Buddhism and Childbirth

If there are as many schools of Buddhism as there are Buddhist teachers, and if the Buddha gave 84,000 different teachings (understanding as he did the variety of human nature) the Buddhist message remains, nevertheless, still quite simple. Each teaching, in a sense, elaborates upon the same core truth. Buddhism teaches about impermanence, non-self and dependent origination. The particular emphasis may vary to suit the individual or historical context, but the core remains essentially the same. It is the same with childbirth.

Though Buddhism and birth both touch unfathomable depths of mystery, freshness and unpredictability, they remain in essence quite simple. A woman could spend her entire pregnancy reading about different approaches to childbirth, discovering many views, a variety of techniques, and quite a few contradictions! Yet the process of birth is essentially simple and has remained unchanged for millions of years. Harmonious childbirth involves surrendering to elemental life-force energy, letting go of attachments, and allowing that “ other power” to take charge. If that sounds rather Buddhist, you are not mistaken. Buddhist teachings have much to offer women preparing for childbirth. The counselling sessions, yoga classes for pregnancy, and childbirth preparation workshops I provide draw deeply from the wisdom the Buddha taught.

Central to Buddhist teaching is the concept of non-self. According to this teaching, the illusion of self is built by attachment to various objects or rupas. The Buddhist term rupa is useful because it includes anything which has impact upon the senses (which is “real” in Buddhist terms). Thus, dreams, ideas, memories, thoughts all are rupas (along with all material objects, of course). As we cling to certain rupas, they shape and fix our sense of identity. Our mind contains them or our mind constantly revisits them (depending on which model of the mind we postulate). The particular constellation of rupas we attach to determines who or what we think we are. In other words, we define ourselves according to these rupas of our experience. As we repeat familiar experiences, the self-concept based on those rupas becomes more and more reinforced.

A woman came to me once who was terrified of motherhood. She had grown up as the youngest daughter in a household of seven girls. Her older sisters had done everything for her when she was small. Though academically accomplished and a successful career woman, she had vivid memories of being unable to tie her own shoes at the age of seven and make her own sandwiches at the age of twelve. Eight months pregnant, Eloise was terrified of baby care, fearing that she would not be able to cope. She had a strong sense of her competence in the working world and an equally strong sense of her incompetence with anything practical. Her self-identity, shaped by these early experiences, was tenaciously intact: She was a person who could not care for anything small or helpless.

In Buddhist psychology, the mind “as container” is only one model. An equally valid model is the mind “as point”. Since a point has no contents, the objects of our experience are all “outside”. What appears to be contents is only the mind travelling round and round the same material. What is fixed here is a pattern of behaviour. Early life experiences, reinforced by choices in adulthood, shaped Eloise’s self-identity. New experiences, that is, the mind going round a fresh track, could loosen that fixed sense of self, showing other possibilities and teaching the illusory nature of self-definition in the first place.

During a session, we did a sculpt with small objects. Eloise recreated a typical family scene, with her older sisters busy baking, knitting and caring for the dog. Only this time, Eloise took a prominent role. Instead of being “the baby”, Eloise instructed her sister in the art of bread making. Afterwards, I commented on how much she knew about bread making for someone who had never done it. I suggested she try. After that success (As an active observer, she had actually learned more during her childhood than she thought!) she agreed to babysit a friend’s puppy. This deliberate choice really began to shift Eloise’s sense of what was possible for her.

The Buddha taught that consciousness is entirely composed of these rupas of our experience. There is no innate self. Everything is “other”, and the illusion of a constant self is merely attachment to a particular configuration of “others”. What is liberating about this teaching is the possibility for change. No one need stay stuck in an unwholesome or deadening existence. Identity becomes a fluid phenomenon, lightly held.

As new behaviour can change old thought patterns, so new thought patterns, if conceptualised with sufficient energy, can change behaviour.

Thoughts are “things”, with impact upon the “mano-vijnana” just like trees and flowers impact the eyes. Different thought patterns shift reality. Conscious change is a matter of intention and focus—deciding to do something, then doing it. (Not always easy!) As Eloise gained success in actual behaviour, positive thought patterns began to replace the unhelpful ones, which generated even more positive behaviour. Fortunately, she went into motherhood with more confidence and less trepidation than she had before.

But the teaching of non-self offers much more than a tool for transforming personal blocks. Even more fundamental is the way in which it clarifies the deep reality of pregnancy--from conception through delivery. Unfortunately, this reality for many women gets obscured by the materialistic and medically-oriented mindset which controls the “birth industry” in our modern world.

A pregnant woman, just like everything else, belongs to something bigger than whatever personal identity she may be holding. She is a part of the life force which animates the cosmos. She is an expression of the creativity of nature. And just as hurricanes and volcanoes remind us that we are ultimately not in charge of our existence, so does labour, a natural force which a woman embodies yet whose power lies outside her conscious direction. This is often a hard fact for modern women to accept, as we have been conditioned to take charge--planning careers, investment strategies, holidays and families, with the expectation that everything will follow along as we intend if only we plot out each detail with enough care.

Labour is not like that. It is about surrendering to elemental forces, becoming fluid like the wind-swept sea. Labour involves letting go of expectations and being present with what is in the moment. Relaxation in a total sense is what it is about. Letting be and letting go. Physically and existentially. Letting go even of any “story” we hold about the cosmic dimensions of our energy and just being present with what Is. Melting, releasing, expanding, softening, opening, staying present, yielding—these are useful images for a woman to hold.

Making a birth plan is these days a common practice, and rightly so. If a woman has specific wishes about how she would like her birth to be managed, she needs to make them explicit to her birth attendants, certainly for the hospital setting. If she does not, the staff will follow standard protocol, which in many hospitals involves invasive interventions and routine control. But how can one plan a labour? If one thing is inherently not conducive to planning, it is childbirth.

In Buddhism, everything depends upon conditions (e.g. healthy plants depend upon good soil, sunshine and water). A certain set of conditions can make certain outcomes more likely, but they cannot determine them. A woman who takes care of her body and spirit during pregnancy, who goes into labour with confidence and awareness, who wants her baby, trusts her body, makes a birth plan, has good support from her partner and birth attendants, has a better chance of a healthy, natural birth than if any of those conditions are lacking. However, nothing is guaranteed. Babies sometimes die when all of the above is in place. I have personally encountered that sad event in two instances. This is the reality of life--which Buddhism teaches--because other forces, outside our control, can change everything. What is needed is faith and trust—no matter what happens.

The Pure Land perspective in Buddhism emphasises this faith. It is a sense of refuge in something bigger than self and an openness to experience as it is, which implies living with and accepting uncertainty. Good childbirth preparation fosters this understanding. For pregnancy and birth only intensify that reality which is ever-present for all of us but often forgotten in ordinary life. We all belong to an interdependent web of being, and our personal power is contingent and relative. Accepting that with trust means surrendering to that greater power and acknowledging that we can never know in advance the outcome of anything.

Along with faith, however, comes the practice of “watering the good seeds”. Just as our life is conditioned by the forces which predominate in the mind, so can we set up conditions which will make our mentality more wholesome. We can nurture the positive thoughts, send our energy outwards in a beneficent direction---not attached to a fixed goal but trusting the universe to respond with something fruitful.

So yes, it is good to make a birth plan, and I have helped women think through the options and write up one that is true to their heart. I also help them choose the place of birth which is right for them and birth attendants who support their vision. This is all about setting up conditions. A low-risk woman who wants a natural birth needs a supportive midwife, not a high-tech hospital which practises “active management of labour”. Yet at the same time, women need to hold their plans lightly, recognising that a power greater than they are is ultimately in charge.

This is truthful living. Mother Nature can be trusted, as she designed this glorious web of life to work—but the design includes suffering and death. Impermanence is a basic truth—central to Buddhism and central to honest childbirth preparation. Death is the other side of birth, and good parenting requires a deep understanding of impermanence. Babies become children who grow older, leave home, and will die sometime themselves. Dukkha is real, as the Buddha teaches.

It is also universal, as the story of Kisagotami poignantly demonstrates. Kisagotami takes her dead baby to the Buddha, begging for medicine to heal him. The Buddha tells her that only mustard seed obtained from a household where nobody has died can restore her child. Kisagotami makes the round of the village, finding in each house a different tale of suffering and grief, but nowhere a family in which nobody has died. The cure for Kisagotami’s grief was not found in escape from suffering, but in acceptance of dukkha and genuine compassion for others. For the energy which arises out of grief can be channelled into a noble life. This is the primary lesson of the Buddha’s Four Noble Truths.

One of the women I knew who lost her baby in childbirth did just that. She named her daughter, she grieved, she held a beautiful funeral at home for friends, she held no one responsible for her loss, she planted flowers, she smiled, she went on to give birth to and raise two healthy boys, who always knew they had a sister. She worked productively at her job and in her community. In her heart, she believed with trust and joy that she would meet her daughter again some day on the spirit plane.

Many people, however, lack this basic faith: that in spite of death and impermanence, life can be trusted. Dread and doubt underpin the anxiety which many pregnant women feel. They approach labour in particular with many fears, very often the fear that “they can’t do it”. Understanding that “they” don’t have to can be profoundly liberating. The self-conscious self is not in charge. Life-force energy works through them and in them, rendering meaningless the concept of boundaries. Inside and outside are not different. The “small self” is conditional and temporal--ultimately delusion--as Buddhism teaches.

The birth wisdom women need already belongs to their bodies. It is a matter of connection to and trust in that ancient wisdom which the body contains. Intelligence permeates the entire physical field, so that each cell understands its role in the mystery of creation. Many women need to be reminded that their bodies knew how to conceive and grow a baby without any conscious direction on their part. So it makes sense that the body would know how to birth a baby too. Childbirth education is more a matter of unlearning than learning--letting go of the rational, conscious, judging, linear (i.e. self-attached) part of the mind and allowing the intuitive, instinctive, holistic dimension to emerge.

The block is usually fear. Fears in pregnancy can take many forms. Complex and often unconscious, fears manifest in action and the body. Their visible expression appears in tension, shallow breathing, muscle clenching, self-consciousness, anxiety, and unproductive habit energy. All of these keep the rational mental faculties on constant alert.

According to Buddhist psychology, these fears are samskaras or traces of past action which have lodged deeply into the psyche. They comprise the vijnana or basic (unenlightened) mentality of a person. The Skandha cycle explains how this mentality is formed.

An individual mind perceives namarupas, which are “objects” seen through the distorted lens of self-identity. This type of perception is avidya, which means not seeing clearly. It typifies the unenlightened state. Vedana is reaction to the perceived namarupa, experienced on the body level--a surge of adrenaline, a blush, sweaty palms, nervous laughter. Samjna is the programmed behaviour that follows swiftly upon the visceral reaction, the mind going on automatic pilot. If this process is repeated often enough, samjna becomes lodged in the memory bank as samskaras, action traces. Samjna thus involves the proliferation of new samskaras as well as the playing out of old ones. The sum of samskaras forms the mentality of the person, the vijnana. And a certain vijnana then perceives namarupas according to its particular bias, thus completing the loop. Unless something happens to break it, the cycle keeps repeating, reinforcing the same stuck pattern of thought and behaviour.

Fear of losing control in childbirth is a common loop which can surface during pregnancy. Many women have heard horror stories about birth which they may have been carrying since early girlhood. The natural attitude of our western culture has--until very recent times-- viewed birth as something women must suffer and endure. It is meant to be painful and undignified . . . a curse, trial or humiliation. The end result, the baby, makes it all worth it, but the experience itself is not to be anticipated with joy or awe—as a powerful rite of initiation, for instance, which it is and which some cultures recognise.

Birth is a rite of passage. A woman who gives birth with awareness enters into an altered state of being. She experiences a deep sense of her own empowerment, which is not “power-over” but “power-with”. As she surrenders to the birth energy, she realises in herself the interconnection of physical, spiritual and energetic power. Movement between the different worlds or states of consciousness flows naturally. A birthing woman is, in fact, the original shaman or “the one who walks between the two worlds”. It is she who guards the door to the spirit plane. For just as the door of death leads to, the door of birth leads from the spirit world beyond this material reality.

In the womb, a spirit being takes on flesh, moving in and out of its tiny body frequently during the months of gestation. It travels widely and dreams vividly, working through material from past lives and considering plans and directions for this new incarnation. So the pregnant woman is in optimal position to mediate between the two worlds. Her work (labour) involves bringing that new spirit safely to the physical plane, which is marked by the baby’s first breath. Before that time and during the first weeks postpartum, her access to the spirit realm is quite open, as the veils are thin during the childbearing year, and particularly during labour itself. This is why pregnant women generally feel hyper-sensitive, intuitive and open. All this becomes even more acute during labour.

As the energy of labour intensifies, the birthing woman enters an altered state of consciousness, an out-of-body “peak experience” characterised by a rosy glow in the aura, a feeling of bliss, and an experience of oneness with all of life. She may be moaning or writhing or shaking or making animal sounds--as the energy is primal, elemental—but her inner state is a form of ecstasy, in the shamanic sense. From the outside, however—from a conventional, civilised, rational perspective--it can appear that she is out of control. Women who are out of touch with their bodies during pregnancy often hold this view themselves, seeing labour as an ordeal of pain and suffering. Terrified to let go of the familiar, they go into labour with this fear of “losing control”, which is ultimately fear about relinquishing strong identity attachments. The civilised, well-mannered, poised, lady-like self has to go during labour. Yet the samskaras which hold this self-image in place can be so tenacious that even women who think they will be able to let go often find themselves inhibited once labour gets going.

I experienced a labour once which got stuck for this very reason. Anna was giving birth at home. A very conscientious and meticulous person, she had everything prepared ahead of time. The house was immaculate, stocked with food and supplies, baby and birth items all in their place. The midwife and I (her apprentice) arrived when her partner phoned to say she was in “active labour”. However, Anna greeted us at the door as a hostess, offering cups of tea and cake and attempting to engage us in social conversation—not the behaviour of a labouring woman! Anna was too attached to her role as hostess and her sense of good manners--habit energy around the proper behaviour when guests come to the house--to let the energy of labour flow.

At that point in her labour (which was in fact quite early), the influence of her mind (her samskaras) could stop the progress of labour, and it did. It was not until after we left and she and her partner had a good few hours in privacy that active labour really got going. When we returned, she no longer noticed or cared if we had tea or cake. Breathing and moaning according to the pulse of the birth energy, she had entered “labour zone” and was oblivious to ordinary life in the room. She had allowed herself to “lose control”, and the baby was born soon afterwards.

Other kinds of fears can surface during pregnancy or labour and manifest in a variety of ways. A woman came to me once who had an overwhelming and irrational fear that her baby would not survive. Early experiences with death in her own childhood may have been the root of her fear. Even so, she wanted the child with a passion as strong as her fear, and loved everything about being pregnant, particularly the fact that her baby was “safe” in the womb. Though she wanted a natural birth and looked forward to meeting her baby, unconsciously she could not let go of the pregnancy. She did not really want her child to leave the security of the womb and face the dangers outside.

At two and a half weeks post due, she was induced and had a forceps delivery in hospital. After the baby was born, she hovered over him for months, barely able to leave his side. She could not buy him nice clothes either, as that was “tempting fate”. Not until he was nine months old could she begin to realise that he was thriving in all ways, and start to face the irrationality of her fears. It was as if she needed this “second pregnancy” before she could trust her child’s inborn orientation towards life.

In my classes and workshops, I draw from the techniques of Buddhist practice, helping women develop trust and the skills they need to move past their fears. Like in anything else, practice helps. It is good that pregnancy lasts nine months. Women who use the time to develop their awareness most often have better birth experiences than those who remain disconnected from the pregnancy and engaged in linear types of work up until the last minute.

Mindfulness of breathing is a basic Buddhist practice which is very useful in childbirth. In labour, a woman needs to stay grounded in the present moment. Mindfulness of breathing takes her there, as the breath is the present moment. Breath is also the bridge between the spirit and physical worlds; it is communion with other power. In mindfulness of breathing, the breath is the mantra, the focus of attention.

Observing the breath in the body is central to yoga as well. In preparing for labour, we begin with the natural breath and proceed to deep yogic breathing, which uses the diaphragm and rib cage but with no strain, as the breath deepens naturally with relaxation and release. We might work too with various types of pranayama, alternate nostril breathing or ujjayi breathing, listening to the sound of the heightened breath at the back of the throat and experiencing its energy through the body. In labour, the breath changes as well, modulating with the intensity of the contractions like a surfer riding the waves of the sea.

Since the relationship between breath and body is primary, we practice mindfulness of breathing often and in various positions—lying down, seated for meditation and in different yoga postures. Moving into, holding, and moving out of yoga postures is particularly useful, as it demonstrates the relationship between movement and breath. The body realises how movement affects the breath and breath affects movement—so that “breathing the baby out” becomes an intelligible phrase.

To “practise” contractions, we usually begin with simple mindfulness of breathing, keeping the attention on the experience of the breath throughout the length of a contraction. The women each get a piece of ice to hold, which creates a strong physical sensation against which they can focus their breath. Next we might add mindfulness of breathing with an image. This can be an actual object in the room, a personal power object, or an object of the imagination—anything which gives a woman strength and keeps her grounded in the present. If a woman chooses her own power object and uses it to practise breathing, it can serve as an invaluable aid in the birthing room, radiating back to her all the energy she has invested in it.

Non-focused awareness is another birthing tool which draws from Buddhist practice, though women usually find this one a bit difficult. I suspect because it requires more practice. Here, all six sense doors open equally, attending to whatever arises in the present moment then releasing it with no attachment or judgement. Awareness moves from internal body sensations to bird and traffic sounds to random thoughts to the texture of the floor. All of these sensations present to the senses (or “minds”) but the “mind” does not form an identity out of them, does not attach. The point here is that in labour the sensation of contractions becomes just another phenomenon to experience. The attention moves to other phenomenon in the room as well and does not attach to “pain”.

Yoga postures too incorporate aspects of Buddhist practice and are very helpful for childbirth preparation. Powerful postures which challenge physical strength and stamina require deep, steady, strong breathing. As the breath generates both energy and calm, it becomes a focal point for the mind and a valuable tool for deepening into the experience. In yoga postures as in labour, the breath helps the mind integrate strong sensations and sustain a calm detachment from “pain”.

Also, each posture refers to a particular configuration of energy in the world--an animal, object in nature, a deity or sage--as the names imply. In a posture, the body not only represents but can actually become this quality of energy. The mind visualises the shape, creating an energetic pattern, and the breath takes the body into the full reality of the image, so that it becomes the tree or cat or warrior. This work loosens the boundaries of self-identity and provides a different experience of surrender to something other.

Ritual and the use of symbol are other dimensions of Buddhist practice I draw upon in this work. Buddhism sees the natural world as sacred. All forms of life manifest the sacred. All express the five elemental energies out of which the material world is formed. Earth, water, fire, air and ether commingle in a never-ending dance. Stones, cherry blossoms, autumn leaves, a bowl of water, a feather, a candle are some of the forms they take. In workshops, we always create an altar or birth shrine out of significant objects and talk about the purpose of such a shrine in the birthing room, both as a symbol of the sacred and an anchor which can generate and recall previous moods of calm and openness.

Activities around a birth shrine can help ground women in the sacredness of the earth and the sacredness of their own earth energy. Often, I do visualisations centred upon objects from the birth altar or lead the women in breathing exercises which connect them to the energetic power of the objects. Sometimes the women go into the garden to gather whatever speaks to them of the qualities they seek and form the altar themselves. Sometimes they do improvisational movement inspired by the objects. Ultimately the objects serve as vehicles. For ritual is about merging, releasing the trap of self-identity and connecting with the universal. Ritual can take us to that place of surrender and ecstasy.

In a sense, all the work I do with pregnant women is about creating the right conditions, an important aspect of Buddhist practice exemplified by the theory of Dependent Origination. Though Dependent Origination can refer to a specific cause-effect chain of twelve linked states, it also has a broader reference. This sense--namely that all mental states arise in dependence upon causes and conditions--forms the heart of Buddhist psychology. Though we cannot plan the perfect birth and expect it to happen, we can set up the conditions which would make it more likely. After that, we let go and trust. Investment in a specific outcome is a sure recipe for disappointment, as well as a continual source of anxiety, worry and fear. Better to remain in the present--where it is possible to choose what feels right for that moment--trusting that out of good actions, good outcomes (even if they contain a hard lesson) will arise.

Many activities outside classes and workshops involve setting up the right conditions for a good birth. Getting out into nature to nourish the spirit is something every pregnant woman needs. Already in tune with the elemental on a body level, she can benefit greatly by communing with the sea and sky, with forests, stones and meadows--freeing herself from restricting timetables and stressful work, tuning into the body and connecting with the baby energetically and emotionally. She needs to take time to meditate, rest, walk, swim, dance. To heal old wounds and deepen her bond to loved ones and spirit as she understands it.

Childbirth preparation, like Buddhism, is finally about cultivating trust as a primary state of mind. Though that is never easy, it is in essence simple. In Buddhist language, it means having faith in “other power”. It involves a realisation of the non-self nature of existence, the reality of impermanence, and the dukkha which arises out of attachment, particularly the attachment to self. In the language of birth, it means becoming a channel of life-force energy. It involves a recognition of the interconnectedness of all existence, the reality of change, and the suffering which arises out of attachments based upon fear. Buddhism has much to offer birth preparation, because ultimately both are about something similar: liberation from fear and learning to trust implicitly in the goodness of life.

© Marianne Jacuzzi 2003