“Yes, You’re Going to Die, but Probably not today.” Reflections on how to Support Laboring Women.

By  Donna Harel, PhD.

I got down to the eye level of the woman struggling on the toilet in front of me. Catrina grimaced and searched my eyes, pleading for relief. Crying out, she asked, “Am I going to die?“

I took a deep breath and smiled. “Yes, you’re going to die,” I said, “but probably not today.”

I dispensed this little bit of wisdom off the cuff with my childbirth student as she labored in her apartment. This simultaneously uncomfortable and comforting reality has carried me through many of my own darkest moments and has encouraged some of the people in my life. Your world may be falling apart. Or at least it feels that way. One day you will die. Probably not now. Let’s see what we can do to get you more comfortable in the meantime.

In over 13 years, I taught natural childbirth to more than three hundred couples. I sometimes provided them phone and text support as they faced decisions in their labors — I never provided advice and instead reminded them of what we learned in class as a framework to make decisions. Catrina and her husband, Brian lived in the apartment across the street, and we had built a friendly rapport during our class together. So when she called just after bedtime to ask for support — her doula would only meet her in the hospital — I had no trouble leaving my family for a little while.

Her labor had progressed pretty rapidly, and by the time I wended my way through the dimly lit, carpeted halls of her building, I could hear quiet moaning outside her door. Brian didn’t look exactly helpless as he answered the door, but he seemed pretty relieved to see me. Someone else to bear witness to Catrina’s pain for a while. And in some moments during labor, that’s all a support person can do.

He led me towards the bathroom. He had kept the lights in the apartment low. Good, I thought, someone had listened in class. Bright lights make most laboring women anxious. No one gives birth in caves anymore. Still, elements that can support a woman turning inward, and not cause her to feel in high alert (such as bright lights, loud noises, machines that go “ping,” people chatting or saying worrisome things), can help keep at bay her stress response, which both hurts and undermines the efficiency of labor.

What was I doing here? I had only attended four other births: my own birth; a hospital birth of a woman whom I had never met (outside of seeing her baby emerge from her body for five minutes); and my two births as a laboring mother. I was born in the typical fashion of 1970s white, middle-class America. My mother’s OB turned to the anesthesiologist and said, “Shut that woman up!” So they knocked her out and extracted me from her body. She awoke to a scrubbed and tubbed bundle in the isolate next to her.

The first birth I ever witnessed took place during my senior year of college. I was visiting Andy at the hospital during his internship, and one of the OB residents invited me to sit in on a labor. When Andy’s pager jolted me awake (we’d squished together on a cot in the intern’s call room) at 3 a.m., I bolted upright and stumbled, already nauseated from the jarring wake-up, through the quiet halls of the hospital towards the labor and delivery floor. As I entered the birthing room, I was confronted with the sight of the laboring woman squatting on the birth table. She barely registered the presence of the people around her, and I was just another face in the parade of hospital personnel she encountered during her labor. As she grunted her way through the process of birthing her third child, I felt my nausea rising, both both the adrenaline of my jolted awakening and from the starkness of the scene. With one great big roar from the mother, another person was suddenly in the room. Holy crap! I have no right to be here, I thought, but wow! Then mom reached for her baby, but the doctor handed him instead to the nurse. Again, holy crap! Far off from becoming a mother myself, this amazing scene gave me a little hint of the power of birth and of the problems of how we do birth in our society, which would propel my journey into birth activism.

As a budding anthropologist, I had a clear sense of birth as a human experience and how it was constructed differently in different contexts. I wanted to explore alternatives to the misogyny of the “biomedical industrial complex,” which in America constructed birth more as a “crisis in need of management” than as a normal part of human experience. By that point, I had spent a few years hanging around homeschoolers for my dissertation research. Many of the mothers in my study cited their natural childbirth experience as formative in their instinctual trust of themselves as parents. Finally, I wanted to go for the adventure and differentiate myself from the experiences of my mother and my mother-in-law.

Married to a physician who felt most comfortable with the hospital setting and who was socialized through his training to see birth as inherently risky, I did not seek out midwifery care, and at the time I knew nothing of doulas. I found a doctor known for her support of natural childbirth, and we took a birthing class with two other couples. Andy and the other two moms were fluent in the language of medicine: one was a chiropractor, and the other was a nurse practitioner. All three of them had a “got this” attitude.

Still, during our last class, when all three couples huddled around a bucket of ice water, the three moms immersing our hands in the ice while our partners tried to support us, I had two reactions: first, a complete desire to escape; then an appreciation that the other women were doing this, too. The inescapable sting of the ice creeping up my wrists commanded most of my attention. I felt my neck and shoulders tense. I tried to relax, but it was a struggle. I envisioned legions of women before me feeling this all-encompassing sensation. This vision, along with a singular sense of grit, propelled me even as my instinct was to pull my hands out of the water before the 90-second timer went off. The partners stepped up big time in this first taste of what trying to support a laboring woman actually might be like. Andy’s steady, firm hand, running clockwise circles on my back as he leaned in, suddenly made me feel a little better. I felt both comfort and security. We could do this.

The ice water turned out to be an interesting analogy for labor. The discomfort can be inescapable at times. You can play with it: notice its quality, find the edges of where the pain ends. You can try to relax the rest of your body (tensing other parts really does amplify the discomfort). You can tune in to the voice of the gentle guides around you, you can tune them out, and tune into your body. You can visualize: calm scenes, cute baby parts, warm light, a vise or a fist squeezing your partner’s testicles (if your partner is male). You can get quiet, hum, scream, sing, and rock. You can appreciate its purpose (each contraction brings you closer to the birth). Whatever you do with it, labor involves discomfort.

And others, to a limited extent, can support a woman in labor. They can rock, soothe, massage, guide, coach, protect from surrounding distractions, and stay with her. They can advocate for her dignity and safety. They can bear witness to (and cheer) her experience. They can be, as one student put it, “a rodeo clown to distract the doctors and nurses so she can have peace and quiet.” They can watch, in awe and in love.

So, after a pretty powerful experience in my own labor with my daughter Ella, and in an effort to goof off from writing my dissertation, I became a birth junkie. I trained in one of the major methods of natural childbirth in the U.S. This method highlights the role of the partner as coach and birth companion and offers a heavy dose of “consumerism” — teaching expectant couples what is normal in labor and how to be good (informed) consumers of maternity care services. I tried to promote safe, empowered births and postpartum experiences for the families I taught.

My birth activism had an arc: the insufferable assuredness of a new convert; the predictable moment of sticking my foot in my mouth; the eventual comfort of knowing my material well enough to know when to take a soft touch and when to be more vociferous about what I wanted to share. Eventually, it stopped being my life goal to empty all the hospitals of birthing women, and I returned to the core principle of wanting to support families in having safe and empowered births, however they defined them.

Still, I initially felt ill-equipped to support Catrina as she labored on the toilet in front of me. And seven years of teaching expectant couples how to give birth “safely and with dignity” hadn’t really prepared me for the intimacy of this moment. Shouldn’t this be her husband’s job? Where was the doula? Why was I here again? Oh, yeah, she asked me.

And when I really looked into her face, I saw not only a woman in labor crying for reassurance, but also an infinity of moments as a parent and from life on this planet. I conjured a genuine smile. It turned out that her infinite moment of pain did come to an end. She now has an amazing daughter, who, like my own kids and children of all time, have split their parents’ worlds wide open: a mess of pain and suffering and joy and goop. And snot. So much snot.

I’ve reminded myself of this in my darker moments, and I hold it up to others when I bear witness to their burdens. Whether this comforts or scares you: You are going to die. But probably not today. How can I help?

Public Rituals For Grieving: Lessons from saying Mourner’s Kaddish for three and a half years 


By Donna Harel, PhD.

Humans have evolved many different ways of managing and commemorating loss, which is always a private as well as social matter. In other words, we have technologies of time and space and material for processing grief.

Pop-up vigils and memorials, burials, cremations, wakes, shivas and, these days, online tributes, mark passing as well as grief. Some traditions emphasize honor for the body of the departed, others treat it as potentially defiling. Some traditions expect grief to be a private affair, others treat it as more social. In some cultures, public wailing, often through hired hands (keening in Ireland and Scotland, Uluation in Muslim tradition) is designed to help mourners connect with the grief in their hearts and at times show the status or esteem of the departed. My own tradition, Judaism, has an elaborate technology for dealing with dying, treatment of bodies, funerary rites, grief and mourning.

Jews mark intense period of mourning for a week, and status as a mourner continues throughout the first year. Regular moments throughout the calendar mark the passing of a loved one beyond the year. Growing up, I was always told that the rituals were not for the dead, but for the living. While many people see these practices as archaic, I personally found them to be healing. Here’s my take on what amounted to a protracted and somewhat unusual experience. While the details were a bit unique, I suspect that they may have a wider resonance for those dealing with loss.

Each week, like a small boat surrounded by others, the name (and the life it represents) floats just a bit further away -one or two waves at a time–until at the end of the year it finally floats so far into the distance and is no longer recited. They will recall the name once a year, remembered more as a distant star than a long-launched boat. If you follow the name as it makes its steady progression out to sea, you hear the names of the other boats, whisked off just a bit further as well. New boats come each week as the familiar ones start to leave. A steady progression across the year in a sea of names. You stand that year as you listen to the names recited. You connect, once a week to the lost soul, now a boat whose distance away marks a longer tether to the grief, the celebration, the mix of memories and emotion.

The reading of names and the ritual of standing and reciting Kaddish Yatom, or “mourner’s kaddish,” the Jewish prayer of remembrance, takes place in my synagogue community each week. In some settings, people recite mourner’s kaddish daily and in others, the names are not recounted. Traditionally, the recitation is a social act and most communities call for a minyan or gathering of ten adults (in very traditional communities only men) as a requirement for the recitation. I suspect that these requirements underpin the social support embedded in the call to public grief. In many communities, people come to minyan for the explicit purpose to ensure that others may recite the mourner’s kaddish. Fun fact: a Torah can stand in for a person to creat a minyan. As the mourners stand for the minute or so, reciting the incantations, either reading or with eyes shut, the community holds them, reciting their bits of ritualized responses. The community creates time and space for the mourners to connect and commune with the memories of their dead loved ones.

Nearly every Shabbat morning between July 2012 and January 2016, I stood for mourner’s kaddish. 175 recitations. I  closed my eyes as the words, even those moving with my own breath, washed over me. First I stood with my father on the shabbat morning following my grandmother, Rachel’s death. She was the last of mine and my husband’s grandparents – those eight sweet people who treated us with so much adoration, unconditional love and very little rebuke. When I stood each week for a year and recited Mourner’s kaddish, I had a chance to commune not only with them, but with that feeling of unconditional adoration and love.

Overlapping that year, by about a week, I began to stand also for my beloved father-in-law. He passed away in July of 2013, shortly before what would have been the due date of a miscarried baby. I’d been connecting to that loss throughout the year of mourning my grandmother. I spent much of 2013 with a growing belly. The promise and disjuncture between life and death, punctuated mourner’ Kaddish  and our third daughter was born in April of 2014. She nuzzled against me in her sling every time I reconnected with her grandfather, her namesake.

My own father passed away in May of 2014, when the baby was 7 weeks old. The names of our two fathers bookended me and the baby as I mingled generally fond memories and impressions with sweet little nuzzles. A dear friend and teacher passed away later that summer, just as my father-in-law’s name cycled out, his boat launched as a distant star. I dwelled in only fond memories of the friend, and she remained a steady companion as I recited kaddish in the year that followed.

My mother passed away in October of 2014. Her death brought to the sacred recitation the mix of feelings that only mothers can bring out in their daughters. All the while, my own little girl started to poke her  head out of the sling. How many times did she nurse during this recitation? This act of mothering surely smoothed over many of my ambivalent feelings.

When my mother’s husband passed away in January of 2015, the baby and I would stand each week with a swirl of memories and mixed, often fraught, emotions. For a while, my father’s name remained on the list. Three parents. One friend. Four sets of emotions. My dad’s name sailed further and further away until May, when his ship launched off into the distance. My beloved friend, always such a strong voice for embracing the other’s burden, steadied me as I faced the impending encounter of standing with singular thoughts of my mother and her husband. The last shabbat that I heard my friend’s name announced, I suddenly incanted “Infinite love and gratitude” instead of the proscribed words. This was her parting gift as her name sailed off into the distance.

So July came and all of the steadying guides and easy relationships had truly departed. As I stood up during the first encounter –just me and my mom and my stepdad– I breathed deeply for the work ahead.  I shifted the 15 month old on my hip and sought to shift from ambivalence to compassion. For the three months, the tight knots of frustration began to loosen. Slowly, slowly, the sensations of the love and nurturance my mother bestowed upon me began to take over. Yes, she was m difficult and not always kind. Judgmental and often divisive, and all those things that some mother’s can be. But between the steady sounds of the incantation, the soft cooing sounds of the baby and the small still voice urging “infinite love and compassion,” I truly swelled with gratitude by our final week together. I recall kissing the baby’s head, then the siddur and wiping the tears that had rolled down my cheeks. “Thank you, Imma,” I uttered as her boat launched out beyond its tether.

“So,” I thought to my step-father as I rose the next week, “It’s just us now. Can we do this?” No one else would be doing this for him; I was the lone torch-bearer. My stepdad had been an imposing figure. A lanky Vietnam veteran- turned carpenter, he was always composed and gentlemanly. He had taken  tireless care of my mother. Yet he always exuded a undercurrent  of  darkness and suppressed  anger. After 15 years of caring for my mother, he was at sea after her death. He was overwhelmed by her convoluted accounting, which required near-forensics to disentangle. He had vascillated between terrific gratitude for our concern towards him and seething anger that we three daughters hadn’t done enough to lighten his burden. He never explained himself before taking his life, and I spent the ensuing months of reciting mourner’s kaddish working through anger and frustration.  I sought connection and gratitude. Images of silly dance parties and construction projects with my girls eventually flashed within my mind’s eye. I envisioned him and my mom dance at my sister’s wedding. And in the months and weeks between October and January, I found gratitude and peace.

When I finally remained seated after three and a half years, I noticed, for the first time, what it’s like to play the part of the community -to hold others as they stand and connect with their departed. I have come to believe in the sacredness of both ends of the production. I still feel the rhythms of the sea of names as they float by, marking time for us as a community and connections of lifetimes for those who remain behind.

I firmly believe that our most intimate encounters with anything divine come by way of others. Ideally, others are there for us as we grieve and rejoice, connect, and say goodbye. So whether you are standing for mourners kaddish or bearing witness to those who do, you are engaging in holy work. And for that, I feel infinite love and gratitude.

Indeed, the closing lines of the mourner’s kaddish call for the establishment of peace within ourselves, among our people and for all creation. Kaddish Yatom is, indeed, a structure and a framework to achieve achieve exactly that.

So what do we do without these very specific technologies for processing grief?

Our day and age abounds with opportunities to miss out on grieving and opportunities to create structures of time and space to grieve. As a person who doesn’t live a highly structured life, I appreciate that my tradition created those structures for me and that I was fortunate enough to make use of them. Without them, however, we might do well to make a weekly or regular time for communing with our losses.

Consider setting an alarm, finding a regular place to close your eyes, listen to the same tune, sounds or poem. Write your way through the relationship. Whatever you do, find time and space and a ritual of sorts to connect, reflect, say “sorry,” “thank you,” “why?”
I hope you find infinite love and gratitude or at least bits of peace.
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