Tag Archive | natural childbirth

Following Your Body’s Urges to Push…

Sense and Sensibility is having a blog carnival around Healthy Birth Practice #5: Avoid giving birth on your back and follow your body’s urges to push.

For this blog carnival, I feel like sharing my own personal experiences with following my body’s urges to push. I gave birth to my first son over six years ago in what was the only freestanding birth center in the state (related side note: when I told my landlord that my new baby was born in a freestanding birth center, she said, “oh, so does everyone there have them standing up?”;-D). When I arrived at the birth center, I was surprised to be ten centimeters dilated already. Fortunately, the midwife on duty said, “go ahead and push when you feel the urge,” and went about her business, rather than encouraging me to push simply because I was at ten or exhorting me to push with loud counting and the near-aggression as is so frequently depicted in the media. After some time, I decided to experiment with the “pressure” feeling I’d been feeling for several hours—as soon as I gave a couple of small, experimental pushes like that, my water broke. I stayed on my knees on the floor for some time—head and arms on the bed—and eventually the doctor suggested that I get up on the bed, where I ended up giving birth to my son in a semi-sitting position.

During this birth, I was very sensitive to suggestion and to “being good,” and so when the bed was mentioned, I felt I had no choices even in such a gentle birth setting. I feel if left to my own urges, I would have stayed kneeling on the floor.

With my second son, who was born at home, I was alone with my husband for nearly the entire labor. As I got closer to giving birth, I felt “driven” to my hands and knees where I began to push spontaneously (and again my water broke with the onset of pushiness). It was a very wild and rapid birth and I barely had conscious thought of whether or not I felt like pushing—it just happened! After several pushes on hands and knees, my son eased out where he was received by my midwife after her arrival five minutes prior.

My third son (second trimester m/c), was born at home with just my husband present.  My labor was again extremely rapid and I found myself kneeling on the floor in child’s pose. This position felt safe and protective to me, but I finally coached myself into awareness that the baby wasn’t going to come out with me crouched on the floor in that manner. I told myself that just like with any other birth, gravity would help. So, I pushed myself up into a kneeling position and my water broke right away. I crouched forward again—feeling fearful—and then told myself to move upright again. As soon as I was back on my knees, some blood clots emerged. I stood then, with knees slightly bent, and my baby was born.

For me, being nearly alone is the best way to follow my body’s own promptings. I feel it can be difficult to heed our bodies’ own wisdom when other people in the room are encouraging directed pushing or are “cheerleading” loudly. Freedom to move as desired and to push spontaneously according to the body’s own urges is a mother and baby friendly approach to birth.

Some of my other posts about second stage labor include: pushing the issue of pushing; waiting before pushing; and thoughts about pushing.

For more information about spontaneous pushing check out this video from Mother’s Advocate.

And, don’t forget my handout: helpful ways to use a hospital bed without lying down.

What to Expect When You Go to the Hospital for a Natural Childbirth

I’ve been debating about whether to share this post or not. I’m concerned that it may come across as unnecessarily negative, pessimistic, or even “combative” or “anti-hospital.”  However, I do think it is honest and I’ve decided to share it. There is a fairly “normal” course of events for women having a natural birth in a hospital setting. In order to be truly prepared to give birth in the hospital, it is important to be prepared for “what to expect” there and to know how to deal with hospital procedures. All hospital procedures/routines can be refused, but this requires being informed, being strong, and really paying attention to what is happening. I hope this list of “what to expect” with help you talk with your medical care provider in advance about hospital routines and your own personal choices, as well as help prevent unpleasant surprises upon actually showing up in the birthing room. This list is modified from material found in the book Woman-Centered Pregnancy and Birth. I am not saying that is how your specific hospital operates, but that many American hospitals function in this manner.

  • Expect to have at least some separation from the person who brought you to the hospital, whether this separation is due to filling out admission paperwork, parking the car, giving a urine sample, being examined in triage, etc.
  • Expect to remove all your clothing and put on a hospital gown that ties in the back.
  • Expect to have staff talk over you, not to you, and to have many different people walk into your room whenever they want without your permission and without introducing themselves.
  • Expect to have your cervix examined by a nurse upon admission and approximately every hour thereafter. Sometimes you may have multiple vaginal exams per hour by more than one person.
  • Expect to have an IV inserted into your arm, or at minimum a saline lock (sometimes called a Hep lock).
  • Expect to be denied food and drink (at best, expect clear liquids or ice).
  • Expect to give a urine sample and perhaps a blood sample.
  • Expect to have an ID bracelet attached to your arm.
  • Expect to have to sign a consent form for birth and for application of a fetal monitor that states that your doctor will be responsible for making the decisions about your care (not you).
  • Expect to have a fetal heart rate monitor attached around your belly—two round discs on straps that will often stay with you continuously until you give birth (or, at best, for 15 minutes out of each hour of your labor).
  • Expect to have your water manually broken at about 4 centimeters (or at least, strongly suggested that you allow it to be broken). After this point, expect to be encourage to have an electrode screwed into the baby’s scalp to measure the heartbeat and a tube places in your uterus to measure your contractions.
  • Expect to be offered pain medications repeatedly.
  • Expect to receive Pitocin at some point during your labor–”to speed things up.”
  • Expect to be encouraged (or even ordered) to remain in your bed through much of labor, especially pushing.
  • Expect to either have your legs put in stirrups or held at a 90 degree angle at the hips.
  • Expect to be told you are not pushing correctly.
  • Expect to hold your baby on your chest for a few minutes, before it is taken away to be dried, warmed, and checked over.
  • Expect the baby to have antibiotic eye ointment put into its eyes (without telling you first).
  • Expect to have your baby suctioned repeatedly.
  • Expect to be given a shot of Pitocin to make your uterus contract and deliver the placenta.
  • Expect not to be shown the placenta.
  • Expect your baby to be given a vitamin K injection.

I think it is important to note that what you can expect is often different than what you deserve and that what you can expect often reduces or eliminates your chances of getting what you deserve. In my classes, I’ve made a conscious decision to present what women deserve in birth and though I also talk about what they can expect and how to work with that, I think sometimes they are left surprised that what they actually experience in the hospital. At minimum, what you deserve are Six Healthy Birth Practices (as articulated by Lamaze):

  1. Let Labor Begin on Its OwnDownload PDF
  2. Walk, Move & Change PositionsDownload PDF
  3. Have Continuous SupportDownload PDF
  4. Avoid Unnecessary InterventionsDownload PDF
  5. Get Upright & Follow Urges to PushDownload PDF
  6. Keep Your Baby With YouDownload PDF

As an example of what I mean about what you can expect clashing with what you deserve, consider the second healthy birth practice “Walk, Move Around, and Change Positions”—monitoring and IVs directly conflict with the smooth implementation of a practice based on freedom of movement throughout labor.

So, how do you work with or around these routine expectations and your desire for a natural birth?

  • Discuss in advance the type of nursing care you would like and request that your doctor put any modifications to the normal routines in your chart as “Doctor’s Orders” (if your doctor is unwilling to do so, seek a new medical care provider!)
  • Labor at home until labor is very well-established.
  • Go through the above list of “what to expect” and make a decision about how to handle each one on a case by case—you may choose to actively refuse something, you may be okay with accepting certain procedures or routines, and you can develop a coping plan for how specifically to work with any particular issue.
  • Take independent childbirth classes and learn a variety of techniques and pain coping practices so that your “toolbox” for working with labor is well stocked.
  • Hire a doula, or bring a knowledgeable, helpful, experienced friend with you. It can help to have a strong advocate with you (this may or may not be a role your husband or partner is willing to take on).
  • Another tactic is to “never ask permission to do what you want, but to go ahead and do it unless the hospital staff actively stops you.” (An example of this is of getting up and walking around during labor)
  • “Many people, if they can find no other way to get around a dangerous or unpleasant hospital policy, unobtrusively ignore it”—a good example of this is with regard to eating and drinking during labor. Restricting birthing women to ice chips or clear liquids is not evidence-based care. Bring light foods and drinks and quietly partake as you please.
  • Leave the hospital early, rather than remaining the full length of stay post-birth. This can minimize separation from baby and other routines you may wish to avoid.
  • For some additional ideas see my post, “Can I really expect to have a great birth?


Finally, and most importantly, “birth is not a time in a woman’s life when she should have to FIGHT for anything,” so if you find that you feel you are preparing yourself for “hospital self-defense” I encourage you to explore your options in birth places and care providers, rather than preparing for a “battle” and hoping for the best. If you feel like you are going to have to fight for your rights in birth, STRONGLY consider the implications of birthing in that setting. Also, as The Pink Kit says, “hope is not a plan”—so if you find yourself saying “I hope I can get what I want” it is time to take another, serious look at your plans and choices for your baby’s birth.

Awakening Your Birth Power

25_ways_to_awaken_your_birth_power

“If you have heard enough birth ‘war stories,’ advice, and medical information…

If you are beginning to doubt yourself and to feel confused and worried about giving birth…

It is time to focus on something simple, positive and inspirational.

It is time to come back to center and listen to your own inner wisdom.

It is time to Awaken your Birth Power.”

I recently received a copy of the book and CD set 25 Ways to Awaken Your Birth Power, by Danette Watson and Stephanie Corkhill Hyles. The book is a collection of 25 short breathing meditations each accompanied by a beautiful (and sort of whimsical) drawing. The enclosed CD has 3 tracks–the first is called “awaken your birth power for pregnancy” and consists of the relevant meditations from the book read aloud. The woman reading has a pleasant, soothing voice with a slight Australian (?) accent. The second track on the CD is “awaken your birth power for labour and birth” and consists of 48 minutes of the relevant meditations from the book read aloud. The third track is an abbreviated almost 8-minute guided meditation. This CD would be perfect to listen to while in labor. The book and its gentle illustrations is a nurturing, confidence-inspiring, birth-power-enhancing, reflective, time-out for use during pregnancy or birth.

Reading it got me thinking about ways in which women awaken their birth power during pregnancy? How did you awaken yours? I’d love to hear about it and to write more about this topic!

I reflected on the ways in which I awakened my own birth power and my sense of confidence in my own inner wisdom. Here are the ways that I came up with when considering my own pregnancies and births:

+I read like a maniac :-) During my second pregnancy, I read a lot of literature about unassisted birth–though I didn’t have an unassisted birth (my midwife was there for 5 minutes of my son’s birth), I found the philosophies of unassisted birthers to be very inspiring.

+I maintained a daily yoga practice that included affirmations about my ability to give birth.

+I had specific dreams that reinforced my confidence.

+I journaled daily.

+I created birth art–needle felted birth goddess sculptures during my first pregnancy. Later, I drew womb labyrinth drawings–the labyrinth is a powerful metaphor for birth and I really connect with it. There are pictures of both of these on a very neglected other blog of mine.

+I talked extensively with my very birth positive friends–no horror stories from them!

+I formed my personal philosophy about birth and its role as a sacred rite of passage.

+My mother had a blessing way ceremony for me (with both my pregnancies) that made feel special and also confident and secure.

+The materials and philosophy on the Trust Birth website. I love their “what we believe” statement. It gives me chills!

+The book Birthing from Within–one of my all-time favorite birth books and a great birth power resource.

Nothing really worried me about my second birth or my ability to do so. I feel like I had a deep and true  and physical sense of confidence and trust in birth. During my second pregnancy, it became a *knowing* for me that I was a capable birth giver. I had complete trust in my body and my baby. With my first pregnancy, I remembering feeling like I was studying for the biggest test of my life–I did not yet have the deep and true sense that developed during my second pregnancy (actually, I think  developed as I read voraciously during the interim between my pregnancies). I also earned my certification as a childbirth educator during the interim between births and that also increased my confidence.

I attended a performance of Birth, the play, in St. Louis last weekend. While there, I picked up one of ICAN‘s flyers called “ICAN Birth” (sponsored by Hypnobabies). I think the flyer is an excellent resource for awakening your birth power, particularly the back panel with a list of things that, “if you were my sister, I’d tell you…” I’m going to order a bunch to give away in my class packets.

How do you awaken your birth power?

Can I really expect to have a great birth?

I received a comment via another blog asking “given my limited situation, can I really expect to have a great birth today?” (homebirth, midwife, and doula were all not options for the person asking the question). I think the answer is a qualified “yes.” The question really got me thinking about ways to help yourself have a great birth, when your overall choices are limited. I came up with a long list of ideas of things that may help contribute to a great birth:

  • Choose your doctor carefully—don’t wait for “the next birth” to find a compatible caregiver. Don’t dismiss uneasiness with your present care provider. As Pam England says, “ask questions before your chile is roasted.” A key point is to pick a provider whose words and actions match (i.e. You ask, “how often do you do episiotomies?” The response, “only when necessary”—if “necessary” actually means 90% of the time, it is time to find a different doctor!). Also, if you don’t want surgery, don’t go to a surgeon (that perhaps means finding a family physician who attends births, rather than an OB, or, an OB with a low cesarean rate).
  • If there are multiple hospitals in your area, choose the one with with the lowest cesarean rate (not the one with the nicest wallpaper or nicest postpartum meal). Hospitals—even those in the same town—vary widely on their policies and the things they “allow” (i.e. amount of separation of mother and baby following birth, guidelines on eating during labor, etc.)
  • When you get the hospital, ask to have a nurse who likes natural birth couples. My experience is that there are some nurses like this in every hospital—she’ll want you for a patient and you’ll want her, ask who she is! If possible, ask your doctor, hospital staff, or office staff who the nurses are who like natural birth—then you’ll have names to ask for in advance.
  • Put a sign at eye level on the outside of your door saying, “I would like a natural birth. Please do not offer pain medications.” (It is much easier to get on with your birth if you don’t have someone popping in to ask when you’re “ready for your epidural!” every 20 minutes.)
  • Work on clear and assertive communication with your doctor and reinforce your preferences often—don’t just mention something once and assume s/he will remember. If you create a birth plan, have the doctor sign it and put it in your chart (then it is more like “doctor’s orders” than “wishes”). Do be aware that needing to do this indicates a certain lack of trust that may mean you are birthing in the wrong setting for you! Birth is not a time in a woman’s life when she should have to fight for anything! You deserve quality care that is based on your unique needs, your unique birthing, and your unique baby! Do not let a birth plan be a substitute for good communication.
  • Cultivate a climate of confidence in your life.
  • Once in labor, stay home for a long time. Do not go to the hospital too early—the more labor you work through at home, the less interference you are likely to run into. When I say “a long time,” I mean that you’ve been having contractions for several hours, that they require your full attention, that you are no longer talking and laughing in between them, that you are using “coping measures” to work with them (like rocking, or swaying, or moaning, or humming), and that you feel like “it’s time” to go in.
  • Ask for the blanket consent forms in advance and modify/initial them as needed—this way you are truly giving “informed consent,” not hurriedly signing anything and everything that is put in front of you because you are focused on birthing instead of signing.
  • Have your partner read a book like The Birth Partner, or Fathers at Birth, and practice the things in the book together. I frequently remind couples in my classes that “coping skills work best when they are integrated into your daily lives, not ‘dusted off’ for use during labor.”
  • Practice prenatal yoga—I love the Lamaze “Yoga for Your Pregnancy” DVD—specifically the short, 5-minute, “birthing room yoga” segment. I teach it to all of my birth class participants.
  • Use the hospital bed as a tool, not as a place to lie down (see my How to Use a Hospital Bed without Lying Down handout)
  • If you feel like you “need a break” in the hospital, retreat to the bathroom. People tend to leave us alone in the bathroom and if you feel like you need some time to focus and regroup, you may find it there. Also, we know how to relax our muscles when sitting on the toilet, so spending some time there can actually help baby descend.
  • Use the “broken record” technique—if asked to lie down for monitoring, say “I prefer to remain sitting” and continue to reinforce that preference without elaborating or “arguing.”
  • During monitoring DO NOT lie down! Sit on the edge of the bed, sit on a birth ball near the bed, sit in a rocking chair or regular chair near the bed, kneel on the bed and rotate your hip during the monitoring—you can still be monitored while in an upright position (as long as you are located very close to the bed).
  • Bring a birth ball with you and use it—sit near the bed if you need to (can have an IV, be monitored, etc. while still sitting upright on the ball). Birth balls have many great uses for an active, comfortable birth!
  • Learn relaxation techniques that you can use no matter what. I have a preference for active birth and movement based coping strategies, but relaxation and breath-based strategies cannot be taken away from you no matters what happens. The book Birthing from Within has lots of great breath-awareness strategies. I also have several good relaxation handouts and practice exercises that I am happy to email to people who would like them.
  • Use affirmations to help cultivate a positive, joyful, welcoming attitude.
  • Read good books and cultivate confidence and trust in your body, your baby, your inherent birth wisdom.
  • Take a good independent birth class (not a hospital based class).
  • Before birth, research and ask questions when things are suggested to you (an example, having an NST [non-stress test] or gestational diabetes testing). A good place to review the evidence behind common forms of care during pregnancy, labor, and birth is at Childbirth Connection, where they have the full text of the book A Guide to Effective Care in Pregnancy and Childbirth available for free download (this contains a summary of all the research behind common forms of care during pregnancy, labor, and birth and whether the evidence supports or does not support those forms of care).
  • When any type of routine intervention is suggested (or assumed) during pregnancy or labor, remember to use your “BRAIN”—ask about the Benefits, the Risks, the Alternatives, check in with your Intuition, what would happen if you did Nothing/or Now Decide.
  • Along those same lines, if an intervention is aggressively promoted while in the birth room, but it is not an emergency (let’s say a “long labor” and augmentation with Pitocin is suggested, you and baby are fine and you feel okay with labor proceeding as it is, knowing that use of Pitocin raises your chances of having further interventions, more painful contractions, or a cesarean), you can ask “Can you guarantee that this will not harm my baby? Can I have in writing that this intervention will not hurt my baby? Please show me the evidence behind this recommendation.”
  • If all your friends have to share is horror stories about how terrible birth was, don’t do what they did.
  • Look at ways in which you might be sabotaging yourself—ask yourself hard and honest questions (i.e. if you greatest fear is having a cesarean, why are you going to a doctor with a 50% cesarean rate? “Can’t switch doctors, etc.” are often excuses or easy ways out if you start to dig below the surface of your own beliefs. A great book to help you explore these kinds of beliefs and questions is Mother’s Intention: How Belief Shapes Birth by Kim Wildner. You might not always want to hear the answers, but it is a good idea to ask yourself difficult questions!
  • Believe you can do it and believe that you and your baby both deserve a beautiful, empowering, positive birth!

I realize that some of these strategies may seem unnecessarily “defensive” and even possibly antagonistic—I wanted to offer a “buffet” of possibilities. Take what works for you and leave the rest!

Great births are definitely possible, in any setting, and there are lots of things you can do to help make a great birth a reality.

What’s at the root?

On a discussion board this week in the birth professionals section (doulas, midwives, birth educators), someone asked the question “what’s at the root of your love of birth?” I was still for a moment and let my intuitive, heart-felt, gut level response come to me and it was this:

Women.

Women’s health, women’s issues, women’s empowerment, women’s rights.

Social justice.

…..

And, that feeling. The “birth power” feeling–that laughing/crying, euphoric, climbed-the-mountain, glowing, rapture…feeling. The transformative, empowering, triumphant, powerful, I DID IT, feeling.

I want all women to have the chance to experience that.

————————-
As I look at my list above and invert it, it becomes my “tree” of birthwork–with women as the root and then spreading up to blossom with that birth-power-feeling. :)

To any birth professionals reading this, how about you? What’s at the root for you?

A Father’s Role

I recently finished reading the new book Labor of Love by Cara Muhlhahn and I was struck by this quote:

“Anyone would cry to see the way families interact around a homebirth. In a home environment, the intimacy and integrity of the family, especially the father or partner, often have pivotal roles to play. In the hospital, these key players are mostly cast aside except to hold the woman’s hand and cheer her on: ‘Push!” At home, they can support the mother in any number of invaluable ways, from regulating the temperature of the water in the pool to preparing food or choosing her favorite music.”

I have noticed this as well–I recently watched the new documentary Orgasmic Birth and was struck by the glaring differences in how fathers behaved at home compared to in hospitals. At home, they embraced their wives. They danced, they murmured, they stroked, they kissed, they held. At the hospital, they held her hand or tentatively stroked her back (with body at a distance–just a hand reaching out to lightly touch her). I’ve seen this in real life as well. I tell men in my classes not to be “scared” of their wives in labor, but to walk through the waves (of discomfort, anxiety, whatever) and just hold and love her. I tell them that they do not need to be “trained” to be more “special” or different than they are. They don’t need to be doulas. What they need to do is love her the way they love her and reach out to her to show her that. I tell them that hospitals can be intimidating and it can be awkward to show physical affection in that setting, but to do reach past that and do it anyway. I’ve read a number of posts and emails recently about whether fathers belong at birth–I think they do, but I also think that the hospital climate too often discourages them from having a real role or being valuable. I think they can be stripped of their position as “lover” and “father” and left feeling helpless and useless.

Natural Childbirth

I have been asked if my classes are appropriate for people planning a medicated birth.

I do focus on natural childbirth (meaning unhindered birth that progresses on its own timeline, under the woman’s own power, and takes place without medication), but I also recognize that many couples choose epidurals. Since women are not generally given an epidural instantly or immediately, most of the “natural childbirth” information is still helpful and valuable to have (in terms of “up until you have the epidural” instead of “up until the baby is born.”). So, a class on labor support could be focused on labor support prior to an epidural and also about working with the epidural for an optimal birth experience. I also like to remind people that you don’t have to necessarily make up your mind before your go into labor about medications or not—you can take the labor one contraction at a time and see where it leads you. It might lead you to an epidural or it might lead you to not have one.