Tag Archive | birth classes

How to Use a Hospital Bed Without Lying Down

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.

For 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):

No pitocin.
Minimal fetal monitoring and preferably with a Doppler only.
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.)
Push with the urge in whatever position works best for me (NO coached, directed, or “cheerleader” style pushing).
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.

House of Babies

Mar19

During my classes, we talk about how media portrayals of birth impact our perceptions and expectations as well as contribute to our fears about birth. Often media portrayals of birth have a tense, “emergency” atmosphere, with lots of rushing around and communicate that birth is a dangerous, medical event requiring rescuing by medical teams. Usually, when I bring this up, people in my classes nod in agreement and have lots of examples to share. However, in the last two classes, women have responded, “well, on House of Babies, I saw…” or “in House of Babies…” or “House of Babies isn’t like that.” Well, cool! I think I need to see House of Babies! (I don’t get any TV channels though, so alas, I can’t see it. Someone in my current class offered to show me a recording of it though, so I’m excited to see it).

I’m encouraged to know that there are shows like this with positive, affirming messages reaching women and showing them what birth can be like in a supportive, midwifery model of care atmosphere.

“Balanced” Information?

Mar15

Occasionally I read that someone is planning to take a hospital sponsored birth class because they feel they will get more “balanced” information. This usually seems to be said with regard to medications “versus” natural birth. There is an excellent discussion about this issue in the book Mother’s Intention: How Belief Shapes Birth.

“Let us look at [the word] ‘balanced’ first…’to make two parts exactly equal.’ What if the two parts are not equal? What if a parent will be making decisions that will affect her and her baby with both short and long term consequences? Is it fair to distort reality so that the information she has to choose from seems ‘equal,’ even though it really isn’t? Why would a parent want information that appears balanced, but isn’t factual?”

From my perspective, independent classes are better able to provide you with truly helpful, accurate, and factual information (even though they might not feel “balanced” towards all interventions/options), because the educator is working for you and not for an institution.

Climate of Confidence, Climate of Doubt

Mar14

Recently I finished reading (and reviewing) the new book Our Bodies, Ourselves: Pregnancy & Birth. In the opening chapter, they identify a concept that I have *felt* for some time, but hadn’t really put a finger on. The authors refer to it as a “climate of confidence” and a “climate of doubt.” I love this way of articulating the messages swirling around pregnant women in our society.

A Climate of Doubt comes from “The media’s preference for portraying emergency situations, and doctors saving babies, sends a message that birth is fraught with danger. Other factors, including the way doctors are trained, financial incentives in the health care system, and a rushed, risk-averse society, also contribute to the popular perception that childbirth is an unbearably painful, risky process to be ‘managed’ in a hospital with the use of many tests, drugs, and procedures. In such an environment, the high-tech medical care that is essential for a small proportion of mothers and babies has become the norm for almost everyone…[a] ‘climate of doubt’ that increases women’s anxiety and fear.”

A Climate of Confidence “reinforces women’s strengths and abilities and minimizes fear. Some of the factors that nourish a climate of confidence include high-quality prenatal care; healthy food and time to rest and exercise; a safe work and home environment; childbearing leave; clear, accurate information about pregnancy and birth; encouragement, love and support from those close to you; and skilled and compassionate health care providers.”

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I encourage my birth class clients to consider ways in which they can create a climate of confidence in their lives as they prepare for their births and their babies.

Words for Pain

Mar8

I recently purchased a new educational DVD about natural birth called It’s My Body, My Baby, My Birth. A childbirth educator interviewed during the film briefly discusses pain and says that we need more words for pain, because it is ridiculous that we have only one word that is used to describe a hangnail, a broken leg, being hit by a car, and labor. I had already been musing about pain during labor and how we perceive it, talk about it, and so forth and this comment was additional food for thought for me. I’m thinking that there are many other words used to describe women’s experiences of labor and birth other than pain–a word that is limited in scope and that for some women may well not even apply to the experiences in birth (I’m thinking of the intriguing “comfortable, easy birthing” philosophy of programs such as Hypnobabies).

I reflected on my own birth experiences and how I would describe them, especially my second birth, which was very quick. I would describe it as:

Powerful

Intense

Triumphant

Empowering

Major (this is a word I kept repeating during labor…”This is MAJOR!”)

Beautiful

Special

Amazing

Awesome

If someone then asked me, “yes, but was it painful.” I would have to think a minute and then say, “oh yeah. I guess it was painful.” However, pain is very far from my dominant interpretation, impression, or experience of this birth. It does not make my “top ten” list of descriptors. I’m interested by that. I’m also interested to know about the other words women use to describe their births and where “pain” falls on their lists (feel free to leave a comment sharing your words for your birth experiences! If pain is at the top of your personal list, that is okay! I’m fascinated by women’s experiences of all kinds.)

I have heard people scoff at this kind of language to describe birth–triumphant, empowering, etc.–saying that it is just natural birth “rhetoric” trying to lie to women or that if giving birth is so wonderful why do we use “euphemisms” to describe it, but the words I chose above are truthfully my experience. Why would describe my births as painful, if that truly is NOT the best word to describe them? If I had to pick the best word, I’d probably say triumphant. Or, I might choose intense (particularly with that second, fast labor and birth).

As I said, I’ve been reflecting a great deal about pain and the word pain and how to address the issue of pain during birth classes. I hope to share some more of these thoughts soon.

Waiting before pushing…

Feb16

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.”

Why “Woman-Centered” Childbirth?

Jan15

I refer to my approach to childbirth education as “woman-centered.” Why? I believe woman-centered birth supports normal birth. The two are inextricably linked. According to the Association of Labor Assistants and Childbirth Educators, “woman-centered childbirth recognizes the primary role of the mother, and allows labor to progress according to the mother’s natural rhythms.” As an ALACE trained educator, I stress the importance of respecting the mother’s instincts and choices about how to give birth, including positions for labor and birth, comfort measures, and choice of caregivers and support. My goal is to help women reclaim trust in their bodies inherent abilities to give birth in a safe and unhindered manner.

This does not mean there is not a role for the father in birth or that I do not value the role of fathers. A father most definitely goes through a “birth” of his own–into fatherhood–and the psychological growth he experiences is significant. He also experiences fears and changes as he prepares to meet his baby and is of significant importance during labor and birth in his irreplaceable role of loving and supporting the mother of his baby. My beliefs about birth are underscored by the feeling that the mother is of central importance in the process of birth and that respecting birth as a woman-centered and woman-directed passage is the healthiest, safest, and best way for babies (and therefore, families!) to be born.

Care Practices that Support Normal Birth

Dec5

The Lamaze Institute for Normal Birth has a powerful series of research based care practice papers describing the six care practices that support normal birth. The papers were updated recently and are available on their website in both HTML and printer-friendly PDF formats. These care practices are of vital importance to the normal birth process. The papers are extensively researched and include many citations and are an excellent resource to share with your doctor or with curious (or doubtful) family members or friends. These care practices form an underlying basis for much of the information I present during classes and are practices that should underlie good care in any birth setting (though, sadly, all too often what women receive from their care providers is NOT evidence based and does not follow these care practices. I will write more about this later). Lamaze’s Care Practices are:

Care Practice #1: Labor Begins on Its Own

“Labor is a set of complex, interacting components. Alteration of the natural process can expose a woman and her baby to unneeded risks.”

Care Practice #2: Freedom of Movement Throughout Labor

“Free movement during labor allows a woman to manage contractions and assist the baby’s rotation and movement through the pelvis.”

Care Practice #3: Continuous Labor Support

“Current research supports the benefits of continuous emotional and physical support during labor.”

Care Practice #4: No Routine Interventions

“Supporting the natural, normal, physiologic process of birth requires clear medical indications prior to any medical intervention.”

Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions

“Allowing a woman to find positions of comfort and encouraging her to push in response to what she feels is beneficial to the birth process.”

Care Practice #6: No Separation of Mother and Baby, with Unlimited Opportunities to Breastfeed

“When a baby is kept with the mother, there are physiological benefits to both, including the facilitation of breastfeeding.”

My own short description of the care practices using more direct language would be:

1. Avoid induction.

2. Stay out of bed. Move around a lot!

3. Hire a doula.

4. Demand individualized care–no interventions that are “just because” or “hospital policy.”

5. Squat, kneel, or get on all fours to push.

6. Breastfeed your baby early and often! Keep your baby with you and do not let hospital staff separate you from your baby because of routines or policies.