a couple thoughts on vbacs

My opinion is that in nearly every case of a physically healthy and mentally prepared pregnant woman, a vaginal birth is completely achievable after a previous cesarean section.  If you don't believe that, then you probably shouldn't try it.  It might be too stressful to be a good experience for anyone.

The one thing I hear people are worried about when attempting a VBAC is that their incision will burst.  There was a time when this did happen to multiple women; and it can be deadly for both the baby and the mother.  But according to my doula instructor (who is also a nurse ... among countless other things), this happened because doctors began trying out cytotec.

Cytotec is a drug that was made for a completely different purpose, but someone noticed that it caused horrifically strong contractions in pregnant women.  Stronger contraction will get the baby out quicker, right?  Well, whether or not that is true, your body can only handle so much.  A weight lifter can only lift so much before they will tear something.  A runner can only run so hard before they will collapse.  And your uterus was built to handle a certain amount of stress.  Drugs can do all sorts of crazy things to make your body change and/or simply ignore the limits that exist to protect it.  While this can be quite useful, it can also be deadly ... as in this case.  This drug caused contractions so strong that the incision burst in laboring women, and also wreaked some serious havoc on those without an incision.

Cytotec now has "Not for Pregnant Women" all over it's labeling, as was shown to me by a midwife recently.  She told me she keeps it on hand in case a woman is bleeding uncontrollably after the birth ... the contractions will close up the uterus and hopefully help stop the bleeding.  "It's something we would do as we were calling 911 at the same time ... I never use it otherwise."

Another newer trend that is contributing to the VBAC fear is that some doctors are favoring a single row of stitches in the uterus, instead of the previously required a double row.  The reasoning is that it is much faster; less time bleeding and having your insides on the outside.  Is it really better?  I don't know, but from what I've been told it's not widely accepted.

Whatever method your doctor may have used in the past, you can't do much about it now.  But there is a lot you can do.  Stay healthy.  Walk, walk, walk.  And learn everything you can.  Read "Understanding the Dangers of Cesarean Birth: Making Informed Decisions".  Scour these websites:
www.dangersofcesareanbirth.com
www.vbac.com
www.childbirthconnection.com

Take control.  Nothing contributes to a successful VBAC more than a prepared, positive mother.

another wonderful VBAC

My sweet friend Chelsea called me a few times throughout her pregnancy to discuss a VBAC.  She was excited, terrified, and seriously wanting one.  Though she did wait till the end to make her final decision, once her doctor expressed some real support, she was gung-ho.  She had a beautiful experience and said I could share her family blog post about it here:

"I want to hurry and type my whole story out before I forget all of the little details. I like details. In fact, expect this to be way too long, full of things that no one really needs to know but that I can't help to include.

So a week ago, I was sitting in my doctor's office and told that it would probably be another week or so, but that I would most likely deliver Nolan before his August 13th due date. I was super excited until I did a little research and found that most women stay dilated 3 to 4 cm for weeks and that I shouldn't get my hopes up to be any different. 

36.3 weeks, the day I went into labor

I stubbornly stuck to my work-outs, hoping that it'd help further some cervical change. On Sunday, I *ahem* had some alone time with my hubby. Sometime later, I had the strangest sensation as my mucus plug worked it's way out. That did not happen with Boston and even though it was kind of exciting, it was mostly really gross. I noticed some strong pressure and what I thought could be contractions almost immediately afterward. Again, some scouting around on the internet and asking my trusted doula friend told me that it was common to lose your plug and it could mean labor within the next 24 hours or not for another month.

I debated whether I was just having false labor or if I should go get things checked out. My doc told me that once I started having contractions, I shouldn't sit around at home but go right in. He made it sound like things would happen pretty fast. We had dinner plans with my family that evening and I decided that if these pains continued for a couple of hours, we'd hit up L&D afterward for a quick check. 

So to dinner we went, where I told everyone what was going on and got lots of cheers that "a baby was coming tonight!" No pressure. Haha. I still wasn't convinced that it was true labor until the night wore on and when I couldn't stand without fidgeting in pain, it was time to go and pay a visit to labor and delivery.

We went home and got my bag packed, just in case. It was something I put off doing because I was only 36 weeks (and 3 days) along. I still had plenty of time, I thought! We live like a block away from the hospital and thought that since they were going to send us home anyway, we might as well just walk over. In fact, my mother in law joked that we should leave my bag...being unprepared meant they would keep me. Sage advice. :) So we kissed Boston good-night and told everyone we'd see them soon.

Walking up to the nurses, I felt so dumb. I explained that while I was probably just having false labor, I wanted to get checked and be assured so that I could try and get some sleep that night. They were totally obliging and led us back to none other than the room I labored in with Boston. Deja vu! Or bad luck, I can't decide.

One uncomfortable exam later and the nurse declares I'm at 5 cm. So wait, I'm really in labor?? Now what? Then she lays the bad news on me: Dr. W is unreachable until Monday afternoon. The on-call OB, Dr. P, doesn't do VBACS. Ever. Are you bleepin' kidding me?! Since I'm pretty far dilated, I'm not quite allowed to leave yet. She says Dr. P. wants me to hang out for two hours to see if I progress. If no change, I could go home but if I dilated further, then we would be completely at the mercy of Dr. P and what he wanted to do.

While my original plan was to walk and move for as long as I could, now I was determined to make labor stop! I sat in a bath for 40 minutes, willing my baby not to come until Dr. W was back. Then I laid on the bed in an almost comatose state for the rest of the time. Thinking I had succeeded, the nurse comes back and tells me (almost grimly) that I'm now a 7! Wow, doing nothing moved me that far along?! Pretty cool, but then dreadful as I realize this means I'm stuck with Dr P. I beg and plead for her to call Dr. W, pretend I'm a four and let me go, tell her I refuse to sign a c-section waver. She nods at me empathetically and says we just have to wait and see what Dr. P wants to do.

I can't remember how long we waited for the answer, but I divided the time between crying in despair to Shane (I'd worked so hard for this labor!) and contemplating an escape plan. Shane comforted me and gave me such a wonderful blessing. I could feel his faith in Heavenly Father and in me as he blessed things to go well.

Profound relief and even excitement came when the nurse said Dr. P would allow me a trial of labor (I later found out that it was the nurses who championed my cause and talked Dr. P into giving me a shot, bless their souls!!) I can so do this! was the mantra in my head. It was probably close to midnight when I was officially admitted, tethered to an i.v. and roaming up and down the halls. I was amazed at how little my pain was. Part of me was nervous that things were too easy and something bad was approaching, the everlasting cynic in me I guess.

At one a.m. I reached 8 cm and decided that it was probably a good time for the epidural. I was required to have one, but wanted to wait as long as I could before getting it. I wasn't in a whole lot of pain but wanted a restful sleep before all the action began.

The epidural was a little more painful than I remember. So many strange sensations. My back is still aching from it. But I did start to feel tired and heavy. The annoying thing was every time I'd drift into sleep, my evil angst-ridden side would nag me awake with worries that my contractions weren't strong enough and that I'd get stuck at a 9 again. That I'd end up back in the OR. This went on for hours.

At 4 a.m. I'd reached a 9 but still wasn't all the way effaced and baby was still at 0 station. My contractions were a little bit weak since he wasn't putting much pressure on my cervix. My bag of waters was still in tact and I kept wondering when they would break it since I was so far dilated.

Two, three, seven hours later...no change. I was in a bit of a state of weepiness and despair as I felt the all-too-familiar stall of labor. I cursed that stupid room where the same thing happened two years ago, I cursed the doctor for not being my doctor (he hadn't been in to see me once!), I felt my fantasy of pushing my baby out and holding him on my chest slipping rapidly away.

Well, my second most-amazing nurse of the day refused to let me get discouraged. Coincidentally, she had had a VBAC herself and reassured me that we weren't out of options yet. Finally, at 11 a.m., Dr. P came and ruptured my membranes. Contractions and pressure increased but not quite enough and an hour later I was given a low-dose of Pitocen. OH MAMA those contractions picked right up. When I was given the epidural, I requested it low enough that I could move my legs and feel the contractions while my nether region stayed nice and numb, but when those transition contractions started coming every minute or so, I began pushing my epi button like there was no tomorrow. Eventually the anisthesiologist came in after hearing my animalistic cries of labor down the hall and gave me not one, but two more doses! I remember my mind being divided between trying to focus on the baby moving down the birth canal and doubting myself that I could go through with this as each contraction peaked. I had Shane on one side trying to rub my arm, my leg, my head to calm me and my mom on the other trying to get me to "Ommm" the right way. Haha, bless her heart, she thought that if I got my vibrations just right there'd be no pain. I almost chucked the tennis ball I was clutching at her.

I'll never forget the utter joy and shock I felt when my nurse annouced I was 10 cm and fully effaced! Tears literally ran down my face. The anisthesiologist said my pain shouldn't be making me cry after two doses of medicine, but I just laughed and told him I was so happy! I'd gotten past the dreaded 9! It worked, even though a big part of me doubted I'd ever see this point! And it was time to push.

Can I just say to ladies who are pregnant: exercise, especially yoga, works!!! I know that's what gave me the strength to be able to push effectively after being through such a long labor and being extremely exhausted. Ok, and it doesn't hurt if your baby is tiny. Once I got over my self-consciousness (I was convinced I'd be one of those mothers who poops all over, scarring and eternally turning off my husband), I pushed like an Amazon woman. The doc did end up giving me an episiotomy (ouuuuch!) but little Nolan's head crowned after about 20 minutes of pushing. Dr. P told me to stop and pretty much just lie there, which was SO hard! I didn't know at the time, but the cord was wrapped around his neck twice and he was a scary shade of blue. Luckily, Dr. P was quick to get it cut (sad for Shane that he once again missed out on cutting the cord) and to pull Nolan the rest of the way out. He went straight to the NICU nurses while I strained to look at him through the afterbirth and stitching up of tender areas.

Thankfully, baby was given a clean bill of health and I got to meet my teeny tiny bundle. A priceless moment, to say the least.

It was such an incredible experience that I'll cherish forever. I'm so thankful to have been able to have the delivery I dreamed about and that everything came together to make that possible. Our bodies are truly amazing, especially if we do all we can to help them out. And modern medicine is such a blessing. There is a fine balance between too much intervention and just enough to enable a successful delivery. The first time I believe I was on the wrong side of that balance whereas this time I wouldn't have been able to do a VBAC without it."

a friend's VBAC birth

A friend of mine recently had her second baby.  The birth of her firstborn son ended up being quite traumatic, and set a fire under her to make sure the birth of their next would be an enjoyable experience.  She took control of everything she could, and welcomed her second son into the world calmly and smoothly.

Because of her mindset and her preparation, she was able to have just the birth she wanted.  Here is an email she sent me with a few details about her VBAC:

"My first baby was an emergency c-section that I had to be put completely out for. I literally wasn't there for the birth of my first child and that event alone had a tremendous effect on how I bonded with my first baby. When I got pregnant the second time, I made up my mind then and there that I was going to try for a VBAC. Many O.B. docs won't even perform VBACs so I approached my doctor cautiously since I wasn't sure what his stance was on the matter. I told him what I wanted to do and he was on board from moment one. I was tremendously lucky getting a doctor who was behind my choice to try for a VBAC.
           I grilled him over and over again about exactly what I could do to increase my chances of having a successful VBAC. He said keeping the weight down and exercising were the only things that I could control. During my first pregnancy, I gained an extreme amount of weight and was fairly unhealthy to start out with. So for this pregnancy, I kept my weight gain down, only gaining about 30 pounds during the whole process. I walked at least 2 miles a day on top of that. At every appointment, I reminded him that I had my mind made up to do this VBAC.
My resolve faltered minutely when the nurse handed me the paperwork I had to sign that listed all of the repercussions that could come from my choice to deliver how I wanted to. It was two whole pages outlining the various and sundry ways I could die. I actually didn't even finish reading the forms. Childbirth is risky. It has been since childbirth started. I trusted my doctor. He said I was a good candidate because of my physical shape and mindset and I believed him. So I didn't even finish reading the forms.
           I started having labor pains on Sunday and spent Monday and Tuesday walking, walking, walking. I knew that the more I walked, the more the baby could drop into the right position for a natural birth. Even at the hospital, I put off getting the epidural so I could walk around more. Getting an epidural too soon ups the risk of needing a c-section. I walked until the pain was almost overwhelming and then got the epidural.
           The VBAC went great and I am so glad I did it. It was the birth experience that I wanted. Even now when I mention to anyone who knows a lot about childbirth - doctors, nurses, doulas, etc. - they always call me brave for trying it. It is risky and I truly wouldn't have put myself and my baby in danger if I hadn't been the absolute best candidate for a VBAC. My advice to anyone thinking about trying for a VBAC is to MAKE SURE your doctor is fully behind letting you try, be in good health, keep weight gain to a minimum, exercise as much as you can and wait for a good long time between pregnancies (I waited three years).
Good luck!!!"

that first time breastfeeding

Breastfeeding is incredibly, significantly, enormously important.  The benefits of breast milk compared to formula are vast, ranging from the actual physical and mental health of your child and yourself to the amount of money you're spending every month.  Learn all about breastfeeding here at La Leche League.  There are consultants across the world who can help out if you are in need.  Try for at least two months; it takes about that long to get into a good routine.

The best time to start breastfeeding is immediately after birth.  After that doctor places your little one onto your stomach and you and your husband have had a bit of oohing and cuddling, start watching for your baby to open his mouth, stick our his tongue, or move his head from side to side. Most babies will do this almost immediately.

Those first few moments after birth are quite important in your baby's life.  They are incredibly alert and awake ... you will find after a couple of hours and then for the following few months your baby will practically want to sleep his young life away.  But for those first moments, your baby will typically be wide-eyed as he takes in your face and your husband's for the first time.  Use those precious minutes to look him in the eye, to touch him skin to skin, and to start working on breastfeeding.

Some babies catch on almost immediately.  For others, it takes a bit of practice.  Remember you aren't the only person who is new at this; your little one is a first-timer as well.  Most hospitals will have a breastfeeding specialist on hand to help with whatever you need.  Ask for them.  Get all the advice you can.  When you get home, call La Leche League if you have more questions.  Talk to friends.  Look things up.  And read this simple list of tips here.

Breast feeding, like birth, is something your body is built for.  Some women face unforeseen problems and are blessed to have the option of formula, but for the vast majority breast feeding is the best way to help your baby to grow into everything he could be.  Work at it.  Make it a serious goal.  One day nursing ends too, just like pregnancy and just like childhood.  You won't regret giving it your all.

ask for your bishop's score

Score	Dilatation	Effacement	Station	Position	Consistency
0	closed	– 30%	-3	Posterior	Firm
1	1 – 2 cm	40 – 50%	-2	Mid-position	Moderately Firm
2	3 – 4 cm	60 – 70%	-1	Anterior	Soft
3	5+ cm	80+%	+1

Have you ever heard of the Bishop's Score?  It's a tallying system most doctors use before inducing labor.  Your score will tell you how likely it is that the induction will work and that you will have a successful normal delivery.  

This table is analyzing the readiness of your cervix for labor.  It measures the dilation, effacement (how thick it is), the station of the baby (how low is he/she; are they sitting on your cervix?  This helps with dilation), the position of your cervix (your cervix rotates till it is in line with your vagina before you will give birth), and the consistency of it.  A score is given to each area, and then are added up.  If you get a 9 or higher, you are in good shape.  3 or lower could be trouble.

If your doctor decides the benefits for you and your baby are better by ending the pregnancy than letting it continue, first ask what your bishop's score is.  This will help you determine if you are okay with an induction or not.  If your score is low, you might be headed for a cesarean section.

All healthy births are good births, just make sure you are prepared so you will not be taken by surprise and can comfortably and happily take care of your little one when they finally come to the big outside world.

There's a good little article on the bishop's score here.

after having a little experience under my belt ...

I have now attended five births; three of which I served as the actual paid doula.

I absolutely love this.

It is such an honor to be asked to participate in such a moving, life-changing moment in a young family's life; and to be trusted that you will bring something positive and vital to the experience.  I am in awe of the strength and will of the mothers as they work with their bodies to bring these little ones into their open arms.  I adore the doting fathers; all of those I worked with were excited, nervous, and itching to find a way to work with his wife and lighten her load.  I remember one man after his wife decided to get an epidural.  She went straight to sleep, and he stood next to her, watching her breath.  Finally, after a few minutes, he turned to me and said, "Is there anything you would suggest I could do for her right now?"

The love and the raw emotion that surrounds this event are positively gripping; I won't lie, I shed a slight tear or two at every single birth.  It has been amazing to me how focused and consumed the parents will be with the hard work of labor; the atmosphere is generally quiet, inward, and intense.  But then, when that little one finally comes out, all intensity vanishes.  Laughter, tears, and gasps are all that remain.

Is there anything more holy than watching that little threesome gaze into each others' eyes, marveling in every little bit of each person?  I surely can't think of much.

I am so incredibly grateful to have this experience, to know that I have done some good in the world, and have gained so much more in return.

I pray that I will continue to have these opportunities to serve.

my current resume

Allison Gunn                                         Resume

Trained doula                                                                                             435 512 4861

            The family unit is the fundamental unit of human society.  I am a firm

            believer that if things are well in the home, it trickles out to create a

            world-wide effect of peace.  There are many elements to creating that

            loving home, but I have decided to aide in the beginning of that family.

            Through emotional support, physical comfort measures, and non-biased

            information,  I believe I can help couples achieve a positive experience

            in the birth of their little one, and therefore feel more empowered

            and confident in their own abilities to raise and love that child to the

            best of their abilities.

Completed Doula Training Oct. 3 2010 Trainer: Ellie Shea RN, CD, HBE, BSN (310) 326-2764 

A s   y o u r   d o u l a,   I   c a n   p r o v i d e :

Basic Massage                                             Infant Wrapping

Information                                                    Help with Hypnobirthing

Training for your partner                             Breathing Techniques

Birthing Ball                                                  Breastfeeding Tips

Photos                                                           One on One Meetings

Your child’s Birth Story                               Resources you might find helpful

B  a  c  k  g  r  o  u  n  d :

MOTHER OF ONE – To MacAlister Gunn, born September 13, 2009

CHIROPRACTIC  ASSISTANT – Holland Chiropractic

Dr. John Holland                   

562 694 8347                         

How does this apply to my doula work?

This job enabled me to do more hands-on work with the patient’s body than I had previously been able to.  I also thoroughly enjoyed the “natural” atmosphere and learned much about the body’s ability to heal itself.

DIRECT CARE SUPERVISOR – Avalon Hills

Doriann Pye-Petersen            

 435 753 3686                        

How does this apply to my doula work?

Here I learned much about the complexity of the female mind, and the power therein.  I watched these girls overcome incredible things, and was amazed by the abilities we posses when we are determined, informed, and loved.

PHYSICAL THERAPY AIDE – Mt. West Physical Therapy

Brad Thomas PT                    

435 755 0781                         

How does this apply to my doula work?

This job was my intro the workings of the human body.  I witnessed people come back from some incredibly difficult circumstances, and learned that a little movement can go a long way in helping the body perform the functions needed.

a beautiful normal birth

When I went to a hypnobirthing class several months ago, I met a beautiful gal named Laura.  I could immediately sense her kindness and calmness and liked her very much.  She would be using a midwife for the birth of her second child, and was very excited about the whole prospect.  She was quite the advocate of home birth to the other couples in the group.

She also talked a lot about getting to know your baby before he or she enters this world.  Talking to him or her, using their name, and getting your husband and siblings all involved was a big deal to her, and it seemed to work wonders with her first child.  I loved the idea of it.

She wrote an article about her birth and posted it.  It is a fantastic birth story; the kind people should most definitely read as it can greatly add to your confidence in your own birthing abilities!

Read Laura's birth story here:

http://www.dailybreeze.com/news/ci_18129253

olive's homebirth/waterbirth

Have you ever thought of waterbirth?

I'm learning all sorts of incredible things. Water has quite the calming effect; it adds the feeling of weightlessness and it generally allows your perineum to stretch a little better. Read more about waterbirth here:

http://www.waterbirth.org/mc/page.do;jsessionid=FFDA4740F8C79DE4D0288D0CD7B52E29.mc1?sitePageId=38425

aromatherapy

Aromatherapy is a great resource for labor!  Most doulas will have massage oils with essential oils in them, but you might want to look into what scents you prefer and what feels most relaxing to you.

A great basic recipe for massage oil during labor:

Ten drops of clary sage, five drops of rose, five drops of ylang-ylang mixed in 2 fl oz (10 tsp) of sweet almond oil.

Look a little more into aromatherapy here:
http://www.birthsource.com/scripts/article.asp?articleid=45

work with your baby

I am currently reading "The Gentle Greeting" by Ronald L. Cole.  It's an older book (published 1998), but it has a lot of great advice in it; especially if you are new to the idea of natural childbirth.

There is one tip in here that I have read in just about every childbirth book or class I have come across so far.  He says that during labor you should:

"Steer your mind away from fearful thoughts.  Work with your baby; assure your child that all will be well.  Picture yourself and your baby feeling ready and working together for a smooth delivery.  Picture your baby entering the world gently to a loving reception.  Picture yourself holding your healthy baby, rewarded by the effort it has taken you both."

Hypnobirthing classes and the "Birthing From Within" book also talked a lot about working with your unborn child.  They are a living human soul as well, and this is as much of an ordeal for them as it will be for you.  Everything I have read has mentioned at one point or another to talk with your baby; encourage him to move down and get ready to greet the world.  It sounds a little silly, but there are some amazing stories regarding this communication between the parents and the unborn child.

Visualizing this, or being reminded to work with your baby can be really helpful in labor.  Some women find it distracting, however.  As with nearly all techniques, you'll never really know till you're actually in labor.  The trick is to be flexible!

terminology

The hypnobirthing classes I attended spent a good deal of time talking about the importance of the terms used throughout labor.  Our understanding of different words translates directly to our bodies; who doesn't get tense when they hear the word "contraction"?  So much of our language is communicated through our bodies.  Likewise, much of our language is absorbed through our bodies.  Here are a few different word choices you might chose (or at least think about) during labor:

• Contraction = Surge.  Some call it a wave.  It ebbs and flows, and if you can release and let your uterus do what it was designed to do instead of tensing up (as "contract" suggests) your birth will be much smoother.
• Birth Coach = Birth Companion.  Usually shouting sports-like encouragement is not very helpful, especially if it is coming from one who doesn't have much experience with it.  You should go through birth together, as companions; seperate individuals and a unified partnership.
• Delivered = Birthed.  No one is delivering you, or the baby.  You are giving birth to that child.  Your body is bringing that tiny human being into the world.
• Bear Down = Breathe Down.  In those final, emotional moments of labor, it is essential to be able to keep yourself open.  "Breathing" down down suggests a more relaxed approach, giving the baby more oxygen, keep the pelvic floor flexible, and giving the body time to adjust.  "Bearing" down brings to mind the capillary-bursting, oxygen-depriving method of holding your breath for ten straight seconds.
• Birth Plan = Birth Preferences.  No birth ever goes according to plan.  The more you can let go and let your body take its course, the more successful you will be.  That does not mean, however, that you should not do your own research and let the staff assisting you know what your ideal birth would look like. 

The fact is that some women do not have pain during birth.  Most of us do; we are conditioned to fear it, our bodies are generally weak, and we do not believe in our own abilities.  Whether we chose to remedy those stumbling blocks or use medication, think positively.  Keep a positive atmosphere in the room.  You and your baby are emotionally and chemically effected by your surroundings.

a comfort measure that works

I spent this past month observing a hypnobirthing class taught by Ellie Shea in Redondo Beach.  I was very impressed with the things I learned. 

The biggest problem to overcome with natural labors today is that woman are conditioned to fear them.  We are told birth is unbearably painful and extremely dangerous to both our infant and ourselves.  Most of us believe that we are biologically flawed and are about to malfunction at any moment.  Hypnobirthing attempts to help woman re-work that entire mind set.

Hypnobirthing is a technique that mothers are encouraged to practice daily throughout the month and up until the birth of their child.  They do not practice being hypnotized so much as they practice getting themselves into hypnosis.  It requires time and concentration, and professional direction from the instructor.  She leads them deeper and deeper into their subconscious; leading the way so they can learn how to get there themselves.

Hypnobirthing works off of several rules of the mind:

1. "The mind can hold only one thought at a time.  Opposing thoughts cannot be held simultaneously; therefore, affirming a positive thought creates a positive outcome.  The person thinking the thought must choose what the nature of that thought will be.  If the pregnant woman refuses to entertain anything but positie images of birthing, she creates a positive mindset.  It prepares her for a positive outcome.
2. Thought precedes reality.  Whatever one focuses upon, whether it be of an internal or external origin, becomes manifested.  Mental images become imprinted, and the subconscious acts out the plan.  By imprinting positive thoughts and birth plans, positive outcomes are realized.  Intention creates experience.
3. For every thought or emotion there is a connected physical response.  Thoughts that are imprinted into the subconscious actually create a biochemical response within the body. Therefore, over a period of time, stressful worrisome thoughts can create negative conditioned responses in our bodies.  This rule is particularly important to HypnoBirthing success.  When fear is present, the fight or flight response is triggered; blodd and oxygen are directed to those muscles of the body that are involved in carrying out fight or flight; oxygen is depleted in the uterus; muscle constriction and pain result.  Positive thoughts and emotions for an easy, comfortable birth produce positive biochemicals in the body.
4. Once a thought is acted upon, the behavior becomes easier with each subsequent similar thought.  Continued reinforcement of a thought or action tends to make the thought more readily accepted and it becomes easier for additional suggestions of the same nature to be accepted and acted upon.  Once an expectant mother accepts the premise that comfortable birthing is a possibility, she can more readily birth according to her own natural instincts."

Go to http://www.hypnobirthing.com/ for more information.

hypnobirthing

This month I have had to opportunity to observe a hypnobirthing class. I absolutely love it. I will post several things about this in the future, but here is a general video to give you an idea of what it is, and if it might be something you would like to look into.

Go to their website for more information: http://www.hypnobirthing.com/default.htm

an important fact ...

If you have any slight desire to have your baby without drugs, you should know something very important:  the pain of contractions peaks at around 7-8 centimeters.
Of course this may vary slightly from labor to labor, but for most women, the pain will not intensify after you have reached that point.  In transition (the name given to the last couple centimeters of dilation), the contractions will most likely become closer together, but their strength will not increase.

Make sure your husband, doula, or birth partner knows this and can remind you of it when things get intense in labor.  Use that fact to help you determine if you truly can't take it any more and need a break, or if you have come far enough that you feel you can muster the courage to finish.

pros and cons of epidurals

Epidurals have some major pros, which most of us all know well.  The first is obviously pain relief.  That alone is why most women get them.  They also can give you a break and let you rest if you labor is extremely long and strenuous, or are not physically or emotionally prepared to handle the labor.  They are especially handy if you need an emergency C-section; if you are already numb they can get your baby out much quicker.

I don't think the risks are as well known, and as there are risks taken in everything we do, sometimes we brush them off, anticipating a relaxed, pain-free labor -- which many women do have.  But many do not.  "Birthing From Within" has a very comprehensive list that I will copy down and shrink a bit for you:

"Epidural anesthesia does not guarantee complete pain relief.  Most women experience decreased pain with an epidural, but not complete relief.  In fact, one study reported that 15% of the women receiving an epidural got no pain relief.  According to another study (Wuitchik, Bakal, and Lipshitz,) the average reduction in pain relief following an epidural went from the maximum score of a 10 to a 5 ....

Epidurals hinder rotation of a posterior (face-up) fetus to the more favorable anterior (face-down) position. Thorp et al.'s randomized controlled study (1989) found that 19 percent of women with epidurals had a posterior baby persisiting into second stage compared with four percent of the non-epidural group.  Failure to rotate into the more advantageous "facing down" position is responsible for increases in Cesarean births and forceps/vacuum extraction deliveries.  This is true even when pitocin is given to strengthen contractions.

Epidurals increase the use of other medical interventions and their related risks for mothers and babies. 

1. Because of the potential for epidural-induced fetal heart rate decelerations, it is necessary to use conitnuous electronic fetal monitoring.  Studies have shown that using continuous electronic fetal monitoring increases the Cesarean rate by 2-3 times (without improving the baby's outcome). ...
2. When epidural anesthesia is introduced, the mother's blood pressure often drops, causing serious fetal distress from decreased oxygen circulation.  Intravenous fluids must be administered rapidly to counteract this side effect of epidurals in the mother.  While this relieves one problem, it creates others, including excessive swelling in the mother's feet, legs, and breasts.  When the breasts are engorged, the nipple is flattened.  This makes it difficult, and sometimes impossible, for the newborn to latch on.
3. Epidural anestehsia also numbs the bladder, eliminating the sensations which signal the need to urinate.  At the same time, huge amounts of IV fluids are flowing into the mother to counteract the anticipated drop in blood pressure.  So to prevent bladder distention, a urinary catheter is needed until the epidural wears off.  Catheterization brings an added risk of bladder infection, which would then require antibiotic treatment.  Studies also show there is a 700% increase in urinary incontinence three months after an epidural.  Even a year later, incontinence remains 200% higher than in non-epidural moms.
4. As explained earlier, epidurals disturb the natural feedback system that stimulates and maintains good, strong labor.  If labor progress slows down or stops altogether, uterine contractions can be artificially stimulated with pitocin through the IV.  Pitocin, even when carefully administered trhough an electronic "pump", can cause unnaturally strong and prolonged contractions.  Such contractions decrease the oxygen supply to the baby causing fetal distress.  This risk requires continuous electronic fetal and uterine monitoring.  Unfortunately, CEFM (regardless of why it is being used) increases cesarean births.
5. One study (Murray, et al, 1981) found that the time it takes to push a baby out is longer for mothers either with an epidural (100.4 minutes) or with pitocin and an epidural (83.8 minutes) compared with unmedicated mothers (47.7 minutes).  As described elsewhere in this chapter, epidurals interfere with the urge to push, the effectiveness of pushing, the rotation of the baby's head into the most favorable position and the mother's physical capacity to choose her most effective birthing position.  That's why with an epidural there is a five-times greater likelihood that forceps or vacuum extraction will be used to pull the baby out.  Another study found forceps were used in 60 percent of mothers with epidurals, and 80 percent in mothers with pitocin and epidurals, but there were no forcep deliveries in the unmedicated group.
6. The incidence of deep vaginal tears that extend into the rectum is three times greater with an epidural (because of the related increase of episiotomy and the use of forceps).  Deep tears are painful and take longer to heal, and may later cause fecal incontinence, and chronic pain during sex.
7. Studies have shown an increase in Cesarean birth rate.  Thorp et. al. found a Cesarean rate of 17 percent in its epidural group and only 2 percent in the non-epidural group, even though the mothers in the two groups were essentially equivalent before the epidural was administered.  Thorp, et. al. (1993) reported that the earlier an epidural is begun, the greater likelihood of Cesarean:  They reported a 50% increase in Cesarean birth rate when an epidural was started at 2 cm; 33% at 3 cm; and 26% at 4 cm.  The increased Cesarean rate can be attributed to the following epidural-induced factors:
1. Fetal distress brought on by a drop in the mother's blood pressure, decreasing placental blood flow.
2. Weakening, slowing or stopping of uterine contractions.
3. Abnormal position of the baby's head, resulting from a failure to rotate and descend normally during second stage because the epidural has numbed and relaxed pelvic floor muscles (and interrupted the feedback loop).
4. Decreased pelvic diameter when the mother is forced to lie on her back.
8. Epidural fever.  The hard work of normal labor raises the mother's temperature slightly, which causes no problems.  Epidural "fever", although medically benign, must be treated more seriously.  The incidence of epidural fever is disturbing.  Among epidural-mothers, one in four will develop an epidural fever after four hours, and almost half after eight hours.  Fusi, et. al (1989) observed that, "The rise in temperature in most women with epidural did not result from an infective process, but from their inability to dissipate the heat generated in the process of labor." .... However, because infection can have serious consequences for both mother and baby, once a fever develops agreesive medical management must be undertaken.  A rise in the mother's temperature (from whatever cause) may result in a rise in the fetus' as well, causing dramatically increased heart rate and possible metabolic deterioration.  Medical management of this condition includes intravenous antibiotic therapy, and speeding up labor with pitocin, forceps, vacuum extraction or Cesarean.  Infection in a newborn is extremely serious and must be treated immediately. .... So, even before results have come back from blood work or spinal taps to show whether an infection is actually present, antibiotics and treatment must begin. At the very least this situation creates tremendous stress and worry, an emotionally painful separation from the baby, and interference with breastfeeding.  Additional medical bills immediately soar into the thousands.  All this pain, anxiety, and expense for what is usually found to be a benign epidural fever (which requires no treatment).  Yet, the workup must be done to avoid missing the timely diagnosis and treatment of an actual infection.
9. It is a popular myth that epidural medication doesn't get to the baby.  Epidural anesthetics do cross the placental barrier.  Anesthetic levels in the baby's blood have been found to be as high as one-third of maternal blood levels.  As a result, compared to the unmedicated babies, babies in the epidural or pitocin-epidural groups showed "drugged behavior" (e.g., trembling, irritability, and immature motor activity) on the first day, with behavioral recovery by the fifth day.  It takes 48 hours for a newborn to eliminate the epidural anesthetic from its system.  When pitocin was used with the epidural, there was an even greater depression of motor activity.  Babies were more tense, hypertonic, and displayed depressed reflexes.  Murray et. al. discovered that a month after birth, unmedicated mothers reported their babies to be more sociable, rewarding, and easy to care for than did the epidural mothers.  In addition, the unmedicated mothers were more responsive to their babies' cries than mothers who had epidural anesthesia in labor.  The early days of the mother-baby relationship may impact bonding and the future of that relationship.  The baby's behavior makes a powerful first impression.  When in the first month, babies appear "disorganized" (which means they are more irritable, withdrawn, look away and suckle less) mothers are more likely to perceive them as difficult babies.  That impression can affect the mother, unconsciously, in ways that shape her behavior toward her newborn, which over time, will shape the baby's personality and consequently the mother-baby relationship."

It's a lot of information, I know.  But it is important to weigh everything you can to make the best decision for your family.  Also, knowing these risks can help you to overcome them if you do get an epidural and can consciously decide to work a little harder to make sure they do not affect you as much.  You are in control of your own health, and for now, the health of your little one.

key questions about your care

During labor, you will more than likely come to a moment when a nurse or doctor suggests some intervention or procedure.  Sometimes people agree simply because they do not know what else to do, but it is a good idea to ask a few questions first.

But as you will likely be in the throws of labor, talk with your husband or partner beforehand and make sure he knows he will be responsible for communicating with the medical staff.  When something is suggested, probably the first question he should ask is, "Is this an emergency?"  If the answer to that is no, he should follow up with, "We'd like to talk about it first."

Penny Simkin made these handy little cards with questions to ask your care provider when a treatment or intervention is suggested:

1. "What is the problem?  Why is it a problem?  How serious is it?  How urgent is it that we begin treatment?
2. Describe the treatment:  How is it done?  How likely is it to detect or solve the problem?
3. If it does not succeed, what are the next steps?
4. Are there risks or side effects to the treatment?
5. Are there any alternatives (including waiting and doing nothing)?
6. Ask questions two, three, and four about any alternatives."

Of course, if it is an emergency, there won't be time to go through all that.  But if it is not, and your partner is able to get information, it will be a huge benefit.  You will be able to focus on the labor, and he will become a sort of labor guardian; a protector of your experience as a family.

(There were more questions regarding testing on these cards.  If you would like to order some, contact ICEA, 1500 Sunday Drive, Suit 102 Raleigh, N.C. 27607)

pain your body is prepared for

Another snippet from "Birthing From Within":

" 'Let me ask you something.  When you're at the dentist, would you havea tooth pulled or a cavity filled without being numbed first?'

'Well, no.'

'So why would you want to go through labor without drugs or an epidural?  Labor hurts a lot more, and for a lot longer, than having a little dental work!  You think about it, but there's no reason to suffer nowadays to have a baby.'

                        -Conversation between an expectant mother and her docter

Why indeed?

During dental procedures, nothing important is lost when you numb sensation, nor are there any significant risks involved.  For most people (older than 5) dental work is not a rite of passage; nor is it an important psychological or social transition in their lives.  Comparing the sudden, externally-induced pain of dental work (or other surgical procedures), with the pain of normal labor is a misleading analogy.

A better analogy might be the one our friend, Linda offered:  Women's bodies were intended to birth.  When baby teeth fall out naturally, we don't need anesthesia.  As labor pain unfolds and intensifies, your body produces endorphins to ease the pain.  When pain is abruptly caused by external actions, the body has no mechanism in place to help you cope with it."

endorphins

Another great excerpt from "Birthing From Within":

"How have women historically survived the pain of childbirth without the drugs?  They had no choice, but luckily, nature prepared women's bodies for such an event.

When the brain perceives pain (especially with the added stimulus of stress) endorphins are released.  Endorphins are chemical compounds secreted by the brain and adrenal glands, and have a pain-relieving effect ten times more potent than morphine.  They are also mood elevators (e.g. "runner's high").

As dilation progresses the sensation of pain will increase.  The more pain you have, the more endorphins are released to help you cope.  The rising level of endorphins contributes to the shift from a thinking, rational mindset to a more primitive and instinctive one.  Endorphins take you to the dream-like state of Laborland, which meshes well with the tasks of birthing."

Endorphins also make your memory a little hazy ... which is also quite convenient, as labor is quite intense and women might have historically fought men off if they could remember every detail. 

An interesting side note to all that:  drugs stop the creation of endorphins.  Your body is no longer under stress, and so it does not create your own pain killer any more.  So if you take some sort of drug to rest for a while, when you come out of it the pain will be worse.  So as you are progressing and things get rough, see where you are at.  The pain of contractions usually peak around 7 or 8 centimeters, so if you are about to that point, try to keep going.  See if you can make it over that hill.  But if it has been an incredibly long time and you are beyond the point of complete and utter exhaustion, take a break.  Maybe take something to numb you up for a while.  

a great use of drugs

"Natural birth" is a difficult word to define. Does it mean you went without drugs?  Does it mean you did it at home?  In the woods?  All these things are fine if it is what you want; again birth has as much to do with your mind as it does with your body.  But sometimes a good, healthy, "natural" birth does involve some drugs or intervention of some sort.

In "Birthing From Within", I just read about an account of a birth that I liked.  She said:

"I've always accomplished what I set out to do.  I've been successful in sports and my profession.  I trusted my body, and my ability to birth naturally.

So, when I was told I was not making progress, I just could not believe it.  I was physically and emotionally spent -- I had nothing left to draw on.  Facing the need to have an epidural was a crisis for me.

I needed the loving support and acceptance from my birth partner and friends to know I was doing the right thing, and that I was not weak or giving up easily.  They told me how strong I had been, and cried with me. 

Later, I realized that all my life I had been in control.  Whenever I set my mind to do something, I made it happen.  I thought giving birth and mothering would be the same way.  Losing control of my labor and having the epidural was a gift because it made me realize that as a mother I could not have the kind of control I was used to in other areas of my life.  I'm learning that though I might have ideas about my baby and mothering, I can't always control what happens.  And I'm still able to be a good mother."

I absolutely love this story.  Sometimes the more you read about all the benefits and risks with different kinds of births, the more set you become on one specific way of getting your child here.  This is a real challenge because the only thing you can really count on with your birth is that it will be unpredictable.  This carries on throughout the rest of your life as a mother. 

So as you are learning, understanding, and making decisions, keep an open mind.  Remember that birth is a perfect process, and that the medical world gives you many options.  Surround yourself during your labor with people who will love and support whatever works best for you.

the pain and power of birth

In "Birthing from Within", I found a great side note with a few thoughts to ponder on as your are deciding what kind of birth you want:

"It's important to realize that the pain and stress of normal labor are part of what keeps this natural process on track.  Here's why you should think twice before trying to eliminate pain:

1. The stress hormones produced in response to labor pain help protect your baby against hypoxia (insufficient oxygen) during labor, as well as preparing its lungs for breathing after it is born.
2. 'Pain guides the mother.  Commonly, the positions and activities she chooses for comfort are also those that promote good labor progress or help shift the baby into the right position for birth.  Remove the pain, and you kill that feedback mechanism.'
3. Removing pain also severs other feedback loops vital to normal labor and birth.  'Nerves in the cervix, and later the pelvic floor muscles and vagina, transmit stretching sensations as well as pain.  These stretch receptors signal the pituitary to produce more oxytocin, which increases the tempo of the labor, causing further cervical dilation .... and the urge to push .... Numb the nerves with an epidural, and you also wipe out the positive feedback mechanism.' "