Archives

Book Review: Get Me Out

Mar12

Book Review: Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank
By Randi Hutter Epstein, MD
W.W. Norton & Company, 2010
ISBN 978-0-393-06458-2
302 pages, hardback, $24.95
http://www.randihutterepstein.com/

Reviewed by Molly Remer, MSW, ICCE

Since it shares a subtitle about the history of childbirth, I expected the new book Get Me Out to be very similar in content to the recent book Birth Day by Mark Sloan or to the book Birth by Tina Cassidy. I wondered how much more could possibly be reported about the history of childbirth. It turns out there is plenty more and I was delighted to discover that Get Me Out stands alone as a unique and interesting contribution to books of this genre.

Written by a physician and mother of four, Get Me Out focuses on some very recent elements of birth history including assisted reproductive technologies (ART), ultrasound, and freebirth, subjects not addressed in the books referenced above. Aside from familiar content about things like the Chamberlen brothers and the Twilight Sleep movement, the remainder of the text was fresh and engaging. Part one included an interesting and disturbing chapter about Marion Sims and his research and experiments with fistula repair on enslaved women. A later chapter explores Sims’ research with artificial insemination (this time with middle class white women). In fact, the latter half of the book contains an extensive historical look at artificial insemination, moving into present day history including an exploration of sperm banking and cryo-preservation of eggs.

Unique among birth history books is Epstein’s chapter on freebirth (more commonly known as “unassisted childbirth”) followed with a chapter about ultrasound including content about 4D and “novelty” ultrasounds. There is also a chapter exploring DES and its effects on reproduction.

Also different than Birth Day and Birth, is the total absence of memoir or personal reflective content. Epstein is a medical journalist and Get Me Out is written in that voice. There is a light, personal tone to the text, but nothing personal aside from occasional descriptions, observations, or quotes from interviews with sperm bank mangers (for example). I found myself feeling a little curious about her personal history of childbirth, an element freely interspersed throughout the texts of other recent birth history books.

As the author says, “…the way we give birth is a story about our deepest desires and our fundamental concerns about life, death, and sex.” Get Me Out is a fascinating tale focusing on our collective, cultural story about birth in the late nineteenth and twentieth centuries, as well as dip into the story that continues being written today.

—
Disclosure: I received a complimentary copy of this book for review purposes.

Birth Violence

Mar6

“‘Old wives’ tales,’ says the Oxford dictionary, are ‘trivial stories, such as are told by garrulous old women.’ It is significant that no one ever talks about ‘old husbands’ tales’ or ‘old doctors’ tales.’ Women are blamed instead. It is implied that there is poison in their speech and that the only safe thing to do is remain silent. The experiences that women share with other women are thus rejected and trivialized…In reality, it is not other women who instill and fuel anxiety in most pregnant women, but the medical system itself.” This quote from the 1980’s book, Giving Birth, by Sheila Kitzinger, remains strikingly relevant today. When women in the United States today enter the hospital to give birth, many experience some form of institutional violence. They may not explicitly define it as violence, but listening to their stories provides a disheartening picture of maternity care today.

What kinds of violence occur in the birth place? Here are a few possible examples of “normative abuse” women may experience when giving birth in U.S. hospital setting

• Restriction of movement
• Restriction of nourishment
• Domination by those in positions of authority—must obey even when it is against her own best interests.
• Routine, forced interventions such as IVs
• Repeated, possibly painful, vaginal examinations by many different people
• Denial of option for VBAC (vaginal birth after cesarean)
• At the most extreme example of overriding patient rights, a forced cesarean section
• Vaginal cutting (episiotomy)
• Abusive language
• Separation from family/restriction of companionship
• Lack of respectful treatment
• Voice and wishes disregarded/unheard
• Emotional manipulation using baby as a “card” to force compliance (“you want a healthy baby don’t you?” No mother doesn’t. It is degrading and dehumanizing to suggest that she doesn’t.)
• Forced separation of mother and baby
• Administration of medications without consent
• Cord traction and interference with third stage (placenta) that may lead to hemorrhage.

The emotional treatment of women in labor is the most significant factor contributing to their satisfaction with their birth experiences (emotional factors of highest importance include having good support from caregivers and being treated with respect). According to Kitzinger, “We are only now discovering the long-term destructive effect on human beings and families of treating women as if they were merely containers, to be opened and relieved of their contents; and of concentrating attention on a bag of muscle and a birth canal, rather than relating to, and caring for, the person to whom they belong. The violence which is a common element in childbirth today leaves many women feeling that birth has been a kind of rape. This sort of experience is not easily forgotten. It can shatter a woman’s self-confidence, make her doubt her ability to mother her baby, destroy joy in the expression of her sexuality, and attack her very sense of self–the roots of her identity. It is psychologically mutilating.”

And, as Mary Rucklos Hampton says, “The effort to separate the physical experience of childbirth from the mental, emotional, and spiritual aspects of this event has served to disempower and violate women.”

—
Molly Remer, MSW, ICCE is a certified childbirth educator and activist who blogs about birth at https://talkbirth.wordpress.com and midwifery at http://cfmidwifery.blogspot.com.

Note: In 2009, I wrote an article about birth violence for International Women’s Day, but it appears to have never been published. So, I decided to post it here (and on the CFM blog in honor of this year’s International Women’s Day on March 8th). I also read two relevant articles recently: How childbirth caused my PTSD and Birth Trauma: An Introduction.

Tips for Emotional Well-Being During Pregnancy

Jan22

I got a lot of wonderful responses to my question about emotional well-being during pregnancy (associated with my giveaway of the book Birth Space, Safe Place). So, courtesy of a lot of wise women, here are some top tips for supporting your emotional well-being during pregnancy and birth:

  • Peaceful Beginnings doula services shared “I think my best tip for emotional well-being during pregnancy (and life in general) is to let go of guilt. We can only do the best we can with the information we have at the time, no more, no less.”
  • Yasmel shared that her most helpful tip, “would be to find whatever gives you positive thoughts and use it, a lot. I loved the book Ina May’s Guide to Childbirth and whenever I started second guessing my homebirth decision, I would open it up and just read the birth stories in it.”
  • Heather appreciated a helpful tip from her sister: “I was having alot of people question my birthing choices and telling me that my baby and I were going to die. None of which happened. She told me that ‘you can’t expect people to agree with your choices or behave respectfully about them. All you can do is know that you are doing what’s right for you and your child and that is all the matters. Don’t let them change your mind with fear. It has no place in childbirth.’”
  • And I especially enjoyed Ahmie’s advice: “remember that cats purr while giving birth. Figure out what makes you ‘purr’ while you’re pregnant and find ways to do more of that as well as to bring those tools to the birth-space with you.”
  • One of the most simple and yet important tips was shared by bubbledumpster, “Trust yourself,” and echoed in several other comments, such as earthmothergypsy who said, “I think one of the best helps emotionally is to encourage mamas to trust in themselves, their bodies and their babies. By giving them support in a way that they don’t feel undermined they can build the above trust in themselves.” And inoakpark who said, ” learning to trust your body (and trusting the people who will be with you at your birth to hold that space), is vital for an emotionally secure pregnancy and birth.”
  • bee in the balm offered another elegantly simple tip “to breathe, just take the time to come back to center and be and breathe.”
  • Nicole d shared that her best tip is “meditation on good/safe birth… the normalcy and miraculous nature of it. So much of pregnancy stress is uncertainty and fear of the birth process. The more you can trust in the process of pregnancy and birth, the more joyful and peaceful pregnancy can be.”
  • For Lee-Ann, “emotional wellbeing came with knowledge, the more I read and the more I normalized the birth process in my mind, the more research I did, the more confident and at peace I became.”
  • Rebekah made an excellent point about honest during pregnancy: “I think being open and honest with yourself and talking to your baby openly helps. It benefits no one to ‘pretend’ like everything is perfect and is okay to have trials, doubts, and fears.”
  • Jessica benefited from midwifery care: “One of the things that helped me a lot was having a midwife that I knew and trusted implicitly. I knew that my body and my baby would know what to do, and that I had a wonderful woman who would let it all unfold!”
  • And whoz_your_doula pointed out the benefit of taking time for yourself: “For me that took the form of meditation and prayer. The early morning is my time for deep reflection before the house begins to stir.”
  • A similar tip was shared by Gentle Beginnings: “I feel it is very important for a woman’s emotional well being to take a few minutes each day to spend time alone. To sit quietly and think about the precious child growing inside them, to disconnect from the world, to envision how peaceful they want their birth to be, to take a stroll in nature and to connect with their inner self. I think we can all benefit from these simple suggestions, but feel it is especially important during pregnancy and childbirth.”
  • Helpful for birth educators as well as couples, Janet shared that her favorite tip is “teaching the mom and her partner to work together towards open and honest communication before hand. I find a lot of the mothers I teach think, ‘Oh, well we talked about it once and I think we are on the same page,’ only to be completely blind-sided afterwards. Keeping these lines of communication open before, during and after pregnancy makes for a much better emotional state for all.”
  • Jamie moved us back to the trust theme: “Trust yourself. Trust that your body knows how to be pregnant and how to give birth. Be positive in the changes your body is going through and how you are being prepared for motherhood in all facets of your being. Know that you can do this—you are doing it!”
  • And another excellent and simple tip was shared by Heather Richins: “My tip is to make sure you stay well fed and hydrated. It is hard to feel good emotionally if you don’t feel good physically.”
  • Deborah had more than one to share: “1) Eat well: increase protein and raw fruits & veggies, and drink lots of water. Decrease refined foods, white flour products and sugars. 2) Exercise: walk, swim, yoga, etc. 3) Talk: find someone you trust and be honest about how you are feeling.”
  • And finally, Kathy offered a comprehensive collection of tips: “to be conscious of their needs each day. This includes physical,emotional, and spiritual. For the physical; Eat well. Whole foods, including whole grains, fruits, vegetables. Protein intakes needs to be adequate for a pregnant woman on a daily basis. Eating often to keep your blood sugars level is especially important for warding off mood swings. For the emotional; Trust yourself and others who care about you. Surround yourself with positive people who support you in what your doing. Communicate your needs and wants. Be willing to be honest and vulnerable. Pregnancy can often ‘stir the pot.’ Being willing to work out your feeling and talk to someone you trust and bring about personal growth and sometimes, bring about healing the past. For the spiritual; It is just as important for the spirit to be fed, as it for the body. Fellowshipping with others of the same faith is uplifting to the spirit. Take time for reflections and meditations each day. Keep a journal.”

I appreciated all the responses and think that emotional well-being is such an important subject. I feel like, especially with a first baby, it is an often overlooked element of birth preparation—a lot of time and energy is spent on the physical health of the pregnant woman, but the emotions are assumed to kind of take care of themselves, to perhaps be no one’s business, or to be dismissed summarily as “crazy pregnancy hormones” and “mood swings of pregnancy!”

Cesarean Trivia

Jan20

Anyone who is even slightly familiar with the history of childbirth in the modern world has probably heard the legendary story of the pig-gelder Jacob Nufer and the first successful cesarean section (performed on his wife in 1500). Successful because both mother and child lived, which had never before been documented to happen with a cesarean—and took quite some time to happen again. For example, there was a 100% mortality rate for cesareans performed in Paris for 89 YEARS (1787–1876). I’ve read several excellent books about the history of birth and feel fairly well-versed in the associated facts. However, this month I finished reading a new book by pediatrician Mark Sloan and was surprised to learn something completely new about the history of the cesarean section. This was that, the well-known legacy of Jacob Nufer notwithstanding, the first well-documented successful cesarean section performed in the English-speaking world was performed by Dr. James Barry in Cape Town South Africa in 1826. James Barry was quite the character, small of stature and very big of opinion and personality. He was a British Army officer who clashed frequently with everyone over everything (including even fighting duels!). He even had public arguments with none other than Florence Nightingale! And…then…the conclusion to this already interesting tale is that after Dr. James Barry died—after his forty year medical and military career—it was discovered that he was actually a woman!

I found this extremely fascinating. (I also imagined Jill at Unnecesarean using her Photoshop talents to make some kind of image about this…) So, despite the dominance of males in the medical profession, the first successful cesarean in the English-speaking world was actually performed by a woman! A point the author brings out in this discussion is that, “Here in the early years of the twenty-first century we have reached a point of high medical irony that would not be lost on James Barry: it now can take more courage—or foolhardiness—not to do a cesarean than it takes to do one.” How true.

Some other non-related quotes from Birth Day that I shared via the CfM Facebook page are as follows:

“Birth is about radical, creative, life-affirming change. It is about adaptation on a nearly unbelievable scale.” –Mark Sloan, MD

The quote above is in regard to the physical adaptations required by the baby immediately after birth—I see it as about both mother and baby though and I enjoy that it comes from a man and a doctor no less!

“Rigid plans work best if you’re building a skyscraper; with something as mysteriously human as giving birth, it’s best, both literally and figuratively, to keep your knees bent.” –Mark Sloan, MD

The above quote is from the segment about what he would want to tell his daughter about giving birth. Though the book wasn’t as “alternative” as many of the birth books I enjoy, I found Birth Day to be a very engaging and entertaining read!

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!

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.

New Edition of The Guide to a Healthy Birth!

Jul31

One of my favorite resources to hand out in birth classes and to give to pregnant friends is Choices in Childbirth‘s booklet “The Guide to a Healthy Birth.” I’m so excited to learn that the second edition of the booklet is now available! (Thanks to Teri at Passion for Birth for the tipoff!) You can download the pdf version directly here. Or, for very minimal shipping, you can order print versions here.

I just ordered 50 copies, so if you’re a real life friend of mine or are taking a class from me, I’d be delighted to give you one of these phenomenal booklets!

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.

Birth Center

Apr8

There is one freestanding birth center in Missouri. It is about 1.5 hours from Rolla in Columbia. Though it can be a challenge to ride in a car while in labor, I have had quite a few clients who have chosen to birth their babies at this wonderful birth center. My own first baby was born there in 2003  (though, at the time, I lived in Jefferson City, so it was only a 30 minute drive for me).

The birth center is called Columbia Community Birth Center.  Phone (573) 447-2700 or visit their website. Phenomenal women. Wonderful place.