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.

The most important event shaping my life as a mother?

Oct22

Recently, this quote from a Midwifery Today blog post came to my attention: “your birth is the most important event in shaping your life as a mother.” It has generated some pretty heated discussion and negative feelings amongst some writers in the blogosphere. Despite my intense commitment to birthwork, I stumble over the quote a bit as well. I would venture to guess that if phrased in less black-and-white terms, it would not have caused such an angry reaction in some women. Perhaps, “your [child’s] birth is a very important event…” or “…is ONE of the most important events…” would have been better received, while communicating a similar idea. While I understand the sentiment and deeply agree that birth matters,  the sweeping assertion of the phrase “the most” doesn’t leave a lot of of room for personal experiences and individual variation!

I found the quote first referenced here with an insightful “rebuttal” of sorts. There is also a very detailed critique here.

I have a lot of my own thoughts based on both the original quote/blog post and on the responses from other bloggers.

It is well documented that birth is NOT “just another day in a woman’s life” and that giving birth does have lasting impact on women’s memories and quality of life. Those day-to-day moments with your children that several bloggers mentioned as more appropriate representations of “most important event shaping my life as a mother” are certainly important too and are the makings of a “real life,” but they don’t necessarily stand out in the memory as transformative events. Kind of like your wedding day stands out as very significant—it matters and is important and is not “just another day”—while simultaneously it is clear that the day-to-day life and love with your husband is actually more important than the wedding day.  So, while I would agree that “ultimately” speaking, your marriage is definitely more important than your wedding, I would also put forth that you are much more like to remember your wedding specifically and clearly and with specific emotion than you are to remember what you ate for breakfast with your honey-pie last weekend and that is one of the reasons why the wedding matters. Perhaps it is an issue of the mudane vs. the miraculous…

I believe you can hold the two experiences simultaneously—you can enjoy the wedding memory, while cherishing your regular old daily husband AND you can enjoy (or suffer from) the birth memory while also cherishing the daily life with the little ones. One doesn’t have to trump the other or to be “what really matters.” There’s room for lots of mattering in an every day life 🙂

I think another key is that birth is (or can be) a “peak experience” for women (and families). I want all women to have a chance to experience that. I certainly do not want her to feel diminished, unworthy, inferior or lacking if birth is not a peak experience in her life, but I also want all women to certainly be given a reasonable opportunity to let birth unfold in all its power and be treated respectfully and humanely by those around her—regardless of what is going on or the eventual outcome.

I love birth and cherish my memories of my sons’ births and consider them to be some of the most transformative, empowering, and significant single days in my life—peak experiences, powerful memories—and I also feel that birth matters as a distinct (and relatively rare) occurrence in a woman life. I believe birth has inherent value and worth on its own terms. I also believe that your feelings about the birth and the baby can most definitely be separated—you can feel pleased as punch with your delightful, precious baby and also be disappointed (or super thrilled with) your birthing. One does not take from the other—you can hold the reality of both and a breadth of feelings about them. And additionally, it is not wrong to want both things—a “good birth” and a “healthy baby.” The two go hand in hand and are not mutually exclusive concepts at all (see links to previous posts below).

All that said, however, I also do not feel that my children’s births were the most important events shaping my life as a mother. They were important, yes, but I think stating with finality that the event that shapes us is definitely X—or putting a finger on THE most important event is NOT something that can be pinned down by any one person or imposed from someone on the outside of yourself. I think it varies by woman and mother and there is room for many things to be true and valuable and okay. So, perhaps your important life shaper is seeing your children decorate the Christmas tree (though I still submit that “peak experiences” carry more emotional and psychological weight that everyday occurrences). For another mother, it could be the day she gave birth to her child. Those are both okay! One woman’s feelings and reality do not invalidate or dismiss another’s.

For me, the profound shaping event was the experience postpartum with my first baby. I have never had an experience that shaped me and impacted me and SHOOK me more profoundly than adjusting to life with my newborn son. That was my journey. That was my struggle. That was my challenge. That is what dissolved me and burned me into ashes and let me rise again as someone the same but also brand new—a mother. I was not “born” when my son was born, I was forged. Made, in the intense weeks that followed his birth.

If another mother states that her postpartum was full of “babymoon bliss,” do I need to dismiss her as deluded, lying, and or possibly perpetuating a myth? No! I can hold both in my awareness—my postpartum experience was my most significant life challenge. Hers was not. Both truths are FINE! Likewise, if I decide share that my sex life post-kids is better than ever before, is that dismissed as “couldn’t possible be true? MY sex life was ruined by kids!” or that I’m somehow lying or misrepresenting the truth? No, both can be true, because we are all different women with different lives and experiences and “realities.” So, if a woman feels like her birth experiences were the most important events shaping her life as a mother, that is totally okay—and, it can be true, without making a woman with the opposite experience diminished or “less than.” Of course, the logical extension of this train of thought, is whether I (and other birth activists) can hold our birth matters truth alongside the realization or acceptance that for some women birth IS “just one day” or that it is not an important event in their lives?

I also think we can draw on powerful memories for present strength—I remember my “birth warrior” feelings and it helps me with other tasks or with day to day life. I remember the laughing, crying, “my baby, MY BABY!” moments of triumph and bliss and ecstasy immediately postpartum and it buoys me with a fresh charge of  love for the little ruffians leaping off the couch in front of me or throwing crackers all over the house.

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Since the “birth experience vs. healthy baby” argument is of special interest to me, I’ve addressed it several other times on this blog:

Birth and Apples

Personal Mastery & Birth

Birth Experience or Healthy Baby?

Evidence Based Care

Another Healthy Mother/Healthy Baby Quote

Birth Talk

Oct19

As I have referenced several times before I have a special interest in the language of birth. That is part of the reason my blog/business is so-named—because is it is a blog that “talks birth” (as in, “let’s get together and talk birth!”), but also because the way you talk about birth matters. I have also referenced before that it was originally going to be called Birth Talk, but when I went to get the gmail address, it was already taken (by a childbirth educator I coincidentally later came to know!). I’ve come to really “bond” with my Talk Birth name and now “birth talk” sounds slightly odd to me (though “talk birth” is really the odder phrasing).

A couple of months ago, I read an interesting article by Debra Bingham about Taking Birth Back. It it, she asks you to consider–when talking about birth–how your basic assumptions affect your discourse (the way you talk about birth):

1. Does your discourse include stories about the power of women?
2. Or do the stories shift the locus of control away from women and their bodies to other authority figures such as nurses, physicians, or machines?
3. Does your discourse assume that women are physiologically capable of giving birth and nourishing their own children?
4. Or does your discourse assume that women’s bodies are fundamentally flawed and in need of medical attention and intervention?

I am frequently attempting to shift the locus of control from “authority” figures back to women–it is shocking to me how ingrained the terminology is about medical care providers (even midwives!), “letting” someone do something, etc.

And, an enormous part of my life revolves around stories about the power of women, so I think I have that one down 😉

The prevailing social discourse about birth assumes a locus of control external to the woman and you rarely hear stories about the “power of women” amongst the general public or mainstream media. Ditto for the assumption of women’s bodies as fundamentally flawed, except replace “rarely” with “frequently.” These messages are so dominating that I think it is hard for women to really “hear” positive birth talk–it seems like a “joyful birth” must be a myth or impossible. Likewise, when a woman is striving to keep the birth talk around her positive, it can be very difficult to override the predominately negative messages coming at her from every side. I see this in my classes, “I believe birth is a natural event, etc., etc. BUT….” (followed by a  “I trust my doctor’s judgment and if he wants me to have this GTT test or this extra ultrasound to check my fluid level, etc. I guess I will do it…” comment that contributes to the “climate of doubt” in her life). There are also the woman’s own “inner voices” to contend with—I hypothesize that the loudly-shouted cultural voices about birth contribute a good deal to the “negative voice” in her inner dialog.

I don’t know any way to “fix” this  other than to continue “talking birth”–good, healthy, positive, normal, humanistic, natural, joyful birth–as widely and frequently as I can!

Birth as a Rite of Passage & ‘Digging Deeper’

Oct16

July 2015 135Childbirth 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.

Small Stone Birth Activism

Oct9

Edited to say that I’ve now added the 2009 version of the article here: Small Stone Birth Activism

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In 2008, I wrote an article called Small Stone Birth Activism for Citizens for Midwifery News. I revised the article in 2009 and it was published in the Fall 2009 edition of the International Journal of Childbirth Education (ICEA’s publication). It begins on page 8. I also have an older version uploaded here. This version is also slightly edited from the original version that appeared in CfM News.

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!

More Birth Quotes

Oct5

Reposting some of the quotes I’ve recently shared via my Facebook page…I’m surprised by how many hits my blog gets for people looking for “birth quotes.” I think as long as I bother typing them into Facebook, I might as well then copy them here for those people searching for birth quotes to find! (Here is a link to a previous post with more birth quotes.)

“For far too many women pregnancy and birth is something that happens to them rather than something they set out consciously and joyfully to do themselves.” –Sheila Kitzinger

“Labor is all about finding your threshold and learning you can go beyond it.” –Father quoted in the book Fathers at Birth

“Wise women mean a spicier, more interesting world, not guided simply by linear reasoning and accomplishment, but by intuition, internal self-agreement and fiece creative love.” –Sareanda Lourdes

“Giving birth and being born brings us into the essence of creation, where the human spirit is courageous and bold and the body, a miracle of wisdom.” –Harriette Hartigan

“I believe in the power of accurate information to help women make the wisest choices for themselves.” – Judy Norsigian

“Humanity cannot invent a drug that can work better than a mother’s body can manufacture or a knife that is sharper than her instinctual nature.” –Patrick Houser

“It has been said that if each of us went out into the world tomorrow and shared our love with two people, ‘such that they got it, and they in turn went out the next day and shared it with two more…following that progression, in less than… 33 days we would reach the entire planet.’ *Thirty-three days*. It begins at the beginning. At birth. A peaceful birth, where there are no hunters and no game.” –Nancy Wainer

“Let parents know that they don’t need special techniques and gadgets to give birth safely and happily. Make sure to communicate to every mother you help, that she has all the essential ingredients for a safe, healthy birth within herself. …A womb, a baby, a vagina, and a few warm pieces of fabric make an excellent, complete birth kit.” –Laura Morgan

“Women’s bodies have their own wisdom, and a system of birth refined over 100,000 generations is not so easily overpowered.” –Sarah Buckley

How do I know I’m really in labor?

Sep28

Mollyblessingway 042When I was in early labor with my first son, I spent quite some time upstairs in our computer room googling, “how to know you’re really in labor” or, “signs of true labor,” or “the difference between false labor and real labor,” or, “how do I know I’m in labor,” or, “how to know I’m in labor.” I would do this between contractions and then when I had a contraction I would think, “Wow! This is definitely it!” Then, it would ease, and I’d start googling again, certain I must just really be experiencing “false labor.” One of my biggest fears was arriving at the birth center and only being two centimeters dilated (or possibly not in labor at all!). So, in honor of my former self, I offer a list of some ways to to gauge whether you are experiencing true labor.

It is true labor if/when:

  • Your contractions fall into a regular pattern. And, that pattern involves contractions that are lasting longer, feeling stronger, and occurring closer together.
  • If when you walk around or otherwise increase your activity, the contractions also increase.
  • And if changing positions and drinking plenty of fluids also do not cause the contractions to ease…
  • The sensation begins in your lower back and spreads like a band around your belly causing a peak of tightness and discomfort in the front and then fades away again.
  • You have been feeling some gastrointestinal upset and may be experiencing diarrhea also.
  • You have pinkish or blood streaked, mucousy discharge.
  • Your membranes have ruptured (keep in mind that labor only begins in this way for roughly 10% of women. So, if your waters have not released, do not be discouraged thinking that you must not be in “real labor.” Many women do not experience their waters breaking until they are pushing or are starting to feel like pushing).
  • Truly, I think that the best sign that you are in labor is if you really feel like you are in labor. This is one of those things that doesn’t feel that helpful to a first-time mom—“yes, but how will I know?! What if I’m in labor and don’t know it until the baby is coming out?!” I promise that for the wide majority of you, at a certain point, you will just know that you are in labor and there will be no more questions about whether this is “really it”—that is the best sign, when you stop wondering “is this really it?” My observation is that this point comes along when you enter active labor and enter your “birth brain” instead of your analytical, logical brain.

Is this really it?

If you are still wondering, “is this really it?” my best piece of advice is to ignore it! Pretend like nothing is happening. Go about your normal day and your normal routine. If you would normally be sleeping, sleep. If you would normally be eating, eat. Go for a walk, water the plants, feed the dog, bake something, go to the store, etc. When your contractions need your full attention, they will ask for it 🙂

Symptoms of pre-labor (“false labor”)

Some “symptoms” that what you are experiencing is instead practice labor, pre-labor, or “false labor” (I do not usually use the phrase “false labor” because I think it is dismissive of women’s experiences. All contractions are doing something and so I refer to them as “practice” rather than “false.” Another good phrase to use is “pre-labor” contractions. My midwife with my second baby referred to them as “toning contractions”):

  • The contractions are irregular (no pattern) and are not increasing in frequency or intensity.
  • If you change positions or drink two large glasses of juice, water, or tea, the contractions subside.
  • The contractions center in your lower abdomen and do not involve your back.
  • The contractions go away if you take a walk, take a shower, or lie down.

This is also a popular question in birth classes. Because labor is a new event for you, it can be hard to know what to expect until it actually happens! There is  pdf handout here with some additional signs and information. There is also a helpful handout with a sort of flowchart of signs/symptoms here.

Oh, and by the way, when I did finally go to the birth center, I was 10 centimeters dilated and started pushing about 30 minutes later!

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What about induction?!

On a closely related topic, why bother with all this guessing about whether or not you’re in labor? Why not be induced instead? Good questions! There are numerous reasons why you should let labor begin on it’s own—labor that begins on its own is usually safer and healthier for both mother and baby. Also, it is less painful than a labor that is induced with medications such as Pitocin. For more information about letting labor begin on its own, check out Lamaze’s Healthy Birth Practice #1, or this video clip from Mother’s Advocate:

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