where should you birth?

Over the holidays, I have been reading "Birthing From Within" by Pam England and Rob Horrowitz.  Its a little hippie-ish, but it has some really great suggestions and helpful thought-provoking questions.  I will now suggest to every client to read this book.  There are lots of things I want to post about, but here was one helpful little list:

"Home Birth is for Women Who Are:

• Healthy
• Eating a sound prenatal diet
• Non-smokers
• Able to envision taking an active role in giving birth, with minimal intervention
• Willing to cope with the pain and hard work of labor (without drugs)
• Living where midwives are available
• Laboring within thirty minutes of a hospital
• Able to cover additional expenses (if their insurance coverage is limited to hospital births)

Hospital Birth is for Women Who Have:

• Chronic medical problems (e.g., diabetes, high blood pressure)
• A prenatal problem (e.g., gestational diabetes, preterm labor, preeclampsia, breech, or at least two weeks overdue)
• A desire to birth in a hospital and/or have access to drugs
• Strong fear and/or mistrust of birth as a natural process
• Planned a home birth, but whose labor did not prgress normally"

when labor stalls

I have a good friend who is worried quite a bit about her labor stalling and then ending up with a c-section.  So ... this post goes out to you!

It is quite common for labor to stall at some point.  Anxiety, exhaustion, dehydration, frustration, poor fetal positioning, and lying still for long periods of time are a few contributing factors.  Some women just have weaker contractions and are in some sort of labor for days.  Some women have not had any sleep the last few days or weeks, and so their bodies will take breaks to try to reserve energy for pushing.  Whatever the case, if the mother is coping well and the infant is tolerating the contractions just fine, there is no reason to immediately turn to a c-section.

The only problem is, some women could be in labor for days.  This is far from appealing to anyone.  The mother and her partner will be emotionally and physically exhausted, and the care provider will not only be tired, but they will be losing time they could be spending with other patients.  Everyone has their limit that they are willing to let things go naturally, and you will have to decide what yours is.  You should definitely be aware that hospitals have the shortest amount of time that labors are allowed to endure, especially as it seems so very much easier to wheel down the hall and cut the baby out.  Most hospitals have a 24 hour policy; from the moment you check in you are on a time clock.  You will also be likely to hear people saying things like, "Let's get this kid out on my shift!"  or, "Your doctor will be here in a couple more hours,"  which is kind enough, but does definitely put pressure on the mother to achieve some sort of schedule.

Birth does not happen that way.

I would suggest making a birth plan, having a good idea of what is most important to you, and then once labor starts .... just don't worry about it.  Let your partner handle schedule stuff while you go inward ... get in that mammalian brain that actually does know the best way to get that baby out.  Sometimes the less you think, the better.

Here are a couple of good articles:
http://www.spinningbabies.com/research-and-references/268-patience-when-labor-stalls
http://www.ncbi.nlm.nih.gov/pubmed/18978113

a thought on nurses

I recently attended a birth in the exact same hospital that I delivered my son at.  My experience was far from "natural", and I was extremely frustrated with the nurses.

But when I went back as a doula, I was amazed at the difference.  The nurses were attentive, aware, and always asking my client's opinion.  One of the nurses was in school to be a midwife, and knew about different birthing positions, pushing techniques, and so on.  My client was able to have her baby placed directly on her stomach, and left there for a solid hour before they took her to the nursery.  She was permitted to labor on the toilet, push as she felt appropriate, did not receive an episiotomy, and delayed cord clamping.  All of these were things I had hoped for but did not experience.

What was the difference?

I think it was her doctor.

Nurses do not know you personally; they do not understand your experiences, your preferences, your strengths or your weaknesses ... but you can bet they know your doctor's.  They understand how your doctor works, and they will treat you accordingly.  My client had a midwife who was well respected in this hospital, and I had the king of c-sections (who is actually in jail now ... oops).  It only makes sense that they will tailor their treatment to the doctor's style more than your own.

So, yet another reason to be sure you find a doctor that you absolutely agree with.  You cannot take someone who is good at doing one thing, and ask them to do another.  It will be frustrating for everyone involved.

delayed cord clamping

Delayed cord clamping is exactly that .... delaying the clamping of the cord for around two minutes; or when it stops pulsing.  This is something that is not done too often in hospitals unless the couple requests it.  It allows the last of the nutrients from the placenta to be delivered to the baby, and has some definite benefits; there was a marked improvement in the content of the babys' blood -- particularly their iron levels -- extending throughout their infancy.

I found a great medical article on it here.

The article concludes with:

"Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign."
 

my firstborn son

This is my personal experience with the birth of my son, and greatly influenced my view on birth as a doula.  I wrote this about two weeks after he was born.

"Okay, so labor is intense. Extremely intense. But now that it's over, I'm surprised by how do-able it is! Don't get me wrong though, it was the most physically difficult thing I've ever been through. Of course, I only have a few broken bones and some stitches from Mom's sewing scissors compare it to, and it definitely outdid all of those. But your body just . . . works. It knows what to do, and you find yourself just saying, "Okay, here we go!"

I did find myself having moments where I just wanted to cry and curl up into a ball of anguish, but that's what having a fantastic labor coach is for! Mark was so positive and attentive, I was almost surprised he'd never done this before. He didn't even have the help of the nurses . . . they weren't too involved with much of anything. Looking back I am still undecided as to if I ever want to deliver in a hospital again.  The home birth option is looking more and more awesome to me, but that still is a bit scary.

So I woke up at two o'clock in the morning on Saturday with what felt like a stomachache. After trying to sleep for a while, I began to realize that this stomachache was coming and going . . . with those braxton-hicks contractions. I felt so excited and terrified, there's nothing like that feeling of oh-my-gosh-this-is-really-happening?  You can't wait for that baby to get here, but on the other hand you realize that yes, there will definitely be some pain involved. I knew Mark would need to clean the Olive Garden windows that morning (one of his many odd-jobs) and so I didn't want to wake him up if this wasn't real. So I lied there for a while, just waiting to see if they got stronger. They never did, but I timed them and although they were all over the place, sometimes they were as close as two minutes apart. So I woke him up! Mark was thrilled, and didn't say a thing about his BYU game later that day. :) So I told him when contractions started, and he timed them. We did this for about two hours until we both fell asleep. We woke up at about six thirty . . .. what??? I was so confused, I should not have been able to fall asleep if this was real labor! So despite his worries, I sent Mark off to clean windows and spent all morning counting contractions. And all afternoon (while watching the BYU game). And all evening. We went on several walks, which definitely made them closer together and stronger, but then they would calm down once I lied back down.

Finally I started bleeding. Bloody show? It's supposed to be natural when it's real labor, but all my books said that it's just mucus tinged pink, and there was definitely more blood than just a "tinge". So I worried. Mark wasn't as worried, he was very reassuring and sweet . . . but I kept worrying. Finally we layed down to try to go to sleep at about 11 that night, and I  couldn't sleep ... I was very worried.  (And also sick of waiting around, not knowing what was going on.)  So we decided to go to the hospital just to get checked. I knew I wasn't going to have the baby quite yet, but I wanted to make sure my placenta hadn't detached or anything crazy like that. So we grabbed my suitcase "just in case", and drove over.

It was so so so busy there. Apparently the next closest hospital decided not to admit Medi-Cal patients, and so this one was over-crowded. I told them I only wanted to be checked, and they warned me that if I left and tried to come back that they probably wouldn't have any space for me. That was a chance I was willing to take; I had done all sorts of reading and studying and knew what I wanted my birthing experience to be like, and it definitely included being at home as long as I possibly could!

So they took me into the last available laboring room and there told me I was dialated to a three and that they were a little concerned about the baby's heart rate, and wanted to keep me strapped to these machines for about another hour so they could monitor him. I was a little frustrated, being strapped to a bed was absolutely the LAST thing I wanted to do while laboring. But I kept telling myself it would only be for an hour and then I could go back to the comforts of my own home! I wasn't concerned about the heart rate, everyone had told me it was very normal for a baby's heart rate to drop a bit with contractions.  (And of course those opinions were more valid than the nurse's.  ??  But having worked in a facility with patients -- my anorexic girls -- I know that nurses have to be ultra-aware of every bad scenario for liability reasons too.  That was what I kept thinking about at this point, and it was bothering me.)

The nurse who was helping us was very sweet, but I felt like she was kind of confused. They were obviously very busy;we heard two babies being born while waiting. But she finally came in and said that they really felt like it would be best if I just stayed. I understood that the hospital was now liable for us, and that it was ridiculously busy and we might not be able to ever get back in, but I wanted to cry. This was not going according to my plan. She told me I could shift positions a bit, but that I couldn't leave the bed and needed to keep the monitors strapped to me. I kept telling myself it was for the good of the baby, but I also didn't trust the old equipment they had me hooked up to. So the following hours consisted of Mark and I laying there watching t.v., left alone unless I moved, which of course made the monitors not work, so a nurse would come rushing in and adjust it. Mark fell asleep at one point, and my contractions were reeeeeaally starting to hurt. I remembered reading that sitting on a backwards chair and leaning forward really took some pressure off, and though I couldn't get to a chair, I thought I might try it on the bed. Well that attempt ended in four nurses running in, turning on all the lights, startling poor Mark half to death, and a stern chastisement informing me that they thought the baby had gone into cardiac arrest. They adjusted everything and left, and I started to cry. Not what I had planned on.

So Mark suddenly became super-dad and rubbed my head and my feet and my back. We decided to play cards, and since I didn't feel like I could focus enough for Slap Jack, we settled on War. So we played for a good half hour with random breaks as the contractions came. They still weren't regular, but they definitely were beginning to hurt. Then of course a nurse came running in saying she couldn't read me very well in this position, and so I layed back down. And the contractions got worse. Mark tickled my back and got the life squeezed out of his hand as I rocked my knee back and forth, breathing as deeply as I possibly could, which seemed to help. The breathing almost made it feel like I was pushing the contractions downward, so they didn't feel like they were choking me so much.

Finally at five thirty the nurse came in to check me. I was exhausted. I hadn't slept in almost two days, and I was already getting shaky. I was thinking this kid better come soon, because I was worried I would be too tired to push him out! The nurse informed me I was at about a six, and still had a good six or seven hours to go. She asked me if I wanted anything, and I told her about my fear of being too tired to push. She told me she could give me a little bit of something to take the edge off, that it would wear off soon and that she could keep it small so what little bit did get to the baby would be through his system and out of there by the time I had to push. That sounded good to me. She gave me half of a dose of nubane, and it knocked me out. I think I forgot to mention that I am really sensitive to medications.

I slept for two hours, and started to come out of it as the morning shift came on and Mark started to tickle my back again. But I felt like I had been run over by a truck. Like I had taken nyquil or something, and just couldn't focus on anything. The contractions started to bring me back, but between them I would drift off to sleep. The new nurse told me I was at an eight and to move from side to side as the contractions came on, because the baby's heart rate was still an issue. She turned up the monitor really loud, and so the next couple hours were spent listening to that heart rate slow down as my pain went up, and Mark helped me rock from side to side until we found a position that the baby "liked". Gads, I that part feels like a hazy nightmare. I hated feeling so groggy, and really depended on Mark to tell me what to do. Plus there is nothing so horrible as hearing that heart rate get slower and slower . . . . and then miraculously pick back up as I moved. The nurse gave me an oxygen mask to help the baby, which at first I hated and it make my mouth taste horrid, but the couple times it fell off I found myself gasping for air, so I suppose it was worth it.

Eventually the pain of the contractions brought me out of it, and boy could I feel them! Contractions have such a distinct feeling . . . it's really hard to describe. My sister-in-law calls it a menstral cramp on steroids, which is fairly accurate. But that still doesn't quite do it. Anyway, despite how much it hurt, it was still doable.  It just happens, whether or not you think you can do it.

At that point some nurses came in and told us they couldn't find some of my paperwork.  I had been routinely tested for an infection that often comes on at the end of pregancy, and they couldn't find the test results.  Well, I knew very well that I had had no infection of any kind, and told them so.  They said sorry, they needed the paperwork.  So they would just go ahead and give me a whole bunch of antibiotics.  I was quite annoyed that they couldn't find a stupid piece of paper, and already feeling guilty that I had used some narcotic that probably had my little infant feeling quite loopy even still -- and maybe causing allergies, who knew??  The drama in my brain was having a hay-day.  But the intense contractions quite impaired my ability to argue, and even though Mark attempted a bit, they hooked me up to a bunch of antibiotics anyway, and off they went.

The nurse had also told us to call her when I felt the urge to push, which kind of made me nervous because I had no idea what that felt like and worried I wouldn't call her in enough time. But those fears were unfounded, because there is no mistaking that feeling. It's like you have to take the biggest dump of your life! And then you find that pushing actually helps the contractions to not hurt so much, maybe because you're actually doing something, working with it, instead of just trying to take it. 

So we called her, and she didn't come. Two contractions went by with no sign of the nurse, and I did not know what to do! Mark ran out into the hall and found someone, and still another contraction went by until she came. Busy busy hospital. So then the pushing began! Mark helped me grab my knees and the nurse kept shoving around down below, which HURT. I was getting very upset with her. I don't know if she could tell or what, she didn't say much and ended up just standing by the machine for a while. Pushing entailed Mark counting to ten while I acted like I was basically trying to poo, taking a deep breath and doing it again and again until the contraction ended. After about forty-five minutes, the nurse told me to stop. STOP??? She had to be joking . . . I could not fight that urge to push! She said the baby's head was crowning and the doctor wasn't there yet. GAAAAH!!! And so I had a minor freak-out as they told me to just breath, and Mark jumped right in with the "hee-hee-hee" breathing to help guide me. I attempted to do that but I think I was crying too . . . finally, after two contractions like that Dr. Vouis ran in, threw on some scrubs and numbed the perineal area. They told me to push again, and Mark started getting so excited and saying "Allie Allie I see him! He has black curly hair, he's coming he's coming!" And then they told me to push again, push push as hard as you can Mamita!! I feel my face turn purple and in the back of my mind wonder if eyes can explode, and then all of a sudden . . . WHOOSH! It feels like all my guts have fallen out of me, Mark is thrilled and the doctor looks startled, and then suddenly there he is, this bloody, lanky little man lying on my stomach . . . suddenly there are three or four nurses in the room -- where did they come from? -- and everyone is hovering, sucking my guts out of the baby's nose and mouth, Mark is kissing me and shaking -- or is it me? -- and whispering, "Oh he's perfect, Allie you did so good, so good. . ." and then the nurses are saying, "Daddy come cut the cord!" And I think, oh my word this is real . . . that is my son.

Then Mark heads with the nurse into another corner of the room and I watch as they clean him up and check him out. Then another nurse starts kneading my stomach and there are a couple more contractions, but they are nothing compared to anything before, and I hardly noticed them. Turns out the doctor had been in the process of an episiotomy when Mac came flying out, he informed me he had not been expecting him to come all in one push, and therefore I tore like crazy. The repairs took a little longer than I wanted them to, but nothing really matters much at that point, because MacAlister was here, he was healthy, and we are a family!"

eating and drinking

During labor, nearly all hospitals restrict eating and drinking.  It stems from a procedure that is rarely used today, and is quite unnecessary.  Eating and drinking (juice, particularly) will boost your energy and aid you physically, and oftentimes emotionally as well.  Talk to your doctor to see if this will be a possibility.

I just read a really great article about it, and here is the first paragraph to tantalize your tastebuds ...

"The traditional practice of restricting food and fluids during labour does not provide any benefits, finds a new review co-authored by a Queen's University Associate Professor."

Read the rest of the article here.

some definitions

pain·ful  [peyn-fuhl] 

–adjective

1. affected with, causing, or characterized by pain: a painful wound; a painful night; a painful memory.

2. laborious; exacting; difficult: a painful life.

3. Archaic . painstaking; careful.

 

in·tense   /ɪnˈtɛns/ Show Spelled[in-tens] 

–adjective

1. existing or occurring in a high or extreme degree: intense heat.

2. acute, strong, or vehement, as sensations, feelings, or emotions: intense anger.

3. of an extreme kind; very great, as in strength, keenness, severity, or the like: an intense gale.

4. having a characteristic quality in a high degree: The intense sunlight was blinding.

5. strenuous or earnest, as activity, exertion, diligence, or thought: an intense life.

6. exhibiting a high degree of some quality or action.

7. having or showing great strength, strong feeling, or tension, as a person, the face, or language.

8. susceptible to strong emotion; emotional: an intense person.

9. (of color) very deep: intense red.

We've all heard that "Pain is mandatory.  Suffering is optional."  Lately, I heard a new one.  A gal was telling me how she had been so worried that the pain would worsen to the point that she would just loose it; but she said that ended up not being the case at all for her.  She told me it didn't become more painful, just more intense.  There is a difference, and as labor is as much, if not more mental than physical, I think it's important to understand the difference. I highlighted my favorite parts.  Hope it helps you. 

(Used this online dictionary) 

 

the love hormone

Ever heard of oxytocin?

"Oxytocin is a hormone that has effects on brain function. Although it is best known for its role in facilitating labor, delivery, and breast-feeding, it is also important in promoting trust, love, and social recognition." (Quote from this article)

 It is an absolutely enormous part of labor, and being nick-named the love hormone, it is also produced with human touch, intimacy, empathy, and breastfeeding to name a few.  Naturally occurring oxytocin enhances the immediate mother-infant bond, and as the icing on the cake ... it dulls pain!

Therefore, if you are able to start labor spontaneously (without medical induction), you will have a natural pain killer going and you will be greatly helped.  If you are induced, you will be much more likely to require pain medication as you will not have the oxytocin flowing yet and the contractions will likely be extremely intense.

So, if you are contemplating a natural birth, here is one more neat little fact for you to gain a little more confidence in your body's abilities.

mother directed pushing in hospital

There are many different ways to push, though most hospitals automatically do directed pushing.  Some women prefer directed pushing, which works very quickly.  But there are options you should know about.  I was unaware that mother-directed pushing even existed, and relied on my husband and nurses counting it out for me.  I pushed as hard as I possibly could -- appreciating the chance to work with my contractions instead of merely coping -- and tried to get him out quickly.  I did.  I pushed for forty five minutes (which is quite fast for a first-time mom), broke blood vessels in my face, chest, and eyes, (they were all red ... it looked scary) and burst Mac out in one push.  No head and then shoulders; he came out all at once.

 And I tore like crazy.

Next time around, I am going to try to take it slowly, do whatever feels right, and tell my doctor to most definitely NOT numb the perineum; otherwise you can't tell when you've stretched to your limit and need to take a break while your skin catches up.

Watch this great video.

why go natural? part 2

Did you read this post?

Well, I remembered something else; it's quite important.

I was worried about my baby.  I understand that many many children are born by c-section or pain killers and seem to be just fine, but I also knew that most c-section babies are a little slower on developing through the first year of life.  There doesn't seem to be as many long term effects, but I couldn't help but wonder about how many things we do not understand about all of this.  It is definitely not a perfect science; in my mind there isn't much that could actually be labeled as "perfect science".  Most "healthy" trends seem to later be practically condemned; an extreme example of that being tobacco. 

Cesarean sections save the lives of countless mothers and babies, but if we are both fine, why ruin a good thing?  I had the idea in my mind of a chick in an egg.  Most of us have helped to hatch eggs in preschool, and have all learned the importance of letting the chick come out itself.  If we attempt to pull the baby out, the chick will later die as it did not have the opportunity to break through on its own and thereby gain the necessary muscles to live.  Now, babies are not chicks.  And we have enough medical knowledge to be able to help that baby, whatever disadvantages it comes to the world with.

Nevertheless, I wanted to try to give my baby the best chance possible.  A cesarean felt like it should be the absolute last option.  Pain killers I was somewhat mixed on, though it worried me that there have been no studies done on how babies are effected by epidurals.  There is a window of time in which narcotics are considered "safe" during labor, outside of which many side effects have been found.  However, I came to the conclusion that I would do all that I could, and if I felt myself losing it, I would resort to drugs.  Otherwise, I would let the process happen that was meant to happen.

(I wish I had known about doulas.  I would have greatly liked an experienced person to give me a few more options before I made the choice to use a drug.  If you have not yet experienced it, let me tell you: birth is by far the most intense thing you will ever experience in your life.)

why go natural?

I have a good friend who is all about medical delivery.  And a lot of relatives.  This friend and I have had many discussions about birth; as she used to work in labor and delivery, she has a lot of stories to tell.  I really enjoy hearing them, there are just so many different things that happen, and I like to know about as many as I can.  The other day she was telling me about her epidural, and then asked me: "Why wouldn't you get one?"  It's a very good question.  Why would you put yourself through it, if you don't have to?  I'm pretty sure I blundered through something or other, but now that I've had more time to think about it, here is a more thorough attempt to convey the multi-layered thought process that brought me to the desire to experience a more natural birth.

First of all, I must preface by saying that my husband is about finished with chiropractic school.  As a chiropractor, your entire philosophy is that the body takes care of itself.  All you do is get it in line, increase movement and bloodflow, and let the body do its thing.  If that is your mantra, then you must treat the body well.  Since we have come out here, we have done a number of things to improve our health, and I have to say that I am feeling and therefore looking better than I ever have.  I have learned a lot about the body and have really increased my faith in its abilities.

Also, I was terrified of a c-section.  I wanted to have control over how many children I would have, and not have to worry about how many scars I could handle.  I wanted to be able to sit up and walk around with my newborn.  And mostly, I just didn't want to get cut up.  So in my reading, I learned that each intervention given makes you about 50% more likely to receive another intervention, which becomes a spiral ending in a c-section.  On the other hand, I also knew very well that my mom had four children with epidurals as cleanly as easily as could be, and that my aunt had been induced with all six of her children and loved every experience.

However, I really liked the idea of giving myself a shot.  I heard on "The Business of Being Born" a statement that absolutely struck a chord with me: "I didn't feel like it was something to be numbed, it was something to be experienced."  I did not want to miss out on any part of my baby's birth, and while most women respond to the drugs in such a way that perhaps even enhance their experience, I really wanted to do it on my own.  I wanted to see what I could do, and I wanted to do what my body was built to do.  I didn't want to have to stare at a machine to know a contraction was coming.  I didn't want to depend on a clock to tell me when to roll over.  I wanted to bring my baby into the world.

Also, I wanted a quick recovery.  A normal birth -- without tears, or cuts, or swelling, or numbness -- will always be easier to recover from. 

All that aside, I did not check into that hospital one hundred percent sure that I would go without an epidural.  I could not rid myself of the idea that I couldn't take the pain.  I just wanted to see what I was capable of.  I did end up getting some sort of narcotic at about six centimeters, and it took me a while to come out of it.  I hated feeling so out of control.  Eventually the contractions pulled me back to the real world, and I was able to feel it all as my son was born. 

Looking back, I would do it all again.  There would be a few things I would change, but believe it or not, they actually all involve making things more natural.  Good thing I want a few more kids, maybe by the end I'll get it down.

when your water breaks

If by chance you are full term and experience a "gush of water" (verses a slow leak, which would mean your bag of waters is still intact) and contractions have not yet started, you will likely feel excited and terrified and rush off to the hospital as quickly as possible.  Most women have been deeply rooted to the fear of infection. 

But before you head to the hosptial, you need to consider a few things.  Were you wanting a more natural birth, or medial?  What kinds of interventions were you hoping for, or wishing to avoid?  Most hospitals will require an induced labor if you come to them with a ruptured bag of waters.  Most hospital policies require the birth of the baby within 24 hours after the waters have ruptured.  Unless you have discussed this with your doctor beforehand, that is more than likely what you can expect.

Hospitals do this because the ruptured bag of waters has been associated with a prolapsed cord (where the umbilical cord comes out before the head, can get pinched, and block oxygen from the baby), and infection.  A recent medical article states, however, that while fewer infants were admitted to the NICU when labor was induced -- verses starting spontaneously -- there was no significant difference in whether or not the infant developed an infection.  It does not give any details as to why the infants were being admitted to the NICU, but later on it does say that babies born with a premature rupture of the membranes and spontaneous labor will be classified by most hospital policies as "high risk" and therefore go straight to the NICU, with or without any obvious emergency. 

In all cases, whether labor was induced or started on its own, an infection occured in 2-3% of the babies born.  So then, if your waters break and you are not wishing to be induced, it would be a good idea to stay home for a while.  Typically contractions will start withing 24 hours after your water has broken, but sometimes it can take up to a week.

Personally, I wouldn't wait around for an entire week.  The longer you wait, the greater the chance that your baby or you will develop some sort of infection and need to be pumped with antibiotics.  However I would give myself about a day to see where it went.  Of course you should be cautious; no sex, no baths -- unless the tub has been thoroughly scrubbed -- and generally keeping yourself clean. 

Nothing happens immediately; not infections, contractions, or especially the birth of your baby -- so if you are looking to avoid being induced, give yourself some time at home and see what your body does.  If, however, you have been begging your doctor to induce you, you are in luck.  A ruptured bag of waters will undoubtedly get the doctor moving.

There is a fantastic article with more information here:
http://pregnancyandbaby.sheknows.com/blog/labor-birth/if-your-water-breaks-should-you-go-to-the-hospital/

a perfect home birth

My sister-in-law is a huge advocate for home birth, and as she has had such wonderful experiences, I asked her to write a favorite down for me.  This is the email she sent:

"I have had four kids.  The first one in the hospital without any pain medication (six hours of labor), and the next three at home (all of them 30 minutes of labor).  I LOVE the miracle of birth.  Everytime I have a baby my heart is on fire and bursting with joy and wonder at the sight of the beautiful little being.  It is the best feeling!  I love every birth story whether it's hospital or home, epidural or natural.  Whatever the story is, it is a miracle and a new little person meets their family for the first time. 

Allie asked me to share one of my stories and I am happy to do so.  My second child was an unexpected homebirth.  It happened so fast that she was delivered in our bathroom with only my husband to help me.  Everything was okay until the paramedics came in and made a big fiasco.  (Long story for another day). So for our third child we thought about a planned homebirth.  I had all kinds of doubts about it.  However, the more I researched, interviewed, and learned from others the more confident I was that homebirth would be safe and healthy choice for us. 

I chose Chris Miller to be my midwife.  She had been a midwife for 30 years and had helped bring over 2,000 babies into the world safely.  She never lost a baby or a mother.  There wasn't a single symptom, question, or concern that she didn't have the answer to.  She never preassured us and always informed us on our options.  She was more personal and professsional then any other doctor I had had.  Luckily for me, she only lived 7 minutes away. 

One morning I had contractions and she came over just in case things went as fast as my last birth (30 minutes). We set up a birth pool and filled it with really warm water and covered it to make sure it stayed warm.  The contractions weren't hard and they were irregular and far between and faded completely away.  She checked me and I was at a three.  While we were saying she could probably  go home, my water broke.  Immediately my contractions started up and were very intense.  She looked at and felt my belly and told me the baby was posterior (the baby's head was down but facing the wrong direction) so when I got in the birthing pool she had me get on my knees and my upper body on the side of the pool.  This allowed my belly to hang down freely and encourage the baby to turn.  It worked right away.  I love being in the water to labor.  Moving is so much easier while you're semi-floating.  Plus it helps me relax so much more.  (I have used Hypnobirthing with every birth.) 

Soon I felt pressure and I turned to a sitting posotion, layed back a little, and delivered a 9lb 13 oz beautiful baby girl.  The pain was intense, but every time a contraction started I just gave into my body.  Rather than tensing up and fighting the contraction, I just relaxed even more.  My body knew what to do and I tried to let it go ahead and do its thing.  The midwife did her part by making sure the baby's heart rate was good and safe.  So thirty minutes after my water broke, I had a baby in my arms and a fire bursting through my heart. 

While I was loving my baby, Chris Miller was checking things so quietly and smoothly that we were hardly interupted by any of it.  Not all homebirths go so smoothly.  Sometimes Chris has to tell the mother that the labor has come to a risk too great to stay at home and the time has come to go to a hospital.  So she goes with the mother to the hospital and stays with her through it all.  Everyone's goal is a healthy baby and mama.  Most of the time though, hospitals are not needed."

                                                                                                          --Danika

"compare labor to running a marathon"

Taken from a fantastic book titled: "The Birth Partner" by Penny Simkin, PT, CD, DONA founder.

"Childbirth has many similaritites to a marathon or other physical endurance event.  Both include pain and psychological demands for the participant.  Both  require stamina and patience.  Both become much more manageable when the participant is well prepared and flexible and has the following:

• Knowledge of what to expect.
• Prior planning with a knowledgeable guide.
• Physical health and fitness.
• Encouragement and support before and throughout the event.
• Confidence that muscle pain and fatigue are normal side effects of such effort.
• Fluids and adequate nourishment.
• The ability to pace herself.
• The availability of expert medical assistance, in case it is needed.

The meaning of the event (the race or the labor) varies among endurance athletes and childbearing women alike.  For some athletes, running a marathon means not only finishing, but also trying to come in at the front of the pack.  For others, finishing is the goal and the reward.  For some childbearing women, labor and birth mean not only having a baby, but also doing it without medical or surgical intervention.  For others, having the baby is the goal and the reward.

It is true for both athletes and birthing women that if they develop complications, or begin to worry about the tough challenges ahead, or become preoccupied with their pain, or lose confidence, or become overwhelmed, they will have to adjust.  The athlete may have to slow down or drop out; the laboring woman may have to change her plans and rely more on her caregiver to help her give birth in a safe and satisfying way.

The analogy between an endurance sporting event and childbirth breaks down, however, when we look further.  One of the greatest differences is the matter of choice.  Marathon runners do not have to run the race.  They choose to do so.  Healthy pregnant women, however, must go through labor and delivery (or another demanding and painful process -- cesarean delivery) if they are to have a child.  The other enormous difference between the two events is their degree of predictability.  The marathon runner knows when the event will take place and how long the course is, and can study and jog the course ahead of time.  The course doesn't change and is th same for all participants.

The most predictable thing about childbirht is its total unpredictability.  A pregnant woman does not know when it will begin, how long it will take, or how painful it will be, and she certainly does not know whether or how how it might be similar or different from her mother's labors or the labors of other women.  She cannot even be sure she can get a good night's sleep beforehand!  And she certainly cannot predict what her postpartum course will be like.

....[Mothers and] birth partners would like to know exactly what to prepare for, but it is simply not possible to answer these questions precisely.  Variations are inherent in childbirth because each human being and each labor are unique.  The key is to accept the unpredictability and pace yourselves while the labor unfolds." 

Penny then goes on to describe the basic process of labor, something that every woman can indeed count on.  I love this analogy and I love this book; birth is not something that should be feared by the mother or the partner.  Learn all you can, and then trust your body.

doula defined

This is an excerpt from my DONA Birth Doula Workshop manual.  I think it is the best, most simple definition I've found:

"The Greek word 'doula' means 'woman caregiver'.  We now use the word to describe a trained and experienced labor companion who provides the woman and her husband or partner continuous emotional support, physical comfort and assistance in obtaining information before, during and just after childbirth.

A postpartum doula provides care to a family with a newborn baby. 

A birth doula:

• Recognizes birth as a key life experience that the mother will remember all her life.
• Understands the phusiology of birth and the emotional needs of a woman in labor
• Assists the woan and her partner in preparing for and carrying out the plans for the birth.
• Stays by the side of the laboring woman throughout the entire labor.
• Provides emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions.
• Facilitates communication between the laboring woman, her partner, and clinical care providers.
• Perceives her role as one who nurtures and protects the woman's memory of her birth experience.

The acceptance of doulas in maternity care is growing rapidly with the recognition of their important contribution to the improved physical outcomes and emotional well being of mothers and infants."

BABIES - Official Trailer [HD]

I loved this movie. So interesting to see the different perspectives!

a wonderful medical birth

I really like the birth story of my friend Rachel for two reasons:  first and foremost, you can tell by her writing that she felt in control and respected.  Secondly, every intervention was far from routine; it was cleared first by her and went extremely smooth.  I think this is the kind of birth the majority of American women hope for today:

"So on Friday I woke up about 4:30 am with contractions, but they weren't consistent, so I decided to just sleep. They were only about 30ish seconds long so I figured that I had some time, and I had a scheduled doctor's appointment that morning, I would just talk to her then.

D and I had to go to my work to get "health screened" for insurance at 8 that morning, so we went there the whole time with me having contractions. It was kinda funny getting my blood drawn while in labor. D wasn't going to go to the doctor's office with me because it was supposed to be just a normal appointment, but with the contractions and all I asked him to come with me.

When we got to the office, the MA hooked me up to the monitor for the non stress test I had scheduled, 20 minutes later the strip showed that I had been having pretty good contractions (they had gotten to be about 45 seconds long and about 5 minutes apart), so the MA said that she wanted me to wait until the Dr. got there to check me out. Once Dr. Carillo got there, she came in to check my dilation. Just as she got in there to check, my water broke all over her and the table! I felt terrible! D says that I made a very strange noise when my water broke. haha She advised me to dry off (ha! like that is possible) and head over to the hospital. We decided it was easier to walk since it was just across the parking lot. I think I threw up about 3 times before we got to the maternity entrance. After every contraction I would get extremely nauseous! So we got to the hospital, and my Dr. had called in a direct admittance, so I didn't have to go through all the checking in, etc. It felt just like the movies; they came and got me with a wheel chair and took me back to the labor delivery place.

Once in our Labor and Delivery room, they asked if I wanted to have an epidural and I said yes, since I was at a 5 when I was at my Dr's office, and I had no idea how long I would be in labor, I said yes, but I didn't know when I wanted it. I didn't want it right then if I was going to be in labor for hours and hours more, but I did eventually want one. They started the IV and needed to get one bag of IV fluid in me before they could start the epidural. The contractions made me really nauseated and I actually puked really bad on the nurse one time. It got all over her and I felt terrible when that happened. Within an hour of being at the hospital I was dilated from a 5 to a 7 and the nurse kept telling me I sounded like a woman in transition (whatever that means) so they called in the anesthesiologist to get the epidural going since my labor was moving so quickly. I had always been afraid of the epidural hurting, but this guy was amazing!!! He timed it perfectly, I was having a horrible contraction as he asked me to curl my back so he could get the epidural in, he said a few things (I don't remember them since I was in such agonizing pain from the contraction) like, "you'll feel a little pressure," etc. I didn't even feel a thing! After the epidural got flowin, life was so much better. I could still feel the pressure of the contractions, so I knew they were happening, but I was numb from my tummy to about my knees. I could still feel my legs for the most part, so I could hold them up, which was really nice. I have to say that I really am grateful that I was not completely numb. At the beginning of my pregnancy I had actually wanted to give birth naturally, but slowly I had decided that an epidural was the way to go for me. So, having the best of both worlds was great for me, because I could feel all I needed to, but I was not blind with pain.

After I got the epidural, I figured it would be a while, so D decided to go grab some lunch so I could nap a little. After he was gone for about twenty minutes and I had had a few more contractions, I really really felt like I needed to push and I told the nurse that and told her we needed to call D from the cafeteria. After he got back, the nurse checked me again and told me I was "complete" and told me to roll on my side and start pushing because the Dr. would be right there. So I pushed that way for about a half hour when Dr. Carillo came in and started getting ready. The cool thing I had no idea would happen was the half of the bed at the bottom just unhooked and moved out of the way so I would be on my back.

I pushed a few more times (about a half hour more), the whole time having D and the Dr. telling me how much of her head was out, etc. It was very helpful to me to have that knowledge, even though I didn't want to see the actual birth from a mirror; it kept me motivated. After a while of pushing, Dr. Carillo asked if I wanted her to help me and of course I said yes, so she pumped me full of lidocaine and gave me a small episiotomy-she said about 3 mm. And out came Leila! They right away placed her on my belly and she was so perfect! For journals sake, I have to say, afterward Dave told me that he cried when he saw her. I didn't notice because I was too busy staring at my little angel, but he said that he did cry. Which makes me love him more.

The second that I met this girl I knew it was all worth it. I never knew I could love anything or anyone so much. I knew that she would be my whole life and I would do anything for her.

D got to cut the cord. Then they took her away to measure, weigh, etc her. It felt so good to have the whole thing over with and have her here with us, but then I felt like I still needed to push. I told Dr. Carillo that and she told me that I needed to wait a second and then started to pull out the rest of the umbilical cord and let me push out the placenta, etc. That was the real relief. The pressure was finally gone from my abdomen.

We were sent up to recovery pretty quickly after Leila was born and stayed there for the next two days. I think I left the room twice.

We are so happy we have our little girl in our lives now. She is such a blessing to us."

Thank you Rachel, and congratulations!

a historical look at birth

In my doula training, we watched a movie entitled "The Timeless Way".  It was amazing.  Very well done.  I wish I could post clips from the film on here, but I cannot.  For this post, I will be drawing from notes I took from that movie, as well as things we discussed as a class.

In nearly every ancient culture, there was a goddess of birth.  She was a goddess of intense passion, ferocity, and mystery.  Pregnant women were considered to become daughters of this mighty goddess.  In the woman herself lay the power to bring forth the child.  Midwives and birthing assistants did very little besides support the mother, unless difficulties arose.  Today we are lucky to have many interventions that save the lives of women and their babies, but sometimes they are used as a routine, disrupting a process that has worked for hundreds of thousands of years.

When looking at artwork from years passed, across all cultures there are an amazing amount of similarities.  Most notable is that the woman is completely upright.  Whether standing and holding onto the husband -- when he was culturally permitted to attend the birth -- or birthing partner and the midwife kneeling behind, or sitting on some sort of chair or stool with the birthing partner at the head and the midwife at the knee, every culture worked with the aid of gravity and movement.


 It is interesting to note the differences in the artwork as time moved on.  In the 1600's men began to replace midwives, but usually only for the difficult births.  Medical journals consisted of drawings of the woman, the midwife, the birthing companion, and the surrounding area.  A doctor named Witkowski studied birth among the native Americans, and drew many such pictures including postures and facial expressions.  They were wonderful sketches.

As time moved on and these doctors became increasingly skilled at fixing things, the artwork began to change.  Medical journals no longer showed pictures of the birth as a whole, but were extremely compartmentalized.  Typically the woman was completely covered -- even her face -- so that only the birthing canal could be seen.  In any picture where the woman's face was left uncovered, the women appear alone and fearful verses early pictures depicting a fierce, passionate woman. With the rest of the laboring woman ignored, the focus on one specific area allowed doctors to learn much about what happened during birth, which lead to many different interventions.  Here is where we also begin to see women laboring flat on their backs versus upright, now still and working against gravity.

Up through the 1930's midwives still came to the homes of low-income families, but those who could afford it went to the hospitals.  Most women had been told that the pain they suffered during childbirth was a curse stemming from Eve, as she was the first to partake of the forbidden fruit.  When the women's rights movement was well underway, feminist activists demanded the use of newly-developing pain killers.  Most notable was a drug-induced "twilight sleep".

Women did not remember anything about the births, and so thought it was a painless process.  The drug did not actually diminish pain, but it did diminish the mother's memory and ability to control herself. There were many instances where women seemed to go mad and attack doctors and nurses, and so they were blindfolded and tied to the beds.  Babies were kept in the nurseries for several days, until the drug wore off enough that the mother could care for her child.

By 1945 most women were convinced of the safety of hospitals.  The fear of infection drove many to these sterile buildings, and babies were delivered without ever touching another human being's skin for several hours.  They were delivered with rubber gloves, bathed with rubber gloves, and brought to their mother carefully wrapped.

At that point midwives were thoroughly discouraged, even for low-income families.  Many advances were made to save the lives of women and their babies, and birth became a medical instead of natural process.  Husbands were not allowed in rooms until the sixties, when the hippies demanded the right to have their loved ones experience the process with them.

Today midwives are still mostly looked down on in our country, and illegal in some states.  One third of all our births end in c-section.  Out of 224 countries, the US ranked in the 180th spot for infant mortality rate.  The three with the lowest infant mortality rate for the year 2010 were Singapore, Bermuda, and Sweden in that order.  Most American women fear birth, and look to avoid the experience in varying degrees.  That option is available in much safer measures today, and most hospitals allow at least one person in the room during labor.  With all we have learned in the medical field, there have been many advances and we understand the process fairly well. This new-found knowledge has taken the ability from the laboring woman and given it to the machine.  The doctor became trained in everything that could go wrong, and the body is often distrusted and dangerous, switching out the goddess of childbirth for the god of medicine.

However, this knowledge has also improved the ability of midwives and the trust in the body in many countries.  Around the world doctors attend high risk or difficult births, and are there for any woman who may be fearful.  The birth of the family is becoming an extremely controversial event with countless options for those who seek them out.  Whether selecting a midwife or a doctor, laboring alone or with family, make sure you feel confident in your choices so your family can be everything you want it to be.

skin to skin contact

If at all possible, try for immediate skin to skin contact with your baby.

VBAC

Vaginal births after cesarean section seem to be pretty rare, if not looked-down on today.  In my experience, talking to friends, once you've had a cesarean surgery you will always have a cesarean.  It seems to be the way most women think.

If you prefer a repeat cesarean, that is just fine -- again, this is your baby, your birth, your family.  But make sure you have done your research before deciding one way or another.  This is important no matter what you choose; preparing to welcome a second baby into the world after your first was delivered surgically tends to heighten the emotion and tension already present.  You must be confident in what you are deciding to do.

I have a wonderful pamphlet bursting with information that you can order at www.choicesinchildbirth.com, and one article by Nicette Jukelevics MA ICCE deals directly with VBAC.  She says that as recently as 1995, one out of four women with a prior cesarean had a vaginal birth.  Today that has jumped to one in ten.  Why the change?  A frustrating but realistic truth is that obstetricians do meet a lot of resistance with their malpractice insurers to cover a VBAC, and cesareans are quite a bit more profitable.  They must also consider that repeat cesareans are a far simpler procedure than initial cesareans.  For us, there are many fears that have been widely publicized and blown out of proportion.

Probably the most well-known fear with VBAC is that of a uterine rupture.  This actually only happens in 0.01% of women.  Many of us also think that the more children we have or the longer we wait, the weaker and weaker that scar becomes.  This is not true.  If you deliver a child vaginally after a cesarean, your likelihood of delivering vaginally greatly increases with any subsequent children.  This could partially be due to the confidence in your own body's abilities finally won.  When deciding, it would be a good idea to ask what kind of stitching your doctor used when repairing the cut.  My trainer, Ellie Shea, R.N., told us that most doctors do a double-layered suture, but today more and more are doing a single layer to save time.

There are many pros and cons to having a VBAC or a repeat cesarean, and it is important to list them out and rate what matters most to you.  If I were in the situation, this is a list I might make:

VBAC
pros

• Gain confidence in yourself and your body.
• Number of children you want will not depend on the number of times your uterus can be cut and healed
• Time required to heal decreases.
• Opportunity to breastfeed immediately, have skin-to-skin contact, and be able to care for your baby immediately is more likely.
• Fewer visible scars.
• Be an active participant in the birth of your child.

cons

• Fear of a cesarean could slow labor, making cesarean more likely.
• An epidural might be necessary should a quick cesarean be needed (this could be a pro, depending on your point of view).
• Feelings of failure/inadequacy should the labor end with a cesarean.
• If the uterus ruptures, there is a 5% chance the baby will suffer loss of oxygen or death.
• Pitocin and cytotec should not be used, as they can increase the risk of a uterine rupture.  A natural labor decreases the risk of uterine rupture far far below 0.01%.  (Could be a pro, depending on your point of view.)
• Limits your option of hospitals; many refuse to do a VBAC.  A hospital that has access to quick cesarean surgery will be your best option.

REPEAT CESAREAN
pros

• Will not feel labor pains.
• Emotional stability -- when you plan on a cesarean, you will not feel cheated out of a vaginal birth.
• Guaranteed your doctor will be available.
• Can schedule your time around the birth.

cons (taken from the article by Nickette Jukelevics)

• Higher risk of infection, adhesions, intestinal obstruction, chronic pain, ectopic pregnancy and placental problems compared to mothers who have a successful VBAC.
• Increased risk for hemorrhage severe enough to require a blood transfusion due to placental problems from accumulating cesareans.
• Higher likelihood of being re-hospitalized for complications related to the surgury
• Decreased fertility and increased risk of miscarriage in future pregnancies
• Greater likelihood of difficulty with mother-infant attachment as well as establishing and continuing breastfeeding.
• Elevated risk for prematurity and serious neonatal respiratory problems in baby.

There is a lot to contemplate when deciding on a VBAC or repeat cesarean.  Once again, I cannot stress enough the importance of doing your own research so you can feel confident in the choice you made.  However your baby enters the world, there will always be risks.  Should something happen, more than anything, the baby will need you.  Be sure that you are emotionally and physically taken care of, so you can take care of that little one.

Websites with more information:
http://www.pregnancytoday.com/articles/complications-cesareans/the-pros-and-cons-of-vbac-4853/
http://www.dangersofcesareanbirth.com
http://www.vbac.com
http://www.childbirthconnection.com
  

a thought on caregivers

When choosing your obstetrician or midwife, keep in mind that he or she is indeed human, and has a certain way that he is comfortable about doing things.  It really is important to find one that is in line and comfortable with the type of birth you are expecting.  If you wanted a c-section, you wouldn't go to a doctor or midwife without any surgical experience.  Likewise if you are leaning toward the more normal route, you aren't going to want a doctor who flies into surgery at the drop of a hat.

My doctor was known as king of c-sections.  He was very skilled at what he did.  I did not end up with an c-section, but I had an episiotomy.  It wasn't what I had in mind, but it was what he felt was best, and everything turned out alright.  Just know that every doctor has a process that they use to go through birth, and every hospital has a procedure.  Get to know yours before deciding if it's a good fit for you.

doula research

DONA (Doulas of North America), an international organization, has a fantastic in-depth description of what doulas are.  Read it here.

This is an excerpt describing the research behind doula care.

"In the late 1970s, when Drs. John Kennell and Marshall Klaus investigated ways to enhance maternal-infant bonding they found, almost accidentally, that introducing a doula into the labor room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications.(6,7) Since their original studies, published in 1980 and 1986, numerous scientific trials have been conducted in many countries comparing usual care with usual care plus a doula.

Table 1 summarizes the findings of North American trials and a meta-analysis of all trials of continuous labor support.(12) Obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas in settings where the women had no loved ones present, the intervention rates were routinely high (as indicated by the data for the control groups) and the doulas were not health care professionals.


Results of 7 North American Trials of Labor Support including 2259 women
(comparing continuous labor support by doulas with usual care)

Author Year (# subjects)	Cesarean Rate	Oxytocin Use	Epidural Rate	Narcotics Use	Instrumental Delivery	Maternal Emotional Distress	5 min. Apgar <7 NICU
Cogan (13) 1988 (25)	N.A.	No diff	N.A.	decrease	N.A.	N.A.	decrease
Hodnett (14) 1989 (103)	No diff	increase	N.A.	decrease	No diff	N.A.	N.A.
Kennell (7) 1991(616)	decrease	decrease	decrease	No diff	decrease	N.A.	decrease
Kennell (8) 1993 (570)	decrease	N.A.	No diff	N.A.	N.A.	N.A.	N.A.
Gordon (15) 1999 (314)	No diff	No diff	decrease	No diff	No diff	decrease	N.A.
McGrath (9) 1999 (531)	decrease	decrease	decrease	decrease	No diff	N.A.	N.A.
Trueba (16) 2000 (100)	decrease	decrease	decrease	N.A.	N.A.	N.A.	N.A.

KEY: No diff- no statistically significant difference between groups;N.A. – not assessed; increase – statistically significant increase in the supported group; decrease – statistically significant decrease in the supported group.

The results of 3 North American Trials 3, 17, 18 including 8052 women (comparing continuous labor support by NURSES – not doulas – with usual care) showed no differences in any outcomes listed in Table 1.
Findings of Hodnett’s et al meta-analysis of 15 trials from N. America, Europe, and Africa(10)

Women cared for during labor by a birth doula, compared to those receiving usual care were

• 26% less likely to give birth by cesarean section
• 41% less likely to give birth with a vacuum extractor or forceps
• 28% less likely to use any analgesia or anesthesia
• 33% less likely to be dissatisfied or negatively rate their birth experience"

"The Business of Being Born" 2007 Trailer

Dani turned me on to this movie ... amazing. It is a great new perspective on your birthing options.  Most of what is in this movie people haven't heard of before ... definitely worth watching to at least learn a little more.

labor pains

More and more women seem to be exploring the option of a natural birth for their child.  Excuse me ... we'll call it normal childbirth instead of natural, as normal includes the use of minimal hospital interventions, which are sometimes needed and even life-saving.  We are learning that normal birth is healthier for us women and our babies, that birth is indeed a perfect process in and of itself without our human meddling, and that major abdominal surgery is just that: major abdominal surgery.

But cesarean rates are still climbing; today one in three women will end up with one.  We know that any medical intervention -- induction, pitocin, epidural, etc. -- greatly increases the likelihood that a cesarean will be necessary.  So why don't we abandon it all and welcome that little one into the world the way nature made us to?  Well, it's simple, really.

Pain.

Pain, pain, pain.  For a woman without high risks, it generally boils down to pain.  As women, we hear over and over again how hard and how painful it is.  In my growing-up years, most of the experienced women I knew had epidurals, and so from what I heard, any feeling of anything most definitely felt painful, especially in comparison to the blissful state of numb.  Epidurals do not last forever, and so at some point something will likely be felt.  How could I not be scared?  I learned about the process, I obsessively watched the births that were dramatic enough to make the cut to Baby Story on TLC, and asked everyone I knew what birth was like.  "Like a cramp on steroids."  "Like knives cutting you up from the inside out." "Ring of fire!"  These were all common responses I heard.  I went into the birth of my son scared but determined to push through, my brain completely muddled as to the decision of medication.  I knew narcotics could effect my baby and make me drowsy.  I knew epidurals could slow labor, keep me from being able to push like I should, give me a 50% greater chance of a c-section (which I was mortally terrified of), and in rare cases cause breathing problems, nerve damage, or heart damage.  (Most recently I learned that there is no real research on the effect epidurals have on infants. Why ...??)  But more than all of that, I knew it would hurt.

There were, however, two women in my life who told me it really wasn't that bad.  They said in was hard for sure, but really not that painful.  Were they superwomen?  Insane?  They both ended up doing home births for a couple of their kids, so in my mind they might have been.  Did they just have the perfect hips/uterus/cervix to birth a child?  Maybe.  But I think something else came to play.  I think, more than anything, it was their perspective.  They knew what birth was in its entirety and planned to just do it.

According to my handy-dandy DONA workbook, under periods of stress men are instinctively geared to resort to "fight or flight".  We've all heard of that.  But according to this, women resort to "tend and befriend" (meaning protect offspring and seek supportive networks).  That's new to me, but it makes a lot of sense.  This has some major effects on our bodies:  dilated pupils, increased oxygen uptake, blood supply taken from internal organs and pumped to the muscle, increase in heart rate, increase in blood sugar, and an increase in estrogen.  If you are in labor, this results in:

• Decrease in blood flow to uterus
• Decrease in uterine contractions
• Increase in duration of first stage of labor
• Decrease in blood flow to placenta
• Increase in fetal production of catecholamines, which results in fetal conservation of oxygen and heart rate deceleration
• Increase in negative perception of events by woman
• Increase in need for reassurance and support
• "Fetal ejection reflex" (rapid expulsion of the fetus)

Crazy, right?  In the beginning of labor, too much anxiety stops it altogether.  That makes sense though.  If you're a neanderthal in labor and a sabor tooth tiger shows up, you're going to want to run away.  If your today's woman and you get to the big hospital and feel more nervous than comforted, your body will have the same effect.  In either case, anxiety equals more pain.

Is there any way we can conquer that cycle?   Two ways:  numb the pain, or calm the mind.  Every woman has to make her own choice; the birth will be whatever she says it is.  If it's wonderful because she couldn't feel anything, or wonderful because she brought that baby into the world with her very own body, it's still wonderful.  We are lucky enough to live in a time where we can choose between the two.

But for those that want to do it themselves, it's a bit trickier.  My training as a doula involves all sorts of massage, encouragement, and information.  To get the first two, you'll have to hire a doula (or convince your partner to study and practice like mad).  But the whole purpose of this blog of mine is to share some of that information.  So let me share two things that really changed my perception of pain.

First is that the perception of pain is just that, a perception.  It is completely in your head.  There are all sorts of classes like hypnobreathing, lamaze, and yoga that help prepare you to respond to the contractions in a more positive way.  Ellie Shea, my trainer said to us:  "It seems our society really fears pain.  Which is interesting, because they will go through all sorts of pain to run a marathon, or even just to go to the gym.  Pain in childbirth is more similar to that than anything else."   She also talked about a doula who's client started voicing frustration at how hard it was, and her doula replied: "They don't call it labor for nothing."  Which is true; it is hard, hard work.  But it is just that: work.  Work your body is built to do.

That brings me to my second point: your body is built to give birth.  It just is.  I happen to be a religious person, but if you are not, call it nature or the cosmos or whatever -- we have been created to be able to give birth.  It's just part of life for us, ladies.  Birth is a perfect process, every part of it was put in for a reason.  When you are in labor and your back aches, move.  It's usually the baby trying to get in the right position.  If squatting on something relieves some pain, do it.  It could be that it's opening up your pelvis.  Labor pains are pains with a purpose.  They get you somewhere.  Somewhere a lot more important than the finish line of a marathon.

So, as cliche as it sounds, trust your body.  Expect it will be hard.  But know that you can do it, however you decide to.  Don't be afraid.  That baby needs you to be confident, empowered, and full of love.  You are about go through the most intense moment of your life, physically and mentally.  The life of you, your partner, and your little one changes forever.  Human beings are incredibly resilient and can bounce back from anything, but your family deserves to start out right.