Tag Archive | active birth

Tuesday Tidbits: Birth Conditioning

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Thinking about the raw, emotional complexity and physical intensity of birth, I am reminded of a past post exploring the question of whether an epidural can really be considered an “informed choice” when it is considered in the context of enforced stillness during labor?

…In this case and in so many others around the nation every day, the physiologically normal and fully appropriate need for freedom of movement during labor ran smack into the hospital’s expectation of stillness. And, medication was a consequence of that stillness, not an inability to cope with normal labor–it was an inability to cope with enforced passivity that was directly counter to the natural urges of her birthing body. Where is the ‘opting’ here? When birthing women are literally backed into corners, no wonder epidural analgesia becomes the nationally popular ‘choice’…

Thoughts on epidurals, risk, and decision making | Talk Birth.

Considering movement during labor also brings us to the idea of sound during labor. What about the implied or explicit expectation of quiet during labor?

We decided that there is a major stigma around “quiet” birth. Why is “quiet” birth synonymous with a “good” birth? Why are we praised on our ability to stay “calm” in our birthing time??? This is crazy! Now let me quickly add: A quiet birth CAN be a beautiful birth, it can be the most beautiful kind, but so can the others.We talked to a mother who explained that in her birthing time she was very “calm and quiet” she also said she was suffering so deeply but everyone kept praising her abilities so she kept on going. How many women bite their tongue, how many women feel trauma and how many women were told they were “crazy, wild and loud”? And why are any of those words bad? We are having a baby, we are doing the most instinctual and primal work we will ever do as humans.

via Blog — TerraVie.

I addressed the interesting notion of a “quiet, calm” birth as synonymous with “coping well” in this past post:

“I believe with all my heart that women’s birth noises are often the seat of their power. It’s like a primal birth song, meeting the pain with sound, singing their babies forth. I’ve had my eardrums roared out on occasions, but I love it. Every time. Never let anyone tell you not to make noise in labor. Roar your babies out, Mamas. Roar.” –Louisa Wales

via What Does Coping Well Mean? | Talk Birth.

Our expectations in birth are shaped by the cultural conditioning, contexts, and environments around them whether we are conscious of them or not. In this past compilation of articles about the role of doulas, Michel Odent makes an interesting point:

…We must add that this cultural conditioning is now shared by the world of women and the world of men as well. While traditionally childbirth was ‘women’s business,’ men are now almost always present at births, a phase of history when most women cannot give birth to the baby and to the placenta without medical assistance. A whole generation of men is learning that a woman is not able to give birth. We have reached an extreme in terms of conditioning. The current dominant paradigm has its keywords: helping, guiding, controlling, managing…coaching, supporting…the focus is always on the role of persons other than two obligatory actors (i.e. mothers and baby). Inside this paradigm, we can include medical circles and natural childbirth movements as well…

–Michel Odent (exploring the role of doulas)

Tuesday Tidbits: The Role of Doulas… | Talk Birth.

And, here are some neat resources I’ve encountered this week…

I signed up to participate in this free telesummit on womb wisdom/nourishing the feminine: Womb Wisdom: Nourishing the Roots of the Feminine with Barbara Hanneloré — Womb Wisdom. (Thanks to Mothering Arts for the link!)

I’ve linked to these beautiful coloring books in past posts. I’m just entranced by them!

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via Blissful Belly Coloring Journal: NOW until April 1st, Buy Both the Blissful Belly and Blissful Birth Coloring Books and Get 25% OFF. Coupon Code is 2blissful. Get it here

And, after participating in a free Spring Equinox event online that was hosted by the Sacred Sister Society (to which I won a year-long membership!), I’ve been enjoying different daily yoga practices using videos from Joy Fisheria from Everyday Chakras. The practice for your core strength is one of my favorites. 🙂

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New taller, mama goddess sculptures for birth altars!

Moving During Labor

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.

Active Birth Video

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

Movement and pain

A brief quote from Biance Lepori an Italian architect who specializes in the design of birth rooms:

“Even pain dissolves with movement; pain killers are a consequence of stillness.” (emphasis mine)

This architect specifically designs rooms that support physiological birth–birth that unfolds accords to the natural biological processes of the woman, on her own timeline, and under her own power.

I emphasize active, normal (physiological) birth in my classes. I feel like the use of movement is one of the single most important ways we have to embrace labor and its rhythms and also to support healthy, physiological birth. Though I teach a variety of positions for labor and birth, “birthing room” yoga poses, and encourage practicing them, I believe that the movements you need during labor come from within and arise spontaneously during labor, not from specific training and practice. The key is the FREEDOM to use movement in the way you need to (many women end up being denied the right to free movement during labor 😦 ). The benefit to practicing different positions and movements prior to birth is that you gain a “body memory” of how to move your body in labor supporting ways.

Benefits of Active Birth

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.

Waiting before pushing…

Your uterus is a powerful muscle and will actually push your baby out without conscious or forced effort from you–at some point following complete dilation your body will begin involuntarily pushing the baby out. Many women experience the unmistakable urge to push as an “uncontrollable urge”–but, in order to feel that uncontrollable urge, you often have to wait a little while! Though some care providers and nurses encourage you to begin pushing as soon as you are fully dilated there is often a natural lull in labor before your body’s own pushing urge begins. Some people refer to this lull as the “rest and be thankful” stage. It gives your body a chance to relax and prepare to do a different type of work (in labor the muscles of your uterus are working to draw your cervix up and open. During pushing, the muscles of your uterus change functions and begin to push down instead of pull up). If you wait to push until you really need to, you will often find that your pushing stage is shorter and progresses more smoothly that pushing before you feel the urge.

I’m reviewing a copy of the wonderful new pregnancy book from Our Bodies, Ourselves and they shared the following about this issue:

“Research suggests that the length of time before the baby is born is the same if you allow one hour of ‘passive descent’ of the baby (when you relax and don’t consciously try to push) or you start pushing immediately after you are fully dilated.”

Will I need an episiotomy?

The short answer is no, you do not “need” an episiotomy. Women rarely (if EVER) actually “need” an episiotomy. An episiotomy is a surgical incision made in the perineum to enlarge the vaginal opening as the baby’s head is being born. This procedure is rarely necessary and you should ask your care provider how often they perform episiotomies. A good answer is, “almost never” or “I’ve done 3 or 4 in my career.” Answers that are NOT good and that should encourage you to question further are, “only if you need it” or, “many first time moms need one” or, “a clean cut is easier to repair than a nasty, jagged tear!” or, “don’t worry about it. I’ll make the decision when the time comes.” These are not good answers, because there has no study has ever shown any benefit to routine use of episiotomy! There is no scientific evidence supporting the practice.

A commonly used analogy to explain why a cut is NOT better than a tear is to imagine a piece of fabric–when you try to tear it, it resists. But, when you make a small cut in the top of the fabric and then then try to tear it, it easily rips all the way down. The same is true of your skin! (and your muscles–an episiotomy cuts through your muscle as well as your skin. Many naturally occurring tears are very small and occur only on the surface of your skin).

Here is some more explanation from an issue of Midwifery Today e-news issue number 8:23:

“Ironically, one of the biggest contributors to perineal tearing is episiotomy, which has long been heralded as the great preventer of tearing. One recent study, which only assessed the effects of episiotomy on third and fourth degree tearing, found a definite correlation between episiotomy and tearing. The risk of severe tearing was found to be nearly four times higher with episiotomy than without. Another study involving thousands of women found that the number one risk factor for perineal tearing was episiotomy.”

Though it often is presented as a choice–i.e. “would you rather tear or be cut?” I offer that there is a third option….Neither! A perineal wound is NOT an inevitable part of giving birth (even with your first baby). Though it is not abnormal to tear, it is also perfectly possible to not tear or need stitches. One way to work with your body to avoid tearing is to give birth on your hands and knees, kneeling, or squatting. Another way is to stop pushing when you feel a burning sensation or “ring of fire” and let the baby’s head naturally ease out. Your uterus will push the baby out without sustained, breath holding, high exertion pushing from you–you can rest and let your uterus do the work! When you are doing forceful or directed pushing you are more likely to tear than if you follow your own body’s pushing urges and signals. Some people also advocate perineal massage prior to birth to help the tissues stretch. While it does not hurt to become more familiar with this part of your body and how your muscles feel when they are relaxed or tense, perineal massage has not been shown to have very much effect on your chance of tearing during birth.