grandmother said that women simply need to be kept busy, you know - doing the ironing! So do anything to keep busy - scrub the bathroom on your hands and knees; go grocery shopping and then bake cookies; make love; take a long walk; take a bath and if it doesn't slow things down, stay in - but don't go to the hospital too soon.

Andrea: I am planning a home water birth for late April/early May. This will be my third baby. My first was born in a hospital - epidural, episiotomy and forceps. My second was born in a birth center. I had a second degree tear with her because she came out like a cannonball. Her heart rate wasn't very good and we discovered she had a twice-looped nuchal cord at birth. So, I am glad I got her out fast.

My personal goal in this birth is to not tear. My midwife really believes that with the birthing pool, I have a very good chance of not tearing - of course provided we don't have to get this one out as fast as we got our last one out. With two scars on my perineum, how promising is it that a waterbirth will truly reduce the likelihood of a tear?

Barbara: Dear Andrea, Are you doing your Kegel exercises? Every bit of time spent in contracting the pelvic floor muscles must be matched with an equal amount of time releasing and relaxing. Thirty-four weeks is an ideal time to focus on letting go and removing all resistance in the pelvic floor. I give suggestions to my clients that they use certain words while surrendering the pelvic muscles completely. I write it down as an affirmation, and someone whispers this to the mother during the pushing phase. Touching and stroking the perineum, either by yourself or from your partner helps with relaxing those muscles as well. I will often direct women to protect their own perineum during pushing. You know where it stings, I don't. The water slows down the emerging baby, relaxes the perineum, provides good blood flow to that area, and being upright in the pool helps put you in a more physiologic position to actually push your baby out.

One of the most frequent causes of tearing is rushing the shoulders out after the head is born. During a waterbirth it is easy to leave the head on the perineum and do nothing until the next full contraction. The baby has absolutely no stimulus to breathe at that point. Also pushing at the peak of a contraction will aid in its efficiency. The statistics on waterbirth are the proof, though. Perineal tearing is less in the water, especially for mothers who have already given birth, even if they have an episiotomy scar. The nurses in a hospital in England wanted to cut down on the episiotomy rate (no pun intended) so they removed all the scissors from the delivery packs. The doctors had to go hunting for scissors and by the time they found them the baby would have been born over an intact perineum.

Nancy: I love your book, and have been inspired to have a home waterbirth as a result of reading it. Last month, I heard Dr. Marshall Klaus speaking about self-attachment, (where the newborn, unassisted, slowly makes it way to mom's nipple, by smelling the amniotic fluid on its hands, and a scent that mom's nipple is emitting.) He said that babies who have had their hands washed will not self attach, as this interferes with their ability to smell. Same thing if mom's nipples have been washed. I am curious about how an underwater birth effects the amniotic smell on the baby's hand. Will the water wash it off, making self-attachment impossible? Any thought on this?

Barbara: Dear Nancy, This is a question that both Marshall Klaus and Penny Simkin have posed to me before. In my personal experience the water alone is not enough to interfere with the attachment process. No chemicals are added to the water and usually the water contains the mother's bacteria (dilute as it may be) and amniotic fluid, blood, and occasionally stool.

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There is a German video that I have of a waterbirth where the baby literally starts to climb up the mother's abdomen with kicking feet and legs. I don't believe there is any interruption in this natural cycle for that baby. Most water born babies breastfeed within the first 5-10 minutes after birth, while mother and baby are still soaking in the tub. One of the key points to a waterbirth is waiting patiently for the placenta and not clamping or cutting the cord until it is out. This aids in keeping the mother and baby attached as a unit and it reduces post partum hemorrhage.

Elise: Do you have a birthing center, or did I misunderstand? Please tell me about your business. I am in Oregon, as well, and would love to learn what I can and perhaps become a midwife when my time is a little available.

Barbara: Dear Elise, We don't have a birth center where babies are born, but we are closely associated with the Andaluz Waterbirth Center in Tualatin. Our offices are on Stafford Road in the Tualatin area, only about 4 minutes south of Meridian Park Hospital. The Andaluz Waterbirth Center is right across the street from Meridian Park Hospital. Our nonprofit agency is just now remodeling our building and starting to focus more in the Portland Community. Our community service is called: The Birth and Parenting Connection: A Community Resource Center. As funding comes in we will be offering low cost childbirth education classes with an emphasis on alternatives, such as water labor. We offer doula trainings several times a year in our center and are planning on Birth Art classes, prenatal yoga, baby massage, and breastfeeding classes. Our business also provides water pools for rent for all the local hospitals and home births. Our busiest hospital is Kaiser Sunnyside. We also rent pools all across the United States and Canada. We have a lending library of resource materials including books and videos. We also provide doula services on a sliding scale. One of our goals is to begin a program to provide a doula for every pregnant teen through the Teen Parent Programs in the local schools. We are seeking grant funding for this. We are a small staff, but one dedicated to working with birthing and parenting families.

Alison: Are there many waterbirths in Canada, and are they performed in hospitals?

Barbara: Dear Alison, Canadian hospitals have been resistant to beginning waterbirth practices for several reasons. First, with national health coverage, every aspect of your health care is covered, so there is little if any competition among hospitals for the consumer market. Hospitals therefore have no intention of adding the cost of birth pool equipment to their budgets. Second, Canada also does not have the same number of midwives attending births in hospitals that the US does. In 98% of the hospitals in the US that are offering waterbirth options they were started by certified nurse midwives. Janet Rush is a clinician and researcher in Toronto, who has written many papers on the use of water during labor. Her sense of Canadian hospitals refusal to offer waterbirth is that they simply don't want to do their homework and look at the research and start something new. There are, however, many home birth midwives in all the provinces that offer waterbirth to their clients. There is even a center in the Toronto area that specializes in waterbirth information and supplies - Birthwaves Canada.

Candie: Is it easier to have a waterbirth rather than a vaginal birth?

Barbara: The only way to have a waterbirth is vaginally. I think you meant to ask if it is easier to birth in water than on the bed. Yes, for the women who have given birth vaginally in water and not in water, they all, without exception, say that the waterbirth was easier. 100% of women who have had one waterbirth would repeat the experience and I hear this all the time, "I would never birth a baby again without water."

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