Moving During Labor

Oct28

The second Healthy Birth Blog carnival is up on Lamaze’s Science & Sensibility blog. It is a great collection of links to posts about the importance of Healthy Birth Practice #2: Walk, Move Around, and Change Positions During Labor. For the blog carnival I contributed a post/handout I made last year called How to Use a Hospital Bed Without Lying Down. We spend quite some time on the subject in my classes and I encourage my clients to treat the bed like a “tool,” rather than a place to lie down. I also encourage strategizing about ways to both meet the needs of the hospital staff for “confinement” as well as the needs of the birthing woman for mobility (so, sitting on birth ball right NEXT to the bed and monitor, instead of lying back in the bed—both sets of needs can be met this way).

When reading through some of the other links in the blog carnival, I particularly enjoyed the one at The Unnecesarean about Women Describe Walking, Moving and Changing Positions in Labor. In the post, Jill points out “For first time mothers who have had no exposure to a birth, the time between, ‘I felt a contraction!’ and ‘I have to push!’ is often a total mystery.” How true is this! How many birth documentaries and shows (even very good ones), essentially only show a few minutes in early labor and then the baby being pushed out? What happened during the other 12 hours?? Obviously, we can have an episode or documentary that lasts 12 hours and shows every single detail, but I do think this gap means it is hard for first time mothers to really get a “vision” of what labor and birth is really like—the “long haul” picture.

Of course, that post made me think about my own births and how movement played an important role in both of them. I think it was equally significant/important for both, but since I was in labor longer with my first baby I used movement much more. In early labor, I sat on the floor cross legged with my back straight (working to keep the baby in “optimal” fetal alignment :), while I ate dinner and watched a movie. Then, I walked in the hallway to see if walking would stimulate any increased contractions. I also sat on the birth ball. As labor moved on, I ONCE tried lying down on my side in bed to “go to sleep” (at the suggestion of my doctor and doula) and that was IT. I had one contraction lying down and it was the worst contraction I’ve ever experienced (both babies). I never laid down again during either birthing! No possible way! When I got tired, I did kneel on the bed with a pile of pillows in front of me and rested my head/arms on the pillows. I also spent a lot of time kneeling by the side of the bed with my head resting on my arms on it. (This was my own bed at home.) I sat and rocked in the rocking chair with my eyes closed. I sat on the floor (briefly) with the rice sock under my belly and husband sitting behind me.When I went to the birth center, I sat in the rocking chair (oh wait, I did lie down one more time, for my sole cervical check of either pregnancy/birth). I also went back to kneeling on the floor with my head on the bed. Then I gave birth to my first son in a semi-sitting position on the birth center bed with my husband behind me/to the side. (Not the position I would have instinctively chosen, I think I would have actually birthed him kneeling by the side of the bed, but I was encouraged to get up into the bed. See his birth story.)

With my second baby, I walked around (again, “testing” out whether labor was “real” and going to intensify) in our kitchen. I squatted down several times (again, “testing” and trying to “make it bigger“). Then, I sat on my birth ball in the living room. I only stayed there for a few contractions and then stood up and wanted something to lean on—I leaned on the back of the (too rocky) recliner. Then, I ended up kind of hanging on my husband for a while—my arms around his neck and my legs dropping kind of outward. I then felt “driven to my knees” and got on my hands and knees on the floor with my arms and head on my birth ball. I quickly decided I didn’t want the ball and got just on my hands and knees with my husband in front of me with his arms around me. My son was born while I was on my hands and knees in this way.

I think when women think about “active birth” or “freedom of movement throughout labor,” sometimes they think this means walking the whole time or squatting up and down and up and down, or literally being *standing up* and moving around “aggressively” throughout labor. My own experiences were “active birth,” but the freedom of movement includes being able to sit in a rocking chair and “meditate” through contractions, or resting on your knees with your head on the bed. The “activity” we’re really talking about is really not lying down-–having the body upright/torso above the pelvis.

Birth as a Rite of Passage & ‘Digging Deeper’

Oct16

Childbirth is a powerful rite of passage. One of my favorite resources, The Pink Kit, has some great reflections on this rite of passage and the words we use to describe the powerful, indescribable act of giving birth:

Whatever the culture, when a woman surrenders to the process, accepts the intense sensations, works through each contraction, and digs deep within herself to achieve the end goal–giving birth–she is touched by the Unknown and Unknowable. Many traditional cultures send their young men into initiation rites where they, too, can learn to understand humbleness and achieve the self-control that women learn in childbirth.

All cultures believe that women become better and more generous through the process of giving birth. That is why some cultures use words such as ‘sacrifice,’ ‘suffering’ and ‘labour.’ These terms can seem overwhelming and to be avoided’ however, seen from a different viewpoint, childbirth helps us to become strong, resourceful and determined.

In a modern world, ‘getting through’ labour without numbing or dumbing the process can be a very powerful experience for a woman, and very challenging.

I like the concept of “digging deeper.” This how The Pink Kit explains it:

You might avoid the pain in labour by moving into a position which is comfortable for you (i.e. reduces the sensations), but it slows labour down and then you stay there for hours. Doing that will increase the likelihood of medical intervention because you will become tired, bored, or frightened, and labour doesn’t progress. Instead, consider remaining in positions that keep you open and the labour progressing, while using your skills to manage the sensations. This is ‘digging deeper’.

I have noticed an emphasis in other natural birth preparation books and explanations about finding positions that are “comfortable.” I very much like the concept of finding positions that help you feel “open”—these positions may certainly also comfortable (and that is great!), but if you remain mindful of “staying open,” it may lead you “dig deeper” and find positions that really help move the baby. In my classes, I encourage women to welcome labor “getting bigger” (not more “painful” or “difficult,” but make it “bigger” and be excited by that change!). I think this idea goes hand in hand with digging deeper.

Pelvic Bodywork

Oct12

I’ve added a new option to my single night class offerings. I am also available to give this session to small groups (doulas, etc.) The following is the class description:

Use external bony landmarks on your own pelvis to “map” your pelvis and explore the types of birthing positions that work best for your unique body. Pelvic mapping increases your comfort level with your body and your confidence in the space and flexibility available for birth. Figuring out the shape of your pelvic outlet helps you understand how your baby might use the space within to move through. You will explore the positions that help you feel open-—these are not the same for every woman. Knowing your own pelvis helps you use positions most appropriate for your own anatomy.

We will also learn several skills for birthing that work with the anatomy of the bony pelvis to create more space for the baby as well as skills to work with body sensations and internal relaxation. If you are a pregnant woman, these are great skills to bring with you to birth. If you are a doula, these are great skills to have in your doula “toolbox.” If you are a childbirth educator or midwife, these are good skills to show to your clients prior to labor. If there is time, we will also learn a breath awareness strategy for releasing pelvic tension during labor.

Let labor begin on its own…

Oct9

One of my blog posts that gets the most hits and is a consistently searched for topic is one that I wrote called “how do I know I’m really in labor?” I revised it recently for participation in a blog carnival at Science and Sensibility about letting labor begin on its own. Let Labor Begin on Its Own is the first of Lamaze’s Six Healthy Birth Practices. Why is letting labor begin on its own so important? Well, the onset of labor is a complex biological system that has its own wisdom–when a woman’s body is pushed into labor on someone else’s timetable rather than her own, the whole biochemical “dance” of labor and birth is impacted. What may seem like a harmless “jump start,” actually has a cascading effect on the rest of the birth (and has an impact on the baby as well). A significant impact is that induced labors are often much more painful than spontaneous labors. If a woman is planning an unmedicated birth, the increased intensity of artificial induced contractions coupled with the lack of the biologically trigged endorphin release that helps birthing women naturally cope with pain, often leads directly into a request for medications. The woman is then sometimes left feeling like she “failed” in her “natural birth” plans and that she “wimped out” and “just couldn’t handle it.” However, she was dealing with something much different than a “natural” labor and so it makes sense that a “natural” birth then didn’t happen. Of course, the cascade of other interventions that accompany an induction, such as an IV and continuous monitoring also severely restrict a woman’s mobility (which also has a dramatic impact on her ability to cope).

I am saddened when I hear women blaming themselves for “not being able to handle it” (or, conversely being angry at “natural birth zealots” for misleading them…), when they were actually just missing significant pieces of their “pain coping pie” as well as dealing with a (probably) more difficult labor. We need to remember to look at the overall healthy birth climate of the birth setting and the use of the six healthy birth practices, rather than at personal “failure.”

There are a lot of excellent links on letting labor begin on its own in the rest of the blog carnival!

Quick Births

Sep19

I recently finished reading the book Permission to Mother by Denise Punger (you can read my full review in an upcoming issue of the CAPPA Quarterly). In one of the Appendices of the book, she addresses “Herbal Inductions–Are They Safe?” Her response is “no” and she adds “A homebirth does not equal a ‘natural birth’ if Blue and Black Cohosh are used to induce.” She opens the section by referencing her third labor which was over 12 hours and gave her “time to emotionally adjust to the escalating physical demands and surprise of my labor” and then goes on to say, “Over and over…I am hearing about intense labors that occur in two hours or less! Women often express delight about their miraculously quick labors (as if a quick labor were the goal). But I don’t sense any emotional, physical, or spiritual satisfaction accompanying these seemingly precipitous deliveries.” She also shares that a commonality in these stories is the use of herbals to induce or augment labor.

This section caught my eye, because I had a very quick birth with my second baby. I also was intrigued by the presumptiveness of dismissing a quick birth as not emotionally, physically, or spiritually satisfying—it seems like someone who is seeing through their own “lens” of 12+ hour labors and can’t imagine another type of timeline for birth. For the past several days I’ve been pondering this issue and considering my own experiences. I also did a variety of google searches looking for information about “emotional impact” of “fast labor” or “precipitous birth.” I turned up surprisingly little information—there was one article that popped up several times titled “The experience of precipitate labor” in the journal Birth. However, I was not able to access the full text of the article to read what it actually says. The results were described as: “The experience of precipitate labor was categorized in terms of physical experience (perception of labor length and contractions), psychological experience (relationship of how women perceived birth to their prenatal expectations, and emotional trajectory of disbelief, alarm, panic, and relief), and external factors (support persons and hospital system).”

My searches also turned up personal birth stories, excerpts from nursing textbooks or emergency medicine texts about handling precipitous birth, and message board discussion threads. The most commonly shared pieces of information about rapid labors is that they can be physically shocking and can be difficult to “catch up with” emotionally, as well as stressful because the mothers often are thinking, “if this is early labor, how I can possibly handle another 12 hours?!” They also reference increased change of hemorrhage. I did not see the questions raised by the Permission to Mother segment directly addressed anywhere. So, I want to know–if you experienced a quick birth what physical, emotional, and spiritual satisfaction did you experience, if any? What about external factors? (support persons, birth environment.) How about your psychological experience and “emotional trajectory”?

My own experiences are as follows:

Second baby, total labor two hours. Forty weeks pregnant. No herbal induction methods used. About 45 minutes were “serious labor.” It was very intense and I’ve said several times before that it felt a bit like a train rushing past and that I had run to catch up with it (emotionally and mentally).

Physical Satisfaction:

I was extremely proud of my body and its super-awesomeness 🙂 I felt that my sense of birth trust was physically manifested in my actual birth experience. My body was a powerful and unstoppable force and I had to get out of my own way and let it happen! I felt driven to my hands and knees–like a power was holding me there. After the birth my body felt weak and “run over by a truck”—I felt powerful and like a warrior during the birth, but afterward it was a physical “crash” of sorts. I did not have excessive bleeding, but I did almost faint several times after getting up (hindsight says, why didn’t I just stay down a while longer?!). I experienced labial tearing (no perineal tearing) and a lot of swelling as well as bruising, that I surmise was a direct result of my son’s rapid birth.

Emotional Satisfaction:

The birth was very emotionally satisfying. I did feel as if I never made it to “labor land” though–that hazy, dreamy, unreal state that I associate with my first son’s birth (and longer labor). I did not feel scared or overwhelmed or out of control as such (I did consciously let go of control—I think these are two different things) . I felt proud of myself. I felt amazed. I felt phenomenal. I felt ecstatic. I felt powerful. I felt empowered. I felt triumphant. I was pleased with how I’d verbally coached myself through labor—telling myself “it’s okay, you’re okay” and “be a clear, open channel for birth” and “relax your legs.” I felt excited and enjoyed the “drama” of already holding my baby after only a short while before thinking, “maybe I’m in labor.” It felt like a wonderful, fulfilling adventure. I didn’t feel like a “victim,” but I did feel like something “happened to me”–as I said, I had to just get out of my own way and let the power roll through me. Later, I felt emotionally upset about the tears and the bruising. This felt like my piece of “failure,” because I had hoped and planned not to tear again.

Spiritual Satisfaction:

This is related to the above for me. I felt like a force of nature–like I was one with the powers of the universe. I was happy with my ability to get out of my head and “be in the now” with the energy of birth. My son’s birth was the most powerful and transformative experience of my life. I think that counts as sprititual satisfaction 🙂

External Factors:

I gave birth at home. If I hadn’t planned a homebirth, I think there would have been more stress and fear involved with trying to get to the hospital (and possibly a car birth, as we live 30 minutes from the hospital). My husband was very physically there with me–holding and supporting me–I felt like we were one person. My mother was present towards the end and held my older son. They felt overwhelmed and surprised by the intensity, but they got out of my way and let me birth! My midwife was present for 5 minutes–enough time to catch the baby. She was calm and a gentle presence. She was very physically supportive postpartum. No one tried to influence or control what I was doing, where I was, or how I was laboring and giving birth. I had complete freedom and control over my environment.

Emotional Trajectory:

I went from excitement—“I hope this is really it!”—to, “Oh my goodness, we don’t have time to fill up the birth pool—just get me my birth shirt, my blessingway bracelet, and my ponytail holder!” and wading deeply in to the rushing waves of energy. The experience became completely encompassing–I was no longer in my left-brain, but was instead holding on to the train and catching up. I did not feel panicked or alarmed and I did not feel relieved when it was over, I felt amazed and happy and blissful and powerful.

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

Sep9

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):

Let Labor Begin on Its Own – Download PDF
Walk, Move & Change Positions – Download PDF
Have Continuous Support – Download PDF
Avoid Unnecessary Interventions – Download PDF
Get Upright & Follow Urges to Push – Download PDF
Keep Your Baby With You – Download 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.

Comfort Measures Illustrations

Aug8

We spend a lot of time in my classes talking about different comfort measures for birth. In fact, one of my most popular classes is my “Labor Support and Comfort Measures” single session class in which we practice all kinds of different skills that may be of use for birthing.

I enjoy Childbirth Connection’s free pdf booklet “Comfort in Labor” and use this as a class resource. Very recently, they added a new section to their website with lots of helpful, line drawing illustrations for Comfort Measures During Labor. The illustrations are the same as in the booklet, but presented on one page without a lot of accompanying text—great for visual learners!

As I’ve referenced before, the Transition to Parenthood website also has a helpful section of comfort measures illustrations available to birth educators.

Even if it might feel silly, I encourage people to print out the images and physically practice the techniques illustrated a couple of times—this helps develop a “body memory” so that when you are actually in labor different labor-beneficial positions feel comfortable and familiar. Also, it helps for the birth partner to have a body memory as well to help reinforce healthy positions or suggest fresh ideas.

Active Birth Video

Jul13

Lamaze and Injoy videos have teamed up on a nice new website called Mother’s Advocate. The site has a variety of handouts and a booklet to download based on “6 Healthy Birth Practices” (which, in and of themselves form a nice little birth plan for a normal, healthy birth!). I especially enjoyed their video on active birth: “get upright and follow urges to push.” The video urges upright birthing positions and avoidance of directed/forceful pushing (the kind with counting that you see so often on tv!).

Can I really expect to have a great birth?

Jun3

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.

For Labor Support Remember TLC or BLT

Apr10

When supporting a woman in labor, remember to use “TLC”:

Touch–this can be massage, hand-holding, foot rubs, stroking her hair, and encouraging frequent position changes. It also includes the use of water (hydrotherapy).

Listen–this is half of the emotional support in labor. Listening builds trust and meets emotional needs. Use active(reflective) listening and lots of encouragement.

Communication–there are two types in labor. One is information sharing–about her progress, her choices, ideas of things to try, interventions, complications. The second is mediation with hospital staff–this can involve reminders about mother’s wishes, and assertiveness about care.

Or, you can use “BLT”:

Breath–remind her to breathe if she is holding her breath. Model a “cleansing breath” if she is stressed. In through the nose and out through the mouth (like a sigh) can be helpful.

Language–this can be mind-body communication, internal conversation, or verbally telling, showing, or modeling (body language).

Touch–as discussed above. Large muscle massage or firm pressure usually feels better to the laboring woman than light patting, stroking, or “tickling” at the skin or clothing level of her body.

Material on TLC is drawn from the International Journal of Childbirth Education, June 1998. Material on BLT from The Pink Kit–New Focus: Breath, Language, and Touch.