Tag Archive | giving birth

Can I really expect to have a great birth?

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 Wisdom: Your Inner Voices

May12

It is International Birth Wisdom Week and I want to share something from The Pink Kit about inner voices during labor. The book says that many women have two voices present during labor–one is a supportive, “managing” voice and the other is a “negative” voice. The first voice gives guidance, makes suggestions, tells you what to do. The second voice perhaps tells you that things are horrible and you can’t do it. (I think many of us have these two voices present during everyday life as well, not just during birth!)

“Women who don’t find labour painful often relate that one voice says, ‘it’s not painful,’ while the other tells them what to do. Women who find labour extremely painful often related that one voice is constantly saying, ‘I don’t like this,’ ‘This is too much,’ ‘I can’t do it,’, etc. But their other voice can still be saying, ‘Keep breathing, ‘Relax,’ …’Now rest…'” Being aware of these inner voices gives you a tool to work with during labor. The Kit also notes that support people should remember these voices as well, saying that if you tell a laboring woman something like, “you’re doing so well!” while her negative inner voice is saying, “I can’t handle this” she might respond to you by saying, “Be quiet!”

Women’s behavior and ability to cope with labour is often a reflection of what those inner voices are saying…There is a mistaken belief that labour is ‘not good’ if the negative voice is big. Not true. The negative voice can be very big, while the manager voice still does The Work. Often the highlight for women is overcoming the obstacles the negative voice puts in the way of good birth…Take heart, many of us feel incredibly powerful after a birth experience that had a loud negative voice.

Reading this made me consider what my inner voices were telling me during my own birth experiences. With my first birth, I had a doubtful voice inside that worried that I was only two centimeters dilated and was going to the birth center too early. I also had a clear supportive voice that told me, “this is normal, your body is made to do this” over and over again. During my second birth, I had a very strong and supportive “manager” voice that “doula’ed” me through my labour. It told me things like, “be a clear open channel for birth” and “relax your legs” and “you’re okay, it’s okay” and “let go here.”

What did your inner voices tell you and how did you work with them?

Personality and Birth

May6

From Sheila Kitzinger’s book The Experience of Childbirth:

In a normal, straightforward labour a woman’s attitude of mind, her approach to the task that awaits her, and her preconceptions concerning the nature of the work that her body has to do, are more important than any sort of physical preparation she can make in advance. Whatever athletic exercises she may essay, however controlled her breathing, however complete her muscular relaxation, in the last resort the thing that matters most is essentially the kind of woman she is, and the sort of personality she has [emphasis mine]. That is why preparation for labour cannot rest in purely physical training and in mechanical techniques of control and release alone. Controlled muscular activity can assist her in making of her labour something she creates, rather than something she passively suffers, but her capacity for achieving this physical coordination is dependent upon her mind–upon her fearlessness and sense of security, her intelligence, her joy in the baby’s coming, her courage, her self-confidence, and the understanding she has of herself. The experience she has of childbirth is a function of her whole personality and ideally the preparation should involve increased self-knowledge and a growing towards maturity.

While there is a certain element of “blame the victim” in this quote that I find distasteful (i.e. “she had XYZ intervention, must be her bad personality…”), I recognize something here that speaks to me. I have observed in some of my clients a certain “quality” of personality (or perhaps determination) that makes me feel secure that they will be fine with or without me–they have something that comes from within that will guide them through birth. There are others who are more ambivilant, who say they want to “try” natural birth. Sometimes they blossom into confidence as the classes proceed, sometimes nothing really changes. I do not really take responsibility for any birth outcome, because birth classes are just a piece of a much more multifaceted puzzle of a woman’s experience. However, I feel like you can see that some women just “have it in them” and in others, that “it” has to be nurtured and grown. I’m not sure exactly what this “it” is, which is why Kitzinger’s quote caught my attention.

Thoughts about Pushing

Apr29

Also from Fathers at Birth, some quotes about pushing:

Powerful, authoritative, and wise energies assist in releasing the baby from the womb. Go with them.

Many women experience the work of pushing and the sensations of the internal movement of the baby as it moves and rotates through the birth canal as intensely gratifying. But some women feel the sensation as painful. They may get exhausted or discouraged and need lots of encouragement. Many women need to move around and change positions. Some women roar and discover a power within they have never encountered before.

With my first baby, I found the pushing stage to be very intense and overwhelming. I had been fairly calm and focused during my labor, but pushing felt scary to me and I said, “I’m scared” quite a few times. I also said, “pushing is supposed to feel GOOD,” because that is what so many people had told me (that pushing felt good/satisfying/rewarding). It didn’t feel good to me! With my second baby, pushing was more like an uncontrollable wave that moved through me and was natural and spontaneous. It didn’t feel “good” really to me, but it was not scary.

Labor is like stairsteps…

Apr29

I have a pile of things to blog about about and one of them was this quote from the book Fathers at Birth:

“Labor is like stairsteps. There is an incline, then a plateau. Another challenging incline, and another plateau. The inclines get steeper and more intense as labor progresses. The plateaus get shorter. However, in deep labor, the incline can go straight up, off the charts, without a plateau. Sometimes women are very close to pushing when this happens and do not know it.”

As a father-to-be, if you notice inclines with no, or very short plateaus, you will know that your baby is very close to being born. Reassure your partner about the wonderful job she doing, how great everything is working, and that she is getting closer and closer to meeting the baby!

Births & Marathons

Apr22

A parallel is often drawn between giving birth and running a marathon. There was a great article called “The Gift of Leaping” in the most recent issue of the International Journal of Childbirth Education (available to download as a pdf here) that was based on this theme.

In it, the author discusses how in both experiences your mind’s strength can be called upon to surpass your physical strength and she notes, “The pain of accomplishment is so much easier than pain endured.” I loved that!

She goes on to share: “I want that feeling of going beyond what you think is possible for laboring women. If you let go of control and allow the process to unfold, you are so proud of yourself. Then pride morphs into self-confidence and trust. What a perfect combination for parenting. When it comes down to it, you have to do this by yourself, be it labor or running. You might hear other laboring women around you or have the support of crowds in a race, but it’s still up to you. there’s a start and a finish and only you can see it through. Fortitude brings a new self-awareness and strength that feels overwhelming…I know one of my greatest challenges in the vocation of perinatal education is getting women to trust the process and her own capabilities before labor. My practice runs helped prepare me for the marathon, but there is no practice run for labor. Women must rely on their confidence and the legacy of the many women who have birthed before them…”

I share her feelings about her greatest challenge. The whole point of my birth classes is for the participants to develop confidence and trust in their ability to give birth naturally. It is difficult to share what birth is really like–it is a singular experience (each birth is different too, so even if you’ve done it before, there are still surprises ahead!) I also feel like it is irreplaceable to start off the parenting journey with a overwhelming sense of power, pride, and capability–a sense that often comes with the “I did it!” of giving birth!

Perceptions of Pain

Apr18

Some time ago I wrote several posts about pain in labor, one of which addressed needing more words for pain. In the book Birthwork, there is an interesting list of possible perceptions of pain in labor:

—‘Satisfying pain‘—enjoyable labour

–‘Positive pain’–it is birthing the baby

—‘Constructive pain’–it is doing a good job

—‘Functional pain’–acceptance of the process

—‘Okay pain’–it hurts but everything is on track

—‘Intense pain’–it is a lot!

–‘Abnormal pain’–something is not right

—‘Overwhelming pain’–unable to manage alone (exacerbated by isolation, fear, exhaustion, and tension).

—‘Off the wall pain’–utterly unbearable (usually associated with intense nerve or spinal pressure).

Even though these aren’t new words for pain, I think they add to our vocabulary for describing what is going on with our birthings. Additionally, keep in mind that you can transform the language and perception of the sensations of labor even further, by not using the word pain or contractions at all–you can refer to “sensations” or “tightenings” or “pressure” or “waves” or “surges” or “intensity” and so forth.

Just Relax?

Apr17

Most approaches to birth preparation emphasize “relaxation” and being able to “relax” during contractions. Some people have noted that the word “relax” isn’t very descriptive to women in labor–or, it can irritate them (“Just relax?!”) while at the same time not really giving them anything specific to work with. I recently finished a really incredible book called Birthwork (more about this will follow in several more posts!) and it addresses this topic as follows:

…it can be disconcerting for a mother to be told to ‘just let go and relax’ during labour without some practical guidance on how to do this or without first acknowledging how tough it is, or how stuck or frustrated the mother may feel. Perhaps a more helpful response might be:

–‘Let’s find a way to open more.’

–‘How can I help you to let go?’

–‘Try softening here.’

–‘Sometimes this works really well. Would you like to try it?’

I particularly like the “soften here” idea. It reminds me of something else I read in The Pink Kit, which was about “directed breathing.” The idea with directed breathing is that you can direct your breath into any specific area of your body–when helping a woman in labor, you might put your hand on her lower back and ask her to “breathe into my hand.” When you practice this at home, it is fascinating to me how you actually have a sensation of “breathing” in your back, or thigh, or shoulder, or wherever–sort of a subtle feeling of expansion.

Non-verbal Communication

Apr13

Birthing women tend to enter “birth brain” while focusing during labor–this is a more primal, instinctive, intuitive, primitive part of their brain and it tends to be fairly nonverbal. I often remind fathers-to-be in my classes not to ask their partners too many questions while they focus on birthing, because questions pull women out of “birth brain” and into the more analytical, rational side of the brain that we use in day-to-day life (this “thinking” brain is not as useful during labor!) Instead, I encourage birth partners to just “do” and then pay attention to the woman’s nonverbal cues (or short, verbal cues) about whether to keep it up–an example I often use is with giving her a drink of water or juice. Instead of asking, “do you want another drink?” Just hold the straw up to her lips! If she is thirsty, she will drink, and if she is not she won’t. No words need to be exchanged. Other reactions might be that she might push the drink away, say “no,” or shake her head.

As I referenced in a prior post, I recently finished reading through The Pink Kit. It has some more related thoughts to add:

Childbirth is such intense work that sometimes a woman just can’t get a full sentence (or even a short one) out of her mouth. You can’t read her mind. However, it’s not too difficult to read her body language…During labour, it will be easier for her to push your hand away, say ‘shhhh,’ grab you and hold on, or put your hand on some part of her body, than to talk. Often a woman can THINK something so loudly, she’s certain she’s said it aloud.”

Birth as a Rite of Passage

Apr11

Part of my philosophy of birth is that it is a significant rite of passage for women, men, and families, not a medical event, emergency, or health crisis. I recently finished working through The Pink Kit and the little book that came with it had some thoughts to share on this subject in the “final word” segment of the book:

We would like to warn you against expecting a ‘perfect birth,’ or for that matter anything in particular, except that you will get through it, with your baby–just about everyone does, no matter what they know and do!

The fact is, there is no such a thing as a ‘perfect life.’ Think about what life passages you may have undergone so far–cutting teeth, starting school, menstruation, the first sexual experience, loved ones dying.

Birthing is also a rite of passage–into parenthood–and like any other passage, it comes upon us and we just have to deal with it. It’s an awe-inspiring experience, and it would be perfectly natural to want to prepare in some way. And you can do that. But to some extent the experience is still out of your control.

Giving birth is definitely the most significant and impactful rite of passage of my life–it is the the gateway to motherhood, which has been the single most life-changing role I’ve had. I believe that this significant, transitional, rite of passage is worthy of appropriate level of awe, respect, and preparation. It is a sacred passage. Accordingly, I also believe the birthing woman should be treated with reverence and respect.