Tag Archive | normal birth

Using the right ingredients…

I seem to be able to relate just about everything I ever read to birth. Some time ago, I read a book called Things I Learned from Knitting and in it the author recounts a story about her attempt to make her friend’s delicious stroganoff:

“The recipe was for a fantastic mushroom stroganoff that I thought was one of the yummiest things I’d ever eaten. I hurried to the grocery store to buy all of the ingredients, but there was one problem: I couldn’t afford them. I decided to make do. I bought substitutes…It called for cream; I used milk. It called for portabella and shiitake mushrooms; I used regular button mushrooms. It called for butter; I used margarine. The wine? I substituted water. I painstakingly put together my version of the stroganoff and was absolutely devastated when it was a pale (and sort of gross) imitation of the glorious dinner I had eaten at my friend’s. I explained the outcome to my mum, telling her that I must not have the skill at cooking that my friend had. I proposed that I just needed practice making the dish…’Darling, practice all you want, but you can’t make a silk purse out of a sow’s ear.'”

How does this relate to birth? When women share their stories with me in person, online, or in articles, I am struck by how often they’ve tried to make do without the “right ingredients” and then blame themselves (or nature) when their birth didn’t turn out the way they had wished. They may have gone to a hospital with a 50% cesarean rate, chosen a physician unsupportive of natural birth, spent much of their labors on their backs in beds, labored while attached to any number of restrictive pieces of technology, taken powerful medications, and so on and then grieve the loss of the beautiful birth experience they had planned.

So, what are the right ingredients? Every woman is different and each birth is different and has its own lessons to impart. However, we do know that some things are the “right ingredients” for many women if they would like to have a normal (physiologically unfolding) birth:

  1. Labor begins on its own (no induction, no pitocin)
  2. Freedom of movement throughout labor (no restriction to bed)
  3. Continuous labor support (from a doula, your husband/partner, or a supportive friend)
  4. No routine interventions (any interventions should be based on the unique needs of you and your baby, not hospital protocol or “this is what we always do”)
  5. Spontaneous pushing in upright or gravity-neutral positions (try squatting, kneeling, hands and knees, or side-lying)
  6. No separation of mother and baby after birth with unlimited opportunities for breastfeeding (do not have the baby taken to the nursery and breastfeed early and often!)

Another wonderful ingredient is confidence in yourself and your body’s natural ability to birth your baby.

Please do not be afraid to seek out a care provider and a birth setting that recognizes the importance of the right ingredients and who will do everything possible to help you use those ingredients to “cook” up a healthy, rewarding, normal birth for you and your baby!

For more information about Six Care Practices that Promote Normal Birth, visit the Lamaze site.

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 šŸ˜¦ ). 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.

Healthy Birth Guides

I recently received a shipment of The 2008/2009 Guide to a Healthy Birth published and distributed free of charge by Choices in Childbirth in NYC. I ordered a stack of these nice little booklets for only the cost of shipping ($11 for 50 booklets). I really like the content and plan to distribute these in my birth classes and encourage other educators to do the same. The emphasis of the booklet is on being an informed consumer and it also touches on the politics of birth and the business of birth, which I really liked. The end of the booklet has an article by Dr. Harvey Karp about the 5 S’s. I particularly enjoyed the chapter called “The Purpose and Power of Pain in Labor.”

All in all, this is a fantastic and nearly free resource and I’m pleased to have them available! Check them out yourself! (You can also download the booklet for free as a pdf.)

I first learned of these booklets from the wonderful Passion for Birth blog.

Top Five Birth Plan…

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.

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.

Overused & Underused Procedures

My previous post about a good experience and a healthy baby as well as reading a relevant section in the wonderful new Our Bodies, Ourselves: Pregnancy & Birth book I’m reviewing made me want to post about this topic. There are a multitude of common procedures that are overused in hospitals and that when used routinely actually harm mothers and babies. I also thought about the multitude of evidence based, helpful procedures that are underused in many birth environments despite research indicating that they contribute to better outcomes for both mother and baby. (The use of the terms “overused” and “underused” and the examples below are taken from the OBOS book.)

Overused Procedures–these techniques are often used routinely (instead of appropriately based on true level of need in which case they can be truly helpful and sometimes even save lives) despite clear evidence that overuse is harmful:

  • Induction of labor
  • Episiotomy
  • Epidurals
  • Cesarean sections

Underused Procedures that have been shown to improve birth outcomes as well as to improve women’s satisfaction with their birth experiences include:

  • Continuous one-on-one support from a skilled caregiver during labor (a doula is a professional labor support provider who offers this one-to-one support).
  • Changing positions during labor (especially positions using gravity).
  • Laboring out of bed.
  • Walking during labor.
  • Comfort measures such as water, massage, and birth balls.

To increase your likelihood of satisfaction with your birth experience and of having a normal birth as well as a healthy mother and baby, choose a birth setting and care provider that supports and USES these underused procedures and only rarely, and appropriately, uses the overused procedures listed above.

Satisfaction with Your Birth Experience

There are four factors that research have found to make the greatest contribution to your degree of satisfaction with your birth experience (experience or not of pain isn’t one of them!):

  • Having good support from caregivers.
  • Having a high quality relationship with caregivers.
  • Being involved with decision making about care.
  • Having better than expected experiences (or having high expectations).

According to additional research, pain relief only becomes important in relationship to level of satisfaction when expectations are NOT met (so, if you planned for a epidural and didn’t have time to get one, or you expected to cope differently with pain than you did, and so forth).

When reflecting on these things based on my personal experiences, they seem completely appropriate (including the experience or not of pain–my sense of satisfaction with my own birth experiences has nothing to do with how much or how little pain I experienced or how I interpreted my sensations as painful or not. With both my babies, I had a high level of satisfaction with my birth experiences and in both I had a high quality relationship with my caregivers (family practice physician with the first baby and midwife with the second). During both labors I had very excellent support from my husband (the professional caregivers had little involvement with either of my births). He was so present for me and so able to provide what I needed that I had a sense of us being like one person during labor. Decision making about care also came into play with my satisfaction level. with my second baby particularly, I was completely in control. No one else made decisions about my care. So, it was much more than “involvement in” decision making, but for me, an important component of satisfaction was total control of decision making.

Finally, I totally identify with the “better than expected experiences.” With my first baby, I was stunned and very pleasantly surprised to arrive at the birth center fully dilated. I had expected to labor for an additional 10 hours or so at the birth center (I was in labor for about 11 when we got there). With my second baby, I was again stunned and also pleasantly surprised to be in labor for a total of 2 hours. While I felt a bit “run over by a truck” by the speed and the intensity of the second labor, I was delighted to have such a quick birth. It was great.

I also started thinking about what else, personally, would be on my list of things contributing to satisfaction with my birth experiences and I think location is a big one for me. Being in an environment of my choosing and in which I felt safe, comfortable, and respected was very important to my feelings of satisfaction. My second baby was born at home and that was very satisfying to me. I’m sure there are other things that were important, but I can’t think of anything specific right now.

How about you? What contributed to your feelings of satisfaction (or not) with your birth experience(s)?

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.

More about normal birth

I recently read on the Passion for Birth blog that the Maternity Care Working Party in the UK has a new consensus statement called Making Normal Birth a Reality. It is difficult to arrive at a concise definition of normal birth (which IĀ define as “physiological birth”). They describe it as aĀ women whose laborĀ “starts spontaneously, progresses spontaneously without drugs, and who give birth spontaneously.” There is a lot of room in each of these for some interventions (such as electronic fetal monitoring) that many activists would argue impede the progress of normal, physiological, naturally progressingĀ birth. However, it is nice to see the emphasis on spontaneity and also to see what other countries are doing/saying about protecting and promoting normal birth.