Birth as a creative process

May30

I recently finished reading the book Rediscovering Birth and there was a section in it that I absolutely LOVED about birth as a creative process. The author quotes another writer, Dr. Michelle Harrison. She forms an analogy about women giving birth as like dancers on a stage and how just as routine interventions for the purpose of “just in case” would hinder the dancers in their creative process, so too, do routine obstetrical interventions hinder the woman’s capacity to give birth in her full strength and creative power:

“Birth is a creative process, not a surgical procedure. I picture dancers on a stage. Once, doing a pirouette, a woman sustained a cervical fracture as result of a fall; she is not paralyzed. We try to make the stage safer, to have the dancers better prepared. But can a dancer wear a collar around her neck, just in case she falls? The presence of the collar will inhibit her free motion. We cannot say to her, ‘this will be entirely natural except for the brace on your neck, just in case.’ It cannot be ‘as if’ it is not there because we know that creative movement and creative expression cannot exist with those constraints. The dancer cannot dance with the brace on. In the same way the birthing woman cannot ‘dance’ with a brace on. The straps around her abdomen, the wires coming from her vagina, change her birth.”

New logo!

May21

I’m delighted to unveil my new logo. I have used the ALACE logo for some time, since I am certified by ALACE, but I really wanted to create my own logo. So, here she is!

She has a yoga connection (“seated mountain pose”), because I have practiced yoga for some time. I also incorporate yoga poses into my birth classes because I feel it is wonderful tool for preparing for birth. To me, this new logo conveys the sense of strength, confidence, and joy that I hope to promote and inspire in my classes.

More Words for Pain

May10

A while ago I posted about needing more words for pain. I got a book for my birthday called Labor Pain (I wanted it in hopes it would have more good coping ideas for me to share with couples in birth classes). In it, she discusses the results of a study about how women feel labor pain. The most frequently used description was “sharp” (62%) followed by camping, aching, stabbing hot, shooting, and heavy. Tiring was another word used (49%), exhausting (36%, intesne (52%), and tight (44%). Other words and descriptions used were burning, grinding, stony, overwhelming, terrific, bruising, knifelike, invaded, baby in charge, powerful, relentless, crampy, like period pain, like thunderbolts, excruciating, frightening, and purposeful. Only 25% of first time mothers and 11% of mothers with other children described pain associated with labor as “horrible” or “excruciating” (the top of the pain-scale range).

Do Epidurals Impact Breastfeeding?

May10

There was a question recently on a list I belong to about the impact of epidurals on breastfeeding. The person asking the question had been told by several hospital based childbirth educators that epidurals do not “cross the placenta’ and thus do not have an impact on the baby. Since this is an issue of concern, I thought I’d share some of my response/thoughts regarding this question here. I was happy to hear Linda J. Smith speak at the LLLI conference luncheon session about this very issue–the impact of birth practices on breastfeeding–and she covered a ton of material about the impact of epidurals on breastfeeding (she also wrote a book on the same topic with the late Mary Kroeger). There is some good information, though much less complete, on her site. The biggest problems with epidurals are the impact on the mother rather than the baby, though the medications used in epidurals DO cross the placenta and get to the baby, they are much less seriously impactful than IV or IM narcotics. An epidural refers to the means of medication delivery not what is actually being delivered into the body, so it is hard to say definitively that one has no effect, because different anesthesiologists use different “cocktails” of drugs in their epidurals. They usually use bupivacaine as the anesthetic, but there are opoids included as well, such as *morphine* or other related opoids like that.

All the books I have as a CBE say that medications used in epidurals do make it to the baby, but effects vary. Most effects are connected to what is happening to mom—i.e. mother gets a fever as a side effect of the meds and that stresses baby. Fluid overloading leads to more fluid in baby’s lungs, etc. The main breastfeeding impact on the mother’s side is excess fluid retention in the breasts due to the fluid “bolus” administered prior to an epidural. Baby is a little sleepy following birth and then can’t latch to severely swollen breasts (which are not “normally” engorged, but excessively so due to excess fluid), and so it goes. You often hear from mothers that their nipples are “too flat” for the baby to latch on to and as you probe further you find that the flatness has NOTHING to do with the mother’s true anatomy, but has to do with that excess fluid. Women are so programmed to look inward and blame themselves for problems that it is really unfortunate (like mothers who “aren’t making enough milk” when it is really a pump with bad suction).

Basically most breastfeeding problems that have to do with birth practices are not correctly attributed to the source—the birth practices—and are instead blamed on the mother (“flat nipples”), the baby (“lazy suck”), or breastfeeding (“sometimes it just doesn’t work out”).


How to Use a Hospital Bed Without Lying Down

Apr30

In classes, I often suggest that when couples enter their hospital room in labor they pile all of their belongings onto the bed rather than the laboring woman hopping into it. I encourage people to start seeing the bed as a tool they can actively use during labor, rather than a place for labor and birth to passively happen to you. To that end, I’ve made a little handout called “helpful ways to use a hospital bed without lying down.” I’m uploading it here in hopes that others may find it useful as well.

Kneeling & leaning on back of hospital bedFor more about the importance of freedom of movement during labor, make sure to check out Lamaze’s Healthy Birth Practice paper: Walk, Move Around, and Change Positions Throughout Labor or this video clip from Mother’s Advocate.

Top Five Birth Plan…

Apr29

Birth plans are a topic often discussed in birth classes. There are SO many things that could be put onto a birth plan that sometimes it is difficult to sort out the most important. I encourage couples in my classes to complete two different “values clarification” exercises to help them include those things on their plan that are MOST important to them, rather than trying to cover everything on a one page birth plan. They often ask what I think is important to include. So, recently I started thinking that if I needed to create a birth plan for a birth in hospital that was as normal and natural as possible and could only include five elements, what would be most important to me, my baby, and a normal birth?

These are my top five after first going into the hospital as late in labor as possible (this isn’t included on my birth plan and doesn’t need to be on anyone’s birth plan–“I plan to labor at home as long as possible”–because it isn’t relevant by the time you get there and people are reading your plan. It belongs on your own personal plan, but not in your “official” plan):

  1. No pitocin.
  2. Minimal fetal monitoring and preferably with a Doppler only.
  3. Freedom of movement throughout labor (stay out of bed, use it as an active tool rather than as a place to lie down. Stay upright during any necessary monitoring.)
  4. Push with the urge in whatever position works best for me (NO coached, directed, or “cheerleader” style pushing).
  5. Baby immediately to me. NO separation.

Ideas for supporting your partner in labor

Apr16

One of my favorite handouts to give in birth classes is a “Cliff’s Notes” to labor support. It is a two page handout with a variety of reminders and ideas about supporting your partner or wife during her labor. There are small illustrations as well and a review of the stages of labor. The handout is available here from the website Transition to Parenthood. This site offers a variety of useful handouts for childbirth educators and for parents-to-be and I really appreciate the educator’s generosity in making her materials available online like this!

The handout referenced focuses primarily on physical support and comfort measures of the laboring woman. Some additional, less concrete things I like to remind fathers-to-be of are:

  • Follow her lead. Labor is like a dance and your partner is leading the dance! Anything I say in class or anything you’ve read about is less important than what she is actually doing and you responding to her.
  • The most important thing you can do is just love her. This is more important than learning “techniques.” Just love her the way you love her and she will feel your love and support.
  • Let it happen. I encourage women to “let birth happen” and to let it flow. As her support person, you can help her by letting her let it happen (instead of hushing her or telling her to calm down or asking her to do something different than what is working for her).
  • Don’t interrupt a woman who is coping well with a new technique or idea–if what she is doing is working for her, encourage THAT instead of trying to introduce new ideas or tips.
  • Remember that as a support person you may also experience the three “emotional signposts” of labor–these are excitement, seriousness, and self-doubt and they correspond to stages of labor. A woman in early labor shows the excitement “signpost” a woman in active labor tends to be very serious and “busy working” and during transition many women show a self-doubt signpost maybe saying they “can’t do this anymore” or “I can’t do this much longer.” It is okay to let your partner know that you are experiencing excitement and seriousness, but try to keep the “self-doubt” signpost under wraps and don’t show her that you are also experiencing that one! Be as calm and supportive and confident and trusting as you can as she journeys through the sometimes challenging time of transition in her labor.

Birth Stories in Six Words or Less…

Apr5

This was a fun “challenge” a friend directed me to that originated with this blog.

The idea is to share your birth story using six words (or less). Here are mine:

First Baby: Maybe two centimeters? No, ten! Hooray!

Second Baby: Two hours. 9#2 baby. I’m awesome!

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How about you? Want to share?

Helping yourself while helping your wife or partner in labor

Mar28

Giving birth is an intensely physical process for the woman giving birth and sometimes we forget what an intensely physical process it is to assist a woman giving birth! Here are a few ideas of ways to take care of yourself while you are helping your wife or partner labor and give birth:

  • Bring healthy snacks for yourself (avoid anything that is strong smelling, like garlic, and don’t drink coffee)–granola bars, sandwiches, trail mix, crackers.
  • Wear comfortable clothes and shoes.
  • Dress in layers–the birth room may be cold or it may be hot.
  • Wear clothes that you don’t mind getting stained.
  • Use good “body mechanics” when providing physical support to your wife. Bend your knees slightly and keep your back straight when helping support your wife in a standing squat. If providing counterpressure on her back with your hands, keep your arms straight and lean your body weight down onto her back to provide the counterpressure, rather than using the muscles in your hands or arms to provide it.
  • Take breaks if you need to–it is okay to take a bathroom break or to get something to drink! If your wife or partner does not want to be left alone, have your doula or a helpful nurse serve as a quick stand-in for you. Use your judgment as to whether to announce to your wife that you are taking a quick bathroom break. Some women may be upset at being “abandoned” without warning, while other are so into the rhythm of labor that they will not notice you taking a quick break and it is better not to disturb their rhythm by making a big announcement that you are leaving.
  • If you feel yourself getting tense or anxious, take slow, deep breaths from your abdomen or do a few quick tension relieving stretches such as rolling your neck from side to side or rotating your shoulders.
  • I encourage women to use affirmations during pregnancy and then during labor to help them greet their labors with confidence and acceptance. Though it might seem silly or feel awkward, you may wish to develop some affirmations to use yourself as well as you assist your wife in labor–try things like, “I am calm and confident” or, “each contraction is bringing our baby closer,” or, “my mind is relaxed, my body is relaxed,” or, “her body knows how to birth our baby.”
  • Trust birth and the process–your wife’s body is well designed to give birth to your baby. She can do it! Believe in her and believe in yourself!