Childbirth! It happens every where. An event unique to women's lives ... happening every place on Earth, in every culture. While our cultures have great diversity in approaches to pregnancy, birth, after birth care and reintroduction of the mother and baby into the daily activity of society; childbirth is extraordinarily similar to all women. It's a natural consequence of being pregnant and exhibits itself as a series of contractive waves that build in intensity, length and frequency. Then the contractive waves change to expulsive efforts and our babies move out of our bodies...out the same hole.

So, we are faced with two realities: our culture diversity and our universal humanity. Common Knowledge Trust, a charitable Trust in New Zealand, produces The Pink Kit Method for birthing better™ resources. The resources explain the four universal components, common to all childbirth experiences and present them as resources for birth preparation, childbirth management and coaching (support) skills that ordinary pregnant women and their support people can use within their own cultural and religious beliefs.

Labour is a unique and infrequent Life experience. There are skills that any woman can learn in order to have a more positive experience and lessen potential birth trauma to themselves and their baby.

The four foundations and universal components of The Pink Kit Method are:

• Know your birthing body: All women share one human body. We can 'map our pelvis', discover the curve or flatness of our sacrum, feel what positions keep our 'map' open and our baby over the pelvic inlet. We can learn to internally relax inside our 'Pelvic Clock' and create space by using The Hip Lift, Kate's Cat and Sit Bone Spread. All of us, men included, can 'feel' the Truth of this self knowledge. We can all 'feel' how our own tension can stop our bodies from being mobile thus inhibiting the birthing process.

• Managing Skills: Any woman and her support can learn to work together well. Women can develop pain management skills, how to focus their skills even when they feel pain.

• Breath, Language and Touch: All humans do these three behaviours. For example, there are only 4 ways that humans breathe and only two that are positive types of breathing in labour. The other two indicate that we are not coping well. We can learn those two and have our support people help us keep to them. These two positive breathing types can be used to focus our energy, expand areas of our body or relax parts of our body. Language or communication can move from general terms e.g. 'relax' to specific cues e.g. 'soften inside your right hip.' Non verbal communication can be established which a woman can use to cue her support person. Touch is as essential and women and her support people can learn a universal way to create deep relaxation of the inner soft tissue through Rising Touch.

Women should not have to struggle through labour or find the pain of labour (which is a very natural part of the process of childbirth) too overbearing. With simple to learn skills, based on preparation, women can respond to the concentrated work that labour requires.

• Preparing the birth canal: The inside of a woman's vagina is as different as finger prints. The baby must pass through this pass. We can prepare that space to be more pliable and flexible. Many traditional cultures do prepare down there. Modern women do not. Besides the tightness of the vaginal soft tissue, women can tense up these inner muscles if she doesn't like the sensation of her baby passing through that area e.g. feeling like you will move your bowel (in public). This can slow the delivery. A baby should not have to struggle through the vagina and a woman's vagina does not need to be damaged when the internal work is done for 8 weeks before labour.

Common Knowledge Trust knows that these skills work because Common Knowledge Trust is the stories and compiled skills of thousands upon thousands of women and men from diverse backgrounds that have worked again and again to improve the birth experience. When women work through the pain of childbirth using good labour management skills, rather then tensing, then childbirth progresses more regularly.

Primary Health care

At the present time, primary health care still comes from the health profession down through Government policies to rural communities. There is rarely a blending of grassroots knowledge to the possibility of modern health delivery. Maternity care in modern countries is a good example, where primary health care has increased the use of operative birth and medical pain relief. As other countries modernize, is this the direct where childbirth should be heading.

The World Health Organization has promoted a midwifery model of care and New Zealand is a country where that was achieved in 1995. Over 85% of pregnant women are attended by a lead maternity carer who is a midwife. There is no shared care, yet referrals to specialists as needed. Midwives are direct entry trained, paid for their service by the Government. Women have choice of home or hospital delivery with the same continuity of care midwife. Yet, the caesarean rate has more than doubled from 13% to close to 30%.

Either there is a major health crisis or something is terribly wrong with something. Common Knowledge Trust has a point of view. The Midwifery Model of care tells women that birth is natural and shouldn't be medicalized. Yet, most modern women will take pain relief for her natural headache. Very little of illness, injury or death (which are all natural parts of Life) are accepted by people who have access to sophisticated modern medical and pharmacology systems. A prescription isn't necessary for many medicines.

Considering that the actual 'giving birth' has potential risks yet is essentially Life giving, there is certainly a great deal of medical attention placed on pregnancy and risk avoidance in childbirth. Does that mean that the 30% of women and babies in New Zealand who are now having caesareans would be dead or injured without one? Consider this fact presented in Time magazine in 1994. More babies suffer injuries from domestic violence then die from all deaths for which children can be immunized. In fact, iatrogenic deaths and injuries in Australia rank no #3. Childbirth is well down the list. The infant mortality rate has not significantly improved because more women use pain relief or are delivered operatively. So something else must be going on. Common Knowledge Trust believes we simply lack skills.

Globalization

Globalization is having an increasing impact on all cultures. If we look at modern maternity care, we can honesty say that it looks likely that most babies will be born by caesarean section within a generation. Does anyone want to stop that?

Curiously, few people are looking at the level of childbirth skills a pregnant woman and her support people have. Instead the people look toward the modern professional to solve the 'problem'. With health care costs soaring and the cost of a caesarean or a vaginal birth with an epidural being higher than a spontaneous vaginal delivery, how can we change the direction of modern birth? And how do these modern birth practices impact modernizing countries and cultures? In The Gathering of Traditional Midwives that Common Knowledge Trust and The Zimbabwe Traditional and Medical Clinic co-hosted in a rural village in S. Zimbabwe, we discovered that the primary health care and the rural health care had not really sat down and spoken together. These rural women are no different from other women elsewhere. Most births, when you get down to it, are a problem if the baby doesn't come out and a woman bleeds too much. We must always remember that death is more accepted in traditional cultures than in the modern world where death is abhorred. In most traditional communities if twins or breech babies come out alive then it's not a problem. A baby head down can have trouble coming out. Whereas in modern countries women are now delivered exclusively by caesarean because there is some added risk. Is that where primary health care in developing countries is going? Now, posterior babies are considered to be as great a risk for caesarean's as a breech or twins.

Common Knowledge Trust and primary health care

Alongside, primary health coming from health professionals down to the communities, there is a possibility of teaching all women about the common knowledge in The Pink Kit Method for birthing better™. Instead of being afraid of the pain of childbirth, all women can learn to work with the contractions with directed breathing, staying open, being in good positions for the baby and keeping the pelvis mobile. At it's most basic, childbirth is an exercise in how an object (the baby) moves through a container (the woman). The object has to pass through a tube (pelvis), open a diaphragm (cervix) and aperture (vagina). There is no doubt that women's minds can impact that process. When she perceives of the pain as too much she will tense up.

When women respond to labour 'pain' by tensing up they close their container by using certain parts of their soft tissues: muscles and connective tissue. If you want to feel how easy it is to stop mobility in your own body do this. Look straight ahead without tensing up any muscles, hold your head still. Don't allow your head to turn. Now, take one index finger and place it on the side of your forehead and gently apply pressure to your head in an effort to turn your head. With little effort on your part you can stop that from happening even when you apply a great deal of pressure. That same type of immobility can easily slow down the passage of this object through our body.

Common Knowledge Trust would like to work with health organizations to make The Pink Kit resources available to women everywhere in the form of simple e-education tools.

Simple and culturally adaptable

The Pink Kit Method is a simple set of skills that any woman in any culture or religious background can learn in the privacy of her own home. All of us are fascinated when we learn something simple that we didn't know existed and makes such common sense. Perhaps in modern countries when everyone begins to think about birth more clearly, then The Pink Kit resources will have an impact on modern birth experience. That would require a huge attitude adjustment. As one doctor said 'Every woman could have an early epidural before she found labour too difficult to cope with than more women would deliver vaginally'. Well, that's one very modern way to deal with 'pain'. At least this doctor recognizes that women are having difficulty dealing with the 'pain' of labour and that epidurals take the pain away and then she relaxes! Hardly a primary health solution!

If we take one step further in primary health, we could all acknowledge that the reason women are having trouble coping with labour contractions in the first place is that they lack basic labour manage skills. So much emphasis in modern maternity has been about 'choice' and 'information'. Skills are non-existent. There is actually the promotion of such ideas that strongly inform women that the less they know the more likely they will 'instinctively' or 'intuitively' birth. This is an idea promoted strongly in the Midwifery Model which sees itself as an ancient art and makes a horrible and terribly misinformed belief that traditional women birthed 'intuitively'. In fact, every traditional culture has it's own sophisticated health system. Although modern scientific medical care often looks down on traditional health knowledge, everyone knows that a great deal of medicines came from herbs. At one time the use of maggots was considered unclean. In fact, primary health is best coming from traditional health care and then blending with modern health systems one a culture to culture basis.

Common Knowledge Trust could take an active role in developing a world wide birth preparation program that women could do in their own home. Every woman could be directed to The Pink Kit resources, learn them and use the skills in labour. Women don't have to like labour pain to feel empowered by birth. They can just feel really good about how they managed themselves.

Fitting in

Where would The Pink Kit resources fit into less modern countries? Without sophisticated, modern medical care available nor the money to implement such programs there are still two primary concerns at all births: babies that don't come out and women who bleed too much. Of course there are many other issues facing women in less modern cultures depending on their local situation. For example, the rural poor in less modern countries have different health issues than people still living in their traditional environment. And, those traditional people living on the fringe of multi-national development such as agribusiness, mining or natural resource exploration that have depleted or altered the historic resources will have different health issues from people who live in areas where there is still an abundance in their natural environment. People living in the tropics have different issues from people living in cold climates.

The reality is that The Pink Kit resources are likely to be used by people who are still living traditionally yet in some way moving toward more modern ways of doing this yet primary health is still held in traditional health. They are more likely to want to prevent problems because that is always the best thing to do. The Pink Kit resources may or may not be used by those people who have totally moved away from their traditions. These people often whole heartedly embrace modern maternity care and even elect for caesareans and definitely use medical pain relief. This is mingled with beliefs that women 'suffer' in childbirth and that the modern system is safer and cleaner while their traditional system is dirty and dangerous. The use of modern medicine in developing countries also indicates a sense of socially or economically upward mobility.

However, back in the village, primary health can bring The Pink Kit resources to the average pregnant woman. All women want birth to go well and no woman wants to suffer in childbirth or be traumatized by giving birth. All women in any culture can adapt this knowledge to their culture and beliefs because they are common sense skills. Common Knowledge Trust is looking for individuals and organizations that can help us produce IT resources: CDs, CDrom and DVD that can easily be used to introduce primary health providers to the skills and can be shown to women in health camps. Common Knowledge Trust is also prepared to train workshop leaders at local levels to pass these common sense skills to women in their communities.

About the author:

Wintergreen is trustee and founder of the Common Knowledge Trust based in Nelson, New Zealand. The trust promotes the Pink Kit Method which gives private childbirth lessons for use in ones own home. For more information visit the website http://www.birthingbetter.com.