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Childbirth and ‘Flow’ Experiences

Aug26

One of my areas of interest within childbirth education is about the importance of birth as an experience. I know this isn’t necessarily a popular approach—more popular is to focus on evidence-based care, because using the dreaded “experience” word implies something too esoteric or “woo-woo,” OR it implies that women value the “experience” over a healthy baby (the very notion of which is so insulting to mothers that I can hardly stand it). However, I tend to think that an overemphasis on evidence-based care simply isn’t enough to explore and describe all that birth means for women. Women deserve even more than evidence-based care! (I actually have an article brewing that addresses this subject.) All too often women’s plans for beautiful births are dismissed with comments such as, “all that really matters is a healthy baby,” or “birth is just one day in a woman’s life.” I believe that wanting a healthy baby is a given and that giving birth is also a transformative rite of passage and life experience that has value in and of itself.

In the textbook Childbirth Education: Practice, Research, & Theory the concept of birth as a peak, or “flow” experience is addressed several times:

The joy and personal growth that can result from successfully meeting challenging experiences has been described as ‘flow experiences’…such experiences are generally better understood in athletics than in childbirth because the public understands athletic events to be character building and an effort or a struggle that requires skill, practice, and concentration and is not without pain. As such, athletic accomplishments are widely recognized for both the product and process…Society focuses the celebration of birth almost totally on the product–the baby–and is rather neutral about the process as long as the mother emerges healthy.

The book also shares the research that when mothers were interviewed postpartum who had had epidurals, their comments following birth focused almost totally on the baby. Women who had relied on relaxation and other non-pharmaceutical coping methods talked about the baby AND about the emotional and psychological benefits of their birth experiences. Women in both groups expressed satisfaction with their birth experiences, but for those in the epidural group “the element of personal accomplishment or mastery was missing in their comments.”

I believe that starting out the parenting adventure with a sense of “personal accomplishment and mastery” is a tremendous gift and I wish all expectant couples had the opportunity to experience birth in this way. In my classes, I strive to emphasize that both process (giving birth) and product (healthy baby, healthy mom) are important, and indeed, are inextricably linked.

Honesty in Birth Preparation

Aug19

Some time ago I came to the disheartening conclusion that what many independent birth educators like myself teach women in birth classes isn’t actually what they can expect, it is what they deserve. And, in our birth culture there can be a dramatic difference between the two. I then wrote an article exploring what many women can expect from a traditional hospital-based “natural” birth—it was published in Pathways magazine and has also made the rounds multiple times as a blog post. So, what then do women deserve? In my mind, they deserve: humane care; respectful, individualized treatment; freedom of movement and choice in a woman-honoring environment; informed consent; the Six Healthy Birth Practices; and the recognition that birth is a significant rite of passage and transformative life event. With this conviction, I therefore refuse to start teaching only what can be expected, because women deserve so very much more than that—but, how to professionally handle the dichotomy in class?

Published in the 80’s, the book Childbirth with Insight by Elizabeth Noble has some thoughts on the subject offer the birth educators of today. In the section addressing the issue of being honest with childbirth education clients about common obstetric practices, she says:

“…instructors in the community cannot afford to discuss obstetric practices in ways that will aggravate local hospitals and obstetricians if they wish to fill their classes. One childbirth educator comments, ‘Imagine if we told couples how it really was…perhaps we’d lose fewer teachers from our group.’ No wonder many of these dedicated and enthusiastic teachers suffer ‘childbirth preparation burnout.’ They are caught in a triple bind. If they describe accurately how birth is managed in some hospitals, couples would become very fearful. If expectant parents anticipate a warm and flexible birth environment and find that such is not the case in the hospital they use, their disappointment is inevitable and bitter. If the instructors advocate childbirth without drugs or anesthesia and these are needed, parents may harbor feelings of guilt and failure.”

The author concludes this segment of the discussion with a very potent and powerful message to birth educators:

“Each instructor must teach what she knows in her bones to be true. A dynamic teacher is constantly changing, becoming more self-aware. At the same time, couples must be warned that almost all hospitals and doctors have expectations based on the mechanical model of birth.” [emphasis mine]

This is such a difficult line to walk—to encourage confidence, trust, and joy in childbearing, while being straightforward about the challenges couples may face when seeking a natural birth experience in a hospital. I always encourage couples to “assume good intent” from hospital staff—they offer medication because they feel like they are helping and also simply because it is the primary “tool” in their medical-model oriented helping toolbox. I also remind them that routines are powerful and if the majority of births occurring at a specific hospital are induced, medicated, heavily intervened with, etc. it can be difficult to buck the trend. Again, not out of some sketchy motive from hospital staff, but simply because of routine or “this is what we always do” or “this is what mothers want from us.”

The very firey, bold, honest, and passionate 1990’s manifesto on VBAC, Open Season even more bluntly addresses the issue of transparency in maternity care and also the effectiveness of childbirth education in this quote:

“If childbirth classes really ‘worked,’ more women would be having babies without interference. More women would be recognizing the complete naturalness of birth and would remain at home, delivering their infants with feelings of confidence and trust. More and more, midwives would be demanded. The names of those hospitals and doctors who treated women and babies with anything less than absolute respect would be public knowledge, and childbirth classes would be the first place these names would be discussed. ‘You’re seeing What’s-His-Face? He’s a pig! In my opinion, of course,’ I tell people who come to my classes. I then proceed to give them the names of people who have used Pig-face. They can always ask Dr. P. for the names of people who have used him and been satisfied with their births, for balance.”

While I’m not personally to the point of taking the “Dr. Pig-face” approach from Open Season, I’ve decided that honesty is the best policy and I’ve started to be very upfront about my challenge with the couples in my classes. Lately, I say, “here’s where I’m wrestling with something. I’m teaching you what you deserve, but it isn’t necessarily what you can expect…” and we proceed to explore choices, talk about communication skills, talk about evidence-based care, making sure the care provider’s words and actions thus far are matching, etc. However, my basic dilemma remains—I am not changing a broken system by teaching individual couples how to navigate it more satisfactorily, I’m actually supporting the broken system (right?!). While one-on-one change efforts have value and are personally rewarding, what I know in my bones to be true is that what we actually need is widespread maternity care reform and systemic change on a global level…

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(I originally posted some content from this post on the ICEA blog.)

Why Do I Care About Birth?

Jul29

Some time ago I wrote a post on the Citizens for Midwifery blog about medical control as acceptable, in which I pondered the question of why do we care about birth, if many birthing women themselves don’t really seem to care? Why do we make it any of our business what other women choose to do with their births? And, is it any of our business anyway?

Well, I’ve been doing some thinking and I made and shared a list of why I care on the CfM blog. However, I wanted to go ahead and share my reasons on this blog as well. This is why I care about about other women’s births:

  • Because women are suffering (birth trauma is real–see organizations like Solace for Mothers–and postpartum mood disorders are very common).
  • Because babies are suffering–late pre-term births are increasingly common due to induction, many babies experience at least some post-birth separation from their mothers (which is not their biological expectation), and many babies spend time in the NICU. Infant mortality rates, especially for minority babies, are higher than in other industrialized countries.
  • Because breastfeeding is suffering and thus public health is suffering (see my previous article on the birth-breastfeeding continuum)
  • Because the physical costs of our current birth model are high (morality and morbidity rates are higher than necessary due to high volume of cesareans and many physicians and hospitals do not practice evidence-based care–continuing to deny laboring women food and drink and continuing to use Cytotec for inductions for example).
  • Because the financial costs of our current birth model to society are high–birth is a multi-billion dollar a year industry. Some facts from CfM:
    • Over four million births in the US each year (26.4 births per 1000 women aged 15-44 years in 2004).
    • Second most common reason for hospitalization of women.
    • Care for mothers and babies combined rank 4th for hospital expenses.
    • Hospital costs for deliveries mounted to more than $30 billion in 2004. More than 30% of births by cesarean section. ranking seventh highest total on the “national bill” for procedures (over $17 billion per year).
    • Of all births, 99% take place in hospitals, 90% are attended by obstetricians.
    • Over 6 million obstetric procedures are performed – the most common category of surgical procedures.

The percentage of births paid for by Medicaid varies from state to state but can be as high as 50% or more in some states. Coverage by all insurers (Federal government, Medicaid, private, HMOs, etc.) varies; many will not reimburse for OOH births, and when midwives are covered, the reimbursement rate is only a percentage of the rate for physicians. We all pay for births, including unnecessary interventions and preventable complications and injuries, through our taxes, health insurance withholding, and individual policies.

  • Because women’s birth memories last a lifetime (see Simkin, Not just another day in a woman’s life).
  • Because women deserve better.
  • Because I know in my heart that birth matters for women, for babies, for families, for culture, for society, and for the world.

Book Review: Giving Birth with Confidence

Jul6

Since I recently wrote a post inspired by a quote from The Official Lamaze Guide: Giving Birth with Confidence, I figured it was high time that I share the review I wrote of the book! The review was originally written in 2007 for CfM News.

The Official Lamaze Guide: Giving Birth with Confidence. By Judith Lothian & Charlotte DeVries. Published in 2005 by Meadowbrook Press (307p), $12.00. ISBN: 088166474X

Reviewed by Molly Remer, MSW, CCCE

Very few pregnancy books deliver the message that we think pregnant women need to hear most: Birth is a normal and natural part of life….We believe deeply that birth is a process you can trust just as millions of women before you have. This belief isn’t sentimental; it’s based on our thorough understanding of the physiologic birth process and research that confirms interfering in that process is harmful unless there is clear evidence that interference provides benefits.

So begins an opening section of the book The Official Lamaze Guide: Giving Birth with Confidence. The degree to which the book accomplishes its simple message can be summarized with a simple review: Excellent! The Lamaze Guide is digestible and reasonable for busy people to manage at less than 300 pages of text and it contains a simple, profound, and elegant message that women in the U.S. desperately need to hear.

The book begins with defining normal birth as “…a normal birth is one that unfolds naturally, free of unnecessary interventions.” It then briefly explains the history of birth and how and why normal birth is not actually the norm in our culture. The authors then clearly address the following areas in one chapter each: early pregnancy; choosing a caregiver and birth site; middle & late pregnancy; preparing for labor and birth; the simple story of birth; keeping birth normal; finding comfort in labor; creating a birth plan and a baby plan; communication and negotiation; greeting your newborn; and early parenting. The authors are clearly very supportive of midwifery and the Midwives Model of Care (though it is not referenced by name) as well as of the benefits of a doula in the birthing room.

The book is framed in the context of Lamaze International’s powerful foundation, the Six Healthy Birth Practices:

The book is also guided by Lamaze’s comprehensive and lovely philosophy of birth:

  • Birth is normal, natural and healthy.
  • The experience of birth profoundly affects women and their families.
  • Women’s inner wisdom guides them through birth.
  • Women’s confidence and ability to give birth is either enhanced or diminished by the care provider and place of birth.
  • Women have the right to give birth free from routine medical interventions.
  • Birth can safely take place in homes, birth centers and hospitals.
  • Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their inner wisdom.

After effectively bolstering the confidence of women in birth, The Lamaze Guide concludes with several useful appendices. The first is the excellent tool “Effective Care in Pregnancy & Childbirth: A Synopsis.” Though this information is easily available on the internet (see www.childbirthconnection.org), I find that many parents do not come across it on their own. How powerful to have it included for easy reference of indisputable evidence based practices. The Mother-Friendly Childbirth Initiative is included in another appendix as well as the always excellent text of The Rights of Childbearing Women. I was delighted to see all of these powerful documents in one place—and, in the hands of consumers who need to be aware of them.

This book is a refreshing presence on the shelves of my local bookstore (yes, there is only one retail book shop in my community and The Lamaze Guide is the only “alternative” birth book stocked in the store!). As I read the book, I kept nodding along and wishing it was in the hands of each pregnant woman in my community. Lamaze has a “name recognition” that gives this book the potential to have a wider and broader impact than other alternative birthing books which, though brilliant contributions, may only end up in the hands of “the choir.” The Lamaze Guide is written in such a matter-of-fact and comforting tone that I cannot see it being off putting to the average consumer as having “hippie” language or “extreme” ideas. The blueprint for normal birth that the book lays out is extreme compared to the standard practices at most hospitals, but the way in which the information is presented opens doors of communication, understanding, and exploration as well as providing the evidence basis to back normal birth. I would not hesitate to lend this book out as it will not scare anyone away with “weird” ideas. With the other books in my personal library, I have to carefully consider my audience before choosing which book has the right style and blend of information—not this one! It is good for everyone with its open, simple message. It is a good addition to lending libraries, personal libraries, to give as a gift, or to recommend to others. The Lamaze Guide is straightforward and clearly written with an unabashedly honest and truthful message of what normal birth is and how it can either be supported or undermined.

My only critique of the book is that in contains no real acknowledgment of the several other well known and effective organizations that train and certify birth educators (other than Lamaze International itself). Conspicuously absent from the resources pages are any of these other organizations.

In conclusion, The Lamaze Guide is a source of information that women need to have and a message that women need to hear. I think Giving Birth with Confidence accomplishes its purpose skillfully and has the potential to be a transformative influence. I hope women read it, absorb it, and begin to Celebrate Birth!

The Birth-Breastfeeding Continuum

May28


Birth professionals have long been aware that there is a connection between birth and breastfeeding, but in recent years experts are making this link more explicit and the inextricable nature of the two experiences is becoming clearer. Birth and breastfeeding exist on a continuum. They are not discreet events. As speaker and author Dia Michels says, “we need a new word—birthandbreastfeeding.” Human women are mammals and the same things that disrupt bonding and breastfeeding for other mammals also apply to women. Darkness, quiet, no disruptions/interruptions, safe, upright, mobile, easy access to food and drink as they choose….these things support healthy births for female mammals! In brief, a normal, healthy, undisturbed birth leads naturally into a normal, healthy, undisturbed breastfeeding relationship. Disturbed birth contributes to disrupted breastfeeding.

New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed. An example is a mother who has an epidural, which leads to excess fluid retention in her breasts (a common side effect of the IV “bolus” of fluid administered in preparation for an epidural). After birth, the baby can’t latch well to the flattened nipple of the overfull breast, leading to frustration for both mother and baby. This frustration can quickly cascade into formula supplementation and before she knows it, the mother is left saying, “something was wrong with my nipples and the baby just couldn’t breastfeed. I tried really hard, but it just didn’t work out.” Nothing is truly wrong with her nipples or with her baby, breastfeeding got off track before her baby was even born!

Problems with breastfeeding often start before baby is born. According to Linda Smith, BSN, FACCE, IBCLC, co-author of the book Impact of Birthing Experiences on Breastfeeding (2004), birth practices that impact breastfeeding include:

  • Mechanical forces of labor (positioning of baby, positioning of mother, etc.)
  • Chemicals (drugs) used in labor
  • Injuries to mother or baby
  • Treatment of mother during labor
  • Treatment of mother after birth
  • Separation from mother after birth
  • Procedures that alter behavior

Linda Smith also notes that a mother’s confidence and trust in her body’s ability to give birth is related to her confidence in her body’s ability to breastfeeding. There are several birth related risk factors for breastfeeding problems (please note that not all babies with risk factors will actually have problems):

  • Induction of labor
  • Epidural and/or narcotic medications
  • Cesarean
  • Instrumental delivery (forceps or vacuum)
  • Post birth suctioning of baby’s airway

Additional procedures that affect baby’s ability to breastfeed if they are done before baby’s first breastfeeding include:

  • Separation of mother and baby for any reason.
  • Weighing and measuring
  • Vitamin K injection
  • Metabolic tests
  • Circumcision
  • Infant hypothermia

According to the Academy of Breastfeeding Medicine (www.bfmed.org), “unmedicated, spontaneous, vaginal birth with immediate skin-to-skin contact leads to the highest likelihood of baby-led breastfeeding initiation.” Immediate skin-to-skin contact restores the biologic continuum begun during conception.

When I was in graduate school, one of my professors used the following analogy to make a point and I now use it with my own students:

There is a river running through town. Daily, emergency workers are called upon to rescue people from the river who have fallen in and are floating downstream drowning. Day after day they pull the gasping people back to land until one of the workers suddenly realizes, “maybe we should go see what is happening upstream and try to stop these people from falling in to begin with?”

My professor then encouraged us to always remember to go “upstream” when working in the helping professions rather than only addressing the immediately presenting problem. Childbirth professionals are in an “upstream” position when it comes to protecting the birth-breastfeeding continuum!

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For more about the value of keeping mothers and babies together following birth, check on Healthy Birth Practice Six: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding from Lamaze.

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References:

If my mom were a platypus: what we can learn by studying mammal lactation, presentation by Dia L. Michels, La Leche League of Missouri Conference, November 2007.

Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Mary Kroeger and Linda J. Smith, Jones and Bartlett Publishers, Inc.; 1 edition (February 2004). ISBN-13 978-0763724818.

Mother-Baby Togetherness, presentation by Dr. Nils Bergman, La Leche League International Conference, July 2007.

The Power of Touch, presentation by Diane Wiessinger, La Leche League of Missouri Conference, November 2007.

Winning at Birth, presentation by Linda J. Smith, La Leche League International Conference, July 2007.

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This article is adapted from “Celebrating World Breastfeeding Week and the Birth-Breastfeeding Continuum” by Molly Remer, MSW, ICCE, published in the International Journal of Childbirth Education, June 2008.

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):

  1. Let Labor Begin on Its Own – Download PDF
  2. Walk, Move & Change Positions – Download PDF
  3. Have Continuous Support – Download PDF
  4. Avoid Unnecessary Interventions – Download PDF
  5. Get Upright & Follow Urges to Push – Download PDF
  6. 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.

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.

Benefits of Active Birth

Feb29

From Janet Balaskas’ classic book, Active Birth:

“When birth is active–

  • There is less need for drugs.
  • Discomfort and pain are less.
  • The uterus functions better, so artificial stimulants are not usually necessary.
  • Labors are shorter.
  • The supply of oxygen to the baby is improved.
  • There is less need for forceps or vacuum extraction.
  • The secretion of hormones that regulate the whole process is not disrupted.”

Make sure to talk to your care provider about your plan for an active birth. You may have to introduce your attendant to the concept and be assertive about your right to have an active, normal birth.